Dr Rupy: Today I am going to be talking about statistics to do with food and health that I believe everyone should really know. It should be plastered across billboards and certainly in GP surgeries. We should all understand how much it costs us every year, that's bad food, where it sits on the list of contributors to ill health and death globally, and conversely, what the impact of good food actually is and how bad people are currently eating according to the current guidelines. Now, I don't think enough people appreciate these numbers, and I personally get a lot of glossed looks whenever I talk about the impact of poor food on health outcomes. And particularly with certain medical professionals, it can almost be seen as an inevitability. And I believe the nonchalant nature in which we address the foundations of ill health is seen within these statistics, and we all need to do better. There is huge potential for improved health if we just simply do the very basics, which is encourage and empower people to eat well every day. That will have an incredible impact on productivity, wealth, happiness, relationships, and so on. And I don't present this idea as a panacea, but just as a huge tool in our toolbox and a massive aspiration for improving health and well-being. And I think if we can all be mini voices in this chorus toward empowering people to do better, to eat well, I feel like we can have a much, much bigger impact across our communities and across the nation as a whole, wherever you're listening to this.
These are facts about food I feel everyone needs to know. People always ask me about why I'm so hung up about food and its impact on health. And honestly, I don't think people appreciate the magnitude of what is going on right now with the impact on poor food on health outcomes, but conversely, the potential of improved health if we simply empower and encourage people to eat well every day. It sounds simpler than it is, but I feel that once you know the statistics that I'm going to share with you today, you will come along with this journey with me and really believe in the power of food and what needs to be done to save us money and to save lives as well. I'm not sharing these figures to scaremonger or shame anyone for not eating well. There are many barriers to eating healthful food that we've discussed on the podcast as well. But I think every doctor and every medical professional in the NHS and globally should understand these figures and the benefits of eating well. So, first off, it costs us billions every single year. Poor health and poor diet costs billions every single year. It's the single leading factor for ill health globally, costing 50 billion dollars in the US and 20 billion in the UK, that's pounds. And for context, with the UK budget for the NHS, which is around 100 million, 100 billion, sorry, every single year, that's 20% of the NHS budget. It's probably more in terms of the knock-on effects of poor health on things like productivity, gross domestic product, etc. But those are the overall numbers. That's a conservative estimate from what I've read. And I think a lot of people would immediately point to obesity. 6.5 billion of that, the pounds on the NHS, were due to obesity. That number is going to be higher with all the other issues around gross domestic product and time off work, but it's not all due to obesity. I would say the main culprits, looking at the figures that we've been across, are sugar and ultra-processed food. So let's talk a bit about sugar intake. Now, excessive sugar intake, I think, is something that everyone could admit to, myself included, particularly during the pandemic, I was definitely consuming a lot of sugar. But excessive sugar intake from using American data is estimated at over 76 grams per day, and that was in 2018. So the likelihood is over the last six years, that number has gone up even more so as it becomes more pervasive in our food system. And again, for context, that is four times the adult intake recommended by the WHO. So sugar and the excess of sugar intake, and I just want to highlight excess, that is most likely going to be related for a lot of the issues that we see because of its relationship to cardiovascular disease and obesity. And the other thing is UPF, as it's currently being referred to as, ultra-processed food. Now, for the UK market, and I would say most people in the UK think that our supermarkets are healthier than your average American supermarket, and I would hasten to agree, but we're not nowhere near where we need to be. And there are some figures that look at the amount of ultra-processed foods in the major supermarkets today and estimating that as around 80%. And that includes product labelled as healthy. If you go to the cereal aisle or the protein bar aisle, a lot of that stuff, even if it is decorated in dark green labelling and it has these earthy tones and beautiful imagery and labels like high in fibre, high in protein, a lot of that is ultra-processed food. I think more people are