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  1. When we eat at regular intervals, our body is discouraged from storing calories. This statement is up for debate and there are certain factors we must take into account when considering the above.  In order to answer this question, we must look at our basal metabolic rate or BMR. BMR is the amount of energy released by our body when it is at rest. A high BMR means we can eat more food without getting fat. Exercise also plays a part in increasing our body’s BMR. However, there is no clear answer as to how often we should eat during a day. In a nutshell, eating several small meals a day is tied to the amount of energy our body needs to spend and not the quantity of mealtimes.[1] Mealtimes in the western population are rapidly shifting towards a less structured pattern. With the rise in ready made meals and fast food chains, people have quick and easy access to food. Therefore, they are able to eat food at their own convenience, at any time or place. According to a study conducted on the subject, researchers have discovered that lacking consistency when it comes to eating may have negative effects on insulin.[2][3] An irregular eating pattern was linked to a decrease in what is known as thermic effect of food (TEF). This means that the body burns calories at a slow rate. It also leads to high concentrations of insulin in the blood. TEF triggers a signal in the brain indicating that the body is full and is no longer hungry. It is low in people who do not have fixed meal times, so an increase in their body weight occurs as a result.[4] Free and multiple access VS. restricted access meals Eating meals on irregular basis and lacking consistency is a potentially serious novel environmental risk factor.[2] This risk factor can lead to obesity and metabolic syndrome which includes increased blood pressure, high blood sugar and cholesterol. Stress is also a factor that should be taken into consideration. High levels of stress are capable of changing a person’s eating pattern and encouraging the consumption of tasty, highly palatable foods. In addition, there is rising evidence that irregular eating patterns can have negative effects on a person’s metabolism, especially in the absence of regular exercise. This adds credibility to the theory that highlights the advantages of staying consistent when it comes to eating several meals a day.[1][3] Eating three meals per day, in addition to snacks, is the most common eating pattern in modern societies. However, this is considered abnormal from an evolutionary point of view.[5] Studies conducted on animal models and human subjects indicate that regular fasting which lasts up to sixteen hours can improve health and help combat diseases. It also encourages the body to shield from and repair damage on a cellular level.[6] However the data on intermittent fasting is yet sparse and all the mechanisms are not fully known. It means that to achieve the positive health outcomes fasting should be properly controlled for every individual. Until substantial research is done it is not recommended to include intermittent fasting as a part of weekly eating regime.[7] Mice who were subjected to alternate day fasting diet while keeping the overall food intake unchanged remained the same weight-wise.[6] This intermittent fasting generated positive outcomes that surpassed those of the calorie restriction diet. These included low blood sugar and insulin levels in addition to better resistance of brain neurons to damage and death.[6]  A similar study also showed that mice who were subjected to time restricted feeding (TRF) received the same calories from their high food diet as those who were free to eat whenever they chose to.[8] Time restricted feeding means being fed within a specific window of time. The mice in the time restricted feeding group had protection against obesity and excessive insulin levels in the blood. They were also shielded from fatty liver when fat accumulates in the liver, leading to inflammation and liver failure. The TRF diet is mainly used as a non-pharmacological method to fight obesity and other diseases.