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StillnessNutrition fact

NHS guidance links a fibre-rich diet with lower risk of heart disease, stroke, type 2 diabetes and bowel cancer, and recommends 30g of fibre a day for adults. On average, UK adults eat only about 20g.

NHS Inform

Health

The story behind the card

The 30g target dates from 2015, when the UK's Scientific Advisory Committee on Nutrition reviewed the evidence on carbohydrates and health and raised the recommended amount. Four years later a large review commissioned by the World Health Organization and published in The Lancet pooled 185 long-term studies and 58 clinical trials. People who ate the most fibre had a 15 to 30% lower risk of dying from any cause or from heart disease, and of developing heart disease, stroke, type 2 diabetes and bowel cancer, than those who ate the least. The largest risk reductions were seen at 25 to 29g a day, and the trends suggested that more could help further. The NHS shows what 30g looks like: wholemeal toast with peanut butter and an orange; wholemeal spaghetti with a lentil sauce; and a baked potato in its skin with carrots and green beans.

Türkçe oku
Birleşik Krallık'ın ulusal sağlık hizmeti NHS'ye göre liften zengin beslenenlerde kalp hastalığı, inme, tip 2 diyabet ve bağırsak kanseri riski daha düşüktür. NHS yetişkinlere günde 30 gram lif önerir; oysa ülkede yetişkinler ortalama yalnızca 20 gram kadar lif alıyor.

30 gramlık hedef 2015'te belirlendi: O yıl Birleşik Krallık'ın Beslenme Bilimsel Danışma Kurulu (SACN), karbonhidratlar ve sağlıkla ilgili kanıtları gözden geçirip önerilen miktarı yükseltti. Dört yıl sonra Dünya Sağlık Örgütü'nün isteğiyle hazırlanıp The Lancet dergisinde yayımlanan geniş bir derleme, 185 uzun süreli gözlem çalışmasının ve 58 klinik deneyin sonuçlarını birleştirdi. En çok lif yiyenlerde, en az yiyenlere göre herhangi bir nedenle ya da kalp hastalığından ölme riski ile kalp hastalığı, inme, tip 2 diyabet ve bağırsak kanserine yakalanma riski %15–30 daha düşüktü. Riskteki en büyük düşüş günde 25–29 gram lif alanlarda görüldü; eğilimler, daha fazlasının ek fayda sağlayabileceğini düşündürüyordu. NHS, 30 gramın bir güne nasıl sığdığını da gösterir: kahvaltıda fıstık ezmeli iki dilim tam buğday ekmeği ve bir portakal, öğlen mercimekli domates soslu kepekli spagetti, akşam kabuğuyla fırınlanmış patates, havuç ve taze fasulye.

Sources and further reading

Background reading: Dietary fiber
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He who has health has hope, and he who has hope has everything.

English quotation books have called this an “Arabian proverb” since at least the 1860s; Tryon Edwards's A Dictionary of Thoughts (1891) is one, but these books give no Arabic original, so the label is best taken loosely. The idea is widely shared: good health gives people the strength to plan and to recover from setbacks. Turkish says “Her şeyin başı sağlık”, health comes first, and when a glass breaks people say “Sağlık olsun”: never mind, as long as everyone is well.

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Protein helps with satiety, the feeling of fullness that lasts after a meal. Meals that include beans and lentils, eggs, fish, dairy or other protein sources can help people feel full for longer, although appetite and digestion vary from person to person.

In studies that compare meals with the same number of calories, the higher-protein version usually keeps people satisfied for longer, although the effect is modest. One reason is that protein prompts the gut to release more of the hormone PYY, which tells the brain that food has arrived; a 2006 study led by Rachel Batterham at University College London found the strongest PYY response after high-protein meals. Another is that the body works harder to process protein: a 2004 review by the Maastricht University physiologist Klaas Westerterp reports that digesting and using it burns 20 to 30% of its calories, against 5 to 10% for carbohydrate and up to 3% for fat. UK guidance puts adults' needs at about 0.75 g of protein per kilogram of body weight a day, around 45 g for women and 56 g for men, and average intakes are well above that.

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The fibre we eat comes from plant foods: fruit, vegetables, wholegrains, beans and lentils, nuts and seeds. Meat, fish, eggs and dairy naturally contain none.

Fibre is the part of plant food that our digestive enzymes cannot break down. Much of it comes from the walls of plant cells, which give stems, peel and seeds their structure. Animals do not make these substances, so meat, fish, eggs and milk contain none. Mushrooms, which are fungi rather than plants, also supply a little fibre from their own cell walls. Nutritionists divide fibre into two kinds. Soluble fibre, found in oats, barley, apples and beans, dissolves in water in the gut, can form a gel and helps lower cholesterol. Insoluble fibre, in wholegrains, brown rice, nuts and the skins of fruit and vegetables, adds bulk and helps food pass through. Once fibre reaches the large intestine, gut bacteria ferment part of it into short-chain fatty acids, compounds that feed the cells lining the bowel.

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Whole fruit keeps its fibre and cell structure, so it takes longer to eat and fills you up more than juice. Juicing breaks the cells open and frees their sugars, which are harder on teeth. The NHS therefore counts juice as one of your five daily portions at most, and advises no more than 150ml a day.

In a 2009 study at Pennsylvania State University, Julie Flood-Obbagy and Barbara Rolls gave 58 adults an apple, apple sauce or apple juice 15 minutes before lunch, each with the same weight and calories. After the whole apple, people felt fuller and ate about 15% fewer calories across the starter and lunch together than on days with no starter. Juice did not have that effect, even with the apple's fibre added back. A larger Harvard analysis of about 187,000 American health professionals, published in the BMJ in 2013, found that people who ate more whole fruit, especially blueberries, grapes and apples, were less likely to develop type 2 diabetes, while those who drank more fruit juice were slightly more likely to. Long-term observational studies like this show a link rather than proof of cause, but the two kinds of evidence point the same way.

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Water makes up about 60% of an adult's body weight. The body needs it to control its temperature, keep blood flowing, digest food and keep organs working. When lost fluid is not replaced, thirst can come with tiredness, headache, dizziness and poorer concentration.

Every day we lose water in urine, in sweat and even in our breath, and more in hot weather or during exercise. About a fifth of what we take in comes from food, especially fruit and vegetables, and the rest from drinks. The NHS suggests 6 to 8 glasses of fluid a day, and water, lower-fat milk, tea and coffee all count. Thirst is the body's alarm: when the blood becomes slightly too concentrated, sensors in the hypothalamus, a small region at the base of the brain, trigger the urge to drink. This alarm weakens with age, which is one reason older people become dehydrated more easily. A simple check is the colour of urine: the NHS advises drinking enough to keep it a clear pale yellow, and darker urine is a sign to drink more.

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