Most diets have one thing in common, though: they all over-promise easy and quick weight loss.

Short-term these diets may lead to weight loss, but over the long-term we know most people will gain the weight back, if not more, because they haven’t learned how to develop healthy eating habits for life.

Does intermittent fasting work? Unlike many of these weight loss fad diets, intermittent fasting has been slowly gaining traction in the research world.

What exactly is intermittent fasting and how does it help lead to weight loss?  First, let’s define intermittent fasting as there are several different versions of the diet in the mainstream.

What is Intermittent Fasting? 

Adapted from Patterson, 2015.

How Does Intermittent Fasting Work for Weight Loss?

Typically, when a person wants to lose weight, they will reduce the number of calories below their normal daily intake over time.

For example, a rule of thumb is to reduce daily calorie intake by 500 to lose one pound in a week, since one pound is equal to ~4500 calories.  This is called continuous caloric restriction (CCR) and is the ‘traditional’ weight loss diet.

Studies have shown that CCR regimes not only reduce body weight they may also help prevent obesity-related diseases [NIA 2018, Schübel 2018].  It is important to note that CCR does not cause malnutrition or deprivation of essential nutrients [NIA 2018].

A fasting diet or intermittent caloric restriction (ICR) is an eating regimen where a person does not eat at all or severely limits intake during a certain time frame (e.g, day, week, month) [NIA 2018].  Over time on a fasting diet, a person may consume fewer calories thereby leading to weight loss.

Decreased calorie intake, whether it’s done through CCR or ICR, leads to weight loss.

This might seem like a no-brainer, but research is starting to show that not only do fasting regimes lead to weight loss, but they may have greater metabolic benefits including lower insulin levels and decreased fat mass compared to traditional dieting [Harvie 2011, 2013].

Intermittent Fasting Benefits

A recent systematic review of four intermittent fasting studies reported a decrease in fat mass and reductions in both low-density lipoprotein (LDL) and triglyceride levels, suggesting improvements in cardiovascular health [Ganesan 2018].

Additional studies are also suggesting that these fasting regimens help lead to weight loss with potential effects on glucose metabolism and inflammation.

These are also benefits shown by traditional weight loss diets, suggesting intermittent fasting may have similar benefits. As more studies on intermittent fasting are conducted, systematic reviews continue to support these cardiometabolic benefits.

Like other intermittent fasting regimens, time restricted eating is also associated with weight loss and may be important for optimal metabolic function [Patterson 2015].

Why researchers are observing these metabolic benefits with ICR is still unknown.  More research will help to identify the mechanisms behind the benefits.

Fasting is a major component of Ramadan, and a review of studies focusing on the effects of fasting during Ramadan reported weight loss and lower levels of low-density lipoprotein cholesterol and fasting blood glucose in both men and women when compared to the beginning of Ramadan [Kul 2013].

Other studies have also reported that Ramadan fasts are associated with lower levels of inflammatory molecules in the blood stream (e.g. C-reactive protein, interleukin-6, tumor necrosis factor-alpha; Aksungar 2007, Faris 2012).

However, these types of molecules are produced normally by our bodies as part of metabolizing the food we eat, so it may make sense that restricting food would lead to lower measurements.

The more important question, and what is still unknown, is whether these changes are permanent or if they go away when people resume their normal eating habits.

Which One is Better, Continuous Calorie Restriction (CCR) or Intermittent Fasting?

To date, most systematic reviews of intermittent fasting studies have suggested that intermittent fasting is equal to standard CCR regimens when it comes to weight loss [Patterson 2015].

More recently in 2018, Shubel et al. showed that the 5:2 diet is equivalent, but not superior, to traditional CCR diets for weight loss and the prevention of metabolic diseases.

A systematic review from 2021 comparing intermittent fasting diets versus CCR diets found that intermittent fasting diets were associated with higher weight loss in four out of 18 studies. At this point, it appears that both dietary methods of weight loss have similar effects.

How Does Fasting Help Improve Health?

While health improvements from fasting might sound counter-intuitive, science is starting to show there might be something to it.  The exact mechanisms of action are still unknown, but to date a few hypotheses have been proposed to explain how intermittent fasting can benefit overall health [Patterson 2015].

Recent studies have suggested there is a possible link between the microbiome and these cardiometabolic intermittent fasting benefits.

These hypotheses include:

1. Improvement in the gene expression associated with the circadian rhythm to favour energy metabolism and body weight regulation.  In other words, fasting regimens may impose a daytime rhythm in food intake, leading to improved energy metabolism and body weight regulation.
2. Enhancement of beneficial colonies of gastrointestinal microbiota which may be more favourable to weight loss.
3. Modification of lifestyle behaviors (e.g. energy intake, energy expenditure, sleep) may accompany fasting behaviours.

To Fast or Not?

So, does intermittent fasting work?  The short answer is yes, it is at least equally effective as traditional weight loss methods.  Every year more studies are reporting benefits beyond weight loss with intermittent fasting regimens.

It is still too early to say that one fasting regimen is better than the other, but studies are showing at the very least these eating patterns lead to weight loss and could even improve overall health.

The questions that remains to be answered is whether or not these regimens are sustainable over a lifetime in adults as well as whether these regimens help reduce risk of diseases.

So, when considering trying an intermittent fast, an appropriately qualified health professional must be consulted to ensure an adequate macro- and micro-nutrients diet is achieved.

Concussions, often called the ‘invisible injury’ because there are no apparent external symptoms, can affect people at all stages of life following an incident like a fall (elderly), heads banging in a school yard (children), or individuals of any age playing a sport.

Sometimes it can be something completely innocuous that causes an impact to the head. Concussion can have short-term and long-term effects on the brain and body, often resulting is what is called a ‘cellular crisis’.

The body has increased nutrition needs during this time, but currently there is no recommended nutrition therapy.

In this KHNI Q Science Short, Dr. Lisa Ryan, PhD, RNutr discusses the latest research on the effects of brain injury and how nutrition may have a role in brain health recovery.

Learn answers to questions like:

1. What is a concussion/brain injury?
2. What physiological effect does it have on the body?
3. How is concussion currently managed?
4. Why might nutrition have a role to play?
5. Which nutrients and non-nutrients are postulated to play a role?

One strategy to improve public health is to reformulate foods to be healthier, which can have an effect at a population-level and does not necessarily rely on individual behaviour change to improve health.  This can be initiated voluntarily by the food and beverage industry.  For example, some companies have set public goals for reducing a nutrient like sodium in their foods by a certain percentage over a time period.  In some parts of the world, reformulation is mandated.  Greater improvements in sodium intakes have been shown in countries where is it mandatory rather than voluntary.

