NUTRITIONAL THERAPY FOR ALL

Nutritional therapy is a science-based practice which seeks to address the root cause of your
health concerns, not just the symptoms.
Through tailored food, nutrient and lifestyle recommendations to suit your individual needs,
it aims to help you towards maintaining optimum health and improved well-being.

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8 16
THIS ISSUE
REPLACING DAIRY?
If you need to avoid cow’s milk,
what nutrients should you put
back in? We look at balancing
your diet with other foods, find
out about some of the obstacles
to going dairy-free, and try out a
range of cheese alternatives
24 ON YOUR PLATE
REGULARS
Five recipes from Amelia Freer’s latest
book Nourish & Glow: The 10-Day Plan
show how eating well can be quick,
uncomplicated, and inexpensive
29 FOOD FACT FILE
Hailed as a superfood by some and
condemned as an unhealthy source of fat
by others, coconut oil is an ongoing source
of debate. Christian Billinghurst writes
32 WORLD CUISINE
Business consultant-turned writer
and cook Reem Kassis tells us about
Palestinian cuisine and shares a recipe for
comfort food from her new book
04 COMMENT / NEWS
12 RESEARCH UPDATE
CONTENTS
RETHINKING BREAKFAST
From sugary biscuits to savoury
porridge, breakfast takes many
forms. Amelia Glean looks at
what is often dubbed the most
important meal of the day, while
we come up with ideas to get
some great nutrients into yours
34 DIFFERENT STROKES
The association between poor sleep and
poor health is unequivocal, but what do
you do if snoring (a partner’s or even your
own) wakes you up? Louise Wates writes
36 ALL ABOUT
We can buy sourdough bread on the high-
street, but the Real Bread Campaign says
some of these don’t deserve the label.
Catherine Morgan investigates
42 CASE STUDY
Nicola Moore from The Optimum
Nutrition Clinic discusses an approach to
help Sharon, who wants to put on weight
but finds it hard to make time for food
28 KITCHEN CHEMISTRY
39 BOOK THERAPY
20
INTERVIEW
With A-listers beating a path to
her practice door, Amelia Freer
has become an ambassador for
nutritional therapy. She spoke to
Catherine Morgan about her latest
book, what motivates her, and the
so-called ‘clean-eating’ trend
44 LITTLE LIVES
Are we feeding our children too much?
Jenna Sinclair looks at snacking culture,
and Catherine Morgan ponders the
problem of portion sizes
48 MOVE IT
Have the This Girl Can adverts persuaded
you to get up and get sweaty? Alice Ball
finds out about the campaign, and speaks
to some women who did
40 PRODUCT NEWS
47 IN SEASON
AUTUMN 2017 | OPTIMUM NUTRITION 3
COMMENT / NEWS
From the editor
R
Editor ecently, I’ve been Ms Angry from
Louise Wates Surrey. I haven’t written any strongly-
worded letters to any newspapers
Art Director — but then I have two whole columns to
Salman Anjum vent my spleen.
“What has made you angry?” I don’t
Designer hear you ask.
Maria Noble “Why, it is the prevalence of the
obesogenic food desert,” I reply.
Contributors
“Obesogenic food desert” probably
Alice Ball
sounds like an oxymoron; while
Christian Billinghurst
“obesogenic” implies an abundance
Maggie Charlesworth
of food, “food desert” implies little or
Yeshi Dolma
nothing. However, it definitely exists.
Charles Dowding
This summer, I spent a couple of days
Amelia Glean
away from home at a music festival. It
Nicola Moore
was just a small event, and a condition of
Catherine Morgan
the very cheap ticket was that no food or
Lisa Patient
Jenna Sinclair
drink should be taken onto the site. There
were food stalls there, or we could leave
Advertising the site and return if need be.
Catherine Morgan The downside to this was that for
catherine.morgan@ion.ac.uk someone who likes eating at least one
piece of greenery a day, it was sorely
ION CEO limiting with just stalls selling burgers,
Chris Mansi chips, chip butties, fish and chips, noodles,
pies, chips, or cakes. And did I mention
Contact us chips? With two music stages, we didn’t
020 8614 7800 | editorial@ion.ac.uk really want to go off-site because there
were too many decent bands playing. If
Connect with us we did nip out it was at least a 15-minute
@ion_nutrition walk — to the nearest fried chicken shop.
instituteforoptimumnutrition If we didn’t want fried chicken, there
ion_nutrition were kebabs, pizzas, and fish and chips. A
20-minute walk would take us into town
Website where we could find a supermarket and
www.ion.ac.uk something fresh, but that would mean
missing out on the music.
Print and digital publishing So the only thing that came close to
CPUK Print Publishing five-a-day for me was the smell of the two
strawberry and rhubarb ciders I had over
Published by the weekend. I ate fish and chips on both
The Institute for Optimum Nutrition (ION) days, and picked at my partner’s chips
Ambassador House for lunch, too, because after wandering
Paradise Road around the festival site a couple of times
Richmond nothing else took my fancy.
TW9 1SQ After the weekend, both of us
United Kingdom commented that we felt awful, and it had
ISSN: 1457-5876 nothing to do with alcohol. (Two drinks
The views expressed by individual authors over two days, honest, guv.)
are not necessarily those of ION or Optimum We both felt heavy and sluggish, and
Nutrition, nor does ION or Optimum Nutrition were craving vegetables and fruit. Saying
recommend or guarantee any of the third-
party products advertised or mentioned in this that, on the train home, my head was
magazine. stuck in carbs and fat mode. So whilst my
partner tucked into some apples, I scoffed
Optimum Nutrition aims to report up-to-date a bag of crisps and a chocolate biscuit. Yet
research on nutrition and health-related I wondered, if I felt “rubbish” after just a
issues. However, articles are not intended
to be used as health recommendations, and couple of days of chips, what did people
ION and Optimum Nutrition do not advocate who ate like that every day feel like?
following any diet or implementing dietary
changes without consulting a qualified health Once back in the office, I got on my
practitioner. soapbox and moaned at anyone who
4 OPTIMUM NUTRITION | AUTUMN 2017
would listen about how the city I had
visited had so little choice. What chance
does anyone stand when surrounded by
cheap and unhealthy fast food? I asked.
Because we keep being told that it
is draining our NHS, there is a moral
judgement attached to obesity, with
blame often levelled at the individual
who has let their weight get out of
control. Over the years — never at the
ION/Optimum Nutrition office — I’ve
heard the same old same old over and
over again: people should eat less and
move more; it isn’t expensive to cook
healthily (something I have been guilty
of saying many times); and that people
should make better choices. One person
I knew used to love watching television
programmes about overweight people
while posting really nasty comments
about them on social media.
That isn’t to say that we don’t have free
will over such things — nobody forced
me to eat crisps and biscuits when there
were apples on offer. But the social factors
influencing nutritional health and ill health
shouldn’t be ignored. I mulled this over
with a nutritional therapist who then told
me about some work she had done with a
food bank, showing people how to make
healthy meals with the ingredients they
were given. “Get into the real world,”
she told me. “Some of these people have
nothing more than a kettle so you can’t
blame them for eating instant noodles.”
It is possible to make amazing meals
with a bag of lentils, but if you haven’t
got anything to cook them in and on, it’s
a bit of a non-starter. This doesn’t mean
that everyone who has nutrition-related
health issues is living in poverty or in an
unhelpful environment, but for those who
do, decision-making becomes that much
tougher.
So when it comes to pointing the finger
of blame, perhaps all of us and, more
importantly, social policy makers should
give a thought to the choices that confront
many people on a daily basis. Poverty
certainly isn’t going to help when £1 will
feed the kids with a bag of chips — which
they will probably eat, and which is going
to be warming and filling.
Malnutrition, as in deficiency in
nutrients, can occur when there is over-
nutrition, too; i.e. we can eat to gain
weight while remaining nutritionally
deficient.
Sadly, the obesogenic food desert is the
malnutrition of obesity writ large.
Louise Wates

