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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
The Good Parenting Food Guide offers straightforward advice for how to encourage children to develop a healthy, unproblematic approach to eating.
- Explores key aspects of children’s eating behavior, including how children learn to like food, the role of food in their life and how habits are formed and can be changed
- Discusses common problems with children’s diets, including picky eating, under-eating, overeating, obesity, eating disorders and how to deal with a child who is critical of how they look
- Turns current research and data into practical tips
- Filled with practical solutions, take home points, drawings, and photos
- Mumsnet Blue Badge Award Winner
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Seitenzahl: 348
Veröffentlichungsjahr: 2014
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Table of Contents
Title page
Copyright page
Dedication
Epigraph
Introduction
Who Is It For?
The Author
The Structure of the Book
A Note on Language
A Note on Detail
Acknowledgments
Facts and theories
1: What is healthy eating?
A Brief History of Healthy Eating
Healthy Eating in the Modern Day
Why Eat a Healthy Diet?
Eating and Illness
Who Has a Healthy Diet?
In Summary
2: How do we learn to like the food we like?
Biological Models of Eating Behavior
Psychological Models of Eating Behavior
In Summary
3: What does food mean to us and what role does it play in our lives?
Food and Emotional Regulation
Food and Conflict
Food and Self-Control
Food and Social Interaction
Food as Self-Identity and Communication
In Summary
4: Why are eating habits so hard to change?
How Do Habits Develop?
Why Are Habits Difficult to Change?
Success Stories
How Can Habits Be Changed?
In Summary
5: Overweight and obesity: Prevalence, consequences, and causes
What Is Obesity?
How Common Is Obesity?
What Are the Consequences of Being Overweight or Obese?
Causes of Obesity
In Summary
6: Overweight and obesity: Prevention and treatments
How Can We Prevent Obesity?
How Can We Treat Obesity?
In Summary
7: Eating disorders: Prevalence, consequences, and causes
Anorexia Nervosa (AN)
Bulimia Nervosa (BN)
What Causes Eating Disorders?
In Summary
8: Eating disorders: Prevention and treatments
How Can We Prevent Eating Disorders?
How Can Eating Disorders Be Treated?
In Summary
Tips and reality
9: “I don't have time to cook”
Cook Whenever You Can
Find Time
Buy Ingredients Not Meals
Shop for the Week
Make Life Easy for Yourself
Prepare Food in Advance
Roll Meals Over from One Day to the Next
Have “Help Yourself” Meals
Cut Corners
Eat as a Family at a Table (If You Can)
Give Yourself Days Off
Share the Load
Make It Your Space
Some Recipes for You
In Summary
10: “My child won't eat a healthy diet”
Tips for Getting Them to Eat More Healthily
Fruit
Vegetables
Complex Carbohydrates
Low Fat
Sugary Foods
In Summary
11: “My child watches too much TV”: Tips for being more active
Why Exercise?
Why Do People Do Exercise? (And How Can You Make Your Child Do More?)
Costs and Benefits of Exercise
Social Norms
Confidence
Habit
Planning
Valuing Health
Happiness
In Summary
12: “My child eats too much”
Decide If You Need to Worry
Don't Put Them on a Diet
Be More Active
Be a Good Role Model for Eating
Be a Good Role Model for Body Size
Say the Right Things
Change Their Environment
Portion Control
Plan Meals
Cook Filling Meals
Eat Breakfast
Eat as a Family
Seize a Moment to Have a Chat
Get a Fruit Bowl
In Summary
13: “My child won't eat enough”
Working Out What Is Normal
Be a Good Role Model for Eating
Be a Good Role Model for Body Satisfaction
Eat as a Family
Say the Right Things
Don't Focus on the Food
Be Encouraging
Cook What They Like
Keep It Varied
Use Mindless Eating
Seize the Moment to Have a Chat
Question What Is Happening at School
Question What Is Happening in the Family
Consider How You Can Change
Use Peer Pressure
Use Natural Breaks in the Routine
Seek Help
In Summary
14: “My child thinks they are fat”
Be a Good Role Model
Say the Right Things about Your Child
Say the Right Things about Others
Acknowledge Their Feelings
Focus on the Positives
Bin the Scales
Move the Mirrors
Don't Comment on What They Wear
Explain the Tricks of the Media
Use Their Peer Group
Challenge Their Beliefs
Give Them a “Good Enough” Principle
Seize the Moment to Have a Word about Eating Problems
Be More Active
Expand Their Interests
Do Something about It
In Summary
15: Take home points
Final Words
Recommended reading
References
Index
This edition first published 2014
© 2014 John Wiley & Sons, Ltd.