A recent scientific review titled “What is the impact of food reformulation on individuals’ behaviour, nutrient intakes and health status? A systematic review of empirical evidence” summarises our existing knowledge of how effective food reformulation can be as a public health strategy by analysing results of 35 published studies.

Results from the review

The review analysed results from 35 published studies on food reformulation.

Consumers were accepting of reformulation of foods in the marketplace

A promising finding was that consumers still purchased reformulated products, meaning they didn’t specifically avoid foods formulated to be healthier. 22 different studies showed improvements in the nutrient content of the average consumer basket (total food purchased from a store).

81% of studies showed positive results for consumer acceptability of reformulated foods, based on comparing sales/purchases of the reformulated product before and after reformulation

 

Reformulation improved nutrient intake

73% of studies showed that reformulation improved nutrient intakes of consumers

Sodium reformulation led to a decrease in sodium intake between 4%-15% per year, depending on study population.  Analysing studies from Europe and the US, the review found that daily population-wide salt intake after reformulation was 0.57g lower than before (equivalent to 221mg sodium), or equivalent to around 10% of the daily limit of 5 grams per day recommended by the World Health Organisation.

Trans fat reformulation led to decreased intakes of 38-85%.  This value is much higher than sodium because mandated trans fat reformulation laws require drastic reductions due to its clear link to heart disease.  Partially hydrogenated oils, which are the main source of artificial trans fat in the diet, are not considered safe for the food supply in the United States, for example.  In Europe, there is a maximum limit of 2 grams of trans fat per 100 grams of total fat in a food.

Trans fat reformulation and decreased mortality

Of the 6 studies which measured the impact of nutrient intake on morbidity or mortality rates, 5 showed a positive effect on reducing mortality

Five of the studies measuring effects on health status looked at trans fat reformulation and found that reducing trans fat in the food supply led to a reduction in mortality of 4.3-6.2%.

Sodium reformulation led to an improvement in blood pressure measurements in the UK.  These findings show promise for nutrient reformulations to affect public health in a positive way.

Challenges for nutrient reformulation

Taste

Reducing nutrients that contribute strongly to the taste of a food or beverage, like sodium or sugar, without reducing consumer liking is the main challenge when it comes to nutrient reformulation.

For sugar, low-calorie sweeteners can drastically reduce total sugar content of a food or beverage.  However, these sweeteners have their own challenges.  They have poor perception among many consumers, and also bring their own flavour off-notes with them.  They are also not recommended as a long-term strategy for reducing sugar content in foods by authority publications like the Dietary Guidelines for Americans.

Sodium reduction faces similar challenges because alternatives to sodium, like potassium chloride, also have off-notes.  Many companies will slowly decrease sodium content in foods over a period of years because sodium sensing is adaptive.  In other words, the less sodium someone is used to tasting, the less they need in a food to stimulate the same salty sensations.  Gradually reducing sodium over time will be unnoticed by many consumers, as a result.

Flavour modulation, which can enhance the inherent sweetness in sugar, mask off-notes, or enhance mouthfeel or saltiness, is a great tool for nutrient reformulation.  This technology is one way to reduce sugar without requiring low-calorie sweeteners or to mask notes of sodium or sugar alternatives.

Functionality

Sugar, sodium, and certain fats have roles in food beyond taste.  Both sugar and sodium can have roles in food safety, as well as important roles in chemical reactions for many baked foods.  These nutrients also have roles in moisture migration, shelf life, etc.  Finding ways to minimise the impact of nutrient reformulation requires a system-level approach and in-depth expertise in food science and applications.

Fibres are seeing some popularity in low-sugar foods and beverages because of their ability to contribute bulk and mouthfeel, as well as sweetness in the case of some fibres.  Fibre is under-consumed in many populations, so this could have additional benefits to public health.

Consumer perception

Due to the taste and functionality challenges listed above, many consumers will associate nutrient reformulations with less taste.

“Consumer acceptance is a key driver of the effectiveness of reformulation in changing dietary intakes, in the absence of which unwarranted substitutions may take place.”

The review summarised in this article found that, despite having high consumer acceptance, compensation for the nutrient content of reformulated foods did occur.  Some studies did not find a link between reformulation and decreased intakes, or smaller decreases than predicted.

This happened more often when reformulation was noticed by consumers, possibly due to it being advertised on a package.  Silent reformulation is one strategy that could be used to reduce the effect of compensation.

The study’s findings encourage future reformulation efforts

“Given the challenges involved in changing behaviours and food choices, reformulation can provide the means to improve dietary intakes and health by changing the environment in which people make their food choices. Nonetheless, the success of reformulation as a public health strategy crucially depends on the breadth of products reformulated and the extent to which they are reformulated.”

The study did not address energy density or calorie reduction, which is another reformulation initiative that is important to address the global obesity issue.  Developing knowledge in sensory science and food science is critical to the future of not only calorie reduction, but nutrient reformulation as a whole.

This diet encourages less than 10% of total calories from carbohydrate and more than 70% of total calories from fat.

This is a stark difference compared to normal dietary recommendations, which encourage 40-65% of calories from carbohydrate and 20-35% of calories from fat.

What are the differences between the Keto diet and a traditional diet?

• Keto diets are defined as a carbohydrate intake of less than 25 percent of total daily caloric intake and a fat intake ranging from 60 up to 80 percent of total daily caloric intake (Burke et al. 2017; Burke, 2015; Chang et al, 2017;).
• High-Carbohydrate, Low-Fat (HCLF) diets are the more “traditional” dietary pattern for endurance athletes, composed of a carbohydrate rich intake of approximately 45 to 65 percent or more of total daily caloric intake (about five to 12 grams carbohydrate/kilogram of body weight/day) and a fat intake of 20 to 35 percent of total daily caloric intake (Manore, 2005; Burke, 2015).

The LCHF diet is not a new invention – the Atkins diet was previously highly popular using a similar concept.

However, with its highly promoted claims relating to its effect on weight loss and other health benefits, it has increased in popularity once again, especially in the athletic community (Burke, 2015; Chang et al, 2017; O’ Neal et al, 2019; Thomas, 2019).

How do Diets Like Keto Impact Exercise?

So, does this mean that LCHF diets are the way forward for our endurance-based athletes?  Not exactly – there is no one size fits all answer because an athlete’s diet is influenced by many factors.

The sport performed, training frequency, personal food preference, food allergies and intolerances and whether the athlete is on or off season in their training cycle all impact their nutritional needs.