[8] Hunger and Satiety When it comes to hunger and satiety, multiple studies have shown that more frequent meals per day may contribute to better appetite control.[9] While another review article agrees with it, the authors also report that eating 3 meals per day is associated with insignificantly lower calories intake when compared to more frequent meals.[10] Low frequency diet could be used for some specific groups of people requiring hypoenergetic (low energy) diet. It was found that eating breakfast and lunch is more effective than eating six smaller portions in low energy diets for type-2 diabetes patients.[11] The question of timing is also very important when it comes to eating. This question has prompted researchers to look into the correlation of eating breakfast and evening meals to the total calories intake. They have shown that satiating morning meals and smaller evening meals reduce the daily calories intake and help people lose weight.[12][13] Physical Exercise is Essential  In the absence of physical activity, eating multiple meals may not lead to better appetite control. It also does not change the body’s composition in a positive manner, especially in non-active people. Adequate protein levels may help athletic people in maintaining their lean body mass if they increase their number of meals. More meals than fewer have a positive effect on different blood markers of health such as LDL cholesterol, total cholesterol as well as insulin. It also helps decrease hunger and improve appetite control.[5] A small number of studies whose participants were athletes showed that increased meal frequency had many benefits. Firstly, it prevents the body from losing lean body mass during a low energy diet. Secondly, it leads to a significant increase in lean body mass and anaerobic power. Thirdly, it helps people get rid of fat.[14][15] Conclusion  Dividing meals into smaller portions leads to better satiety and allows for better caloric control. However, there are no other proven health benefits linked to this eating pattern. It is thought that the total caloric intake, meal time and the regularity pattern of food intake are important rather than the number of meals per day. Still for some groups of people frequent small meals are beneficial, e.g. for sportsmen it helps to increase the lean body mass and power. So this is the quantity of food and regularity pattern that actually matters the most.  [1] Parks, E., & McCrory, M. (2005). When to eat and how often?. Am J Clin Nutr, 81(1), 3-4. Retrieved from http://ajcn.nutrition.org/content/81/1/3.full  [2] Sierra-Johnson, J., Undén, A., Linestrand, M., Rosell, M., Sjogren, P., & Kolak, M. et al. (2008). Eating Meals Irregularly: A Novel Environmental Risk Factor for the Metabolic Syndrome. Obesity, 16(6), 1302-1307. http://dx.doi.org/10.1038/oby.2008.203 [3] Mattson, M., Allison, D., Fontana, L., Harvie, M., Longo, V., & Malaisse, W. et al. (2014). Meal frequency and timing in health and disease. Proceedings Of The National Academy Of Sciences, 111(47), 16647-16653. http://dx.doi.org/10.1073/pnas.1413965111 [4] Farshchi, H., Taylor, M., & Macdonald, I. (2004). Decreased thermic effect of food after an irregular compared with a regular meal pattern in healthy lean women. International Journal Of Obesity, 28(5), 653-660. http://dx.doi.org/10.1038/sj.ijo.0802616 [5] La Bounty, P., Campbell, B., Wilson, J., Galvan, E., Berardi, J., & Kleiner, S. et al. (2011). International Society of Sports Nutrition position stand: meal frequency. Journal Of The International Society Of Sports Nutrition, 8(1), 4. http://dx.doi.org/10.1186/1550-2783-8-4 [6] Anson, R., Guo, Z., de Cabo, R., Iyun, T., Rios, M., & Hagepanos, A. et al. (2003). Intermittent fasting dissociates beneficial effects of dietary restriction on glucose metabolism and neuronal resistance to injury from calorie intake. Proceedings Of The National Academy Of Sciences, 100(10), 6216-6220. http://dx.doi.org/10.1073/pnas.1035720100 [7] Horne, B., Muhlestein, J., & Anderson, J. (2015). Health effects of intermittent fasting: hormesis or harm? A systematic review. American Journal Of Clinical Nutrition, 102(2), 464-470. http://dx.doi.org/10.3945/ajcn.115.109553 [8] Hatori, M., Vollmers, C., Zarrinpar, A., DiTacchio, L., Bushong, E., & Gill, S. et