Afdfc 2010 an_appetite_for_change_am

Sally Hogg

Deputy Director of Partnerships &

Engagement, NHS Suffolk

Better food. Better health.

Let’s get Suffolk cooking!

Sally Hogg

Deputy Director of Partnerships & Engagement

NHS Suffolk

Content

• Health in Suffolk

• Drivers – national & local

• Lifestyle barriers / challenges

• Market Segmentation

• HAS projects

• HAS community grants

• Weight Management

• How you can get involved?

Health in Suffolk

Health in Suffolk –

Coronary Heart Disease

• Coronary heart disease is the most common cause of

premature death in Suffolk.

• Risk factors include age, ethnicity, high fat diet, obesity

and diabetes.

• One of the main contributors to the gap in life expectancy

in deprived areas.

• 50% fall in people dying from CHD mainly attributed to

better lifestyle choices.

Health in Suffolk ─ Diabetes

• Estimated prevalence of diabetes expected to

increase by 32% between 2005 and 2025.

• Incidence of type 2 diabetes virtually unheard of in

children and young people 10 years ago.

• Diabetes is the third most prevalent long term

condition in Suffolk.

• Approximately 10% of people are unaware they

have diabetes.

• Prevalence is higher in Black Caribbean, Indian,

Pakistani and Bangladeshi populations.

Health in Suffolk ─ Obesity

• About two-thirds adults and a third of children are either

overweight or obese.

• 41% males in Suffolk classified as overweight (2008).

• More than half of all adults expected to be obese by

2050.

• In 2008/09, 15.3% of 11 year olds classed as obese.

• In 2008/09, 8.9% of 5 year olds classed as obese.

National and local drivers for change

Government reviews:

Marmot (2010)

Healthy Weight. Healthy Lives (2008)

Lifestyle barriers and

challenges • Culture

• Knowledge

• Communities

• Lifestyle

• Time

• Cost

Market segmentation

– family breakdown

• Overprotective

• Enabling

• Unaware / uninformed

• Preoccupied

• Reactive

Overprotective parents

I don‟t want to

make a big deal,

his weight isn‟t

really a problem.

It‟s just puppy

fat, and other

kids should

learn to stop

talking about it.

She started putting on weight

at about 11, but you know, I

didn‟t want to draw attention

to it, because I‟ve read about

the anorexia and that.

Children

shouldn‟t be

judged based on

their bodies.

HAS projects

HAS community grants

£58,000 has been awarded in

community grants to projects that

promote healthy eating.

Weight Management

How to get involved

• Business awards

• School awards

• Health Manager

Or visit the big orange HAS bus outside and

speak to the team!

John Stein

Professor for Neurophysiology,

University of Oxford,

and Chair, Dyslexia Trust

Why good nutrition

is important for

optimum cognition

and behaviour

John Stein

Magdalen College,

Oxford University, UK

Supported by: The Dyslexia Research Trust (www.dyslexic.org.uk),

Dyers & Colourists, Esmee Fairbairn,

Garfield Weston and Wellcome Trusts, BBC Children in Need

D R T

Nutrition &

Cognition

Fish & our evolution

Cognition & magnocellular neurones

Low fish intake → low cognition

Improved fish intake → improved cognition

Supported by: The Dyslexia Research Trust (www.dyslexic.org.uk),

Dyers & Colourists, Esmee Fairbairn,

Garfield Weston and Wellcome Trusts, BBC Children in Need

D R T

Botticelli – Venus emerges from the sea

• Alistair Hardy, Elaine

Morgan

• Humans evolved from

apes, living by water

• Naked ─ v. little hair

• Sweating, not panting

• Low Larynx

• Bipedal

• Vitamins A & D, iron,

iodine, zinc, EPA & DHA

from fish are essential

Fish Diet

• Adapting to a fish hunting /

gathering economy allowed

10 fold expansion of our

brain size and 100 fold

increase in connections

compared with chimps

• Modern diet is a disaster!

• Too much of the 3 S‟s:

Sugar, Salt, Saturated Fat

Not enough omega 3 from

fish together with vitamins

A&D, iron, iodine, zinc

Modern diet is appalling! Too much of the 3 S‟s: sugar, salt, saturated fat

Not enough omega 3 from fish; vits A&D, iron, iodine, zinc, fibre

An effect of the 3 S‟s

Fish oils

are also

important

for

focussing

attention.