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Library of Congress Cataloging-in-Publication data is available for this book.
ISBN 9781118741894 (hardback); ISBN 9781118709375 (paperback)
A catalogue record for this book is available from the British Library.
Cover images: From top: © BestPhotoStudio / Shutterstock; photo © Andrew Peart; © Wavebreakmedia / Shutterstock; © Sofarina79 / Shutterstock; photo © Andrew Peart; © Fotofreaks / Shutterstock
Cover design by Cyan Design
For Harry and Ellie who have taught me everything I know about being a parent.
One thing is certain: if we stay the same, nothing around us is likely to change very much. So if we're hoping for changes in the family, we may need to start with ourselves. Let's get started!
(Candida Hunt and Annette Mountford, 2003. The Parenting Puzzle. The Family Links Nurturing Programme. Oxford: Family Links)
Introduction
Feeding children should be easy. Hunger is a basic biological drive and eating should be a straightforward and fun part of family life. But so often it is not. Parents are busy, food is expensive and cooking takes time, and even when you have managed to prepare the family meal, children announce random likes and dislikes that seem to come out of nowhere. And on top of all that, we have the fears of obesity and eating disorders looming in the background. How do we get our children to eat healthily when they don't like healthy food? How do we get them to eat more without making them fat? How do we keep them a normal weight without giving them an eating disorder? How do we get them to be more active when all they want to do is watch TV or play on their phone? And what do we do about a daughter who starts to obsess about her weight?
This book aims to describe what constitutes a healthy diet and how to achieve this without making food an issue for your child. It addresses many of the problems parents face when feeding their children and offers tips on how to overcome these without making matters worse. And it looks at the ways in which we talk about food, shop and prepare food, and eat food with our children, and the impact this has on them as they grow up.
Who Is It For?
This book is aimed at parents with children across the age range from babies and toddlers through to teenagers and young adults. Some may feel they have a specific problem with feeding their child, but many may just want to know how to bring their children up to have a healthy approach to eating. The book could also be used by health visitors, nurses, GPs, dieticians, and nutritionists who need extra information or want a resource to recommend to their patients.
The Author
I am a Professor in Health Psychology at the University of Surrey and have carried out research in the area of eating behavior, food preferences, obesity, and eating disorders for 25 years. I also teach psychologists, dieticians, nutritionists, and medical students about how we learn to like the food we like and how eating is about so much more than just hunger and fullness. I have published over 140 papers and five books, two of which focus specifically on eating behavior. These are Fat Chance! The Myth of Dieting Explained and The Psychology of Eating: From Healthy to Disordered Behavior. In addition, I have published several articles in magazines and often contribute to health discussions on the radio, television, and in magazines and newspapers.
I also have two children now aged 14 and 11.
This book is the end result of 25 years of knowing the theory and doing research into eating behavior and 14 years of working out how on earth to put it into practice. My motto for parenting is “Aim high, then when you slither into a pit you have further to fall.” My motto for food is “Try to give your child a healthy diet. But try even harder NOT to give them a problem with food.” This book is about managing that middle ground when you have aimed high but life has added in a good dose of slither. It is also about managing what your child eats without making food an issue.
The Structure of the Book
The book is in two halves. The first half covers facts and theories and the second describes tips and reality. Ideally I would like all readers to start at the beginning and read straight through. But if you don't have the time (or inclination) to do this, there are “take home points” for each chapter in the first half and “what do we know” and “what can we do” catch-up points for the second half.
Facts and theories
This section consists of eight chapters which describe the facts and theories about eating and its related problems. First, it describes healthy eating in terms of what is healthy for different age groups, and why a healthy diet is important in both childhood and later life, and it looks at who actually eats a healthy diet. The next two chapters then focus on how we learn to like the food we eat and the role food plays in our lives. They describe the impact of simple familiarity, the role of learning from others, and the associations we make between food, social situations, and our mood. I then highlight how food has many meanings beyond hunger and fullness which influence what and how much we eat. This section then describes how eating behavior is a habit, and why habits are so hard to change, and it offers some general ways in which habits can be broken. The next four chapters look at eating problems, with a focus on obesity and eating disorders. They describe how common these problems are, their causes, how they can be prevented, and possible treatments. They also cover how some of the strategies used to treat obesity and eating disorders can be used at home.
