Further information

Alcohol consumption and increasing health risks

Excessive alcohol consumption on a regular basis is directly associated with a variety of health problems including:

• 7 types of cancers-bowel, breast, liver, mouth, throat, pharyngeal and oesophagus
• Pancreatitis
• Liver Disease
• Diabetes
• Heart disease
• There are increased health risks associated with excessive, binge drinking which can lead to accidents or injuries, or from increasing your risk of developing certain diseases.

Alcoholic drinks are high in calories and can contribute to ill health through obesity. This risks of health problems can be reduced by staying within the recommended limits.

What is a unit of alcohol?

10ml (1cl) or 8g of pure alcohol equals one unit.

One unit, for example, is roughly equal to:

• half a pint of regular beer, lager, or apple cider (3-4 percent alcohol by volume [abv])
• a small pub measure of spirits (25ml) (40 percent abv)
• a fortified wine, such as sherry or port, in a standard pub measure (50ml) (20 percent abv).

One and a half units are available in:

• a small glass (125ml) of wine of average strength (12 percent abv)
• a standard pub measure of spirits (35ml) (40 percent abv).

Remember that many wines, beers, and ciders sold in bars and restaurants are stronger than the more traditional ‘ordinary’ strengths, so if you’re not familiar with the drink, it’s worth asking about the strength. When drinking out, wines are frequently served in 175ml or 250ml measures and when drinking at home, you are more likely to pour yourself a larger measure than a typical pub measure.

Low Risk Drinking Guidelines

Moderate drinking was once thought to have health benefits, but these benefits are much less than previously thought, and may only apply to certain groups of people. There is no completely safe level of drinking but sticking within the low risk guidelines lowers your risk of harming your health. Men and women are advised not to drink more than 14 units a week which is the equivalent of 6 pints of average strength beer 10 small glasses low strength wine.

If you regularly drink as much as 14 units per week, it’s best to spread your drinking evenly over three or more days.

If you have one or two heavy drinking episodes a week, you increase your risk of long-term illness and injury these include:

• The risk of developing a range of health problems (including cancers of the mouth, throat and breast) increases the more you drink on a regular basis
• If you wish to cut down the amount you drink, a good way to help achieve this is to have several drink-free days a week

Drinking too much – the effects of alcohol

Binge drinking (consuming more than four units at a time) and drinking to get drunk, both of which are common among young adults, are harmful to one’s health and should be avoided at all costs. To put it another way, you shouldn’t save up all of your units for the week and consume them all at once. According to studies, young female British women consume among the highest levels of alcohol in the world.

Binge drinking can result in a variety of social and health issues, including violent and unsafe behaviour, as well as vomiting, collapse, and seizures, all of which can be life-threatening.

Heavy and prolonged drinking can cause a variety of health issues, including cancer, liver disease, stroke, high blood pressure, and mental health issues.

Everyone has different tolerances, but those who believe they can drink a lot without getting sick are still causing harm to their bodies and putting themselves at risk of social and health problems.

Many people refer to themselves as social drinkers and because they are not alcoholics or binge drinkers, may wrongly think they are not at risk. However, social drinkers may easily consume more than 14 units on a regular basis and are also putting their health at risk. For example, they are:

• three times more likely to have mouth cancer
• three times more likely to have a stroke

Women who regularly drink two large glasses of 13% wine (6.5 units) or more a day:

• are twice as likely to have high blood pressure
• are 50% more likely to have breast cancer.

Many people who have health problems caused by alcohol aren’t alcoholics. They are people who have consumed more alcohol than is recommended on a regular basis for several years. If you have consumed too much alcohol, you should refrain from drinking for at least 48 hours to allow your body to recover.

How many calories does alcohol contain?

Be aware that alcohol is high in calories and so can contribute to weight gain. One gram provides seven calories (7kcal), compared with 4kcal per gram for carbohydrate and protein. One unit contains eight grams or 10ml of alcohol, which provides 56kcal. Other ingredients, such as sugar, cream, and fruit juice, can, however, increase the number of calories consumed. When watching or recalling what they eat, many people forget to include drinks. These ‘liquid calories’ can quickly add up and go unnoticed. Alcohol stimulates the appetite, which can lead to binge eating at mealtimes, late at night, and even the next day.