This is far

more

important

than you

might think! “My teacher said I don’t pay enough attention in class.

At least, that’s what I think she said.”

Focussing attention

Accurate automatic focussing

of attention is essential for:

• sequencing sounds for

speaking, understanding,

emotional tone

• sequencing letters visually

for reading

• sequencing skilled

movements

• emotional expression

(faces, gesture) for social

communication

Neurodevelopmental problems are

characterised by poor focussing of

attention:

• Specific language impairment

(developmental dysphasia)

• Developmental dyslexia

• Developmental dyspraxia

• Attention hyperactivity (ADHD)

• Asberger‟s, autism

• Schizophrenia

• Depression

• Antisocial behaviour

These are leading causes of ill health in

the developed world. $200 billion in

USA; £80 billion in UK

Magnocellular Neurones &

Attention

• Impaired m-cell development has been found in prematurity, foetal alcohol syndrome, developmental dyslexia, dyspraxia, dysphasia, ADHD, ASD, Williams, schizophrenia, depression, violent personalities?

• High dynamic sensitivity requires high membrane flexibility provided by local environment of essential fatty acids, particularly long chain omega 3s, found in fish oils

• Hence m-cells are very vulnerable to omega-3 deficiency

• A system of large neurones specialised for temporal processing – tracking changes in light, sound, position etc.

• Crucial for direction of attention

• Large, fast conduction, fast transmission, high anisotropy

• All express same surface antigen, CAT 301

• Found throughout the whole brain: visual, auditory, skin, muscle proprioceptors, cerebral cortex, hippocampus, cerebellum, brainstem

Role of magnocellular neurones

in developmental dyslexia,

dysphasia, dyspraxia, ADHD, autism,

antisocial behaviour?

Dyslexia – visual and auditory inattention, poor sequencing incoordination, unsteady eyes, reading and spelling difficulties

Dysphasia (specific language impairment) auditory inattention to sound sequences, incoordinated speech mispronunciations, lisps, stuttering

Dyspraxia – motor inattention, incoordination

ADHD – inattention, hyperactivity, impulsivity, incoordination

Autism – inattention to social cues, incoordination, poor communication skills

Antisocial behaviour, conduct disorder – inattention to social cues, Co morbidity.

All caused by impaired development of magnocells?

Some nerve cells are much

larger than others

(magnocellular) ─ rapid

responses for timing events,

high sensitivity to change:

motion, flicker.

Control attention and

eye movements.

Very vulnerable to

omega-3 deficiency

Most nerve cells are smaller

(parvocellular):

for static responses, eg.

colour, fine detail

Magnocellular

Neurones

Visual magnocellular system dominates

visuomotor pathway

Directs visual attention & eye movements

The visual magnocellular system is

impaired in poor readers

• 30% smaller LGN magnocells

post mortem

• Reduced and delayed evoked brain

waves

• Reduced visual motion sensitivity

• Lower sensitivity to flicker

• Lower sensitivity to low spatial, high

temporal frequency contrast gratings

• Reduced activation of cortical visual

motion areas (FMRI)

• Lower stereoacuity

• Unstable attention & eye control

• Poor visual sequential attention ─

slower visual search

These claims are vigorously

disputed ─ 3 problems:

• Definition of magno-system:

only anatomically distinct in

LGN and cortical layer 4

• Selectivity of stimuli

• Mild deficit requires highly

sensitive tests to reveal it

Nevertheless in the last 10 years

90% of new research papers have

supported magnocellular theory.

But Brent Skottun has written 20

papers criticising others‟ work!

Abnormal magnocells in

dyslexic brain

Weak m-system causes unstable

vision ─ blur

Weak magnocellular system causes

unstable vision ─ oscillopsia

“The letters go all blurry”

“The letters move over each other, so I can‟t tell

which is which”

“The letters seem to float all over the page”

“The letters move in and out of the page”

“The letters split and go double”

“The c moved over the r, so it looked like another c”

“The p joined up with the c”

“d‟s and b‟s sort of get the wrong way round”

“The page goes all glary and hurts my eyes”

“I keep on losing my place”

Cod Liver Oil Queue, 1944

„Most Britons

were better fed

in 1942 at the

height of

the German

blockade than

they are now‟

Dr Hugh Sinclair,

Magdalen College,

Oxford

Fish is good for the heart & brain! • By increasing membrane

flexibility, speed up neuronal Na, K, NMDA, GABAa currents; ie. accelerate neuronal responses