al. (2012). Time-Restricted Feeding without Reducing Caloric Intake Prevents Metabolic Diseases in Mice Fed a High-Fat Diet. Cell Metabolism, 15(6), 848-860. http://dx.doi.org/10.1016/j.cmet.2012.04.019 [9] Munsters, M., & Saris, W. (2012). Effects of Meal Frequency on Metabolic Profiles and Substrate Partitioning in Lean Healthy Males. Plos ONE, 7(6), e38632. http://dx.doi.org/10.1371/journal.pone.0038632 [10] Bachman, J., & Raynor, H. (2011). Effects of Manipulating Eating Frequency During a Behavioral Weight Loss Intervention: A Pilot Randomized Controlled Trial. Obesity, 20(5), 985-992. http://dx.doi.org/10.1038/oby.2011.360 [11] Kahleova, H., Belinova, L., Malinska, H., Oliyarnyk, O., Trnovska, J., & Skop, V. et al. (2014). Eating two larger meals a day (breakfast and lunch) is more effective than six smaller meals in a reduced-energy regimen for patients with type 2 diabetes: a randomised crossover study. Diabetologia, 57(8), 1552-1560. http://dx.doi.org/10.1007/s00125-014-3253-5 [12] de Castro, J. (2004). The time of day of food intake influences overall intake in humans. J Nutr., 134(1), 104-111. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/14704301 [13] Keim, N., Van Loan, M., Horn, W., Barbieri, T., & Mayclin, P. (1997). Weight Loss is Greater with Consumption of Large Morning Meals and Fat-Free Mass Is Preserved with Large Evening Meals in Women on a Controlled Weight Reduction Regimen. J Nutr., 127(1), 75-82. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9040548 [14] Iwao, S., Mori, K., & Sato, Y. (2008). Effects of meal frequency on body composition during weight control in boxers. Scandinavian Journal Of Medicine & Science In Sports, 6(5), 265-272. http://dx.doi.org/10.1111/j.1600-0838.1996.tb00469.x [15] Benardot, D., Martin, D., Thompson, W., & Roman, S. (2005). Between-meal Energy Intake Effects On Body Composition, Performance And Total Caloric Consumption In Athletes. Medicine & Science In Sports & Exercise, 37(Supplement), S339. http://dx.doi.org/10.1097/00005768-200505001-01753
  2. It is indisputable that what we eat is critical to our state of health. Nutrients provide the body with the raw materials for our most basic functions. Essential nutrients are nutrients that the body requires for growth, development and functional maintenance. However many diets, particularly the Western diet, unfortunately lack some of these essential nutrients. Additionally, processed food high in fats and sugars that have been chemically changed, often to the point of becoming toxic, is consumed in increasingly large quantities. As many functions of the body are interactive and interdependent, an imbalance of essential nutrients can have far-reaching negative effects. High levels of some substances found in processed or artificially ‘enhanced’ food may have the ability to alter our metabolic state and adversely affect our body’s functions. In obesity, an overweight but in some ways undernourished, state, the long term risk of chronic diseases including type 2 diabetes, heart disease and arthritis is vastly increased.[1] [2] Until recently it was believed that a wide range of diseases, such as type 2 diabetes, obesity, heart disease, stroke and some cancers could be caused by a single gene mutation. More recent findings, however, indicate that these conditions are attributable to a network of biological dysfunction. Furthermore, it is now also known that a lack of essential nutrients, caused by an inadequate supply in the diet, can be an important factor in this biological dysfunction.[3] In order to better understand and treat these diseases, intense research is required to identify how multiple nutrients interact, and how these interactions affect body functions. As the relationship between nutrition, metabolic function and disease becomes more apparent, the view of the virtues of food in simplistic terms of calories or fat will no doubt require revision.[4] Focus must be drawn to food that it is essential to include, rather than just highlighting those to avoid. In the diet of the future, instead of looking at foodstuffs as the ‘enemy’, to be continually reduced or excluded, we will perhaps instead be directed to see the diet as a means to promote good health. By including the right kinds of foods we may even be able to decrease or eliminate the risk of many diseases that are currently epidemic in Western societies. Additionally, with the advent of personalised medicine and advances in genotyping, future diets may even be designed to coincide with an individual’s unique metabolism.