getting wise to the marketing schemes of a lot of these companies, but I still want to underline the fact that a lot of the stuff that we feel is healthy is actually still technically ultra-processed food. There was a study published in the BMJ in 2019, so five years ago from the date of this recording, and found that over 50% of the UK's diet is ultra-processed food. The exact number was 57%, but actually, if you look at specific strata and poorer communities, it can be as high as 75% of one's diet. It kind of begs the question, what is ultra-processed food? So there is a classification system called NOVA. If I pull up this image on YouTube, I'll describe it for the folks listening to this. It's pretty easy to recognise what is an ultra-processed food versus an unprocessed or minimally processed food. There's a classification system that has four clear elements. So on the far left, you've got the green products, and these are things like, well in the image you can see a lovely looking pineapple, there's a steak in the middle, there's an egg, tomato, potato. These are minimally processed or unprocessed foods, pretty easy to recognise. Then you've got some processed culinary ingredients, and they've stated clearly culinary ingredients, and these are the yellow NOVA foods. So included in that are oils, you've also got things like butter, and so these are things that you use in fairly small amounts but still contribute to a healthful diet. And then the further right you go, you've got your orange and red areas. So these are processed and ultra-processed food. And there's a clear distinction between the two that is made on this diagram, but I think in the supermarket, it is easy to recognise the two categories, but perhaps not the distinguishing features between the two categories. Now, they've got Coca-Cola or a can of pop and pizza on the far right. And then they've also got bread as a processed food, or certain types of cheeses. So the cheese, if it's looking like plastic and it looks very, very different from a raw cheese or a minimally processed pasteurised cheese, you can pretty much bet that that's going to be a processed food. You tend to find them in spreads, you tend to find them with a happy-looking cow on the front. I don't want to name names, but you know what I mean. Those are the kind of foods that we want to be avoiding. But the interesting thing is the ultra-processing, so these are specific foods on the far right, making up over 50% of our diet. That's quite worrying, and it's certainly where a lot of the blame lies. And I'm not trying to point the finger at food manufacturers because ultimately, they are tasked with something quite hard: creating shelf-stable, hyper-palatable, cheap food that is easy to transport globally to feed a hungry nation. We had to do that at the early part of last century. Now we're in a completely different scenario, so it requires a different strategy when it comes to improving our food system. And I have seen some interesting suggestions about adding elements to ultra-processed food to make it healthful. Time will tell whether that actually leads to better health outcomes or not. But for now, we want to be moving further along the spectrum to the green and the yellow areas of the NOVA food classification. So why are ultra-processed foods bad? Well, they are linked to a number of really scary outcomes. More ultra-processed food in your diet is linked to a higher risk of cardiovascular disease and overall mortality. It is causative of type two diabetes. It can greatly increase the risk of mental illnesses, something that we've discussed on the podcast before with a number of different psychiatrists. It can increase the risk of dementia and cancers. There's also a relationship with polycystic ovary syndrome as well, perhaps related to the metabolic disturbances that it can cause. It has led to this phenomena of something referred to as over-nourished and nutrient-poor. I actually think that name is a bit of a misnomer because you can be obese and under-nourished, but what it's referring to is an excess amount of calories consumed in each 24-hour period, whilst still being nutrient-poor, so not having enough of your essential micronutrients. And that isn't just to say vitamins and minerals, but also things like omega-3, which is a vital part of the diet. In fact, low omega-3 as part of one's diet is potentially as damaging as smoking. It's come out of some observational studies, so not the best evidence, but something I think a lot more people need to be aware of. And it's led to a phenomena of overeating as a result of the ultra-processed nature of the foods as well. So, number one, if there's anything you get away from listening to this podcast or watching this YouTube video, is that it is costing you as a taxpayer in either the UK or the US billions every single year. And the more we can save from these food-related health issues, the better for us as well. The second thing is that it is the biggest killer. It is the largest contributor