• Thus improve magnocellular timing functions

• Increase neurogenesis; decrease apoptosis

• Increase neurite outgrowth (syntaxin) & synapse formation

• Hence improve memory (Alzheimer‟s)

• Strengthen hemispheric lateralisation

• Anti-inflammatory

• Reduce pain transmission (TRPV1 receptors)

• Prevent accumulation of insoluble amyloid precursor protein (Alzheimer‟s)

Fish oils

Omega-3s enable

membrane flexibility ─

50% of the membrane

enclosing this

magnocellular nerve

cell consists of

a single long chain

omega-3 fatty acid

(DHA)

● New Zealand (5.8%)

● Canada (5.2%)

● France (4.5%)

● Korea (2.3%)

Japan (0.12%)

● ●

Taiwan (0.6%)

● USA

(3.0%)

● Puerto Rico

(3.0%)

● West

Germany (5.0%)

Annual apparent fish consumption (lbs per person)

Fish consumption and prevalence of major depression

Annual pre

vale

nce o

f m

ajo

r depre

ssio

n (

rate

/100 p

eople

)

20 40 60 80 100 120 140 160

0

1

2

3

4

5

6

Changes in Hamilton

Depression Rating

scale (HDRS) over

time in patients

treated with:

- fluoxetine

- EPA

- or EPA+fluoxetine

0 2 4 6 8

0

5

10

15

20

25

30

35

EPA + fluoxetine

EPA

fluoxetine

TIME (weeks)

Fatty acid deficiencies in dyslexia and young offenders?

• Modern diet, particularly of the poor,

is highly deficient in essential

micronutrients, particularly omega-3s

• Many children with neurodevelopmental

problems and young offenders have

clinical signs of omega-3 deficiency

• Low blood and brain omega-3s

• Fish oil omega-3 supplements can

greatly improve m-function, attention,

reading and reduce violence

Gold standard

for evidence of

effect – double

blind, randomised

control trials

(RCTs)

Randomly allocate

to active treatment

or placebo groups;

then all other

factors should be

the same between

the groups. Hence

any difference in

outcome must be

due to active

treatment

Durham RCT ─ Omega 3 EPA supplements

helped dyspraxic children to improve their concentration

and their reading (Richardson & Montgomery)

Treatment effect sizes after 3 months

0.26

0.31

0.34

0.50

0.54

0.58

0.61

-0.60 -0.40 -0.20 0.00 0.20 0.40 0.60 0.80

Conners' Index

DSM Hyperactivity

Emotional Lability

Conners' Total

Restless-Impulsive

DSM Total

DSM Inattention

Global scales(Mean change / Baseline SD)

HUFA (n=15)

Placebo (n=14)

Richardson et al.

In violent offenders, poor visual perception reduces ability to read facial

expressions

1133 offences: ITT- Active vs Placebo: -26.3 % (p ‹ 0.03)

Supplementation for at least 2 weeks: -34.0%

Violent offences only: -37.0%

0

0.2

0.4

0.6

0.8

1

1.2

1.4

Before Supplementation During Supplementation

Ratio

of

Rate

of

Dis

cip

linary

Incid

ents

S

up

ple

menta

tio

n/B

aselin

e

Active

Placebo

Error bars at 2SE to indicate the 95% confidence interval

Omega-3, vitamins & mineral supplements reduced

offences in Young Offenders by 1/3rd

(NJ - Gesch et al.)

0

2

4

6

8

10

12

voormeting nameting

voedingssupplementen

placebo-conditie

No of incidents in Dutch prison

per 1000 prisoner days

Supplements versus placebo.

• Low visual magnocellular sensitivity poor visual reading

& spelling, inaccurate interpretation of facial expressions,

poor theory of mind

• Low auditory magnocellular sensitivity inaccurate

phonology, poor interpretation of speech feeling

• Lower kinaesthetic magnocellular sensitivity poor

interpretation of gesture

• Low cerebellar (motor magnocellular) function low skill

• Lower prefrontal function poor self-inhibition, impulsivity

and inappropriate reactions – antisocial

• These may all be ameliorated by improving diet

Sensorimotor basis of poor

communication?