The purpose of this article is to provide some clarity by taking an evidence-based approach to the question and analysing best practice for an endurance athlete.

Type of exercise determines which fuel our bodies use

During exercise, the body uses a variety of fuel sources i.e. carbohydrate or fats. The type of fuel used depends on the duration and intensity of the session.

Low intensity sessions (such as an easy paced 30-60-minute leisure walk or run) are predominantly aerobically based during which the body would use a combination of both carbohydrates and fats.

During higher intensity sessions (such as shuttle runs or hill sprints when breathing is difficult, and an athlete is working at or close to their maximum capacity) the body will use carbohydrate as its preferred source for fuel.

The fuel used in moderate intensity exercise sessions is individual and is determined by the athlete’s adaptations from their aerobic training over time. This is because one becomes better at oxidising (using) fats for energy via training and can therefore rely less on carbohydrates during moderate intensity exercise sessions (team field sports, for example).

Can Low Carbohydrate Diets Work for Endurance Exercise?

Current research (Burke, 2015; Burke et al., 2017) suggests that LCHF dietary intake may have a significant negative effect on performance output once the intensity of the activity increases (i.e. sprinting, or hard, short bursts).

Conversely, LCHF diets have been shown to help reduce an endurance athlete’s response to fatigue at a low intensity– what this means is that the athlete would be able to run for longer at a suboptimal pace, indicating a potential benefit to the endurance athlete.

However, just “going” is not the goal of any athlete looking to achieve optimal performance hence the need to determine a diet that will also increase performance.

A four-week investigation conducted by Burke et al. (2017) looked at the effects of a ketogenic low carbohydrate, high fat (LCHF) diet in comparison to high carbohydrate (CHO) low fat (HCLF) dietary pattern. The study specifically focused on fuel adaptation, metabolism and performance of elite race walkers during 3 weeks of intense training.

There were three diet groups included:

1. A high carbohydrate diet (HCLF)- 60-65% of energy came from carbohydrates, 15-20% protein, 20% fat; consumed daily and before during and after training (9 women).
2. Periodized CHO group: Same composition as HCLF, at different intervals according to training demands and fuel needs with some training sessions focused on high CHO availability (high muscle glycogen, CHO feeding during session) and others with low CHO availability (low pre-exercise glycogen, overnight fasted or delayed post-session refuelling) (10 women).
3. A LCHF diet: 75-80% fat, 15-20% protein, <50g/day CHO (10 women).

Outcome: The research found that there were no benefits to performance in the low carbohydrate diet consumed by group 3.

In fact, performance levels were not seen to improve in the LCHF group despite preforming 3 weeks of intensified training, in comparison to the athletes assigned to the other dietary patterns who all demonstrated significant performance improvements after the 3 weeks of intensified training.

It was also found that there was an increased need for more oxygen to perform the same amount of work when an athlete is fuelled on LCHF. Interestingly, an improvement in performance was achieved by the carbohydrate groups (diets 1 and 2).

Earlier research by Burke et al. (2015) also found that cycling and sprinting performance was reduced when the athlete consumed a LCHF diet.

A study by Lambert et al. (1994) did show that a LCHF dietary intake may be effective in endurance athletes. Five endurance trained elite cyclists were required to consume, in random order, a HCLF diet (high carbohydrate (74%) and low fat (12%)) or a LCHF diet (high fat (67%) and low carbohydrate (7%)) for a two-week period.

For training output, they were required to exercise to exhaustion at 60% of their VO₂max (their maximum aerobic exercise capacity). The participants prescribed the LCHF doubled their time to exhaustion in moderate intensity exercise – 60% of their VO₂ max, which was longer in comparison to the HCLF diet.

In other words, they were able to keep going for longer on the LCHF dietary protocol. These studies support the concept that LCHF diets may enable athletes to keep going for longer but only at lower intensities.

Why don’t all studies show improvements in endurance performance on a LCHF diet?

The main purpose and theory behind the use of LCHF diets in endurance activities is that this style of dietary management would allow an endurance athlete to alter the type of fuel (carbohydrates or fats) that they rely on during exercising.

In theory, improving an athlete’s ability to utilize fat during exercise would allow them to rely less on their limited carbohydrate stores during exercise and more on their nearly-limitless stores of fats.

If this was to work for a given endurance athlete, they would be capable of going for longer without hitting the metaphorical wall of fatigue, exhaustion, dizziness, and lethargy associated with depletion of carbohydrate stores during prolonged, intense exercise/ race. In theory it works very well.

Unfortunately, studies exploring the effects of fat adaptation on exercise performance in the athletic population are limited and the question remains unanswered.

However, what we do know is that looking through the evidence base to date, a combination of carbohydrates (generally normal-high levels) and fats for fuel (so not fat adapted) have yielded better performance results for the athlete in endurance-based training and sport events trials (Bartlett et al. 2015; Burke et al. 2011; Stellingwerff 2013).

If low-carbohydrate diets don’t improve performance in endurance exercise, what are other uses they might have?

During off season or sustained periods of lighter training (often used to give the body a break from continuous high levels of training), the use of a LCHF diet can work very well to help maintain weight or reduce fat mass with the goal of an improved body composition for competition.

LCHF diets paired with a calorie-controlled intake provide a promising method of helping control body weight and fat mass while maintaining lean body mass (Volek et al., 2002; Zajac et al, 2014).

However, this is more suited when making weight is a consideration for the athlete and not advised when performance is a priority.

For the recreational athlete, where performance (and competition) is not the main objective, the LCHF dietary pattern may be suitable for maintaining physique while still reaching training goals.

So, what’s the verdict?

The research to date favours the use of a more traditional, HCLF dietary approach for overall endurance performance. However, individual differences between athletes should also be a consideration and carbohydrate intake should meet the purpose and need of training/performance.

There is no one-size fits all approach; there is no “perfect” or “ideal” dietary approach for endurance athletes.

Few athletes understand exactly why and how adjusting their dietary intake in line with their training programme can optimise their performance i.e. increased carbohydrates on heavy training or double session days will increase performance and recovery while reducing carbohydrates on rest day is more beneficial.

Why do we see recommendations to reduce saturated fat intake, while at the same time see headlines from studies showing full-fat dairy may be healthy for us?

The answer lies in the fact that food can often be more than the sum of its parts.

Dairy, saturated fat & health

Dairy is a nutrient rich food group which has been championed for its role in bone, dental and muscle health for decades. On the contrary, dairy has also been the subject of ‘negative press’ concerning its saturated fat content, which is linked to heart disease and other metabolic complications. Cardiovascular disease (CVD) remains the number 1 cause of mortality globally, representing 31% of all deaths (1).