[5] There is increasing evidence of the adverse impact on health caused by food that is processed, or has a high sugar and fat content. As we find out more about the true, scientifically-backed ways to maintain a healthy diet, we can shape our health and even our future. Current thinking shows that a balanced and varied diet consisting of freshly prepared food from natural sources, rich in essential nutrients and free from pesticides is the most sensible option to maintain health.   [1] Li, YX. & Zhou, L. (2015) Vitamin D deficiency, obesity and diabetes. Cell Mol Biol (Noisy-le-grand). 61(3). 35-8. [2] Han, TS. & Lean, ME. (2016) A clinical perspective of obesity, metabolic syndrome and cardiovascular disease. JRSM Cardiovasc Dis. doi: 10.1177/2048004016633371. [3] American Heart Association Nutrition Committee et al. (2006) Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 114(1). 82-96. [4] Rozin, P. et al. (1999) Attitudes to Food and the Role of Food in Life in the U.S.A., Japan, Flemish Belgium and France: Possible Implications for the Diet–Health Debate. Appetite. 33(2). 163-80. [5] Chadwick, R. (2004) Nutrigenomics, individualism and public health. Proceed Nutr Soc. 63(1). 161-6.  
  3. What makes a healthy diet?

    The foundation of a healthy diet is balance, variety and moderation. The maintenance of a healthy body requires the intake of carbohydrate (sugar, starch or fibre), fat, protein, vitamins and minerals. The World Health Organisation states that a healthy adult diet should therefore ideally contain a balance of fruit, vegetables, legumes (e.g. lentils and beans), nuts and whole grains (e.g. unprocessed cereals or brown rice), with a minimum of five portions (400g) of fruit and vegetables to be consumed daily.[1] To achieve the optimum level of nutrition, a healthy diet should consist of:  Approximately one third starchy foods such as bread, rice or pasta (preferably whole grain varieties, as the increased fibre content is beneficial to the intestine)[2], [3]  Some protein rich foods such as meat, fish or lentils Some milk or other dairy products Limited amounts of fat, salt and sugar Fats should make up less than a third of daily caloric intake, and the unsaturated fats found in fish, avocado, nuts, sunflower and olive oils are preferable to the saturated fats found in fatty meats, coconut oil, cream, cheese and lard. This is because unsaturated fats can provide beneficial fatty acids such as omegas 3 and 6, that are known to help decrease cholesterol levels.[4] Indeed studies have shown that a diet containing a maximum of 10% of daily caloric intake from saturated fat significantly decreases the risk of heart disease.[5], [6]  Studies have also shown that coronary heart disease (CHD) risk is reduced by 10-15% for each 5% of energy intake that is exchanged from saturated to polyunsaturated (but not monounsaturated) fats. Exchanging saturated fat with carbohydrates increases CHD risk, by 7% for each 5% exchanged.[7] Trans fats commonly found in processed or ‘fast’ foods such as pizza, pies and margarines should also be avoided, as they can also increase the risk of raised cholesterol, type 2 diabetes and stroke.[8]  Meat is a good source of protein which also contains vitamins and minerals including iron, zinc and B group vitamins, making it one of the main dietary sources of vitamin B12.[9] Opting for lean meat and skinless poultry can help to reduce the fat intake associated with eating meat. However, certain meat-cooking processes, such as BBQing, have recently been shown to be carcinogenic,[10] and some meat products can contain endocrine-disrupting chemicals,[11] so care should be taken when choosing and preparing meat for consumption. Fish is an alternative significant source of protein which also contains numerous vitamins and minerals. Oily fish is also rich in omega-3 fatty acids which, as stated above, are considered beneficial for health via the prevention of heart disease and reduction of cholesterol levels.