It’s been a long time coming but finally the National Heart Foundation (NHF) has released their new version of the Healthy Food Pyramid. And, unsurprisingly, it’s a big improvement on previous models. Unlike our food based guidelines, which haven’t been updated for 10 years and therefore still promote a grain-based diet, the NHF model (based on a healthy heart) has gone some way to recognising the impact a high intake of these foods can have on health outcomes, and has also undergone market research to determine what messages may be best understood by the general population.
What I really like about this new model is that it’s colourful, bright and it doesn’t try to dictate portion amounts which most people read as a ‘one-size fits all’ approach. It instead focuses on the proportion of the plate that each food group should contribute – a volumetric-based approach. I like that vegetables and fruit are given priority over everything else (the type of diet that most people promoting whole-food advocate also), where previously breads, cereals and grains featured in the ‘eat most’ category (that’s what you get when the US Department of Agriculture has a hand in developing food guidance systems). I also really like that they’ve removed potatoes and other starchy vegetables from the ‘eat most’ category. They are the type of carbohydrate (CHO) foods that I advocate people eat, and if everyone was metabolically healthy and had no problems in regulating their appetite, their presence with non-starchy vegetables wouldn’t be a problem because people might naturally consume appropriate amounts. However, with two-thirds of New Zealanders overweight or obese, it’s not a good idea to promote these in the same vein as you would, say, broccoli. You could argue the same for fruit but from a practical perspective (and what I see a lot in my clinic) I think we are more inclined to half fill our plate with potatoes (i.e ‘vegetables’). This shift is also in line with the WHO, who have (for a few years) deemed potatoes (and bananas) as ‘starch’ and not vegetables.
However, the next food group prioritised is the wholegrain and cereals group – and that’s where I would instead advocate animal protein sources. These have a higher nutrient content and (in my opinion) more health benefits than breads and cereals with regards to nutrients (when the diet also contains substantive amounts of vegetables and some fruit). The importance of protein was highlighted in mainstream media this week actually, with this study reporting the role that protein has in helping regulate appetite and food consumption. Most of you reading this are probably aware that protein has a satisfying effect on appetite – you only need to have eggs for breakfast one morning and cereal the next to recognise the difference in your subsequent appetite (and mood, concentration, blood sugar, energy levels etc). The review investigated the evidence for the protein leverage theory, a concept which was suggests the changes in the percentage of protein in a diet can dictate our overall energy intake. If you consume a diet that is reduced in protein, you are more likely to increase your energy intake until your protein requirement is met – leading to an overall increase in energy intake and subsequent body weight. The paper reviewed studies looking at this relationship and, on balance, the evidence supported that a low protein intake relative to carbohydrate and fat in the diet promoted appetite and a higher energy intake. When energy intake from protein decreased from 20% to 10%, overall dietary energy intake increased markedly. This dropped off when protein in the diet was reduced to 20% from a greater percentage (i.e. from 30% to 20%). What was interesting here was that, regardless of whether energy from fat or carbohydrate was higher, the body will increase the drive for food to ensure that adequate amounts of protein are consumed. This might mean advocating protein-rich whole foods that by default contain good fats could go someway to reducing overall intake of foods that are high in refined sugar and processed carbohydrates. Something to consider for a population that is predominantly overweight.
However, it’s not just protein that’s important in the diet – it’s good quality protein. I’ve banged on about this before, but in New Zealand our main problem is not absolute protein intake – it’s where it comes from and how it’s spread across the day. The way we typically consume food is to be quite light on protein at the start of the day and more heavy come the end of the day. On average, men have an intake of 102g of protein per day, and women around 71g per day. With around 16.4% and 16.5% of our dietary energy coming from protein. With a range of 15-25% being recommended, while it might be deemed adequate, this is definitely on the lower side. The major contributor of protein in our diet comes from the bread group (encompassing all types of breads, rolls, buns, crumpets and bagels) – all foods that could potentially drive an increase in appetite. As protein from animal sources not only contain all essential amino acids (the building blocks in our body) and are a good source of natural fats (contributing to their nutrient density), increasing our dietary protein from these foods is far preferable to relying on plant-based sources. As a side issue (yet related point), as an island nation surrounded by water where one of our major industries is dairy farming, it’s criminal that people in our population don’t have access to the quality protein sources necessary for a nutrient dense diet and overall health. Bagels and crumpets don’t cut it. Hence why I’d move the eggs, animal sources of protein up one level and promote their importance in the diet.
I also want to add that a diet high in fruit and vegetables is more beneficial when there is enough fat in the diet to be able to absorb the fat soluble vitamins and important phytochemicals etc that are present. Complete ‘nutrition’ isn’t just about just eating the food – you have to be able to absorb the nutrients it contains. This isn’t promoting a ‘high fat’ diet, but higher fat? Certainly. When the general population has carbohydrate-based diet that, if combined with fat, is the main driver of metabolic disorder and subsequent chronic disease, promoting a high fat diet can be problematic. This is certainly true with a dietary guidance system that lists wholegrain cereals high up in the list of dietary priority, and in a food environment where children’s cereals can claim to be ‘74% wholegrain’ yet in reality deliver little more than rampant hunger by 10am.
So what would my pyramid look like?
(ok, so I’m limited by the emoticons on my phone, but you get the drift).
The good thing with the NHF Healthy Heart (and message) is that, for the most part, it is indicating a minimally processed food diet – which most of us agree is the way to go. It’s definitely better than the Food and Nutrition Guidelines which state we should aim for at least six serves of breads and cereals, and at least one serve of food from ‘meat, poultry or meat alternatives.’ While I’m not on board with all the NHF messages, I definitely think it’s a marked improvement on the last one, and one step further in promoting the adoption of a whole food diet.