The effect of saturated fat on health has been hotly debated in recent years and the latest evidence review for Saturated Fat and Health from the UK Scientific Advisory Committee on Nutrition (August 1^st, 2019) recommends limiting saturated fat intake to ~10% of total calories (2). Saturated fat raises blood cholesterol levels, particularly low-density lipoprotein (LDL) cholesterol, which is a primary risk factor for cardiovascular disease.

At the same time, recent evidence from several large prospective cohort studies, systematic reviews and meta-analyses combining the results of thousands of subjects, have shown that milk and dairy foods, which can be high in saturated fat, have neutral or protective effects on cardiometabolic diseases (3-6).

These studies are having an impact on people’s beliefs of dairy. The idea that dairy fat is healthy is becoming more widespread among consumers. Bulletproof coffee, which encourages adding dairy fat to coffee specifically for potential health benefits, has grown into a successful lifestyle brand, and full-fat dairy is often encouraged as part of the ketogenic diet, one of the most popular diets in the world.

Whole milk and yoghurt have a saturated fat content of 2.3%, however cheese can range from 3-35% saturated fat which means that dairy is often targeted by public health bodies in efforts to reduce saturated fat intake. However, recent evidence has shown that cheese consumption does not raise LDL cholesterol compared to the same amount of fat from butter (7). This paradox may be due to a theory known as the ‘Dairy Matrix’. In reality, we eat whole foods rather than single nutrients. Dietary recommendations to reduce saturated fat do not distinguish between nutritionally poor ‘fried processed foods’ and nutritionally dense foods such as dairy.

How can a food high in saturated fat be healthy?

The Dairy Matrix: more than the sum of its parts

Dairy is a unique blend of nutrients including calcium, phosphorus, iodine, Vitamin B2 and B12, fermented cultures (yoghurt and cheese) bioactive peptides and high-quality protein containing all of the essential amino acids. Recently, scientists are considering the effects of milk and dairy foods on health beyond the benefits of the individual nutrients they contain. ‘The Dairy Matrix’ hypothesis suggests that the nutrients in dairy can interact with one another in ways that are beneficial for health (8).

Studies show that the dairy matrix has health benefits beyond the individual supplementation of the same nutrients and effective on cardiometabolic disease, weight management, bone mass density, bone metabolism, blood lipid levels and blood pressure (9).

Is cheese good or bad for heart health?

In relation to cheese, the explanation for the beneficial rather than harmful effects on cardiovascular diseases (CVD) might be due to interactions between components of the cheese matrix, including calcium, phosphorus, the milkfat globule membrane, and starter cultures, which together modify saturated fatty acid-induced increases in blood lipids. One thought is that these nutrients may block absorption of the saturated fats in cheese, but this has not been proven.

A 2018 study published in the American Journal of Clinical Nutrition examined the effects of dairy fat in cheese versus butter on markers of cardiometabolic health in 164 overweight volunteers. They consumed 40g dairy fat daily for 6 weeks, one group consumed the fat as cheddar cheese and another group consumed the fat as butter (matched for calcium and protein). Results indicated that dairy fat, eaten in the form of cheese, appears to differently affect blood lipids compared with the same constituents eaten in a butter matrix, with significantly lower total cholesterol observed when all nutrients are consumed within a cheese matrix (10). Observational studies have also shown that yoghurt and cheese consumption are linked to a reduce risk of diabetes (6, 8).

Dairy and bone health: more than just calcium?

Furthermore, the effects of milk and dairy foods on bone health may be due in part to positive interactions of calcium, protein and phosphorus with each other and with lactose and bioactive peptides in the dairy matrices, rather than simply a ‘calcium effect’ as is often assumed (11). Similarly, milk is a key element of the Dietary Approaches to Stop Hypertension (DASH) diet for preventing and treating blood pressure. This anti-hypertensive property is likely due to the combination of minerals and protein found in dairy. Moreover, a study examining the effects of cows’ milk, calcium fortified soy milk and calcium supplement on weight and body fat reduction in premenopausal overweight and obese women found that weight loss was greatest in subjects consuming milk compared to calcium matched soy drink and calcium supplements (12).

Emerging research on the dairy matrix and health

• Bioactive peptides present in milk are being investigated in relation to cardiometabolic health, immune health and (13).
• Fermented dairy contains bacteria with potential to produce short chain fatty acids in the gut which can have positive health benefits (14).
• Dairy fat has >400 fatty acids with different physiological properties. Milk fat globule membrane (MFGM) encloses the fatty acids and has shown potential benefits in relation to lipid metabolism (15)
• Dairy fat contains odd chain fatty acids C15 and C17 which cannot be synthesised by the body and are used as biomarkers of dairy intake. These fatty acids are contained in MFGM and may confer health benefits such as reduced risk of CVD and Type 2 Diabetes (16-17)
• Grass fed dairy products have higher levels of polyunsaturated fat Conjugated Linoleic acid which has shown potential benefits for cardiometabolic health. See link to our article about the Nutrition Benefits of Grass fed dairy.
• Food is complex in terms of its nutritional content and physical structure which can impact the digestion and metabolism of the nutrients. The structure of dairy products varies from the solid matrix of cheese, to the gel-like structure of yogurt, to liquid milk. Rates of gastric emptying can affect satiety and appetite.
• The matrix structure can also influence protein absorption. Casein consumed in a milk matrix is more slowly digested and absorbed than in supplement format, without an impact on muscle protein synthesis (18).

More research into the dairy matrix will allow us to fully understand the health benefits of dairy but current evidence indicates that dairy is a nutritious food group that contributes positively to overall health when eaten as part of a balanced diet.

In recent years, many people are choosing to reduce /remove dairy from their diet due to a variety of reasons such as veganism, taste preferences, intolerance, to promote animal welfare and environmental sustainability. However, removing dairy from the diet should be carefully considered as it is a major source of nutrients and significant efforts should be made to ensure the diet is nutritionally balanced. A registered Dietitian or Nutritionist can support with individualised advice for meeting dietary requirements.

However, there have also been mixed messages about soy in the media over the past few decades, which leaves many people confused about soy’s role in health.

“Is soy unhealthy or healthy?” is the common question this article will answer based on recent science.

What is Soy?

Soy is a plant that originated in Asia and is now grown in many places around the globe.