Moderation key to good health
R esearch following the diets of more
than 135,000 people across five
continents has shown that a moderate
intake of fat, fruits, and vegetables, and
avoidance of high carbohydrate intake, is
associated with lower risk of death.
Lowest risk of death was found in those
who ate three to four daily servings of
fruits, vegetables, and legumes, with
little additional benefit found in eating
higher amounts. About 35 per cent
of energy intake coming from dietary
fat was also associated with a lower
risk of death, when compared to lower
dietary fat intake. However, diets high
in carbohydrates (more than 60 per
cent of energy intake) were associated
with higher mortality — although not for
cardiovascular disease (CVD).
Reported in The Lancet, the study was
led by researchers at the Population
Health Research Institute (PHRI) of
McMaster University, and Hamilton
Health Sciences in Canada, using data
from the Prospective Urban Rural
Epidemiology (PURE) study, which
followed people from 18 low-income,
middle-income and high-income countries
for an average of seven and a half years.
The findings are likely to add to ongoing
debate over dietary fats, as it was found
that these were not associated with major
CVD. This was observed for saturated
fats, polyunsaturated fats, and mono-
unsaturated fats. Saturated fats were also
associated with lower stroke risk.
The researchers said the results were
consistent with several observational
studies and randomised controlled trials
conducted in western countries during the
last two decades.
Mahshid Dehghan, the study’s lead
author and an investigator at PHRI, said
the new study, when viewed in the context
of most previous studies, questioned the
conventional beliefs about dietary fats and
clinical outcomes.
“A decrease in fat intake automatically
led to an increase in carbohydrate
consumption and our findings may explain
why certain populations such as South
Asians, who do not consume much fat
but consume a lot of carbohydrates, have
higher mortality rates,” she said.
A second paper from the PURE study
assessed fruit, vegetable and legume
consumption and related them to deaths,
heart disease and strokes.
“Our study found the lowest risk of
death in those who consumed three to
four servings or the equivalent to 375
to 500 grams of fruits, vegetables and
Events
Lincoln Sausage Festival
14 October
www.lincolncastle.com/content/
lincoln-sausage-festival-0
VegfestUK London 2017
Kensington Olympia
21-22 October
www. london.vegfest.co.uk/
Food Matters Live
Excel London
21-23 November
www. Foodmatterslive.com
Eat & Drink Festival Christmas 2017
Kensington Olympia
22-26 November
www.eatanddrinkchristmaslondon.
com
BBC Goodfood 2017 Festive Fayre
Hampton Court Palace
8-10 December
www.bbcgoodfoodshow.com/
hampton-court-palace-festive-fayre
legumes per day, with little additional
benefit for intake beyond that range,”
said Victoria Miller, the lead author of
the paper. Additionally, fruit intake was
more strongly associated with benefit
than vegetables, and raw vegetable
intake more strongly associated with a
lower risk of death compared to cooked
vegetable intake. “Dietary guidelines do
not differentiate between the benefits
of raw versus cooked vegetables — our
results indicate that recommendations
should emphasise raw vegetable intake
over cooked,” said Miller.
However, being observational studies,
the papers can only establish association
and not cause and effect. Whilst
calling the PURE study “an impressive
undertaking”, a commentary in The Lancet
stated that “uncertainty [about what
constitutes a healthy diet] is likely to
prevail until well designed randomised
controlled trials are done.”
Source: McMaster University
COMMENT / NEWS
#Twitter
Let’s see what’s been going on in
cyberspace by sharing some of
our favourite tweets
@CarolGranger2
Breast fatty tissue inflammation linked to
high glucose, insulin, triglycerides, CRP,
IL6 = worse cancer prognosis
t.co/SIIlPii5BE
@MapMyGut
Yo-yo weight gain driven by gut bacteria’s
‘memory’ of obesity! #microbiome
#yoyodiets t.co/S7irgV60Zj
@BANTonline
Excessively High Ratio of Omega-6 to
Omega-3 Polyunsaturated Fatty Acids
Promotes Inflammation t.co/zC2SgreLTq
@_SamMantra
Here’s a lady that really knows about the
brain & gut connection #faboulousfoods
#foodsforyourmoods #nutrition
#mindfuleating
@ION_Nutrition
Class of 2017! Congratulations! Enjoy your
journey!
@ION_Nutrition
Is depression a kind of allergic reaction?
http://bit.ly/2y61bau
@ION_Nutrition
Scratch-and-Sniff Test could predict
Parkinson’s earlier than previously thought
http://bit.ly/2xaIaTi
@drjamesdinic
Is sugar an addiction? Our clinical
experience would suggest ‘yes’.
http://bit.ly/2iVq8yI
@ION_Nutrition
ION graduate nutritional therapists are
regulated by @CNHC_UK PSA recognised
http://bit.ly/2yDRRru
For your chance to have your tweet featured
in the magazine or retweeted, please use the
hashtag #ion_nutrition.
AUTUMN 2017 | OPTIMUM NUTRITION 5
COMMENT / NEWS