Tips and reality
This section consists of six chapters and takes a much more practical approach, offering some simple tips for managing some of the problems with parenting and food. These are all grounded in the facts and theories given in the first section and, I hope, illustrate how they can be turned into practice. This section addresses the following problems:
“I don't have time to cook”“My child won't eat a healthy diet”“My child watches too much TV”“My child eats too much”“My child won't eat enough”“My child thinks they are fat”I have also put together some simple recipes for family meals that take very little time and effort (really!), help you keep your sanity, and are always healthier than ready meals or takeaways. These are in the chapter on cooking (Chapter 9).
Finally, the last chapter pulls together some of the key ideas of the book and offers some final take home points.
A Note on Language
I am a mum and for the last 14 years of my life have lived in a world of mums at toddler groups, the school gate, sports days, and the local park. In my world it is still mums who do most of the day-to-day parenting of their children and worry about whether or not they are doing a good job. I am fully aware that times are changing and that, out there, many men are stepping up to the task in hand. In fact we have one full-time house dad at my daughter's school and I take my hat off to him as he seems to have all the effort without some of the rewards of chat and friendship. So in this book I often say “mums” when I really mean “the parent in charge.” I hope this doesn't alienate dads. It is not meant to at all. It just reflects the world that I see and those who I expect will be most interested in reading this book.
A Note on Detail
I am an academic and most of my writing is for academic papers and people who do research. The aim of this book is to make this research interesting and accessible to busy parents. I have therefore tried to include enough detail to be useful but not too much detail, which can be boring. If you want any further information then please use the recommended reading and reference lists at the end of the book. Please also read my more academic book on eating behavior: The Psychology of Eating: From Healthy to Disordered Behavior, 2nd edition, published by Wiley Blackwell in 2010.
Acknowledgments
I am grateful to the following mums who gave me their feedback on an earlier draft of this book and, I hope, helped me pitch it at the right level: Frances Brewer, Anne Neale, Liz Paoli, Anne Peart, Sarah Richardson, and Melanie Simcox.
The photos are taken by David Armstrong, Jane Ogden, Ellie Ogden, and Harry Ogden.
Facts and theories
1
What is healthy eating?
A Brief History of Healthy Eating
The nature of a good diet has changed dramatically over the years. In 1824 The Family Oracle of Good Health published in the UK recommended that young ladies should eat the following at breakfast: “plain biscuit (not bread), broiled beef steaks or mutton chops, under done without any fat and half a pint of bottled ale, the genuine Scots ale is the best”; or if this was too strong, it suggested “one small breakfast cup of good strong tea or of coffee – weak tea or coffee is always bad for the nerves as well as the complexion.” Dinner is later described as similar to breakfast, with “no vegetables, boiled meat, no made dishes being permitted much less fruit, sweet things or pastry … the steaks and chops must always be the chief part of your food.” In the 1840s Dr Kitchener recommended in his diet book a lunch of “a bit of roasted poultry, a basin of good beef tea, eggs poached … a sandwich – stale bread – and half a pint of good home brewed beer” (1). In the US at this time, diets were based around the staples of corn, rye, oats, and barley for making bread, the use of molasses as a cheap sweetener, and a quantity of salt pork, which could survive the warmer weather in the absence of refrigeration. Blood pudding was also a source of meat; it was made from hog or occasionally beef blood and chopped pork, seasoned and stuffed into a casing which was eaten with butter crackers to provide a meal for the workers. What constituted a healthy diet in the nineteenth century was very different from current recommendations.
Most improvements in the diets of many Western countries mainly came about as a result of the rationing imposed during both the world wars. These rations resulted in a reduction in the consumption of sweet foods and an increase in the role of carbohydrate in the diet. In addition, the need to provide the armed forces with safe and healthy food stimulated research into food technology and established dietary standards.
