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Opinion: Five a day will keep the doctors away, or will they?

Chartered Psychologist Dr Jolanta Burke looks at the five-a-day advice and wonders if we’re getting enough nutrition.

Dr Jolanta Burke

EATING FIVE PORTIONS of fruits and vegetables a day is meant to be a recipe for better health. Yet, the latest research disagrees. So, where did we go wrong?

It all began with the World Health Organization promoting five-a-day to reduce chronic diseases like obesity, cardiovascular disease, diabetes and cancer. According to the World Health Report, close to three million deaths each year were attributable to low fruit and vegetable intake.

Governments followed suit implementing five-a-day campaigns and promoting initiatives encouraging healthy nutrition. While the Bord Bia research here is now showing an increase in consumption of fruit and vegetables in Ireland, on average, we eat only four portions a day, which is less than the recommended amount. Is four a day enough to keep us healthy?

Is five enough?

In ground-breaking research, economists from the University of Warwick identified that while five-a-day prevented obesity, it had a barely moderate effect on psychological wellbeing. Arguably, those who ate minimal portions of fruit and vegetables a day fared worst in their wellbeing and were least satisfied with life.

At the same time, wellbeing increased with each extra portion of fruit and vegetables consumed, reaching the ultimate level at seven portions a day. This means that to keep our minds healthy, we need more than five portions a day.

What about the body? Is five a day enough to keep the doctor away? Unfortunately not. According to one large-scale study, we need to eat seven portions a day to reduce the risk of death from cancer and heart disease; according to another, eating as many as 10 portions a day reduces these deaths by 30%.

Even though we are not there yet, in relation to eating the fruit and vegetables, the good news is that Covid-19 increased the fruit and vegetable consumption by an average of half a portion. This happened as a result of significant lifestyle changes associated with working from home.

Given the magnitude of lifestyle change required to increase portions of fruit and vegetables a day, is aiming at seven or 10 portions a day doable? Changing habits is difficult. Increasing intake of fruit and vegetables, especially when people do not like eating them, is even more challenging. The information-sharing about the benefits of fruit and vegetable eating is not enough to alter behaviour.

Positive psychology

What often gets in the way of lifestyle changes is our mood. When in a bad mood, we may be more likely to pick on comfort food and thus revert to the old habits. This is where psychology and, specifically, positive psychology may help.

Positive psychology is a science of wellbeing and optimal human functioning. It provides a range of research-based tools, the aim of which is to enhance psychological wellbeing. In a recent study, positive psychology tools were amalgamated with lifestyle medicine tools creating a powerful engine for driving change.

Lifestyle medicine is an evidence-based approach to improving nutrition, sleep quality, physical activity, and reducing stress and substance intake, such as smoking or alcohol.

Researchers designed a 10-week programme that included improvement in nutritional habits, such as eating eight portions of plant-based food a day and some psychological techniques that helped them maintain it.

Psychological techniques offered participants social support by encouraging them to prepare a high-fibre, plant-based meal and enjoy it with friends; they inspired them to spend time reflecting on three good things that happened to them during the day; they also empowered them to perform acts of kindness and forgive someone who had hurt them.

Intertwining lifestyle medicine techniques with positive psychology tools resulted in a significant increase in individuals’ well-being, and the effect continued three months later.

While the researchers did not assess the programme’s impact on fruit and vegetable intake portions, this research offered a great starting point for managing change, especially given the significant increase in participants’ wellbeing.

Nutrition matters

After all, it is a chicken and egg situation. Eating seven portions a day is associated with high levels of psychological wellbeing. However, having higher levels of psychological wellbeing is also associated with participants looking after their physical wellbeing.

Given that we do not know what happened first, why not use psychological wellbeing to help us eat more fruit and vegetables a day?

Here is a positive psychological activity (Best Possible Self) that can help you do it:

Imagine yourself three months from now. You have changed your lifestyle significantly, accomplished what you were hoping to achieve and began to eat more portions of fruit and vegetables a day. What small changes have you made to help you get there? How have you motivated yourself in the last three months? Who helped you do it? Now write about it for the next 10 minutes.

You know yourself, your circumstances and your network better than anyone else. This adapted activity from Dr Ben Gibson from the Liverpool John Moore’s University has the potential to improve your mood and enhance your motivation to make a change.

Do not throw away your “Best Possible Self” writing; read it back, especially when your healthy eating habit has slipped. It will keep your motivation going.

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Most importantly, however, enjoy the process and Bon Appétit!

Dr Jolanta Burke is a Chartered Psychologist with the British Psychological Society and a Senior Lecturer in the Centre for Positive Psychology, RCSI University of Medicine and Health Sciences.

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Dr Jolanta Burke

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