One step closer to personalised diets

S tudies on mice have indicated that compounds produced by gut microbes could show which animals are at greater risk of becoming
obese or developing health conditions such as diabetes or cardiovascular disease, and could potentially pave the way towards tailor-
made diets for humans.
Until now, diets have tended to fall into the one-size-fits-all category, usually based on national guidelines. However, not all diets work
for everybody all the time — a problem that is a source of frustration that leaves many people feeling like failures.
In research led by scientists at Imperial College London and INSERM UMRS 1138 in Paris, mouse urine was tested for microbial
compounds that enabled the team to understand the makeup of the animals’ gut bacteria. Key chemical signatures from the compounds
then made it possible for the team to accurately predict how the animals would respond to a high-fat diet.
The study, which was published in Cell Reports, used genetically similar mice to highlight the role that gut bacteria played in how the body
responds to changes in diet and the impacts on health.
Although a high-fat diet is seen as a major factor in obesity and obesity-related disease, studies have found that individual people can
respond differently to the same diet; which is why individuals with a similar diet and lifestyle may not gain or lose weight at the same rate.
Part of this difference in response is now understood to lie in the differences between our microbiomes — the collection of bacteria that
live inside our guts — and how they are affected by our diet, environment, or factors such as antibiotics.
“We know that our environment and genetics can influence our risk of obesity and disease, but the effects of these communities of
bacteria living inside us are less well understood,” said Dr Marc-Emmanuel Dumas, from the Department of Surgery & Cancer at Imperial,
who led the research. “By using a group of mice with the same genetic makeup, we were able to zoom in on the variability in animals
switched to a high-fat diet.”
After screening the mouse urine for compounds produced by gut bacteria, the team put the mice on the same high-fat diet. It was found
that some mice gained weight more easily, and some became less tolerant to glucose, which is one of the early signs of type 2 diabetes.
Analysis revealed that key chemical signatures in their urine were predictive of some outcomes, such as changes in behaviour, weight-
gain and tolerance to glucose. One compound in particular, trimethylamine-N-oxide (TMAO), was shown to be predictive of glucose
tolerance.
Professor Jeremy Nicholson, Head of the Department of Surgery & Cancer at Imperial, said: “This study is another fascinating example
of the power of the microbiome to influence the host with respect to major health risks. It shows that value of a diet is determined not only
by your genes, but also the genes of your gut microbes. This work has implications in lots of different areas, which is why it’s so exciting.”
The findings will be explored further as part of an ongoing large clinical trial of 2,000 patients. It is hoped that, in the future, it will be
possible to use urine and blood to create a patient profile to predict the best diet for different individuals.

Reference:
O’Hare R (2017). Gut bacteria can help to predict how the body will respond to fatty foods. Imperial College London. www3.imperial.ac.uk/
newsandeventspggrp/imperialcollege/newssummary/news_5-7-2017-12-25-46

Tomato appears to reduce skin cancer in male mice

A study at The Ohio State University, USA, and published online in

the journal Scientific Reports, found that a daily diet with tomato
appeared to cut by half the development of skin cancer tumours in
male mice.
Scientists found that, on average, male mice that were given
a diet of 10 per cent tomato powder each day for 35 weeks, and
then exposed to ultraviolet light (UV), experienced a 50 per cent
decrease in skin cancer tumours compared to mice that ate no
dehydrated tomato.
However, no such difference was found in female mice. Research
has already shown that male mice develop tumours earlier after UV
exposure, and that their tumours are more numerous, larger, and
more aggressive.
“This study showed us that we do need to consider sex when
exploring different preventive strategies,” said the study’s senior
author, Tatiana Oberyszyn.
It is thought that dietary carotenoids, which give tomatoes their
colour, may help protect skin against UV light damage.
“Foods are not drugs, but they can possibly, over the lifetime
of consumption, alter the development of certain diseases,” said
Jessica Cooperstone, a co-author of the study.

Reference:
Turner T (2017). Diet rich in tomatoes cuts skin cancer in half in mice. The
Ohio State University. www. news.osu.edu/news/2017/07/13/tomato-
skin-cancer/

6 OPTIMUM NUTRITION | AUTUMN 2017

 COMMENT / NEWS

Crispy jellies an eco-friendly food solution

T he search for new food security options has led a

gastrophysicist from the University of Southern Denmark
(SDU) to investigate the possibilities of eating jellyfish.
Although they are commonly eaten in some parts of Asia,
jellyfish have been yet to grace most western tables — although
it is not completely unknown in the UK; self-styled ‘gastronaut’
Stefan Gates once cooked jellyfish burgers on the BBC’s children’s
programme Blue Peter.
As our oceans are full of jellyfish to the point that marine
biologists are investigating ways of culling them, using them for
food could be a way of reducing their numbers whilst putting them
to use in the food chain.
The Danish research looked at finding a way to dry jellyfish so
that they lose their gristly consistency and become “paper-thin
and crunchy: a bit like a potato crisp”. This involved steeping the
jellyfish in alcohol to extract the water from them.
Gastrophysicist Mie Thorborg Pedersen said: “In the course of a
couple of days, the alcohol replaces the water in the jellyfish. In the
subsequent evaporation process they become bone dry.” The crisps
do not have an overly distinctive taste but, she says, “the mouth
feel and the aesthetic appearance in particular have gastronomic
potential”.
As a physicist, Pedersen does not regard the jellyfish as an
animal, but as a gel. “Gels respond differently when put in different
solutions,” she says. “In alcohol some gels simply collapse, and that
is exactly what we see a jellyfish doing. As the jellyfish collapses,
the water is extracted from it and its volume is reduced.”
Traditional processing plants use kitchen salt and alum to extract
the water from the jellyfish, but this new process could speed up
production by days.
The work was carried out with SDU researchers, Jonathan
Brewer, Lars Duelund and Per Lyngs Hansen, and the results
published in The International Journal of Gastronomy and Food
Science.