globally to death and morbidity. Poor diet has led to the development of various chronic diseases, ones that I've already mentioned so far: cardiovascular disease, stroke, diabetes. And according to a study published in The Lancet in 2019, poor diet was responsible for more than 11 million deaths. That was from data looking at 2017. Now, I just want to put this in context. This is essentially a COVID pandemic three times every year. And I don't want to discredit or to diminish the impact of COVID. COVID was a terrible thing to happen globally. But we are essentially enduring and tolerating deaths of a magnitude three times what we've shut the entire world down for just four years ago. We're doing this every single year. And so, you know, I would say even if you were to discount the total number of deaths and discount the ones that are due to under-nourishment, so people not having enough food in developing nations where they don't have access to ultra-processed foods and all the rest of it, even if you discount 50% of that, even 60%, we're still looking at a huge excess death count as a result directly of poor diet. So something needs to be done about that. And I think, you know, if we were willing to shut down the entire world for COVID, we should be enabling ourselves and our governments to do something pretty drastic when it comes to food. And I don't want to be a sceptic about this, and I don't want to be conspiratorial, but I think a lobbying movement has probably got something to do with why the action has been so woeful and so slow as well, across all governments. It's probably why a lot of our food ministers have moved on, ones that had pretty high hopes of making real change to our food system. So that's the second thing. It's the biggest killer. It costs the most money. We've already said that's number one. The third thing, and this is on a more positive note, is food is medicine. Food is literally a powerful drug. And I want to clarify this because I think the food is medicine statement can be seen as or believed or interpreted to be pretty extreme and not encompassing of the facts. I just want to rectify this. Medicine is the practice of using interventions and treatments in both a reactive treatment pattern, in a way to relieve someone's symptoms and treat disease, as it is to prevent disease as well. So if you look at the definition of medicine, it is the use of interventions and substances to prevent and treat illnesses. Food very much qualifies as a medicine using that criteria. And I like to think about all different types of medicines like a football team. It's really part of a medical toolkit that we all have access to as medics and as other allied health professionals as well. So within this team, you have your strikers, your midfield, your defence, and your goalkeeper. I see targeted interventions like drugs, antibiotics, for example, or pain relievers, or surgical interventions like an appendicectomy, for example, or removal of someone's colon to treat inflammatory bowel disease, as very targeted interventions. That's what most people think about with regards to medicine. They are strikers, highly targeted, highly effective, depending on which team you're talking about, and very direct. Our goalie on the other side, on the other hand, we have our goalie, and our goalie is the prevention side of things. Without having a strong goalie, you're not going to have an effective overall team because if your striker is making goals all day long, but you're letting in goals the whole time, you don't really have a very balanced team. So food is very much our prevention. It can be sometimes the striker as well, but in the mainstay of cases, your food is your goalie. Sometimes goalies can be strikers, you've obviously seen a goalie take a penalty, and sometimes strikers can go in goal. Sometimes that happens. It's a little bit strange when it does, usually in a World Cup after a red card. I'm getting a little bit carried away with the analogy here, but you get the main point. You've got these different areas. And then your core, your midfield, your defence, these are things like sleep, exercise, mindset, community. These are the core of what makes a healthy, productive human being. So, our diet is a super powerful medicine, and it's something that needs to be respected such that it is a part of our medical training, which is something that I don't believe we do well in the UK. Just to put some facts and figures on this, I want to explain my perspective that consistent healthy nutrition supports our immune system, our gut health, it prevents the most common and costly diseases, it can prevent as well as be the intervention for certain diseases as well. So here's just a snapshot looking at certain areas of the body and certain areas of medicine. Heart health. You know what trial I'm going to talk about, the PREDIMED trial. It found that individuals following a Mediterranean-style diet, there are many different diets out there, but in this case, a Mediterranean-style diet