A healthy balanced diet containing a variety of foods is required to provide all of the nutrients required to maintain health and reduce disease risk. Alcoholic drinks lack most essential nutrients and vitamins so if these are providing most of the calories in the diet then there is a risk of nutritional deficiencies.

The practise of ‘saving’ calories from food for alcohol, i.e. drinking it instead of eating to avoid gaining weight, may result in your body not receiving all of the nutrients it requires.

Alcohol is also a diuretic, meaning it causes the body to lose more water than it normally would. It’s best to drink water or other low-calorie soft drinks in between and after you drink it to avoid dehydration.

Practical advice on reducing your consumption

If you want to try to cut down on your alcohol consumption, here are some helpful hints:

Set a limit on how much alcohol you will consume on a night out, or a budget for how much money you will spend.

Inform your friends and family that you are attempting to reduce your consumption so that they can assist you.

Always eat something before starting to drink – either before going out for the evening or while you’re out. Even a snack at work, such as vegetable and bean soup, oatcakes, or a smoothie, will help.

If you’re thirsty, don’t drink alcohol.

Salty snacks such as crisps and salted nuts should be avoided because they:

make you thirsty (as well as being high in fat and salt) Try drinking non-alcoholic or low-alcoholic beverages more routinely.

Always keep a glass or bottle of water on hand, as well as a jug of water on the table. This will slow down your alcohol consumption.

Consider the strength of your drink and opt for beers or lagers with a lower alcohol content.

Slowly sip a drink to make it last longer. Don’t refill the glass until it’s empty, so you can keep track of how much you’ve consumed.

Replace high-calorie mixers with lower-calorie alternatives, such as low calorie tonic or diet cola, and alternate drinks with water, diet, or low-calorie beverages. Make a spritzer with white wine and sparkling water. Select a half pint, a small can, a small glass, and a single measure. Use a wine glass that is smaller.

Breastfeeding and pregnancy

If you are planning a pregnancy, you should abstain from drinking alcohol completely. It can make it difficult to conceive, harm the unborn child, and even result in an early miscarriage. If you were drinking before learning you were pregnant, you should stop drinking for the remainder of the pregnancy. However, try not to worry as it is very unlikely to have caused any harm, but you should stop drinking for the remainder of the pregnancy. If you are breastfeeding, occasional drinking, such as one or two units once or twice a week, is not harmful to your baby but drinking any more than this can cause problems. It’s best to avoid drinking alcohol just before a feed. This is because it can pass to the baby in small amounts through breast milk.

If you have diabetes, gastric ulcers, high blood pressure, or depression, or if you are taking certain medications, you should exercise caution or seek medical advice. If you’re not sure, consult your doctor or pharmacist.

Suggested content

Dr Mike asks us to rethink the way we drink!!!

Carbohydrates and our diet

Carbohydrates are an essential nutrient that we use as a source of energy. For many people, carbohydrates are an important part of a healthy, wellbalanced diet. There are a lot of conflicting messages about carbohydratecontaining foods. Carbohydrate-rich foods provide us with energy, vitamins, minerals, and fibre, all of which are beneficial to our health.

Carbohydrates are food nutrients that are broken down into glucose, which is used as a source of energy by the body.

Carbohydrate-rich foods can be classified into the following groups:

• Foods high in complex or less processed starchy carbohydrates that break down more slowly into glucose (e.g. wholegrain bread, wholegrain rice).
• Fruit, milk, and yogurt are examples of foods that contain natural sugars.
• Free sugars. Foods high in free sugars will quickly convert to glucose (e.g. sweets, sugar, honey). We try to limit the amount of free sugars in our food as much as possible. Note: If naturally occurring sugars such as lactose or fructose remain in the food, they do not count as free sugars (e.g. an apple does not count as free sugars, but will be treated as free sugar if removed from the food e.g. apple juice)
• Dietary fiber. Foods high in dietary fiber help keep your digestive system healthy. They are often found in foods that have complex or starchy carbs, as well as fruits and vegetables, like apples and pears.