Reference:
Anyone for crispy jellyfish? University of Southern Denmark. www.sdu.
dk/en/om_sdu/fakulteterne/naturvidenskab/aktuelt/2017_07_04_
crisp_jelly

Iron may protect against coronary artery disease

D ietary iron may help protect against coronary artery disease (CAD), the most common form of cardiovascular disease (CVD),
according to findings from Imperial College London and University College London.
Although the role of dietary iron in CVD has been investigated in unrelated studies, there have been opposing results. In this study,
rather than looking at iron intake, researchers screened medical records for individuals with CAD, and then looked for DNA markers that
determined whether individuals would have slightly higher or lower iron status.
Using a public database, the researchers studied data for more than 48,000 people, looking out for three points in the genome where
a single ‘letter’ difference in the DNA (called a single nucleotide polymorphism or SNP) can slightly increase or reduce a person’s iron
status.
Then, on screening data for these SNPs for more than 50,000 patients with CAD, it was found that individuals whose DNA indicated
higher iron status also had a lower risk of CAD.
However, as this was just an observational study, whether iron supplementation could help reduce the risk of CAD would need to be
tested through randomised controlled trials.
Lead author Dr Dipender Gill said: “We have shown that having low iron status increases the risk of coronary artery disease, but this
doesn’t mean correcting that resolves the increased risk. What we have highlighted is a potential therapeutic target that we didn’t know
about before, and one that’s easily modifiable.”
The study’s findings were published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology.

Reference:
O’Hare R (2017). Low iron levels linked with increased risk of heart disease. Imperial College London. www3.imperial.ac.uk/newsandeventspggrp/
imperialcollege/newssummary/news_10-7-2017-12-58-31

AUTUMN 2017 | OPTIMUM NUTRITION 7

FEATURE
Cutting out dairy can mean excluding a large group of nutrients from the diet. So if you are thinking
of taking milk-based foods off your menu, what nutrients should you think of adding in?
I
f you looked inside the Institute for
Optimum Nutrition (ION)/Optimum
Nutrition fridge, you would discover a
variety of nut-based milks alongside cow’s
milk, butter, and the occasional block of
cheese. Just as staff follow their preferred
diets, our only agenda is to promote
health through (perhaps, unsurprisingly)
optimum nutrition.
In some instances, however, a
nutritional therapist may suggest reducing
or cutting out dairy for at least a trial
period. So, we take a look at some of the
nutritional and practical issues involved in
making such a change.
Although dairy is found in countless
products, the expansion of the ‘free from’
market is making it much easier to make
what — at first glance — appear to be
like-for-like swaps. However, whilst many
such products might satisfy a craving,
they will be compositionally different to
dairy-based products and so, nutritionally,
cannot be treated as direct exchanges.
Just like human breast milk, any
mammalian milk that we can buy for
8 OPTIMUM NUTRITION | AUTUMN 2017
According to the Dairy Council, 200ml
of semi-skimmed milk provides:
31 per cent of calcium; 74 per cent
of vitamin B12; 41 per cent of iodine;
14 per cent of protein; 35 per cent of
riboflavin (vitamin B2); 23 per cent of
vitamin B5 (pantothenic acid); and 28
per cent of phosphorus of our of our
recommended daily intake.
A 30g serving of hard cheese provides:
15 per cent of protein; 28 per cent of
calcium; 22 per cent of phosphorus;
29 per cent of vitamin B12; and full-fat
only hard cheese also provides 15 per
cent of vitamin A of our recommended
daily intake.
(Source: www.milk.co.uk/nutritious-dairy)
human consumption — cow’s, goat’s,
sheep’s or camel’s — is full of nutrients
to feed young. Nutrient levels will vary
depending upon the diet of the animal
that produced the milk, but it is generally
an excellent source of vitamins and
minerals. And in a world that is becoming
more aware of the microbiome and how
it affects our overall health, fermented
milk products such as aged cheeses,
yoghurt and kefir have also been shown
to be beneficial through their gut-friendly
bacteria.
It is because of such nutritional benefits
that a dairy-free cheese and pickle
sandwich probably won’t pack the same
nutritional punch; which is why you may
consider finding nutrient top-ups from
elsewhere.
Growing market
Many supermarkets stock limited
ranges, but an online search will reveal a
staggering variety of available dairy-free
cheeses, ranging from Cheddar-style
blocks, to plain or flavoured spreads, to
‘melty’ cheeses that are marketed to the
pizza-loving crowd.