had a 30% reduction in the risk of cardiovascular events. Pretty impressive. And a Mediterranean-style diet is just plant-centric, good healthy fats, judicious use of animal proteins, and very little if any ultra-processed foods. The New England Journal of Medicine found that adherence to a healthy lifestyle, including a nutritious diet, was associated with an 82% lower risk of coronary heart disease. So that's just the heart. Brain. A study published in the journal of Neurology found that adherence to the Mediterranean diet was associated with a lower risk of cognitive decline. The Mediterranean diet, like I've described before, has those healthful elements like extra virgin olive oil and also spices and particular vegetables like brassica vegetables that we know are very brain-healthy. And there's an age-old saying, what is good for your brain is generally good for your heart health as well. Blood pressure. Massive hidden killer. A lot of people don't realise that they're walking around with very high blood pressures, and it can be very preventable using diet, but we also have targeted medications for that. But just focusing on food, in the US, nearly half of adults have high blood pressure. That is pretty phenomenal. In the UK, it's not far behind. It's one in three or one in four. What do most people know about blood pressure and diet? Remove the salt. Just remove the salt. That is the main piece of advice that you're going to get from most doctors. I'm not calling out doctors here, but that is something that has been drilled into everyone when it comes to the link between diet and blood pressure. I think this is the most lacklustre advice imaginable. It is the most lacklustre advice imaginable. Everyone should know about the DASH diet, a dietary approach to stop hypertension, which emphasises pretty much a Mediterranean diet: fruits, vegetables, whole grain, lean proteins, low-fat dairy. It can lower systolic blood pressure by up to 14 millimoles of mercury. That is huge. To put that into context, that is the difference between me starting one or two antihypertensive medications to not. And so everyone should know what the DASH diet is. If you say DASH diet to most people on the street, they will have no idea what you're talking about. They probably think you're talking about a diet to have when you're in a dash. Like that, people should understand what impacts blood pressure as much as they currently understand salt to have a negative impact on blood pressure. When you ask someone about blood pressure, they should know about the intake of potassium-rich foods, and not bananas. I'm not talking about bananas, I'm talking about dark green leafy vegetables, I'm talking about seeds, I'm talking about all those different legumes, many of which have higher amounts of potassium in than your average banana as well. So, that's just heart health and that's just blood pressure. Cancer. The World Cancer Research Fund found that 30 to 40% of all cancers can be prevented by adopting a healthy diet, ensuring healthy weight, and engaging in regular activity. Now, cancer is a very emotive topic for a lot of reasons. Many of which, or most of us will know someone in our lifetime who suffers from cancer. And I don't want this to come across as blame, and I don't want it to be to come across as scaremongering either. But the facts and the figures don't lie. I think another important caveat is that cancer is used as an umbrella term to encompass what are very different disease processes. Pancreatic cancer is very different to a breast cancer, which is different to a prostate cancer, which is different to a brain. It's all very different. And so I think lumping everything together is perhaps the wrong thing to do. However, looking at a macro scale, if we can prevent 30 to 40% of all cancers by adopting a healthy diet, my ask to you is the next time you're doing a fundraiser, have that associated with a healthful activity like walking or doing a marathon, and at the end, encourage the healthy diet as well. So instead of having teas and cakes and Lucozade and high sugary drinks, why don't we change that to things that also are additive to the exercise that you've just done as well? So, less tea parties and more kale parties. I say that in jest, but I do mean it from the bottom of my heart. I think there's a culture shift that needs to change, and it happens in small, targeted ways. And hopefully this podcast and this YouTube episode is going to encourage you to be more cognizant of the stats that are, for me, just stark and they smack me in the face every time I look at them. Regularly eating brassica or cruciferous vegetables like Brussels sprouts is also linked to a lower risk of cancer, depression, heart disease. And in one study, older women who ate over 45 grams of cruciferous vegetables daily were 46% less likely to develop calcium buildup on their aorta. They are also much less likely to suffer from cancer as well. And that's just looking at one ingredient. So just to summarise so far, diet