Healthy Eating in the Modern Day
Over the past 30 years there has been a proliferation of literature on healthy eating. A visit to any bookstore will reveal shelves of books full of diets designed to improve health through weight management, salt reduction, a Mediterranean approach to eating, or the consumption of fiber. Nowadays there is, however, a consensus among nutritionists as to what constitutes a healthy diet (2). Descriptions of healthy eating tend to divide food into broad food groups and make recommendations as to the relative consumption of each of these groups. Recommendations change across the lifespan as we grow from babies into toddlers, to children, to teenagers, then adults. They even change as adults get older, as we need different diets at different stages, such as pregnancy, the menopause and as we progress into older adulthood. Current recommendations for children aged over 5 and for adults are the same, and are outlined below. These are:
Fruit and vegetables:A wide variety of fruit and vegetables should be eaten, and preferably five or more servings should be eaten per day.Bread, pasta, other cereals, and potatoes:Plenty of complex carbohydrate foods should be eaten, preferably those high in fiber such as brown bread, brown pasta, and brown rice.Meat, fish, and alternatives:Moderate amounts of meat, fish, and alternatives should be eaten and it is recommended that the low-fat varieties are chosen.Milk and dairy products:These should be eaten in moderation, and the low-fat alternatives should be chosen where possible.Fatty and sugary foods:Food such as potato chips, sweets, and sugary drinks should be consumed infrequently and in small amounts.Other recommendations for adults include a moderate intake of alcohol (a maximum of 3–4 units per day for men and 2–3 units per day for women), the consumption of fluoridated water where possible, a limited salt intake of 6 g per day, eating unsaturated fats from olive oil and oily fish rather than saturated fats from butter and margarine, and consuming complex carbohydrates (e.g. bread and pasta) rather than simple carbohydrates (e.g. sugar). It is also recommended that men aged between 19 and 59 consume about 2,550 calories per day and that similarly aged women consume about 1,920 calories per day, although this depends on body size and degree of physical activity.
Recommendations for children are less restrictive for fatty foods and dairy products, and it is suggested that parents should not restrict the fat intake of children aged under 2. By 5 years old, however, children should be consuming a diet similar to that recommended for adults, which is high in complex carbohydrates such as brown bread, brown pasta, and brown rice, high in fruit and vegetables, and relatively low in fat and sugary foods. They should also have a diet that is low in salt and should not drink any alcohol until they are at least 16.
Adults and children should also drink plenty of fluids to keep them hydrated. Foods such as fruit, vegetables, soups, and stews are also a good source of fluid. Caffeinated drinks can make you dehydrated but decaffeinated ones can count as part of your fluid intake. A balanced diet is shown in the “healthy plate” below.
A balanced diet: the healthy plate (© Adam Merrin)
Children's diets across the years will now be described in detail.
Babies 0–6 months
Current recommendations state clearly that breast milk is the best possible food for all babies up until 6 months old. It contains the perfect nutritional mix for growth and development and also enables antibodies to be passed from the mother to the baby to help their immune system and defend against disease. There is also some evidence that breast milk helps expose the baby to a wide range of tastes as flavors from the mother's diet flow straight into the breast milk. Children like the foods they are familiar with (see Chapter 2). It is possible that early exposure through breast milk helps children to like a wider range of foods once they move on to solids.
When still in the womb the placenta acts as a filter and blocks some molecules from getting to the baby. Therefore, if you drink alcohol when pregnant, only some but not all of this alcohol will reach the fetus. Breasts do not have this filter so any alcohol you drink will go straight into the breast milk. For this reason it is recommended not to drink alcohol either while pregnant or while breast-feeding. The evidence for this remains weak, but to me personally, it seems to make sense. You wouldn't put alcohol in your baby's bottle so why put it in their breast milk?
While breast-feeding, the mother needs to eat a healthy balanced diet high in fruit and vegetables and brown bread, brown pasta, and brown rice and relatively low in fat and sugary foods. At this time mothers shouldn't try to eat for two or lose weight by eating a restricted diet. They should just eat a healthy diet to keep themselves and the baby well nourished.
But some women genuinely struggle to breast-feed and then feel guilty. Being a mum is a huge responsibility in so many ways, with so many possibilities for guilt and beating ourselves up. Therefore if you have weighed up the pros and cons and decide to stop breast-feeding, don't feel guilty. Just move on. And one benefit of not breast-feeding is that dads can take on a greater role in parenting, which may well keep them more involved in the longer term.
Babies 6–12 months
Current recommendations state that babies should be fully breast-fed (or bottle-fed) until 6 months when weaning onto solids can start. At first most of their food will still come from milk so the main aim of early weaning is to get them used to eating and encouraging them to try different tastes. Some mums make up ice-cube trays of mashed-up sweet potatoes or vegetables, or purée parts of their own meal to spoon-feed to their baby. Others hit the shelves of jars in the shops, while others toss their baby bits of finger food from their own plate to chew on. Nutritionally, at this stage it is probably best to create perfectly balanced frozen cubes of food which can be defrosted on time to be wolfed down by your compliant child. But life isn't always like that and the last thing you need at this stage is a parent frazzled by the food processor and cross with a baby who throws the carefully prepared food onto the floor. So psychologically (for you and your child) it is probably best to give your child a mix of a variety of foods including mashed-up vegetables, handy jars, and whatever you have on your plate, in order to keep your sanity and not make food into an issue.