Several of these products contain
ingredients such as water and coconut
oil, with soya protein, thickeners, and
modified maize starch also finding their
way onto many labels. As a result, these
will have a very different nutritional profile
to their dairy equivalents. They may also
act differently when used in cooking.
In terms of micro-nutrients, some
manufacturers are getting around this
by fortifying their products so that some
dairy-free milks, for example, have
added calcium and vitamins B2, D and
B12 — with the latter being particularly
important because it is difficult to obtain
naturally from a vegan diet.
If, for whatever reason, you are
excluding dairy from your diet, here are
some of the nutrients you should think of
adding to your diet in other food forms.
Calcium
What it does: Not just essential for bone
development and strength, calcium
is important for regulating muscle
contractions (including heartbeat) and
ensuring that our blood clots normally.
Sources include: green leafy vegetables
such as broccoli, cabbage, kale,
watercress, pak choi and spring greens
(spinach contains calcium but is a poor
bioavailable source), Brussels sprouts,
cauliflower, okra, and edamame beans.
It is also found in calcium-set tofu, nuts
and seeds. An excellent, non-vegetarian
source, which is also rich in omega-3, is
sardine/pilchard, if the bones are eaten.
Vitamin B12
What it does: This vitamin is responsible
for making red blood cells, releasing
energy from food, and also works
alongside folate. It is vital for the nervous
system and has been strongly associated
with brain health. The NHS advises that as
we get older, vitamin B12 becomes harder
to absorb, so even greater attention needs
to be paid to taking it in some form.
Sources include: animal products
such as liver, meat and fish. For vegans,
Marmite is a good source, as are some
fortified foods: e.g. nutritional yeast, used
to give foods a cheesy flavour, can contain
B12, but check the label. Vitamin B12-
status tests can be carried out through
GPs and through nutritional therapists.
Iodine
What it does: This is essential for thyroid
health, although anyone with hyper-
thyroidism (Graves’ disease/over-active
thyroid) should avoid taking in too much
iodine. The NHS advises that adults need
0.14mg of iodine a day, and that this
should be available through a varied diet.
Sources include: sea vegetables or
seaweeds, white fish such as haddock and
cod, and shellfish, eggs, meat and poultry.
Iodine can also sometimes be obtained
through ‘iodised salt’ which has been
fortified.
Vitamin A (retinol)
What it does: This is important for helping
the immune system to work properly, for
healthy skin and the lining of some parts
of the body, and for good eye health (see
page 14 for eye health update).
Sources include: eggs and oily fish.
Liver and liver pâté are excellent sources;
but because they contain high levels of
vitamin A, are only recommended once
a week to avoid taking in too much —
current advice is that more than a daily
average of 1.5mg of vitamin A over the
years may affect bone strength, and make
them more prone to fracture in later years.
Vegetarian options are orange-coloured
vegetables such as carrots, squash
and sweet potato; these contain beta-
carotene, which is converted by the body
into vitamin A. Because vitamin A is a fat-
soluble vitamin, it needs fat (e.g. olive oil)
in the diet in order to be absorbed.
Vitamin B2 (riboflavin)
What it does: This is important for the
nervous system, skin, eyes, and for energy
production.
Sources include: eggs, organ meats
such as kidney and liver (although liver
should be restricted — see vitamin A)
and meat. Vegetarian sources include
mushrooms, whole grains, spinach and
fortified foods.
Phosphorus
What it does: This helps with bone and
teeth health, and also helps to release
energy from food.
Sources include: vegetarian sources
such as brown rice, bread, and oats, and
non-vegetarian sources such as meat, fish
and poultry.
Fat
We are commonly told to avoid fat, but
it is essential to our diet. It is a source of
energy, and also helps absorption of other
nutrients such as vitamins A, D and E.
Sources include: oils used for cooking
and salad dressings, avocados, oily fish,
seeds and nuts.
Protein
Protein is essential for the body’s growth
and repair.
Sources include: meat, poultry, fish and
eggs. However legumes, pulses and nuts
are excellent vegetarian sources.
FEATURE
SOME TRIALS
(AND ERRORS) IN
GOING DAIRY-FREE
T
he head of The Optimum Nutrition
Clinic at the Institute for Optimum
Nutrition (ION), Nicola Moore,
advises clients to avoid trying to fill
the gap left by dairy with replacement
products. “All of us can get stuck in how
we think about food,” she says. “But rather
than looking for like-for-like replacements,
which may not be the same taste-wise or
nutritionally, I would encourage clients to
find a new way of eating that allows them
to explore a whole range of different types
of food.”
But in reality, many find it hard to adapt
and that’s when some dairy-free products
can be useful. Two dairy-quitters told us
about their experiences.
MEL: “I gave up dairy around my mid-
twenties due to increasing symptoms
such as excessive phlegm, bloating, gas,
sore stomach, etc. At the time I was living
away from home with someone who
didn’t like dairy so it was much easier.
When visiting my parents, they would
try and support me with the purchase of
soy cheeses, etc. My extended family are
also very understanding and often have
alternatives for me.
“I actually found it very difficult to give
up initially. I was passionately in love with
dairy and had undoubtedly consumed
excessive levels! More and more, however,
I began to see the effect of not having
dairy and how much better I felt. I think it
took me about 10 years to be truly over it.
“I don’t have any problems eating out.
I think restaurants are so much more
aware of various intolerances so there
are plenty of options and restaurants will
make changes to their dishes on occasion.
I prefer soya milk for tea and coffee, and
coconut substitutes in cooking, yoghurt
etc.
“Since giving up dairy I have absolutely
noticed a difference; reduced bloating,
gas, nausea, diarrhoea and mucous/
phlegm.
“I do occasionally have a bit of dairy
— but it is predominantly cheese. I find
it hard to pass up a soft blue! However,
now I am very conscious of how much
I eat and will ensure I do not have any