The plant’s beans (the soybeans) can be eaten on their own (like edamame) or used to make soy foods (like tofu, miso, tempeh, soy milk and soy sauce).

Soy flour and protein are also added to many prepared foods, from breads to breakfast cereals to energy bars.

Soy contains high amounts of isoflavones, which are phytonutrients. Phytonutrients are compounds found in plants that have actions in our body, but are not vitamins or minerals.

Isoflavones belong to a group of substances called phytoestrogens (plant oestrogens).  As the name implies, they can have certain actions in our body that are similar to the human hormone oestrogen, but with much weaker effects.

Because oestrogen can play a role in breast cancer development and survival, there have been many questions raised about the risks and benefits of diets high in soy.

Is Soy Unhealthy or Healthy?

The main takeaway from published research is that soy is a nutritious food.

Science shows that typical consumption of soy (1-2 servings of soy-based foods or drinks per day) in a balanced diet is unlikely to cause harm, and may provide health benefits, to the general public.

Soy as a food is:

• Low in calories and saturated fat
• Rich in high quality protein, especially among plant protein sources
• High in fibre

Just 100 grams of raw soybean (less than half of a cup) contains (USDA Food Composition Database):

• 13 grams of protein
• 4 grams of dietary fibre
• 3 grams of polyunsaturated fatty acids
• 20% daily value of calcium and iron
• 48% daily value of vitamin C
• 18% daily value of potassium

Dietary guidelines around the world encourage most of these are nutrients in the diet, solidifying soy’s role in a healthy diet.

These traits make soy a great food to include in a balanced diet.

In the sections below, we review the specific roles soy has in health.

It is important to note that, although research shows that consuming soy can improve some health outcomes, soy is considered an allergen and would be inappropriate to consume for those with a diagnosed allergy to soy.

Soy as a Plant Protein Option

Soy is a healthy source of plant protein for most people.

When it comes to choosing a plant protein source, protein quality is one of the key deciding factors.

Protein quality is a measure of how the amino acid content of a protein measures to what the human body needs, as well as how digestible that protein is.

As shown in the graph below, soy is one of the few plant-based proteins that is equivalent in quality to animal-based proteins.

This is because soy contains all nine essential amino acids in significant amounts.

This can be useful for vegans, as other vegan sources of protein are often low in the essential amino acids lysine and methionine.

It can also be helpful in achieving protein claims in certain parts of the world.  For this reason, soy is often a great choice for a plant-based protein in foods and beverages.

Soy, Oestrogen and Cancer

• Overall evidence from human studies shows that consuming soy doesn’t increase the risk of cancer.
• Recent research has found that consuming 1-2 portions of soy per day does not cause any harm for breast cancer survivors.
• Soy is considered to be safe for men to consume and does not affect testosterone concentrations.

What is the relationship between soy and development of breast cancer?

It is not likely that eating moderate amounts of soy foods increases the risk of breast cancer.

The majority of high-quality studies and analyses have found that eating soy foods does not increase risk, even when eaten at levels much higher than those typically consumed in countries like the US(Trock 2006, Wu 2008).

Many studies suggest that soy may help protect against breast cancer (Trock 2006, Wu 2008).

Results from an analysis that combined findings from multiple studies in Asian populations found that soy may have a protective effect on breast cancer incidence.

However, when the same analyses were done in studies of US and other Western populations, there was no link between soy and breast cancer risk (Wu 2013).

It seems the benefit only comes with a pattern of intake that is seen in most Asian countries, where women begin eating soy early in life and eat it in amounts many times greater than typically seen in the US.

In Japan, for example, soy intake ranges from 38 g to around 78 g per day, equivalent to 26 to 54 mg isoflavones.  In the US, soy intake ranges from less than 1.5 to 4.3 g per day, or 1 mg to 3 mg isoflavones (Nagata 2010).

As a breast cancer survivor, is soy safe?

Current studies suggest that eating moderate amounts of soy foods is safe for breast cancer survivors (Shu 2009, Cassileth 2012, Nechuta 2012).

Evidence suggests that a diet high in soy may improve survival and lower the risk of recurrence in women with breast cancer. The benefits don’t appear to be limited to Asian populations, either.

One analysis combined data from three large, long-running studies of survivors from both Asian and Western countries.

It found that women who ate at least 10 mg of soy isoflavones per day after a breast cancer diagnosis had a 25 percent lower risk of recurrence compared to those eating less than 4 mg soy isoflavones per day (Nechuta 2012).

An analysis of 6235 breast cancer survivors found that, after 9.4 years after diagnosis, soy intake did not increase risk of mortality.

The study found that those with the highest soy consumption had a trend toward reduced risk of mortality, although these results were not statistically significant (Zhang 2017).

Soy and Heart Health

Research has shown soy intake  has a role in reducing LDL and total cholesterol, both of which are outcomes linked to improved heart health.

A scientific review of 46 studies on soy’s role in heart health was published in 2019 (Mejia 2019).

In the study, researchers found that consuming soy protein at a dose of ~25 grams per day led to a decrease in LDL cholesterol of 4.76 mg/dL (3-4%) and a decrease in total cholesterol of 6.41 mg/dL over 6 weeks, which could be considered a clinically significant reduction.

Around 75% of the studies reviewed showed a positive effect for consuming soy protein, according to the researchers.

This review is important in helping solidify the role of soy protein in heart health and counter the unwarranted negative perception of soy among many consumers.

The high obesity rates globally suggest that on average, we consume too many calories relative to our requirements.  For many people, though, intakes of certain vitamins, minerals and fibre are below recommendations.

For example, recent findings from the UK National Diet and Nutrition Survey (NDNS) show that the current UK diet is not in line with the government recommendations on eating healthily and achieving a balanced diet (Eatwell guide), with several micronutrient intakes below the lower reference nutrient intake (LRNI).

According to the NDNS, one in four girls in the UK aged 11-18 years has an intake below recommendation for vitamin A, riboflavin, zinc and iodine, and over half have a low intake of iron.

Diet Quality is About More Than Calories

Addressing these issues may require looking at the overall quality of our food rather than focusing on restricting individual nutrients.

Healthy eating is not simply about eating less and cutting things out, it can also be the result of eating more nutritious food or eating more ‘nutrient-dense’ food.

Some foods that are relatively high in calories can also have a high nutritional value, like nuts, seeds, oily fish and olive or rapeseed oil. Thinking of calories as numbers, these foods might be avoided by consumers, which should be included as part of healthy dietary patterns.

Interestingly, foods with similar calorie content can also be different in terms of nutritional quality. For example, whole grain versions of bread, pasta and rice are higher in fibre than refined (white) versions.