Toddlers 12–24 months
As babies turn into toddlers they suddenly become much more active and their need for energy increases dramatically. At this age children move away from mashed-up food and start eating more adult-like meals. Children need energy, but they don't need sugar for energy, as although this might give them an immediate boost, their energy levels will quickly plummet, making them more tired than they were in the first place. So during this time they need a diet high in complex carbohydrates such as brown bread, brown pasta, and brown rice, high in fruit and vegetables, with moderate amounts of meat and fish, and relatively low in fat and sugary foods. They also need lots of dairy products for their calcium levels. But try to do the following:
Keep the variety going.Give them plenty of savory foods.Eat with them when you can.Get them to eat with other children.Have regular meal times.We like what we know (see Chapter 2) and now is the time to get them to know the tastes of the foods you will want them to like later on. It is also the time to start planting the seed of family eating, social eating, and planned eating, all of which are predictive of a healthy attitude as they grow up.
Children 2–5 years
By this stage most children should be eating a balanced diet high in complex carbohydrates and fruit and vegetables with a moderate amount of protein and low in fat and sugary foods. They shouldn't be on a low-fat diet as such and should now be drinking full fat milk and plenty of cheese for their fat and calcium intake. But neither should they be eating lots of high-fat foods such as crisps and deep fried chips. Children at this stage can become quite picky (called neophobia) and often refuse new foods, preferring to eat the same old familiar foods over and over again. Tips for overcoming this are described in Chapter 10, but simple approaches involve sheer persistence (putting it on their plate but not making a fuss about it), getting them to eat with other children, and eating different foods yourself in front of them. Some children seem to go through a stage when they hardly eat anything and live off air, while others seem forever hungry. Tips for managing children who either overeat or undereat are described in Chapters 12 and 13. But often these are just stages that they grow out of and the best way to help them to grow out of it is to ignore it. Making it into the focus of the dinner table can often make it worse.
Children 5–12
By age 5, recommendations suggest that children should eat the same kind of diet as adults. Ideally they also should be eating at the table, with the family, at regular meal times and eating the same food as everyone else. Obviously this is not always possible due to life getting in the way, but wherever possible try to include your children in with what and when you are eating. Also, have other children round for tea and send your child round to others for tea, to get them used to eating with others and as a means to get the healthy habits of their friends to rub off on them. Social eating and peer pressure are central to the way in which we decide which foods we like (see Chapter 2) and at this age this can be a useful strategy to encourage your own children to eat a more varied diet. Remember at this age you are still mostly in control of what they eat and most of their eating is done at home.
As for the school dinners versus packed lunch debate, I think there are pros and cons of both. You can control a packed lunch and fill it with healthy foods, but they can be very repetitive and children can get stuck in a rut of eating the same thing every day (and you have to buy it and prepare it every morning). School dinners may not always be the healthiest but they are bought and prepared by someone else and varied, and they encourage children to eat what they are given rather than what they have specifically requested the night before. But the choice is yours!
Teenagers 13–18
Children grow hugely in their teens and are bombarded by hormones that can make them starving all the time. It is also the time when they start to eat away from home more, have money to buy snacks, and become more influenced by their friends than by their parents. Nutritionally they need a healthy balanced diet the same as adults. But you might find that they need more snacks between meals, so make sure you have plenty of fruit, toast, cheese, crackers, yoghurt, breadsticks, and biscuits to keep them going.
So even if you can't control what they eat outside of the home, still provide healthy meals for when they are around, still have set meal times when they have to be back, and try to eat with them at the table as often as possible. Issues with body size might start to surface at this stage and tips for managing a child who feels fat are given in Chapter 14. Chapter 11 also deals with how to get your child to be more active, and Chapters 12 and 13 address overeating and undereating. But the most important factors are being a good role model yourself in terms of what you eat and how you talk about your body size and food, eating as a family, having regular meal times, and making chat, not food, the focus of the table.