Conclusions

• Impaired magnocellular function causes

defective allocation of visual & auditory attention

(also cutaneous, proprioceptive, motor intention)

• Hence impaired cognition, social interaction,

impulsivity, lack of self control

• May result from:

Genetic vulnerability

Fish omega 3 deficiency

• This knowledge is exciting because these

weaknesses can be remedied

John Stein

Visit

The Dyslexia Research Trust

(www.dyslexic.org.uk)

Good nutrition is

indeed important

for optimum cognition

and behaviour

D R T

Mike Duckett

Catering Service Manager,

Royal Brompton Hospital and

Harefield Foundation Trust

Good Fresh Food /

Healthier Patients

Sustainable Service at the

Royal Brompton Hospital

Mike Duckett

Catering Service Manager Royal Brompton Hospital &

Harefield Foundation Trust

Benefits of Change

Improving the patients hospital experience by providing good basic freshly cooked meals through healthier tastier menus

Tastier well cooked food increases appetite and contentment reduces patient stress levels

Cooking on site to a recognised recipe and local sourced known ingredients

Fresh food cooked daily enhances the nutritional content of food

Healthier food and lifestyle reduces the high levels of obesity and diabetes

Children eat familiar food but served healthier

Good food reduces expensive waste

Royal Brompton Kitchen

Royal Visitor

Well fed satisfied

Less stressful

Patients

Well nourished

Patients get well

Reducing hospital

time

reduces

cost

to health service

Good local food

equals healthier

patients

Local food

Supportive

To community

Encourages

Farming

community

Fresh

Food

Cooked on

site

Investment

In small

businesses

Quality

Food Value

for

Money

The Key to Local Procurement

Identify and support the local farmer and supplier, what they can provide and how. Look for quality and taste

Change the menu to what is being grown and available year round

Negotiate local agreements. Unwieldy national contracts are restrictive and costly.

Commodities should be led by quality and taste rather than cost. Value for money is “what is eaten on the plate” not necessarily the bottom line

Seasonal food is paramount and frequent menu changes imperative

Sourcing local food reduces air miles and carbon foot printing

Purchasing directly from the source of the food costs less cuts out the middle man

Make payments on time (if possible on delivery)

Local Food,

at its best

Venison, game and wild rabbit

Free range eggs and local bacon

Organic milk and organic porridge oats

Seasonal orchard Kent fruit and juices

Soups are freshly made daily

Forequarter meat butchered for roasting

Freedom food chicken

Organic burger and additive free sausages

Whole breast meat chicken nuggets

Asparagus

Food with no preservatives or modified ingredients

What the NHS procures

Annually

250,000 litres of orange juice

12.3 million loaves of bread

62 million litres of milk

1.3 million chicken legs

17 trusts in London ─

69 Hospitals responsible for

food ordering

Just 20% of food ordered locally

would provide a boost of

£3 million to farming and small

business in the South East

Royal Brompton Hospital

7,000 litres orchard juice

40,000 kilos Kent potatoes

25,000 litres of organic milk

800 kilos local bacon

900 kilos local sausages

9,600 Chicken legs freedom food

50,000 free range eggs

Government Spending

and Support

Government needs to change the 120 pages of

rules and regulations on how to procure food.

Public catering should support regional British

food to be sustainable for the future. This is

being achieved through the Chelsea cluster in

London.

£2.2 billion is spent annually in the public sector

on food -- a £300 million on hospital meals.

Collaboration on local procurement would save

£50 million per year.

The menu ingredients

checked

Typical patients menu

Lunch

Roasted red pepper soup ─ roll & butter

Haddock fillet in batter with lemon wedge

Baked shoulder lamb herb crust

Mozzarella, tomato & avocado salad

Cheese, onion & potato pie

Creamed and chipped potatoes

Garden peas and cauliflower florets

Lemon sponge and custard

Sago pudding

Fresh fruit

Patient satisfaction is 20% higher than the NHS Hospital average

Meals go to the wards 20 mins prior to serving

Sustainability future –

reducing Carbon Foot printing

All food waste is now collected for composting and returned to the gardens

Reduction in the use of plastic cups and replaced recyclable paper

Deliveries reduced to three per week instead of daily, saving 60,000 food miles

Marine stewardship fish used oil collected for bio diesel

Healthier staff meals to reduce absenteeism

Shortlisted as a finalist to the national recycling awards 2010