dairy for a few days after at the very least.
For the most part I don’t have symptoms
or [have] very mild symptoms when I
consume cheese. I could not drink a glass
of milk or have a milkshake etc. at all as
this would give me immediate symptoms.”
AUTUMN 2017 | OPTIMUM NUTRITION 9
 FEATURE
LOUISE: “A couple of years ago, I started
getting acne — something I’d never
experienced before — accompanied
by rosacea, which is when the skin on
your nose and cheeks goes red. My
GP prescribed a cream, but there was
no attempt to investigate the cause —
although he did ask if I drank a lot of
alcohol, which I don’t.
“After a chance conversation with
a nutritional therapist, I took a food
intolerance test which to my surprise
showed a mild intolerance to dairy protein
[casein]. I’d rarely had any bloating or
symptoms I imagined an intolerance
might cause, but I thought I’d give it a go
— I thought it would be pretty easy to cut
out milk.
“In reality, it was so hard. What I quickly
found out was that dairy is in so many
things where you don’t expect to find it
— even beef-flavoured crisps! And I also
quickly realised how fundamental cheese
had been to my diet — and I really missed
it.
“I tried out lots of vegan cheeses,
experimenting with combining them with
flavours. But apart from a couple which I
quite like, I’m not a fan. Saying that, I am
LOOKING FOR A CREME DE LA CREME
Christian Billinghurst put his food processor through its paces to make three homemade
dairy-free creams that were destined to enrobe a savoury pasta sauce
P
reparing dairy-free creams using rice,
cashew or avocado should not pose
a problem for even the most novice
cook. The easiest of these three, however,
was rice cream. This required soaking two
cups of brown rice in three cups of water
overnight before draining it, rinsing it off
and then blending it with two cups of
water in a food processor.
Similarly, to make cashew nut cream,
cashews were soaked before being
blended — with a touch of lemon
juice and salt added for flavour. One
disadvantage, however, was that it did
thicken rapidly — so be careful that your
food processor doesn’t become stuck and
overheat. Increasing water content will
help avoid this.
Slightly more complex, avocado cream
involved blending garlic, lemon, water
and avocados before adding a splash
of soya milk to give the mix the desired
consistency.
To put all three to the test, they were
References:
1. food52.com/recipes/22349-basic-rice-
cream-vegan
10 OPTIMUM NUTRITION | AUTUMN 2017
“I no longer have post-
nasal drip and a blocked
nose at night. Now, if
I have a cheese-binge
my sinuses get really
blocked”
glad for them in a pizza every now and
then. But generally, I rarely buy them. I
prefer to go without and just occasionally
have normal cheese — if I have just a little
in one day, I can get away with it. If I eat
cow’s milk cheese for a couple of days,
the skin on my face gets sore and I get an
acne flare-up. After a weekend in Holland
and eating lots of cheese, my skin got
really angry and took weeks to calm down.
“After trying out various ‘milks’ I settled
on unsweetened almond milk, which I use
for cooking. It makes a decent semolina
pudding! I think if you aren’t afraid to
experiment and have access to online
tips, then it is possible to find other ways
of doing things. It never occurred to me
before that I could use olive oil to make
garlic bread.
then used in a savoury pasta sauce
following a single recipe, before being
judged back at the ION/Optimum Nutrition
office.
Whilst all three creams got nods
of approval, the avocado cream was
preferred for its strong, unique flavours.
Although avocado cream (usually made
by blending avocados and then adding
flavours such as vanilla or chocolate)
is increasingly being used for creating
dessert recipes such as ice cream and
chocolate mousse, it’s not something that
you might want to serve with your scones.
But for our pasta sauce, it did add a quirky
dimension. Avocado also contains a good
concoction of vitamins and minerals, as
well as healthy monounsaturated fatty
acids, which makes them a nutritionally
sound option.
The more traditional among us,
however, may prefer cashew nut cream
as this did well in terms of texture and
richness, and came close to resembling
2. thismessisours.com/recipes/how-to-make-
cashew-cream-gluten-free-vegan/
“My acne, rosacea, and even blepharitis
— an eye condition I had been living with
since my mid-twenties, and which had
worsened — now seem manageable.
“One other difference I have noticed is
that I no longer have post-nasal drip and
a blocked nose at night. Now, if I have
a cheese-binge my sinuses get really
blocked.
“There’s no medical evidence to show
that dairy was causing my problems — I
can only go by my experience. I also
realise there could be other factors at
large — I’ve started the menopause and
so hormones are probably a factor as well.
“I stay off cow’s dairy probably 99 per
cent of the time and goat’s and sheep’s
dairy 95 per cent of the time — although
I don’t seem to get the same reactions
with these anyway. If there is something
I really, really want I will have it. Saying
that, though, my sensory perception has
changed. I recently sniffed a cup of tea
that had milk in it and didn’t like the milky
smell at all. I now prefer almond milk in
my tea. But I might taste some cheese and
think it’s incredible! What I have found,
though, is that I don’t have to have it, and I
can live without it — mostly.”
dairy cream both in flavour and mouth-
feel. Cashews are also a good source of
protein, healthy fats, and vitamins E, K and
B6. The only down side is that it did need
a fair bit of seasoning, which could be a
disadvantage if you are looking to reduce
salt intake.
Our last cream, made from brown
rice, was a little underwhelming in
comparison to the other two, with some
testers noticing a ‘grainy’ taste. But it
was still pleasant enough although,
like the cashew cream, it also needed a
fair bit of seasoning. Nutritionally, rice
cream wouldn’t have the same benefits
as avocado or cashew creams, but as
brown rice is quite cheap to buy and can
be stored for a long time, it is a winner on
price and convenience.
What our home-spun test did show,
however, was that at least when it comes
to a comforting cream sauce, there are
great dairy-free alternatives that you don’t
need to be a chef to create.
3. www.peta.org/recipes/avocado-cream-
pasta/
 FEATURE