Can low carb diets help you lose weight?

Energy can be found in all foods, including those high in carbohydrates. While we may require less energy and carbohydrate when we are less active, they continue to be an important source of energy and an essential food group for health. Carbohydrates and our diet Department of Nutrition and Dietetics While any type of dietary restriction can result in weight loss, weight loss is not always the same as fat loss. The changes in fluid and weight that occur during rapid weight loss are not always related to health or wellbeing. As with any dietary restriction, a low-carbohydrate diet will have less food volume and possibly less dietary fibre. Without proper planning and support, embarking on a low-carbohydrate diet can negatively impact gut health and result in constipation.

Some people find that adjusting carbohydrates is a good way to lose weight, while others find that any dietary restriction (including carbohydrate restriction) causes cravings or is unsustainable.

In general, being aware of portion sizes of all foods, including carbohydrate, is a good idea. It’s important to remember that maintaining a healthy weight is difficult and restricting any food group (including carbohydrates) is generally not advised for a variety of reasons. including the physical and psychological consequences of restriction. A registered dietitian can help you with your specific health needs.

How many carbs should we consume?

This is a question that many people find difficult to answer. While ‘very low carbohydrate diets’ are not generally advised, our portion sizes as a nation have increased dramatically over the last 40 years. Many of us should try to be more ‘carbohydrate conscious.’ This means consuming adequate amounts of ‘foods containing starchy carbohydrate,’ avoiding high-sugar and processed foods, and choosing wholegrain alternatives whenever possible.

A portion of carbohydrate-containing foods that is roughly the size of your fist is an appropriate mealtime portion. This can then be adjusted based on your level of activity. Recent studies suggest that we should balance our portions this way so that half of our energy comes from carbohydrates.

Free Sugars

Sugars added to food (e.g., biscuits, chocolate, cake) or sugars naturally present in honey, syrups, and fruit juices are all examples of free sugars. These have been linked to poor dental health as well as poor cardiovascular outcomes. Sugar is a hot topic in the media and among the general public, and the sugar debate can be perplexing because sugar can be found in a variety of foods. According to current recommendations, it is important to be aware of “free sugars” and to limit our intake of them. Adults should consume no more than 30 grams of free sugar (approximately seven teaspoons) per day. Free sugars include table sugar, syrup, treacles, honeys, coconut sugar, and fruit juice.

What doesn’t qualify as “free sugar”?

Milk, whole fruits, and vegetables contain natural sugars. Glucose found within the structure of plants releases glucose more slowly in their natural state and contains fiber to slow absorption.

Summary

• Carbohydrates are broken down into glucose, which our bodies use as a source of energy.
• Carbohydrate-rich foods are an important part of our diets and can be incorporated into a healthy, balanced diet.
• Wherever possible, go for whole grain options.
• Choose the appropriate portion to meet your specific energy requirements.
• Be aware that foods high in ‘free sugars’ often provide a lot of energy with little nutritional value, so consume them in moderation.
• Consult your doctor or a dietitian before beginning a low-carbohydrate diet.

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Healthy Eating and the Eatwell Guide

Healthy Eating is about making better, choices from a variety of foods to ensure you get the necessary vitamins and mineral for good health and well-being. It means enjoying your food whilst being mindful of what you consume. Healthy eating doesn’t have to be difficult, boring or involve dieting.

The Eatwell Guide

The Eatwell Guide provided by Public Health England helps you to get a balance of healthier and more sustainable food. It shows how much of what you eat overall should come from each food group. A larger version can be found at the end of this document for printing out if required.

There are four major food groups to consider. These are the following:

• Carbohydrates
• Fruit and vegetables
• High Protein Foods
• Dairy (& alternatives)

Carbohydrate – just over one third of your daily food consumption (38%*)

Carbohydrates (starch) are the body’s primary source of energy (fuel). Starch is broken down into glucose, which the body uses for energy.
Foods that are high in starch are an important part of the diet. They should account for about a third of all the food we consume. You should aim for 3-5 servings a day.