Similarly, processed meats contain more salt than lean unprocessed meats, even if they have a similar number of calories.

The Quality Calorie Concept

In this context, the British Nutrition Foundation’s (BNF) Quality Calorie Concept (QC) encourages looking not just at the number of calories in a food, but also the nutrient content of a food to ensure we get enough of the nutrients we need (including vitamins, minerals and fibre) and limit the amount of those that are of concern (free sugars, salt and saturated fat).

The QC Concept also looks at incorporating other components of a healthy diet, such as protein (beans and pulses, lean meat and skinless chicken and turkey, seafood, eggs), plenty of fruit and vegetables and some dairy foods e.g. plain yogurts, milk and cheese.

Portion size is also key, so remember to QC in moderation – it is about getting the right types of foods and drinks in the right amounts.

To help manage portion size, there are some practical measures you can use; for example, keeping the amount of nuts you eat to a handful, and using a spoon to measure out oils and spreads.

The Find Your Balance guide to portion size aims to help you find the right balance for you.

Although the QC is aimed toward improving diets, these concepts can also be applied by the food and beverage industry to improve the nutrition of foods and beverages.

A focus by the food and beverage industry to improve nutrient density by increasing vitamins, minerals, fibre in food, as well as incorporating servings of vegetables, fruits and lean protein, all while limiting sugar, sodium, and saturated fat has the potential to have a significant impact on public health.

BNF also provides a few budget friendly ideas on how to choose inexpensive, healthy items for QC on a budget.

Improving Nutrient Density

The QC concept suggests small, simple swaps that can be made every day to improve the nutritional quality of our diets, for the same or fewer calories.

Food reformulation can also positively impact on dietary intake at population level.  Therefore, the food industry plays an important role in encouraging consumer demand for nutrient dense foods.

These tips can be adapted for food and beverage formulation to improve the quality of the carbohydrates present in baked goods, including healthier lipids in their snack offering or fortifying beverages with protein or micronutrients.

Here are some tips to improve nutritional density of foods and drinks:

QC for breakfast

• Include whole grain options, lower fat dairy and fruit in dishes.  For example, try exchanging a fried egg, bacon and tomato sauce in a white roll for a poached egg, canned sardines and sliced tomato in a wholemeal roll.  With this swap, you will be increasing your intake of calcium, fibre, healthy fats and vitamin D. Both options have similar calories, but the latter offers higher nutritional quality.
• Add frozen blueberries to a morning smoothie, or add sliced banana to a bowl of cereal instead of refined sugar.

QC for snacks

• Think lower sugar, salt and saturated fat.  For example, you can choose a handful of lightly salted peanuts instead of potato crisps to increase the amount of fibre and minerals you are getting from your snack.
• Focus on portion size for indulgent snacks.

QC for meals

• Incorporate whole grains, such as whole wheat bread for a sandwich or whole grain pasta in a pasta dish.
• Focus on healthier cooking options – fried foods have extra calories from the breading and the fat absorbed during frying, but air-frying or baking add fewer calories to a meal.
• Add vegetables to your dishes by using tomato or vegetable based sauces rather than creamy ones or focusing on vegetables as the topping of a pizza.
• Swap processed meats like sausage or salami for lean meat, chicken, fish or shellfish.

QC for drinks

• Water is great for hydration and contains zero calories.
• Choose drinks with no or low amounts of added sugar.
• Pick juices made from 100% juice.
• Pay attention to serving size – a standard serving is 240 millilitres or 1 cup, but many mugs and glasses are much larger than that.

People of all ages may experience loneliness.  However, older people, particularly those living alone, are especially vulnerable.

Loneliness and social isolation can negatively impact our mental and physical health (1), in part through adversely affecting behaviours like healthy eating and physical activity.

How Social Isolation Impacts Eating and Nutrition

Food and social interaction are deeply intertwined.  Food is often shared and represents a way of connecting with others: eating together at mealtimes, cooking for loved ones or feasting together during celebrations.

Social distancing means that these social aspects of eating have been temporarily removed for people living alone.  In addition, feelings of loneliness, reduced accessibility to food and changes to normal daily routines can pose nutritional challenges.

Research shows that social isolation and loneliness are associated with reduced appetite (2), lower food intake (3), reduced physical activity (4) and increased risk of under-nutrition among older people (5).

On the other hand, while under-consumption of food is more common in socially isolated older adults, some individuals may respond to isolation by using food as an emotional coping mechanism leading to overeating.

In addition to affecting how much we eat, isolation also appears to affect what we eat.

Socially isolated older adults consume fewer fruits and vegetables (4) and eating alone more frequently is associated with lower dietary variety (6).

Cooking for one may reduce the motivation to cook and enjoy a “proper meal” (7) and instead older adults may opt for quick, nutritionally incomplete meals like tea and toast.

Mitigating the Impact of Isolation on Health

It is imperative that we engage in healthy behaviours to mitigate the harmful effects of the physical inactivity and isolation that can accompany staying at home.

Eating well, particularly in combination with physical activity, can prevent malnutrition and nutrient deficiencies, improve our feelings of well-being, help preserve muscle mass, strength and mobility, promote gut health, support the immune system and lower the risk chronic illnesses and infectious diseases (8).

Tips for Eating Well During Social Isolation

1. Take steps to combat loneliness to help prevent the adverse effects on appetite and food intake.

• Connect virtually – make frequent telephone or video calls to family and friends
• Structure your day and your sleeping habits – having a daily routine can provide a sense or normality and control
• Keep busy – brainstorm tasks and activities you can do from home (exercising, gardening, reading, cleaning, crosswords etc.)

2. Maintain good eating habits

• Keep a regular meal pattern – this can provide structure to your day and can help to create awareness around how much and what you are eating
• Plan meals ahead of time, and try to include high protein foods, whole grains, fruits, and vegetables at each meal
• Mix it up – try to eat a variety of different food rather than sticking to the same meals each day

3. Stay motivated when cooking for one

• Have a virtual lunch or dinner date with a friend or family member
• Bulk cook easy-to-prepare, one-pot dishes like curries, stews and soups when you’re feeling energetic.  Freeze individual portions for days when you don’t feel motivated to cook.
• Keep a well-stocked food cupboard so that you always have some ingredients to hand to make a simple meal

4. Check in with your appetite and your food intake

• If you find your appetite is lower than normal and / or you are unintentionally losing weight, try eating small, nourishing snacks frequently (e.g. high protein drinks, yogurts, crackers and cheese, or dried fruit and nuts) and add extra calories to meals (e.g. add milk, skimmed milk powder or cream to soups and mashed potatoes, or use full fat dairy products)
• Include physical activity in your day 
• Speak to your doctor if you are worried or continue to lose weight

Adapting these Strategies to Improve Nutrition of Older Adults

For companies looking to adapt dietary strategies to improve nutrition of older adults, finding ways to increase dietary variety, nutritional density for smaller appetites, and frequent engagement can be key for success.