SAY CHEESE!
What we did: We put a selection of dairy-free cheeses to a taste test.
How we did it: Cheeses were selected for variety and not to make direct comparisons. Ten tasters rated the cheeses for taste, appearance,
texture, and overall palatability when heated. Scores were given from 1 (low) to 5 (high), and then averaged out.

(Cheeses were eaten on their own, or with plain crackers. The scores and comments reflect tasters’ individual opinions. It was noted that cheese is often
used as an ingredient in a recipe, and that some varieties might be preferred when eaten with other ingredients. Price was not taken into consideration
when ranking products.)

Name of cheese We paid Taste Texture Appearance Score when Nutrition: Allergens/ Best comments
(Ranked in order (prices melted Protein (per 100g as
of overall average may vary) labelled)
scores)

Average score out of 5

Follow Your Heart £3.29 3.9 3.4 4.3 3.3 No allergens Taste winner
Smoked Gouda (200g) Protein: 0g “Nice, smokey after-taste”
“Melted nicely”
Style Slices
Tesco free from £2.25 3.3 3.2 4.0 4.0 Contains oat fibre & Price winner/Melted winner
Milk, Gluten & (200g) soya “Spicy, flavour mellows when
Protein: 0.5g melted”
Wheat Jalapeño & “Nice after-taste”
Chilli Cheddar
Sheese Greek £2.69 3.2 3.5 3.9 3.5 Contains soya “Tangy flavour which
Style (200g) Protein: 0.7g mellowed when heated“

Violife Cheddar £2.79 3.1 2.6 4.2 3.3 No allergens “Would be good in a burger or
Flavour Slices (200g) Protein: 0g on toast”

Vegusto Herb £4.99 2.7 2.3 3.0 3.3 Contains nuts “Flavour was dramatically
Cheese (200g) Protein: 3.4g enhanced with heating”
“Became creamy when
heated”

Follow Your Heart £4.69 2.4 2.5 3.0 3.1 No allergens “Melts very nicely”
Vegan Gourmet (227g) Protein: 0.7g “Could possibly be good in a
mac and cheese”
Shreds

VBites Cheezly £2.29 1.7 2.0 2.0 1.9 Contains soya

Mozzarella style (200g) Protein: 5.4g

Cicioni £7.75 1.3 1.5 1.0 1.3 Contains nuts Protein winner
(160g) Protein: 16.7g

AUTUMN 2017 | OPTIMUM NUTRITION 11

RESEARCH UPDATE

This summer, a study published in the online journal BMJ Open1 revealed that long-term use of
commonly-prescribed proton pump inhibitors (PPIs) was associated with a higher risk of early
death. Lisa Patient looks at what recent research says about both PPIs and acid reflux

S
ometimes prescribed for the
treatment of gastric ulcers, bacterial
infection Helicobacter pylori, and
diseases such as Barrett’s oesophagus (a
non-cancerous complication of chronic
acid reflux that can develop into cancer in
some people), PPIs are most commonly
prescribed for acid reflux.
Known as gastro-oesophageal reflux
disease (GORD); the symptoms of acid
reflux include heartburn, an acid taste
in the mouth, bad breath, bloating,
nausea and/or vomiting. Whilst PPIs
have been shown to be effective in
treating the condition, recent studies
indicate that long-term use may have
serious consequences. For this reason,
the team behind the latest research
has urged caution over prescribing PPIs
unnecessarily.
Researchers at the Washington
University School of Medicine, USA,
studied more than 250,000 medical
records of people taking PPIs or H2
blockers. While PPIs inhibit the enzymes
necessary for acid production in the
stomach, reducing it to around 10 per cent
of normal acid production, H2 blockers
reduce the amount of histamine (which
stimulates acid production) released
in the stomach. The team found that,
compared with H2 blocker use, PPI
use was associated with a 25 per cent
heightened risk of death from all causes
— a risk that increased the longer PPIs
were taken.1
According to the BMJ, the research
“indicated a link between PPI use and a
heightened risk of chronic kidney disease/
kidney disease progression, dementia,
Clostridium difficile infections, and bone
fractures in people with brittle bone
disease (osteoporosis).” And although
the research was not conclusive, evidence
suggested that PPIs “may boost the risk of
tissue damage arising from normal cellular
processes, known as oxidative stress,
as well as the shortening of telomeres,
which sit on the end of chromosomes and
perform a role similar to the plastic tips on
the end of shoelaces”.
Although the study did not attribute
the deaths to any one side-effect, senior
author Ziyad Al-Aly, a kidney specialist,