Current recommendations for healthy eating in adults therefore describe a balanced and varied diet which is high in fruit and vegetables and complex carbohydrates and low in fat and sugary foods. Children's diets should approximate this, but can be higher in fat and dairy products until the age of 5. Children's diets should also be low in salt.
Why Eat a Healthy Diet?
Healthy eating is important for children as it impacts on health in two key ways: first, eating healthily in childhood helps growth and general development. Second, how we eat in childhood relates to how we eat as an adult and can either protect from or promote illnesses later in life. This chapter will now describe eating to be a healthy child and eating for a healthy life.
We are what we eat: start off as you mean to go on
Eating to be a healthy child
Children need a healthy diet to help them develop, grow, think, and learn. Every organ that they develop, every muscle they build, and every bone they make comes from the food they eat. So, although we don't understand the exact details of how each cell of our body is produced, it makes sense to give children a varied and balanced diet in order to increase the chances that it contains what they need to grow from tiny babies into fully grown adults.
Recently there has been much emphasis on obesity and the problem of being overweight. But this is only a tiny part of the problem. Regardless of body weight or how fat a child is, they need healthy food to grow strong teeth and bones, to develop a heart that works properly, a digestive system than can do its job, a set of lungs to breathe, and a brain that can keep them alive. And this all comes from food. I remember once reading about how many of the soldiers who died in the Vietnam War had heart disease, even at the age of 20, due to their diet. So even though these men looked at the peak of fitness in terms of their body size and shape, inside they were already diseased. And if children don't have a healthy diet, some may start to feel tired and breathless, suffer from asthma or joint problems, or be unable to keep up with their peers. But most will seem fine. Yet inside they may well be storing up problems for adulthood, as many of the problems adults face have started way before they are detected by the person themselves, let alone the health professionals they come into contact with.
We are what we eat (© Adam Merrin)
Eating for a healthy life
Understanding children's diets is important not only in terms of the health of the child but also in terms of health later on in life, as there is some evidence that dietary habits acquired in childhood carry on into adulthood. For example, studies show that adults prefer to eat foods that they ate as children. In addition, long-term studies such as the Minnesota Heart Study and the Bogalusa Heart Study indicate that those who choose unhealthy foods as children continue to do so when they are grown up (3, 4). There is also some evidence for the impact of childhood nutrition on adult health. For example, poor fetal and infant growth seems to be linked with problems of managing blood sugar levels at age 64, and the levels of fat in the blood of the child have been shown to relate to adult heart disease. David Barker has specifically examined the role of both childhood and in utero nutrition in the development of adult illnesses and has provided evidence for his “Fetal Origins Hypothesis.” His research indicates that early nutrition starting in the womb may relate to illnesses such as hypertension, heart disease, stroke, and chronic bronchitis (5).
Eating and Illness
An individual's health is influenced by a multitude of factors including their genetic makeup, their behavior, and their environment. Diet plays a central role and can contribute directly towards health. It can also impact on health through an interaction with a genetic predisposition. The effects of overeating, undereating, obesity, and eating disorders on health are discussed in Chapters 5–8. The impact of the actual composition of a person's diet on coronary heart disease, cancer, diabetes, and gallstones is described here.
Diet and coronary heart disease
The term “coronary heart disease” refers to a disease of the heart involving coronary arteries which are not functioning properly. The most important forms are angina (chest pain), heart attack, and sudden cardiac death. All these forms of heart disease are caused by narrowing of the arteries due to fatty deposits which obstruct the flow of blood. This is called atherosclerosis. Angina is a powerful pain in the chest, which sometimes radiates down the left arm. It develops when blood flow to the coronary arteries is restricted to such an extent that the heart muscle is starved of oxygen. An acute heart attack occurs when blood flow is restricted below a threshold level and some heart tissue is destroyed. It also seems to happen when a blood clot has further restricted blood flow to the heart. Sudden cardiac death typically occurs in patients who have already suffered damage to the heart through previous heart attacks, although it can occur in patients who previously seemed to have healthy arteries.
How common is heart disease?
Coronary heart disease (CHD) is responsible for 43 percent of deaths in men across Europe and 54 percent of deaths in women. In the UK, in 2008 CHD was responsible for 35 percent of deaths in men and 34 percent of deaths in women. It is the main cause of premature death in the UK (i.e. under 75 years) and worldwide it is estimated that 17 million people die from CHD each year, with the highest death rates being in China, India, and Russia. Deaths from CHD have declined in recent years in North America and across Europe, mainly due to the decline in smoking and other lifestyle factors. The highest death rates from CHD are found in men and women in the manual classes, and men and women of Asian origin. In middle age, the death rate is up to five times higher for men than for women; this evens out, however, in old age when CHD is the leading cause of death for both men and women. In the UK about 150,000 people each year survive a heart attack, with women showing poorer recovery than men in terms of both mood and activity levels.