[4] However, as with meat, many of the high-temperature cooking processes used on fish can lead to the formation of carcinogenic compounds, such as polyaromatic hydrocarbons. Dairy products such as milk, cheese and yoghurt are also good sources of protein and are rich in calcium, essential for healthy bones. There has previously been controversy over the effect of dairy products in the diet, as some can be quite high in fat. However, observational studies have shown that dairy fat does not necessarily contributes to obesity.[12]  Fruit and vegetables are an essential source of dietary vitamins and minerals, and there is increasing evidence that eating at least five portions a day reduces the risks of heart disease, stroke and some cancers. Studies have demonstrated the efficacy of a Mediterranean style diet, which includes lots of fruits and vegetables, in reducing both cancers and cardiovascular disease [13], [14],[15], [16], [17] However it is important to note that not all fruits and vegetables are equal. For example, a fresh piece of fruit is inherently more healthy than its fried equivalent, a glass of sugar-loaded, low fibre fruit juice or a processed alternative. Care should be taken to always wash and peel fruits and vegetables though, as they are commonly contaminated with pesticide residues, even when organic options are chosen, due to the widespread contamination of our environment.[18], [19]  Sugar should ideally contribute less than 10% of daily caloric intake, or ideally less than 5% for additional health benefits.[20] This is about 50g, or 12 teaspoons, for a person consuming the recommended 2000 calories a day. Sugar is routinely added to numerous foods and drinks by manufacturers, cooks and consumers, but it also occurs naturally in honey, syrups and fruit juices and so monitoring intake can prove difficult.[21], [22], [23] Salt intake should also be limited to 5g (one teaspoon) per day, although iodised salt can be beneficial, as it provides the essential mineral iodine. Reduction in overall salt intake helps prevent high blood pressure and reduces the risk of heart disease. In fact it has been shown that reducing sodium intake to <2 g/day can lower systolic blood pressure by 3.47 mmHg, and diastolic blood pressure by 1.81 mmHg.[24], [25] Consuming more calories than are required by the body will ultimately result in weight gain. When monitoring dietary calorie intake, drinks are often forgotten, yet sugary drinks, beer and alcohol all have a high calorific value.[26] Fats and sugars are good sources of energy, but excessive consumption can also result in obesity and the increased risk of type 2 diabetes, some cancers, heart disease and stroke.[27], [28], [29], [30] Dairy products can also have a high caloric value and should be consumed as part of a balanced diet, choosing low fat options when possible. However it is important to remember that children under two years should not be given skimmed milk, as it lacks essential fatty acids and fat soluble vitamins, which are important for development.  Many eating habits are learned in childhood, so it is important that parents and educators explain the importance of a balanced diet and healthy eating choices early in life. By eating a healthy diet ourselves, and by instilling good eating habits in children we may be able to tackle some of the problems facing the modern world today, such as the increased prevalences of obesity and cancer. [1] Lichtenstein, A et al. (2006). Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee.American Heart Association Nutrition Committee, 114(1), 82-96.  [2] Schatzkin, A et al. (2008). Prospective Study of Dietary Fiber, Whole Grain Foods,   and Small Intestinal Cancer. Gastroenterology, 135(4), 1163-1167.  [3] Jenkins , D et al. (1987). Starchy foods and fiber: reduced rate of digestion and improved carbohydrate metabolism , Journal of Gastroenterology.Scandinavian Journal of Gastroenterology, 22(129), 132-141.  [4] Covington, M. (2004). Omega 3 Fatty Acids. American Family Physician, 70(1), 133-140.  [5] Perk, J. et al. (2012). European Guidelines on cardiovascular disease prevention in clinical practice . European Heart Journal, 33(13), 1635-1701. [6] Piepole, M. et al. (2016). 