Examples of 1 serving:

• 180g cooked pasta (75g dried)
• 40g or about 3 handfuls of flaked breakfast cereals
• 1 baked potato about the size of your fist
• 2 slices of medium sliced bread
• Their high energy content means that you need to be careful to not consume more than the guidance. You shouldn’t avoid or limit them but instead, keep track of how much starch you consume in total. A dietary imbalance can be caused by eliminating one food group, such as carbohydrates. As you will see in the Eatwell Guide; bread, potatoes, rice, and pasta are examples of starchy foods. Wholegrain alternatives are healthier, look for food labelling stating ‘100% wholegrain’ or ‘100% wholewheat.
• Fibre-rich foods aid in the proper functioning of the gut and provide numerous other health benefits. People who are overweight or obese lose weight when they eat a diet rich in high-fibre, starchy carbohydrates, according to research.

Fruit and vegetables – just over one third of your daily food consumption (40%*)

Micronutrients are abundant in fruits and vegetables. Vitamins, minerals, and antioxidants are among them. Micronutrients are required for many biochemical processes in the body that keep us healthy. Fibre is abundant in fruits and vegetables. They’re usually low in calories and delicious. Different colours indicate different nutrients too, which each play a part in keeping our bodies healthy.
According to current UK guidelines, at least five portions (roughly a large handful or 80g of each) of different fruits and vegetables should be consumed each day. They should make up just over a third of our dietary intake. Fruit and vegetables are available in a variety of forms, including dried, frozen, canned, and fresh. In fact, frozen retains more vitamins and minerals, because it is picked and iced at peak ripeness when it is most nutritious and flavourful. Frozen foods tends to be cheaper than fresh too.

Examples of 1 serving:

• 1 apple, orange, pear, banana
• A handful of grapes, cherries or berries
• 2 plums, satsumas or kiwis
• 150ml of fruit juice**
• 30g dried fruit**

**Only have 1 serving of dried fruit or fruit juice as their health benefits beyond this become lessened due to high sugar values and increased calories.

Protein – about one eighth of your daily consumption (12%*)

Protein provides us with the key amino acids which are the building blocks of the body. They are important for renewal and repair. It is the most important component of the human body. Just like different fruit and veg, different types of protein provide us with the variety of vitamins and minerals that we need to stay healthy and strong. Therefore, it very important to vary your protein sources. As well as eating meat and fish, we should include vegetarian sources each week; eggs, beans and pulses, tofu, nuts and seeds are all great alternatives.

Meat and fish also provide a form of iron (haem) that is easily absorbed by the body. Essential fatty acids can also be found in fish (eg. omega-3).

Protein can also be found in plant-based foods. Protein is abundant in pulses, nuts, and seeds. Whether you’re a vegetarian or vegan, pulses are a great meat substitute.

Cutting back on red meat (beef, lamb, goat, and pork) is good for your health and the environment: the current recommendation is to eat no more than 300g of red meat per week. Try and choose lean cuts of red meats. Processed meats such as bacon, salami, hot dogs, and ham should be avoided. The consumption of these cured meat products has been linked to a significantly increased risk of certain types of gut cancer.

You should be eating 2-3 servings of protein per day, which can come from a range of different foods.

Examples of 1 serving:

• A piece of grilled chicken without skin about half the size of your hand
• 2 boiled eggs
• A piece of fresh salmon about half the size of your hand
• ½ a tin of beans
• 2 tablespoons of hummus

Dairy and alternatives – just under one eighth of your daily consumption (8%*)

Dairy products (and calcium-fortified alternatives) are the body’s primary source of calcium, which is required for healthy bone and tooth growth, development, and maintenance. Protein can also be found in dairy products and alternatives.