causes the most costly conditions, diet causes the most deaths globally, food is 100% medicine, and it's something that needs to be appreciated a lot more using the stats that I've just talked about. The fourth is a lot of people like to suggest that the reason why we have such poor diets is because our dietary guidelines are so terrible. And I have a lot of issues with the current dietary guidelines. I think in a perfect world, they can be improved. But there is a startling fact that I don't think people recognise enough. And this brings me on to my last point. Less than 1% of people follow the dietary guidelines. We've already learned about how pervasive ultra-processed foods are in our food system, in our supermarkets, what we generally have access to. It's no wonder that people don't follow the dietary guidelines. If they were to just follow the dietary guidelines, a lot of improvements can be made. And I say that as someone who is critical of the dietary guidelines. I just want to bring them up for you as well because there's UK ones, American ones, and there's Danish ones that I wanted to have a look at. So if you look at the UK dietary guidelines, and for folks listening, I'm just going to describe them. This is probably the most complicated guide. It's called the Eatwell guide, and it's a circular image with, I would say, about a third of the plate being largely plants. So you've got leeks on there, carrots, cucumber, brassica vegetables, berries that also happen to be my boys, as you've seen my slogan on my on my t-shirts. You've got another third split in half, so you say a sixth and a sixth. There's some dairy, there's some nuts, fats, and poultry. And you've got another third, which I think is probably the biggest issue for a lot of people, myself included, of carbohydrates, but most of the carbohydrates on that Eatwell guide are processed. So you've got bread there, you've got crackers, you've got white pasta, bagels, a lot of which, if you were to try and choose them in the supermarket, you'd unknowingly sort of choose the ultra-processed version of those seemingly healthful ingredients. But there are some flowers in there, there's oats, and there's a few other elements. But I think that's probably the biggest issue that most people have. If you look at the American ones, pretty good. Half of your plate is fruits and vegetables, a quarter of it, or just under a quarter of it is protein, and the rest of it is grain. And they've just put grain here, they haven't put carbohydrates. And I would agree, you know, it's open to interpretation, but if you're thinking of healthful grains, barley, rye, spelt, buckwheat, red rice, whole grains is perhaps what I would just have emphasized there. And there's a bit of dairy off the side as well. But I think that's a really simple plate and one that I don't think many people should have an issue with. And then you've got the Danish plate. Now, the Danish plate, I love, mainly because it's so stylish-looking. I mean, it looks like one of the shoots from my second book where we laid out the ingredients in a lovely minimalist way with some pastel colours underneath. You've got orange, you've got some beets in there, some kale. It's all looking very minimalist, almost like you've just stepped into a really cool coffee store and they are showing you what's on the menu that is seasonal and delicious. It's kind of hard, I would say, to figure out exactly what proportions you should be having on your plate in a 24-hour period just because it's kind of like style over substance here. But I appreciate the aesthetic, and I think that's a, if you're listening to this on the podcast, just look up the Danish guidelines image. It's pretty cool. I like that. But like I said, not many of us actually adhere to the guidelines. As controversial as they are, the British Nutrition Foundation, they published an article describing not just the benefits of the dietary guidelines to health, but also for the planet. And in this article, Professor Judy Buttriss, who was the chief exec of the BNF, she said this, "Looking at the available evidence, we recommend that an obvious step is to work together with others in the field of nutrition and beyond to promote diets aligned with the UK's Eatwell guide. An advantage of this kind of plant-rich diet, which can still include some meat, fish, and dairy products, is that it is based on dietary patterns already familiar in the UK." And she also went on to talk about again how less than 1% of people actually adhere to the dietary guidelines. It is pretty astonishing, but I guess given the context of how ultra-processed foods dominate our supermarkets, it kind of shouldn't be as surprising as it is. So those are four things I think everyone should understand. We don't adhere to the nutritional guidelines, even though a lot of people like to, you know, discredit them. Food is medicinal, despite what you might have heard from other people in and outside the health sphere. It is the most costly and it is the most deadly