Sue McVie, who was Managing Director of Oakhouse Foods, outlined some ways she sees companies can bring the strategies from this article to life.

“Loneliness is a significant issue amongst the elderly consumer and can result in loss of appetite and poor nutrition.

From a nutritional perspective, we know that our customers’ appetites can be small. Some strategies that can be used to help maintain nutritional balance include more frequent, smaller portions like ‘mini-meals’ and ‘lighter bites’, as well as making sure there is a diverse range of foods offered to encourage dietary variety.”

‘Deconditioning’ and the Potential of Muscle Mass Loss

For many people, staying at home may lead to a reduction in time spent walking and engaging in other physical activities. Even relatively short periods (~2 weeks) of very low physical activity / low daily step count (<2,000 – 3,000 steps per day) are known to adversely affect skeletal muscle health (1, 2).

This is of particular concern among older adults who are already at high risk of muscle mass and strength loss.

Unlike younger adults who “bounce back” relatively easily from transient periods of inactivity, recovery in older adults is slow and may be incomplete (1, 2).

As such, these periods of inactivity may have long lasting negative effects on physical function and mobility. Fortunately, simple measures can be taken to minimise the deterioration in muscle health.

Nutrition and Maintaining Muscle Mass for Older Adults

What we eat can help us to maintain our muscle health while remaining at home, especially when combined with resistance exercise.

Protein-rich foods combined with a balanced diet of whole grains, fruits, and vegetables can be an important part of staying healthy and maintaining mobility.

Protein Power

Compared to younger adults, older adults are less efficient at using the protein they eat (found in foods like milk, yoghurt, fish, eggs, meat, beans, nuts) to build new muscle (3).  This means that older adults need more protein in their diets than younger ones and not eating enough protein can contribute to muscle loss.

Expert groups recommend that healthy older adults should consume 1.0 – 1.2 g of protein per kilogram of body weight per day to help preserve muscle (4, 5).

It is particularly important to ensure that older adults continue to consume adequate amounts of protein while isolating.

Some tips include:

• Prioritise protein – as physical activity levels fall during social distancing, the number of calories we burn per day decreases and appetite may also decline.  Prioritising protein-rich foods can help maintain a similar protein intake as before social distancing was introduced.
• Choose high quality sources – higher quality protein sources (e.g. milk, yoghurt, fish, eggs, meat, poultry) are better at stimulating muscle growth compared to lower quality protein sources (6).  Getting a moderate-size serving of high quality protein (25-30 grams) at each meal can improve muscle retention.
• Boost breakfast – breakfast tends to be low in protein, so breakfast foods are an opportunity to boost daily protein intake.  Making porridge with milk rather than water, adding Greek yoghurt to muesli or a smoothie, making an omelette or scrambled eggs, or drinking a glass of milk alongside your meal are all common ways of boosting protein at breakfast.
• Pair protein with exercise – the exercise will make muscles more efficient at using the protein from the meal to build new muscle (7).
• Pre-bed protein – consume a protein-rich snack (e.g. Greek yogurt, cottage cheese) before bed to boost muscle building rates overnight (8).

Calories Count

Studies indicate that consuming either too few or too many calories over several weeks can worsen muscle loss during periods of inactivity (9, 10).

It is normal for people to have a slightly lower appetite when they are less active than usual at home.  However, if appetite drops considerably and results in weight loss, this may accelerate muscle loss.

Small, nourishing snacks frequently throughout the day to give a constant source of protein (e.g. milky drinks, yoghurts, crackers and cheese, custard) and add extra calories to meals (e.g. add milk, skimmed milk powder or cream to soups and mashed potatoes, use full fat dairy products) are two ways to prevent appetite-related weight and muscle loss.

Alternatively, some people may find that, despite decreased activity levels, they are eating more than usual due to boredom or stress. In this case, eating plenty of fruit and vegetables which are low in calories and high in fibre can people stay full.

Prioritising protein-rich foods as discussed above and reducing intake of high-calorie, low protein foods (e.g. biscuits, chocolate, crisps, sweets, butter) can help reduce risk of weight gain.

Physical Activity to Maintain Muscle Mass

Use it or Lose it

The best way to protect muscles against the adverse effects of inactivity is to keep using them.

Resistance exercise, defined as exercising muscles against an external force (e.g. weights, resistance bands, our own body weight), is by far the most potent strategy to maintain muscle mass and strength.

Research has shown that incorporating resistance exercise during periods of reduced activity can attenuate or even abolish the decline in muscle mass (11, 12) and strength (12, 13).

Importantly, even relatively low amounts of resistance exercise appear to be effective once performed regularly (e.g. every other day) (12).

Although most older people may not have access to resistance training equipment at home, body weight exercises can be performed (e.g. sit-to-stands, wall push ups, leg extensions from a chair).

It is important for people to check with their doctor to find out if they have any contra-indications to exercise or if there are any reasons to modify their workout.

Reduce Sedentary Time – Exercise “Snacks”

Engaging in physical tasks around the house each day like gardening, active chores (e.g. sweeping, hoovering) or even walking around while on the telephone can help to minimise inactivity while staying at home, thus reducing the detrimental effect on muscle.

People can also break up prolonged periods of sitting with “exercise snacks”.

Exercise snacks are short bursts of exercise spread throughout the day (e.g. briskly climbing the stairs during ad breaks on TV).

A recent study reported that performing brisk stair climbing (approximately 20 seconds of climbing per “snack”) three times per day, three days per week, improved fitness and leg power in sedentary people (14).

Therefore, exercise snacks like these may help to reduce declines in fitness that occur during periods of inactivity.

Stay on Track

Staying motivated can be difficult, especially when we are isolated at home and separated from loved ones.

To maintain muscle health it is important to keep up the exercise and healthy eating for the duration of isolation.  Some tips to help stay motivated include:

• Set goals about when and where to do the exercise (15)
• Choose activities you enjoy (16)
• Monitor your exercise using diaries or apps or ask a friend or family member to monitor you (15)
• Plan your protein-rich meals for the week ahead and make a shopping list
• Keep a stock of protein-rich foods (e.g. tinned fish, freeze extra poultry, meat and fish)
• Experiment with new protein-rich recipes to keep things interesting

The purpose of this article to explain why this happens.  The reality is, nutrition is a relatively new and constantly evolving science.