Saturated fats can be found in milk, cheese, cream, and milk-based sauces and yoghurts. Low-fat and small-quantity options are recommended. Be aware that fat-free flavoured yoghurts often contain added sugar to boost flavour . If you’re allergic or intolerant to dairy, there are alternatives that you can use such as soy, nut, oat or rice milks. Also, if you are choosing plantbased drinks, look for those that are unsweetened and fortified with the vitamins and minerals usually found in animal milks, e.g. calcium, vitamin B12 and iodine. You should aim for 3 servings of dairy per day.

Examples of 1 serving:

• ½ glass or 125ml of milk (or substitute such as fortified soya or almond milk)
• 1 pot of low fat yogurt
• 30g or 3 teaspoons of soft cheese
• 30g or a piece the size of two thumbs of Cheddar cheese

Healthy Fats – a very small amount each day (1%* of our daily consumption)

Finally, fat is essential. We need a small amount to protect our organs, absorb certain vitamins and to help us to grow. However, we do need to be careful about the type and amount we eat because it’s high in energy. Although all fats have the same calorie content, their effects on the body, particularly cholesterol levels, differ. The reference intake of fat is a maximum of 70g per day for adults (of which no more than 20g of saturated fat should be consumed).

Unsaturated Fats

Dietary fat should be made up of unsaturated oils and spreads. Olive oil, rapeseed nut and seed oils, and other vegetable oils contain these. All of them contain ‘good’ HDL cholesterol, which can help the body rid itself of potentially harmful LDL cholesterol (found in saturated fats). You can help to keep your heart healthy by swapping saturated fats with unsaturated fats that come from nuts, seeds, vegetable oils and fish. Consequently, to reduce saturated fat in your diet, cook with vegetable oils rather than butter and lard and try using yogurt instead of cream.

Examples of 1 serving:

• 1 tablespoon of oil, butter, margarine or mayonnaise
• 2 tablespoons of reduced fat cream
• 2 tablespoons of avocado
• 8-10 olives
• 10 peanuts

Saturated fats

Saturated fats can raise the level of a type of cholesterol called LDL, which can build up in the arteries and blood vessels over time, causing heart disease and other circulatory problems.

Saturated fats are abundant in fatty meat, butter, cheese, cream, and a variety of processed foods (though not eggs or shellfish). Another type of saturated fat is trans saturated (or hydrogenated) fat. They are primarily produced artificially and used in the food industr.y

Saturated fats should be avoided at all costs.

*From official segment proportions supplied by www.gov.uk for health promotional material

Essential Fatty Acids (EFAs)

EFAs (such as omega-3 oils) are referred to as ‘essential’ because they are not produced by our bodies and must be obtained through food. White fish have EFAs in their skin, but oily fish like fresh and canned salmon, mackerel, sardines, and fresh tuna have them in their flesh. One portion of oily fish and one portion of white fish per week is recommended for fish eaters.

Some plant oils, such as flaxseed, rapeseed, and soya, contain EFAs, but not as much as fish and seafood.

Other considerations

‘Free or added’ sugar – try to avoid.

Of all the sugar and starch choices you have, simple carbohydrates in the form of added sugar is the least healthy option. Added sugars include refined sugars, such as table sugar, but also natural sweeteners such as honey or maple syrup. These sugars, despite being less processed, are still simple carbohydrates that contain little additional nutritive value, such as essential vitamins and minerals. A diet high in added sugar is common in the U.K. and it can increase your chances of weight gain and obesity. The recommended daily limit for free sugar is 30 grams, the same as six teaspoons of sugar.

Salt

Blood pressure can be raised by eating too much salt. The majority of the salt we consume is added to processed foods. Adults should consume no more than 6 grams of salt per day on a daily basis (one tsp).

Snacks that are high in fat and sugarAside from providing calories, fatty and/or sugary snacks and drinks have little nutritional value. They can be included in one’s diet, but only in small amounts and infrequently.