of all the areas. So if we were to focus our efforts on just one area, it should be on food, it should be on diet. And that's why I'm so hung up about this, and that's why I go on about it so much, and that's why I have a whole podcast dedicated to helping you figure out ways in which you can improve your diet one day at a time. And it just takes small, consistent steps in the right direction to completely overhaul your diet. And I'm living sort of proof of how this is possible. I was having, unbeknownst to me, an ultra-processed diet back in 2009 when I had my own heart condition as a 24-year-old working in A&E and working in a district general hospital doing night shifts and all the rest of it. I had a quote-unquote normal diet. It was cereal in the morning, sandwiches in the afternoon, and pasta in the evening. Most people are having that today. And so it's, for me as someone who had their own issues, it shouldn't be surprising that we see this much downstream effect of our diets. And I'm not saying that everyone has access to healthful foods, but I definitely think we as a population, as a global community, need to do a lot more when it comes to encouraging and empowering people to eat better every single day. I'm going to end this podcast with a few actionable tips. So I think first off, food is medicine really does need to be a recognised mainstream concept if we do care about the pursuit of a healthier population. But here's some tips and action points. I've just got three for you. So, first off, share this information with as many people as possible. Share the numbers that we're spending, share the number of deaths every single year, share the impact of food. So a massive reduction in mortality from cardiovascular disease, dementia, cancer, etc. And also, do share the last point, which is most people don't adhere to the guidelines, despite as much controversy as you've probably heard about them. First off, just one more. It's a concept that I talked about on my TED talk. Just one more is a really lovely, simple mantra to have every time you sit down to eat. I'll give you an example. I just had some toasted bread with eggs on top for my afternoon lunch/snack. And I always have this, it kind of comes natural to me. I added roasted butternut squash on the side and mixed that through with the eggs. And that was a delicious addition to my lunch, and I added just one more. Can you add just one more fruit, vegetable, nut, or seed at every mealtime? You know, it can be as simple as just having a handful of pumpkin seeds. It can be as simple as grabbing a handful of greens or a salad or something like that. Anything to add to the nutrient diversity and quantity of your meal. Plant points. They're an interesting concept. They've become quite fashionable now. And instead of looking at the weight of a portion, so a portion of fruit and vegetables is 80 grams, this is just looking at the inclusion of the ingredient itself. So a plant point is awarded to anything that is a fruit or a vegetable or a legume as well. Nuts and seeds also count as a plant point. And then herbs and spices contribute a quarter plant point. And the aim of the game is to try and get 30 of these plant points every single week. It's easy and it can be done very, very simply with the just one more concept as well. Just increasing plant point consumption every single week can improve the diversity of your gut microbiome, and it can also have drastic reductions on mortality and the likelihood of disease as well. So very, very simple addition to your diet. And the third thing I would say is every time you sit down to have a meal, without this feeling too overwhelming, so take it easy on yourself as well, just think about how much of your health is in your hands. Every time you sit down to eat, there is something to be grateful for, and it is an opportunity to positively influence your health. It is an opportunity to be grateful for the farmers, the soil, the nutrients that you're about to receive, in any way form that is. It doesn't matter whether you're sitting down and you're having something mildly processed, but you have the opportunity to positively influence your body every time you sit down for a meal. And so really sort of wallow in that gratitude for what this is serving you. It is a, it's a something that I've been leaning to a lot more as I nourish myself, as I learn more about the journey that food takes to get to our plates. And I think it's something that we can't really brush under the carpet in this conversation when it comes to improving the quality and the quantity of nutrient-rich ingredients available to all of us. So, that is my chat about food facts you need to know and things that I hope everyone and I wish everyone knew. So please share this as widely as possible. And I'd love to hear about any other facts that you want to run by me. So let me know in the comments on YouTube. I would love to see what you guys have to say about it and what other topics you want us to talk about next time.
