So you think you have a balanced diet?

Experts who claim that we can get all the nutrients we need from our diet always use the caveat ‘a healthy balanced diet’, but hand-on-heart how many of us can say we eat a healthy balanced diet 100 per cent of the time - and even if we are confident that our diet is healthy, does it really provide all the nutrients we need? One of the most notable changes in the world of nutrition is a shift in focus from adequate to optimal nutrition, achieving the best diet possible for our health.

What does the ideal diet look like?

A balanced diet is not rocket science and most of us know the basics even if we don’t always follow them. It should include all the vitamins, minerals, essential fatty acids, amino acids and energy we need for optimum health – without providing any to excess.

In practice that means:

• Protein (meat, fish and vegetarian alternatives such as beans, pulses, soy and Quorn),
• Complex carbs (brown rice, bread and pasta as well as other wholegrains and also pulses)
• Healthy fats (olive oil, avocado, nuts and seeds).
• More than five servings of fruit and veg daily (more vegetables ideally)
• A couple of servings of oily fish each week. These are a great source of the omega 3 fatty acids that need to be obtained from the diet.
• A few servings of dairy each day. If you don’t eat dairy then look to other sources of calcium, e.g. fortified plant milks such as soya milk.

How much to eat?

Three balanced meals every day is plenty for the average adult, although snacking can add extra nutrition when it’s required, for instance for very active people looking to maintain their weight or people trying to put weight on in a healthy way.

Eating a portion size that leaves you feeling full but not stuffed is key to maintaining a healthy weight.

What not to eat

Sugar. This is most people’s Achilles heel. Filling up on foods rich in the white stuff just leaves less room for more nutritious offerings that add real value to your diet. The effects of sugar  can also impact on hormones and satiety, encouraging you to overeat.

Too many people seek out the weird and wonderful without first of all getting the basics right. Trendy diets can seem appealing but they often include cutting out entire food groups leaving you defunct of key vitamins and minerals - in the case of dairy-free, for example,  calcium  and vitamin B12.

The healthy diet saboteurs

While adopting a ‘healthy balanced diet’ is good advice, achieving optimal nutrition means understanding the effects of other certain factors in your life on the nutrients  you absorb. Even if we follow a perfect diet, lifestyle and life-stage factors such as coffee drinking, medication, the pill and going through the menopause  can affect how well we absorb and use vital minerals such as calcium, iron , magnesium , selenium and zinc. Adapting the way you eat and including supplements can improve nutrient absorption and help to bridge any shortfalls in your diet.

If you have IBS or a gut imbalance

The bacteria living in and on your body play an important role in wellbeing. They stimulate digestion, break down dietary fibre and also secrete acids and enzymes – all of which affect how well you absorb certain minerals, especially calcium and iron. If you are experiencing digestive issues such as  bloating , poor digestion or have been diagnosed with  irritable bowel syndrome  or other gut issues, it’s likely that your microbiome  is affected.

What to do: Take a probiotic supplement  and increase your intake of prebiotic foods that help to feed healthy gut bacteria. These include onions, garlic, bananas and Jerusalem artichoke. Foods such as potatoes and rice develop ‘resistant starches’ if they are cooked and then left to cool (via a process called retrogradation) and these also act as prebiotics.

Drinking tea and coffee with meals

The otherwise beneficial antioxidants in tea and coffee  bind iron and other minerals in food and supplements to reduce their absorption. Drinking coffee with a meal can reduce the amount of iron you absorb by up to 80 per cent and reduce the uptake of other minerals such as zinc, magnesium and calcium.

What to do: Drink water with meals and wash down supplements (and medicines) with water or orange juice, unless otherwise instructed. Don’t have tea or coffee within an hour of a meal.

Eating too much fibre

We all know that fibre is important for digestive health , but dietary fibre acts like a sponge and can bind minerals such as copper and iron so that they remain unabsorbed. This is especially true of bran and related substances (phytates) found in wheat and barley. Fibre can reduce uptake of iron by at least 50 per cent, as well as reducing absorption of zinc, calcium and manganese. If you are vegetarian you need an estimated 1.8 times more iron as the form of iron present in plants is less easily absorbed than the haem iron found in meat.

What to do: Vitamin C counteracts the effects of phytate on iron absorption, so eat vitamin-rich fruit and vegetables with meals. Ensure you obtain enough calcium from milk and dairy products,  broccoli, nuts, seeds and pulses. Antioxidant rich onions, garlic, and pungent spices such as ginger and black pepper can enhance nutrient absorption. Go easy on unleavened bread (tortilla, roti) where phytates are mainly found - enzymes in yeast-raised bread break phytates down.

Taking hormones

Oral contraceptives  allow us to control fertility, but they can reduce body levels of magnesium, selenium and zinc, as well as some vitamins. On the plus side, these hormones can improve iron status by reducing the blood (and therefore the iron) lost during menstruation. However, post-menopausal women who take a form of  HRT  that continues to cause a regular monthly bleed will have  a higher iron requirement than women whose periods stop at the menopause.

What to do: If you are taking oral contraceptives or hormone replacement therapy, consider taking a multivitamin and mineral supplement.

You’re over the age of 50

As we get older, our absorption of minerals decreases  because we produce less stomach acid, bile and intestinal juices. Atrophic gastritis affects as many as 19 per cent of people in their 50s, 24 per cent in their 60s, 32 per cent of those in their 70s and 40 per cent of those aged 80 plus – an overall prevalence of 31.5 per cent of those aged 60 or more.

At the same time, our needs for most vitamins and minerals increase as metabolism functions less efficiently than  in your youth. Minerals whose absorption is affected by low stomach acidity include calcium, iron while among the vitamins,  B vitamins  are most affected.

What to do: Choose supplements designed for your age group- multivitamins for those over 50 contain boosted levels of the key nutrients such as B vitamins whose absorption is reduced in later life. Taking digestive enzyme supplements may help, too, especially if you experience indigestion when eating certain foods.

You’re taking medication

An increasing number of medicines are known to affect nutrient absorption. Drugs that reduce the production of stomach acid (eg, to treat indigestion such as ranitidine or omeprazole) will affect the solubility of minerals such as calcium, iron, magnesium, zinc and phosphate so that less is absorbed in the small intestine. Some drugs, such as diuretics used to treat high blood pressure can reduce mineral levels by increasing mineral losses via the kidneys, while oral corticosteroids such as prednisolone taken for some autoimmune conditions reduce calcium absorption, so long term use can be associated with thinning bones.

What to do: Talk to a pharmacist about the effects of your medication on nutrient absorption and consider taking a multivitamin supplement such as Healthspan MultiVitality Gold with 27 micronutrients  (£9.95 for 180 tablets).

Dr Sarah Brewer  is a GP, author and Healthspan Medical Director.  Rob Hobson  is a Registered Nutritionist, Healthspan Head of Nutrition and author of Detox Kitchen Bible.