Summary

• It is possible to be and stay healthy by eating a variety of foods in the recommended proportions and (portion sizes). It is critical to maintain a sense of equilibrium.
• Diets that eliminate entire food groups deprive your body of essential nutrients and limit your food options. Make starchy foods your main source of calories.
• Consume plenty of fruits and vegetables.
• Once or twice a week, try to replace meat with pulses.
• Limit your intake of saturated fats, salt, and sugar. Look for these on food labels, especially in processed foods. Fatty and sugary snacks are usually high in calories and don’t provide much else in the way of nutrition.
• Unless you have a specific deficiency, a well-balanced diet should provide your body with all of the vitamins and minerals it requires.

Liver Disease and diet

A guide for adult patients, their carers and families

What is Liver Disease ?

There are many different types of liver disease. You can help prevent or reverse some of them by maintaining a healthy weight and staying within the recommended alcohol limits if you drink.

Some types are: Alcohol-related liver disease caused by regularly drinking too much alcohol.

Non-alcoholic fatty liver disease (steatohepatitis -NASH) caused by obesity leading to fatty deposits within the liver.

Hepatitis caused by a viral infection and sometimes related to excessive alcohol consumption.

Haemochromatosis caused by a genetic abnormality.

Primary biliary cirrhosis often caused by a problem with the immune system.

What are the symptoms of liver disease ?

Most types of liver disease do not cause any symptoms in the early stages. Once you start to get symptoms of liver disease, your liver is already damaged and scarred. This is known as cirrhosis and cannot be reversed. The common symptoms are :

• feeling very tired and weak all the time
• loss of appetite – which may lead to weight loss
• loss of sex drive (libido)
• yellow skin and whites of the eyes (jaundice)
• itchy skin, or feeling or being sick.

Treatment for Liver disease

The goal of treatment is to slow down the build-up of scar tissue and prevent or treat any problems that arise. This can be achieved through a healthy diet and lifestyle.

When you are unwell with liver disease, your body has a higher demand for energy and protein. This is because the liver plays a major role in storing and releasing energy and protein, and when it is not working well these functions do not work properly either.

Good nutrition can help overcome symptoms of liver disease and prevent complications by:

• Slowing down muscle wasting
• Helping wounds heal more quickly
• Helping prevent and fight infections

Eat little and often and the importance of Starchy Foods

Instead of having three main meals aim to eat something every 2 to 3 hours and eat a snack before bedtime. This should be something high in starchy carbohydrates such as cereal, porridge, rice pudding or shortbread. It is important to have regular meals and snacks which contain starchy carbohydrate, ideally every 2-3 hours during the day. Starchy carbohydrate containing foods include bread; potato; cereals & cereal bars; pasta; noodles; rice; and biscuits or crackers.

Carbohydrate bedtime snack

It is important to have a bedtime snack containing 50g of carbohydrate as it is a long time until breakfast.

Protein

When cirrhosis develops your liver is no longer able to store glycogen, a form of carbohydrate which it needs to meet your body’s energy demands. Your liver tries to make up for this but you often need more energy and protein in your diet.

Protein can help prevent muscle wastage and oedema. A good source of protein should be included with at least 3-4 meals or snacks a day. This could be meat, poultry, fish, cheese, eggs, pulses such as beans, peas and lentils, or meat alternatives such as soya, tofu, beans, seeds and nuts.

Fruit and Vegetables

Make sure you include fruit and vegetables in your diet, which are important for vitamins, minerals and fibre. A small glass of fruit juice or fruit smoothie a day may be included if you are unable to eat enough fruit and vegetables.

Fluids

It is important to drink around 6-8 cups of fluid a day to help prevent constipation and dehydration, unless you have been given a fluid restriction by your doctor. Avoiding caffeinated drinks is important as the liver usually breaks down caffeine. Choose decaffeinated tea and coffee or fruity/herbal teas, or chose milky drinks if your appetite is poor. The most important lifestyle change you can

Fluid Retention – ascites and oedema

Ascites is the collection of fluid around your middle and oedema is the collection of fluid in your feet, ankles and legs. This can cause your weight to change greatly, and can mask the fact that you are losing muscle or fat. Reducing salt in the diet can help reduce fluid retention. In order to reduce salt in the diet, it is recommended no salt is added at the table and it is used sparingly in cooking. Three quarters of the salt in our diet is already in the foods we eat. The table below lists high salt foods to avoid and suitable alternatives.

