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  1. A crucial part of a healthy lifestyle is generally considered to be the inclusion of plenty (5-7 portions per day) of fruit and vegetables in our diets. However current farming practices include the use of pesticides, antibiotics and hormones to treat crops in order to increase output via higher crop production and faster plant growth. Furthermore, by limiting pest damage, the use of pesticides can also enhance the looks of produce. These chemicals can remain on the surface of fruits and vegetables, even on organic varieties,[1] contaminating them and leading to pesticide ingestion by consumers. Unfortunately, the drugs, hormones, and pesticides currently in use can be hazardous to humans if consumed in a quantity large enough. By definition, pesticides are designed to kill, and the majority are toxic to humans at some level.[2] Organophosphates (OPs) are a group of organic compounds containing phosphates that are frequently used in pesticides and are known to be toxic to humans.[3], [4], [5]  Studies into the effects of OPs have mainly been carried out in subjects that are exposed to OPs through their occupation, for example, farm workers or crop sprayers. These studies have found the symptoms of OP poisoning to include nausea, abdominal cramps, diarrhoea, dizziness anxiety, and confusion.[6] Fortunately, as severe as the symptoms may be, they are frequently reversible.[6] There have not been as many studies in people who have not been occupationally exposed to pesticides, but those undertaken have found that exposure to a low dose over a long period of time may be associated with neurodegenerative conditions such as Parkinson’s disease.[7], [8] Furthermore, prenatal exposure may result in long term irreversible changes in the brain structure of the unborn child, resulting in a lower IQ and a poorer memory.[9], [10], [11]  One of the larger studies, examining a nationally representative sample of children exposed to a chronic low dose of pesticides, found an increased chance of attention deficit hyperactivity disorder (ADHD) in children aged 8-15 years old.[12] Increased quantities of OPs were also found in their urine, indicating systemic exposure.[12] The degree of damage that pesticides such as OPs can inflict is directly proportional to the amount of substance ingested. It is not disputed that pesticide residues are present on fruit and vegetables, which unfortunately means that, in the quest to remain healthy by eating high proportions of fruits and vegetables in their daily diet, many consumers may also potentially be ingesting high levels of toxins. Could it be that the ‘healthier’ the diet based on a higher fruit and vegetable content, the higher the risk of toxicity? Test data obtained in 2014 from the US Department of Agriculture and the Federal Drug Agency found that as little as 1.7% of tomatoes, 2.2% of cherries, 1.7% of strawberries and 2.5% of peaches were pesticide free, meaning that over 97% of these products were contaminated with these chemicals.[13] The average potato had more pesticide residue by weight than any other produce tested,[13] which is of particular concern as many people eat potatoes most days.[14] The UK’s 2014 Pesticides Residues Committee Annual Report stated that, of 3,615 samples tested, 56.2% had no pesticides, 41.9% contained pesticides below the ‘safe’ limit and 1.9% above the limits.[1]  Whilst these tests mean that the vast majority of pesticide residues were well below the maximum residue limit (MRL) and are therefore unlikely to be toxic, some products did exceed the MRL. Nevertheless, the health benefits of eating plenty of fruit and vegetables remain clear and rather than omitting them from the diet whatsoever, it is advisable to wash fruits and vegetables well. Some studies suggest that washing with salt water is an effective way of removing pesticides.[15], [16] Indeed one study using chinese cabbage found that washing with soda-salt water removed as much as 60% of pesticides.[17] An even better approach is to peel them when possible, to remove the potentially harmful wax that is applied during processing.[18]  Furthermore, whilst organic produce generally contains less pesticide residues than non-organic produce, even these fruits and vegetables are not guaranteed pesticide-free.