It’s a good thing that we see dietary recommendations change, because it means we learned something new and can apply those learnings to improve health.

The downside is it results in confusing messages for people.  So, let’s walk through a couple of the most confusing food stories in recent decades and see what there is to learn.

Foods like eggs or coffee, staples for breakfasts far and wide, have both been a part of the human diet for centuries.  For many years, though, we were encouraged not to consume them regularly lest we shorten our life span.

For eggs, the concern was focused on the amount of cholesterol in an egg, thought to be associated with heart disease.

For coffee, it was the caffeine.  So, when did the egg- and coffee-shaming begin?

Are Eggs Healthy or Not?

It all began in 1968 when the American Heart Association (AHA) recommended that people consume no more than three eggs yolks per week to lower risk of cardiovascular disease (CVD) [AHA 1968].

From the perspective of a health care provider, it was simple to explain to explain the link between dietary cholesterol and high blood cholesterol, and for patients it was an easy dietary modification.  It appeared to be a win-win for everyone, unless you were an egg farmer.

Not until 1999, when Hu et al. published a large, long-term population study on egg intake and heart disease incidence did we start looking at the egg differently.  The study, which included over 117,000 men and women, found  there was no difference in CVD risk between people who ate one egg/week and those who ate one egg /day.

Since then, multiple epidemiological and meta-analyses have reached the same conclusion [McNamara 2015].

Eggs Are More Than Their Cholesterol Content

One theory is that dietary cholesterol does not impact our blood cholesterol as much as we once thought.  Another theory, which is becoming more common in nutrition science, is that foods can be more than the sum of their parts, just as we’ve seen with dairy.

The ‘incredible edible egg’ is packed full with all kinds of nutritional goodies.

One medium egg does have half of the daily value for cholesterol, but with it comes 6 grams of complete protein and many micronutrients that many people in the US do not get enough of, like calcium, potassium, and choline, according to the 2015 Dietary Guidelines.

For egg-lovers and the egg farmers, nutrition science continues to show how important eggs are in our diet.  Two recent studies have further supported the health benefits of eggs.

The first, a 9-year cohort study, examined the effect of egg consumption in over 415,000 subjects who were free of any chronic disease (e.g. heart disease, diabetes) at the beginning of the study.  Researchers found that 13% of the subjects had at least one or more servings of eggs a day, and 9% rarely consumed eggs.

After nine years, the people that ate eggs every day had lower overall heart disease risk, with up to 26% less risk of haemorrhagic stroke, 28% less risk of dying from a haemorrhagic stroke, and 18% less risk of lethal complication from CVD.

The second study was designed to determine the effects of either high (>12 eggs/wk) or low (<2 eggs/wk) egg consumption in people with prediabetes or type 2 diabetes (T2D) on a 3-month energy-restricted diet [Fuller 2018].

Weight loss was similar between groups and there were no differences between groups in glycemia, traditional serum lipids, markers of inflammation, or oxidative stress. Interestingly, the presence of 12 eggs/week did not lead to weight gain [Fuller 2018].

Our understanding of egg’s role in a healthy diet has evolved quite a bit since 1968, which is why we have seen recommendations change over that period of time.

Is Coffee Healthy or Not?

“Coffee: it will stunt your growth, give you a stomach ulcer and increase your risk for heart disease!” Does this quote sound familiar?  For years doctors warned their patients not to drink coffee because of its purported negative health effects.

There was also concern that when people drink coffee, they would become addicted to the “energy” they felt from the caffeine.

As people increased their coffee consumption, they would develop a tolerance to caffeine and would need to drink more coffee in order to get that energized feeling.

Thankfully for the more than 60% of Americans that drink at least one cup of coffee a day, research is now starting to highlight coffee’s positive health benefits and debunk the previous negative [Daily Coffee News].

So, why the change in heart? It is partly due to the recognition that the earlier studies on coffee did not account for common high-risk behaviours among heavy coffee drinkers (e.g. smoking, alcohol, physical inactivity) that each have their own role in heart disease risk [Mayo Clinic].  

Scientists are also now identifying many components in coffee with potential healthful benefits (e.g. antioxidants, caffeic acid, cafestol, and so on) [Mellbye 2018, Kang 2009].   

Other studies have suggested that drinking 3-4 cups of coffee per day is associated with ~25% lower risk of developing T2D compared to people consuming < 2 cups coffee per day [Huxley 2009, Santos 2016, Jiang 2014].

Where do things stand now?  The 2015 Dietary Guidelines Advisory Committee reviewed the literature on coffee’s link to health, and found that moderate coffee consumption is associated with a reduced risk of heart disease and stroke.

The science also showed that both decaffeinated and caffeinated coffee were associated with a reduced risk of developing type 2 diabetes.

Finally, caffeine intake from coffee was associated with improved cognitive health and could play a role in preventing Parkinson’s disease [Scientific Report of the 2015 Dietary Guidelines Advisory Committee].

Coffee, Cancer, and California: Missing the Forest for the Trees

Despite this evidence, debate around coffee continues.  In 2018, California made an attempt to require warnings on coffee regarding a possible role in causing cancer, under Proposition 65, due to its acrylamide content.

Scientists across the globe gathered to debate this legislation, due to the association between coffee consumption and the positive health outcomes listed above, and the legislation was eventually overturned.

This is a great example of the mistakes that can be made when we focus on one specific chemical or nutrient in a food, rather than the whole food’s role in health.

Moderation is key

While it the tide has definitely changed for coffee and health, it is important to keep in mind that the too much of anything is not necessarily a good thing, and coffee is no exception.

For example, high consumption of unfiltered coffee (boiled or espresso) has been associated with mild elevations in serum cholesterol [Scientific Report of the 2015 Dietary Guidelines Advisory Committee].

It is also generally recommended that people consume no more than 200 mg of caffeine at once, and no more than 400 mg of caffeine over the course of a day [ILSI NA].

We are still learning how different individuals metabolise caffeine, so these are recommendations for populations rather than specific individuals.

The Bottom Line: Use Moderation and Focus on the Big Picture

The verdict for eggs and coffee- they have their place in a healthy diet, but moderation is key.  So go ahead and have coffee with your eggs in the morning, just keep an eye on the calories you may be adding to the eggs with different ingredients (e.g. butter) or the cream, sugar, or syrups in coffee.