If you have a poor appetite

• Aim to eat every 2-3 hours and include some starchy carbohydrate in all meals/snacks.
• Use one pint of full cream milk a day, have at least two milky drinks a day.
• Avoid filling up on drinks which contain little nourishment i.e. tea, coffee, packet soups.
• Avoid “diet” or “light” products; always go for full-fat products.

Fortify Your Foods

• Add grated cheese, butter/spread, cream to potatoes, soups, sauces, vegetables.
• Add extra sugar/ honey to breakfast cereals, milk puddings, yoghurts.
• To make enriched milk add 4 tablespoons of milk powder (e.g. Marvel® or supermarket own brand) into 1 pint of full cream milk. Use this milk in drinks, to make sauces, on cereals.
• If you are struggling to eat enough, your dietitian will be able to suggest suitable supplement drinks to have in between your meals. You can also buy Meritene® or Complan® milkshakes, smoothies and soups from supermarkets or chemists, which are a good source of protein and energy.

Suggested Meal Plan

Breakfast

• 2 Eggs on toast with mushrooms and tomatoes OR
• 2 Slices of peanut butter on toast with a banana OR
• Cereal with fruit/dried fruit and enriched milk.

Mid-Morning

• Milk shake (i.e. enriched milk, with 1 scoop of ice-cream and 1 small banana/ 10 strawberries) OR
• 2 toasted crumpets/malt loaf with butter OR
• 3 biscuits and a glass of milk

Lunch

• Sandwich with meat, fish, eggs or cheese and salad OR
• Jacket potato with tuna, minced meat, beans or cheese and salad

Dessert

• Yoghurt OR rice pudding OR fruit with cream OR
• Ice cream and fruit crumble, sponge pudding and custard/ ice cream Bedtime snack Containing 50g carbohydrates, as suggested above.

Mid Afternoon

• A piece of cake/chocolate bar OR
• Hot chocolate, Ovaltine®/ Horlicks® made with milk.

Evening meals

• Meat or fish with potatoes and vegetables OR
• Lasagne or pasta with mince meat and vegetables OR
• Meat/ fish/ lentil and vegetable curry with rice

Support

• The British Liver Trust

Help to stop smoking

What are the health risks of smoking?

Smokers is one of the biggest causes of death and illness in the UK. It increases your risk of developing more than 50 serious health conditions including cancer, heart attacks, stroke and respiratory disease. These can be fatal or cause irreversible long-term damage to your health. In some cases, this may be caused by being around those that smoke and inhaling their second-hand smoke (passive smoking).

Smoking and cancer

Smoking causes around 7 out of every 10 cases of lung cancer (70%). It also causes cancer in many other parts of the body, including the:

• Mouth
• Throat
• voice box (larynx)
• oesophagus (the tube between your mouth and stomach)
• bladder
• bowel
• cervix
• kidney
• liver
• stomach
• pancreas

Smoking and heart disease

Smoking damages your heart and your blood circulation, increasing your risk of developing conditions such as:

• coronary heart disease
• heart attack
• stroke
• peripheral vascular disease (damaged blood vessels)
• cerebrovascular disease (damaged arteries that supply blood to your brain)

Smoking and respiratory disease

Smoking also damages your lungs, leading to conditions such as:

• chronic obstructive pulmonary disease (COPD), which incorporates bronchitis and emphysema
• pneumonia
• Smoking can also worsen or prolong the symptoms of respiratory conditions such as asthma, or respiratory tract infections such as the common cold.

Smoking and respiratory disease

Smoking also damages your lungs, leading to conditions such as:

• chronic obstructive pulmonary disease (COPD), which incorporates bronchitis and emphysema
  pneumonia
• Smoking can also worsen or prolong the symptoms of respiratory conditions such as asthma, or respiratory tract infections such as the common cold.