Although biological factors play a part in coronary heart disease, diet is probably the fundamental factor. This is clearly shown by incidence of the disease in immigrant groups. For example, death from heart disease is very rare in Japan, but Japanese people who move to the West quickly show the pattern of mortality of their new environment – probably because they change their behavior. Coronary heart disease usually involves three factors: (i) narrowing of the arteries (atherosclerosis); (ii) a blood clot (thrombosis) and the impact of this, which can be sudden death, heart attack, angina, or no symptoms; this depends on (iii) the state of the heart muscle. Each of these three factors is influenced by different components of the diet.
Narrowing of the arteries
The material that accumulates in the arteries causing them to get narrower is cholesterol ester. Cholesterol ester exists in the blood and is higher in individuals with a genetic condition called familial hypercholesterolemia. Half of the cholesterol in the blood is created by the liver and half comes from the diet. Diet influences blood levels of cholesterol in two ways. First, blood cholesterol can be raised by saturated fat found in animal fat and in boiled, plunged, or espresso coffee (not instant or filtered). Second, blood cholesterol levels can be reduced by polyunsaturated fats found in plant oils, by soluble types of fiber such as pectin found in fruit and vegetables, by oat fiber found in vegetables, oatmeal, and oat bran, and by soya protein.
A blood clot (thrombosis)
A blood clot is caused by an increase in the clotting factors in the blood including Factor VIII, fibrinogen, and platelets. Under normal healthy conditions a blood clot is essential to stop unwanted bleeding. If there is already a degree of narrowing of the arteries this can cause a heart attack. The formation of blood clots is influenced by diet in the following ways: a fatty meal can increase Factor VIII; smoking and obesity are associated with increased fibrinogen; alcohol is associated with decreased fibrinogen; and fish oil (found in sardines, herring, mackerel, and salmon) has been shown to help prevent platelets from clustering together and causing a clot.
The state of the heart muscle
The general healthiness of the heart muscle may determine how an individual responds to having a thrombosis. An overall healthy diet consisting of a balance between the five food groups is associated with a healthier heart muscle.
Diet and blood pressure
Raised blood pressure (essential hypertension) is one of the main risk factors for coronary heart disease and is linked with heart attacks, angina, and strokes. It is more common in older people and is related to diet in the following ways.
Salt
Salt is the component of diet best known to affect blood pressure and can cause hypertension which is linked to heart disease, strokes, and kidney problems. As a means to reduce hypertension, it is recommended that we eat less than 6 g of salt per day, which is much less than that currently consumed by most people. Avoiding salt is difficult, however, as most of the salt consumed is not added at the table (9 percent) or added in cooking (6 percent) but used in the processing of food (58.7 percent). For example, salted peanuts contain less salt than bread per 100 g. Many canned foods (such as baked beans) and breakfast cereals also have very high salt levels, which are masked by the sugar added.
Salt is also necessary, particularly in poorer countries where diarrhea is common, as it helps the body to rehydrate itself. In fact Britain imposed an extortionately high salt tax when it governed India, as salt was not only a useful flavor enhancer but also an essential part of the diet and therefore guaranteed a high level of revenue.
Alcohol
Alcohol consumption has several negative effects on health. For example, alcoholism increases the chances of liver cirrhosis, cancers (e.g. pancreas and liver), memory problems, and self-harm through accidents. Alcohol also increases the chances of hypertension; heavy drinkers have higher blood pressure than light drinkers and abstainers, and this has been shown to fall dramatically if alcoholic beer is replaced by low-alcohol beer.
In terms of alcohol's impact on mortality, data from the UK show that the number of deaths has more than doubled from 4,144 in 1991 to 8,380 in 2004. Data also show that death rates are higher for men than for women and that this gap has widened over recent years.
Alcohol may, however, also have a positive effect on health and there is some evidence that a glass of red wine per day may protect against heart disease. But, it is just as beneficial to drink cranberry juice, and much of the benefit from that one glass of wine is probably as much to do with stress reduction and the feeling of having a treat at the end of the day as the content of the wine itself.