2016 European Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal, 37(1), 2315 - 2381. [7] Go, AS. et al. (2016). Heart disease and stroke statistics - a 2014 update: a report from the American Heart Association. Circulation, 139(3), e28-292 [8] Mozaffarian, D. (2009). Health effects of trans-fatty acids: experimental and observational evidence. European Journal of Clinical Nutrition, 63(2). [9] Williams, P. (2007). Nutritional composition of red meat. Journal of the Dieticians Association of Australia, 64(S4), 113-119. [10] European Commission. (2002) Polycyclic aromatic hydrocarbons - occurrence in foods, dietary exposure and health effects. Retrieved April 2016 from, http://ec.europa.eu/food/fs/sc/scf/out154_en.pdf  [11] Sanchez-Zamorano LM, et al. (2016) The Western dietary pattern is associated with increased serum concentrations of free estradiol in postmenopausal women: implications for breast cancer prevention. Nutr Res, 36(8), 845-54. [12] Kraytz, M. et al. (2013). The relationship between high-fat dairy consumption and obesity, cardiovascular, and metabolic disease Kratz M1, Baars T, Guyenet S.European Journal of Nutrition, 52(1), 1-24. [13] Liu, S. et al. (2000). Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study. The American Journal of Clinical Nutrition, 72(4), 922-928.   [14] Report of the joint who/fao expert consultation. (2002). Diet, nutrition and the prevention of chronic diseases. WHO Technical Report Series, 916,  [15] Aune, D. et al. (2012). Fruits, vegetables and breast cancer risk: a systematic review and meta-analysis of prospective studies. Breast Cancer Research and Treatment, 134(2), 479-493.  [16] Williams, M. et al. (2005). The role of dietary factors in cancer prevention: beyond fruits and vegetables. Nutrition in Clinical Practice, 20(4), 451-459.   [17] Slavin, J.L. & Lloyd, B. (2012). Health benefits of fruits and vegetables. Advances in Nutrition, 3(4), 506-516.  [18] European Commission (2008) Annex II: pesticides - plant protection products referred to in Article 5(1). Retrieved October 2016 from, http://ec.europa.eu/agriculture/organic/eu-policy/expert-advice/documents/final-reports/final_report_egtop_on_plant_protection_products_en.pdf  [19] The Expert Committee on Pesticide Residues in Food. (2015) Report on the Pesticide Residues Monitoring Programme for Quarter 1 2015. Retrieved October 2016 from, http://webarchive.nationalarchives.gov.uk/20151023155227/http://www.pesticides.gov.uk/Resources/CRD/PRiF/Documents/Results%20and%20Reports/2015/Q1%202015%20FINAL.pdf [20] World health organisation. (2003). Global Strategy on Diet, Physical Activity and Health. WHO Technical Report Series, 916.  [21] World health organisation. (2015). Sugars intake for adults and children. Guideline.  Retrieved October 2016 from, http://apps.who.int/iris/bitstream/10665/149782/1/9789241549028_eng.pdf [22] Malik, V.S et al. (2010). Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. US National Library of Medicine, 121(11),1356-1364.   [23] Meneton, P et al. (2005). Links Between Dietary Salt Intake, Renal Salt Handling, Blood Pressure, and Cardiovascular Diseases. Physiological Reviews, 85(2), 679-715.  [24] World health organisation. (2012). Sodium intake for adults and children. Guideline. Retrieved October 2016 from, http://apps.who.int/iris/bitstream/10665/77985/1/9789241504836_eng.pdf  [25] Steinberger, J & Daniels, S.R. (2003). Obesity, Insulin Resistance, Diabetes, and Cardiovascular Risk in Children. American Heart Association , 107(1), 1448-1453. [26] Vartanian, LR. et al. (2007) Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 97(4). 667-75. [27] Azeem, S. et al. (2015). Diet and Colorectal Cancer Risk in Asia - a Systematic Review. Asian Pacific Journal of Cancer Prevention, 16(13), 5389-5396. [28] Ley, S. et al. (2014). Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet, 383(9933), 1999-2007. [29] De souza, R. et al. (2015). Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ, 351(H3978), . [30] Richelsen, B. (2013). Sugar-sweetened beverages and cardio-metabolic disease risks. Current Opinion in Clinical Nutrition and Metabolic Care, 16(4), 478-484