Smoking and sexual health

In men, smoking can cause impotence because it limits the blood supply to the penis. It can also reduce the fertility of both men and women.

Health risks of passive smoking

Second-hand smoke comes from the tip of a lit cigarette and the smoke that the smoker breathes out. Breathing in second-hand smoke, also known as passive smoking, increases your risk of getting the same health conditions as smokers. For example, if you have never smoked but you have a spouse who smokes, your risk of developing lung cancer increases by about a quarter.

Babies and children are particularly vulnerable to the effects of secondhand smoke. A child who’s exposed to passive smoke is at increased risk of developing chest infections, meningitis, a persistent cough and, if they have asthma, their symptoms will get worse. They’re also at increased risk of cot death and an ear infection called glue ear.

Health risks of smoking during pregnancy

If you smoke when you’re pregnant, you put your unborn baby’s health at risk, as well as your own. Smoking during pregnancy increases the risk of complications such as:

• miscarriage
• premature (early) birth
• a low birth weight baby
• stillbirth

What help is available to stop smoking?

Local Stop Smoking Services

Local stop smoking services are free, friendly and can massively boost your chances of quitting for good. Most people who see an adviser will get through the first month after quitting without smoking a cigarette. These services are staffed by expert advisers provide a range of proven methods to help you quit. They’ll give you accurate information and advice, as well as professional support, during the first few months you stop smoking.

They also make it easy and affordable for you to get stop smoking treatments, such as Varenicline (Champix), Bupropion (Zyban), nicotine replacement therapy, such as patches and gum You’ll normally be offered a one-to-one appointment with an adviser, but many areas also offer group and drop-in services as well. The venue could be at a local GP surgery, pharmacy, high-street shop, or even a mobile bus clinic.

How to contact your Local Stop Smoking Service

• Your GP can refer you or you can phone your local stop smoking service to make an appointment with an adviser.
• Call the free Smokefree National Helpline on 0300 123 1044
• Go online at www.nhs.uk/better-health/quit-smoking/find-yourlocal- stop-smoking-service/

What about E-cigarettes ?

E-cigarettes, also known as vapes or e-cigs have become very popular in recent years. It is an increasingly popular alternative to smoking and an aid in smoking cessation. An e-cigarette is a device that allows you to inhale nicotine in a vapour rather than smoke.

E-cigarettes do not burn tobacco and do not produce tar or carbon monoxide, two of the most damaging elements in tobacco smoke. They work by heating a liquid that typically contains nicotine, propylene glycol and/or vegetable glycerine, and flavourings.

How do I choose the right e-cigarette for me?

A rechargeable e-cigarette with a refillable tank delivers nicotine more effectively and quickly than a disposable model and is likely to give you a better chance of quitting smoking.

• If you’re a lighter smoker, you could try a cigalike, vape pen or pod system.
• If you’re a heavier smoker, it’s advisable to try a vape pen, pod system or mod.
• It’s also important to choose the right strength of e-liquid to satisfy your needs.
• A specialist vape shop can help find the right device and liquid for you. You can get advice from a specialist vape shop or your local stop smoking service.

How safe are e-cigarettes?

In the UK, e-cigarettes are tightly regulated for safety and quality.

They’re not completely risk free, but they carry a small fraction of the risk of cigarettes.

E-cigarettes do not produce tar or carbon monoxide, two of the most harmful elements in tobacco smoke.

The liquid and vapour contain some potentially harmful chemicals also found in cigarette smoke, but at much lower levels.

Whilst there have been no long term studies a recent study by the NHS suggested that E-Cigarettes are significantly (95%) less harmful than smoking.

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Resources

Better Health is a national campaign to encourage healthier lifestyle choices, by losing weight, getting active, reducing alcohol consumption and quitting smoking.

You can get daily email support throughout your 28 day quit smoking journey.

You can engage with others who are on the same journey on the Smoke free Facebook page.

They have an app, NHS Quit Smoking, that allows you to track your progress, see how much you’re saving and get daily support and encouragement.