[19] Tests performed in the EU identified pesticide residues in a wide range of organic food products, even finding traces of the highly toxic dichlorodiphenyltrichloroethane (DDT)[20] Organic regulations stipulate that pesticides can be used in organic production, as long as the chemicals are ‘natural’. However one such ‘natural’ pesticide, rotenone, has been linked to the development of Parkinson’s disease in humans,[21] with such a strong effect that it is now used to create animal models of Parkinson’s disease.[22] With the help of more robust regulations governing organic production, organic fruits and vegetables should one day be the exception to the pesticide--contamination rule. However until then, care should also be taken to wash and peel organic produce. [1] National Archives. (2016)  Retrieved September, 2016, from http://webarchive.nationalarchives.gov.uk/20151023160002/http://pesticides.gov.uk/Resources/CRD/PRiF/Documents/Results and Reports/2014/PRIF Annual Report 2014 FINAL.pdf  [2] Damalas, C. et al. (2011) Pesticide Exposure, Safety Issues, and Risk Assessment Indicators. Int J Environ Res Public Health, 8(5), 1402 - 1419. [3] Costa, L. (2006) Current issues in organophosphate toxicology. Clinica Chimica Acta, 366(1-2), 1-13. [4] Kerami-mohajeri, S. et al. (2011) Toxic influence of organophosphate, carbamate, and organochlorine pesticides on cellular metabolism of lipids, proteins, and carbohydrates.Hum and Experiment Toxicology, 30(9), 1119-1140. [5] Kamanyire, R. (2004). Organophosphate toxicity and occupational exposure. Occupational Medicine, 54(2), 69-75. [6] Peter, JV. et al (2014) Clinical features of organophosphate poisoning: A review of different classification systems and approaches. Indian J Crit Care Med, 18(11), 735-45. [7] Slotkin, T. et al. (2011) Developmental exposure to organophosphates triggers transcriptional changes in genes associated with Parkinson's disease in vitro and in vivo. Brain Res Bull, 86(5-6), 340-347. [8] Berry, C. et al. (2010) Paraquat and Parkinson's disease. Cell Death and Different, 17(7), 1115 - 1125. [9] Ruah, V. et al. (2012) Brain anomalies in children exposed prenatally to a common organophosphate pesticide. PNAS, 109(20), 7871-7876. [10] Cecchi, A. et al. (2012) Environmental exposure to organophosphate pesticides: Assessment of endocrine disruption and hepatotoxicity in pregnant women. Ecotoxicol and Environ Safety, 80(1), 280 -287. [11] Columbia University (2016). Prenatal Exposure to Insecticide Chlorpyrifos Linked to Alterations in Brain Structure and Cognition. Retrieved September, 2016, from https://www.mailman.columbia.edu/public-health-now/news/prenatal-exposure-insecticide-chlorpyrifos-linked-alterations-brain-structure  [12] Bouchard, M. et al. (2010) Attention-deficit/hyperactivity disorder and urinary metabolites of organophosphate pesticides. Pediatrics, 125(6), 1270-1277. [13] USDA (2016) Retrieved September, 2016, from https://www.ams.usda.gov/sites/default/files/media/2014%20PDP%20Annual%20Summary.pdf          [14] King, JC. & Slavin, JL. (2013). White potatoes, human health, and dietary guidance. Adv Nutr, 4(3), 393S-401S. [15] Aktar, W. et al. (2009) Risk assessment and decontamination of Quinalphos under different culinary processes in/on cabbage. Environ Monit Assess, 163(1), 369-377. [16] Vemuri, SB. et al. (2014) Methods for removal of pesticide residues in tomatoes. Food Sci Technol, 2(5), 64-68. [17] Zhang, Y-S. et al. (2013) Study on universal cleaning solution in removing blended pesticide residues in Chinese cabbage. J Environ Chem Ecotoxicol, 5(8), 202-207 [18] Ministry of Fisheries, Crops and Livestock (2004) Retrieved October 2016 from, http://pdf.usaid.gov/pdf_docs/Pnacy849.pdf  [19] European Commission (2008) Annex II: pesticides - plant protection products referred to in Article 5(1). Retrieved October 2016 from, https://members.wto.org/crnattachments/2016/TBT/EEC/16_0337_01_e.pdf  [20] 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  [21] Nandipati, S. & Litvan, I. (2016) Environmental exposures and Parkinson’s Disease. Int J Environ Res Public Health, 13(9), doi: 10.3390/ijerph13090881 [epub ahead of print] [22] Johnson, ME. & Bobrovskaya, L. (2015) An update on the rotenone models of Parkinson's disease: their ability to reproduce the features of clinical disease and model gene-environment interactions. Neurotoxicity, 46, 101-16.
  2. 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