12 OPTIMUM NUTRITION | AUTUMN 2017


In 2013, a US study of
over 25,000 medical
records concluded
that long-term PPI use
could lead to vitamin
B12 deficiency
had previously co-authored a 2016 paper
which concluded that PPIs increased the
risk of kidney decline, chronic kidney
disease, and kidney failure.2
Because this latest study was
observational, its conclusions should be
treated with caution; it only established
association and not cause and effect —
the team did not have data on causes of
death. But Al-Aly said: “No matter how
we sliced and diced the data from this
large data set, we saw the same thing:
There’s an increased risk of death among
PPI users.
“For example, when we compared
patients taking H2 blockers with those
taking PPIs for one to two years, we found
those on PPIs had a 50 per cent increased
risk of dying over the next five years.”3
Research has also indicated an
association between increased risk
of mental health issues and PPI use,
particularly in the elderly. A cohort study
in Germany of more than 3,000 people
aged 75 and above found a “significantly
increased risk of any dementia and
Alzheimer’s disease” in those people
taking PPIs.4 However it is worth noting
that a 2016 Japanese study of 175
PPI-users found that people who didn’t
respond well to PPI therapy developed
mental health disorders, sleep disorders
and psychological distress due to the
symptoms of GORD, whereas those who
fully responded to PPIs did not.5
Vitamin B12
In 2013, a US study of over 25,000
medical records concluded that long-
term PPI use could lead to vitamin B12
References:
1. Xie Y et al (2017). Risk of death among users
of proton pump inhibitors: A longitudinal
observational cohort study of United States
veterans. BMJ Open, 7(6), e015735.
2. Xie Y et al (2016). Proton pump inhibitors and
risk of incident CKD and progression to ESRD. J
of the Am Soc of Nephrol, ASN-2015121377.
3. medicine.wustl.edu/news/popular-heartburn-
drugs-linked-higher-death-risk/
4. Haenisch B et al (2015). Risk of dementia in
elderly patients with the use of proton pump
inhibitors. Euro Arch of Psy & Clin Neurosc,
265(5).
deficiency.6 This is because stomach acid
is necessary to separate vitamin B12 from
proteins in food, which is the first step in
vitamin B12 absorption. But PPIs reduce
stomach acid, making less available for
the job. Vitamin B12 deficiency can lead
to fatigue and mental health issues such
as depression, so the NHS currently
recommends PPI-users be checked for
vitamin B12 deficiency.
However, changing lifestyle habits
could potentially reduce the need for
PPIs. One review of lifestyle and dietary
factors stated that the most important
factors for reducing symptoms of GORD
were reaching a healthy weight and giving
up smoking. The review cited trials that
had found that eating an earlier evening
meal and raising the head end of the bed
could reduce symptoms of night-time acid
reflux.7
It may also help to split main meals
into smaller meals. A study from Poland
involving 512 volunteers found that
eating just one or two large meals a day
increased the incidence of acid reflux.8
The researchers linked this finding
to the theory that eating large meals
causes stretching of the stomach walls,
which weakens the function of the lower
oesophageal sphincter — the job of which
is to keep acid in the stomach.
Triggers
The bad news for some is that one trigger
for acid reflux is chocolate. A very small
trial in 2001 on seven GORD patients at
the University of Michigan found that
chocolate significantly increased the
number of reflux events for all seven
Stomach acid causes
small proteins to
be released in the
oesophagus, leading
to an inflammatory
reaction
5. Kimura Y et al (2016). Persistent reflux
symptoms cause anxiety, depression,
and mental health and sleep disorders in
gastroesophageal reflux disease patients. J of
Clin Biochem and Nutr, 59(1), 71-77.
6. Lam JR et al (2013). Proton pump inhibitor and
histamine 2 receptor antagonist use and vitamin
B12 deficiency. JAMA, 310(22), 2435-2442.
7. Ness-Jensen E et al (2016). Lifestyle
intervention in gastroesophageal reflux disease.
Clin Gastroent and Hepatol, 14(2), 175-182.
8. Jarosz M & Taraszewska A (2014). Risk factors
for gastroesophageal reflux disease: the role of
RESEARCH UPDATE
PPIs versus H2 blockers
PPIs inhibit the enzymes necessary
for acid production in the stomach,
reducing it to around 10 per cent of
normal acid production. H2 blockers
reduce the amount of histamine
(which stimulates acid production)
released in the stomach.
patients.9 This is because chocolate
stimulates the release of large amounts
of the neurotransmitter serotonin in
the intestines, which causes the lower
oesophageal sphincter to relax and open
up a small amount, allowing acid to enter
the oesophagus from the stomach.
Another recent study into food triggers,
this time from Korea, found that hot spicy
stews, rice cakes, ramen noodles and fried
foods were the main culprits, followed
by doughnuts, breads, coffee, pizza, and
hotdogs.10 But large-scale studies into
trigger foods appear to be rare.
Inflammation
Recently, the understanding of acid reflux
was challenged by a paper published in
JAMA. In earlier rat studies, it was found
that it took several weeks for acid released
into the oesophagus to cause damage,
rather than burning as soon as the acid
made contact (as it would with a chemical
burn). This led the research team to
look into the mechanism more closely
using 12 human subjects; concluding
that stomach acid causes small proteins
called cytokines to be released in the
oesophagus, leading to an inflammatory
reaction, rather than a chemical burn.11
This line of research may lead to an
alternative way of dealing with acid reflux,
using anti-inflammatory foods such as
those high in antioxidants and omega-3
fats, alongside practical dietary advice
which should include guidance on eating
smaller meals and avoiding common
trigger foods.
diet. Przeglad Gastroent, 9(5), 297.
9. University of Michigan Health System. (2001).
Study offers hope for chocolate-loving reflux
disease sufferers. www.sciencedaily.com/
releases/2001/05/010523072217.htm
10. Choe J et al (2017). Foods inducing typical
gastroesophageal reflux disease symptoms in
Korea. J of Neurogastroent and Motility, 3(3):363-
369.
11. Dunbar KB et al (2016). Association of
acute gastroesophageal reflux disease with
esophageal histologic changes. JAMA, 315(19),
2104-2112.
AUTUMN 2017 | OPTIMUM NUTRITION 13
RESEARCH UPDATE
Research has led to a call for the NHS to fund supplements to slow down macular degeneration
T
he association between eye health
and nutrition is not new; we only
need think of when children would
(falsely) be told that eating carrots would
enable them to see in the dark. Certainly,
carrots are a good source of beta-carotene
(a pre-cursor for vitamin A), which has
been found to be beneficial for eye health,
but it won’t give us cats’ eyes!
Preventing ‘wet’ macular degeneration
More recently, however, the BMJ reported
how new research published online in
the British Journal of Ophthalmology1 has
proposed that a supplement combining
antioxidants with zinc and copper would
be “a relatively inexpensive and effective”
means to halt the progression of the ‘wet’
form of age related macular degeneration
(nAMD).
According to the research team, which
included specialists based in the UK
and US, such supplements — which are
already commercially available — should
be funded by the NHS for people who
already have nAMD in one eye.
In nAMD, abnormal blood vessels grow
underneath the retina. These vessels can
leak fluid and blood, which can damage
the macular (the part of the retina
responsible for central vision). According
to the researchers, medical interventions
currently used to treat the condition
are expensive and have been linked to
heightened risk of inflammation of the
inside of the eye (endophthalmitis) and
possibly an increased risk of stroke.
Two types of supplement were assessed
in treating people with early stage disease
in one eye (category 4) or both eyes
(category 3), and compared with people
not given either supplement.
The findings, which were based on data
from the Age Related Eye Disease Study
(AREDS), UK treatment costs, and AMD
prevalence figures for people over the age
of 55, concluded that a daily supplement
14 OPTIMUM NUTRITION | AUTUMN 2017
combining high-dose antioxidants and
zinc lowered the risk of developing nAMD.
Formulation 1 contained high doses of
vitamins C and E, beta-carotene, zinc and
copper; in formulation 2, beta-carotene
was replaced with lutein and zeaxanthin,
but the other constituents remained the
same.
An analysis showed that both
formulations would be cost-effective for
treating patients with early stage nAMD,
but would be more cost-effective for
those with the condition in just one eye.
While savings could be made by giving
supplements to people with intermediate
stage nAMD in both eyes, the argument
for funding them for people with the
condition in one eye was “extremely
strong”.
Savings
The researchers calculated that, over
the course of a lifetime, patients given
supplements would need nearly eight
fewer injections of anti-VEGF therapies
into their eye, representing a cost-saving
to the NHS of nearly £3,000 per patient,
adding up to around £131 million a year.
It was also proposed that patients
given this treatment would gain additional
time lived without impaired vision.
The researchers wrote: “Given the
burden and cost of treatment, prevention
of nAMD seems, therefore, an attractive
strategy to avoid the chronic and costly
anti-VEG[F] therapies, and preserve visual
function.”
Although recommending supplements
for category 4 patients as a “dominant
cost-effective intervention”, the
researchers did point out that successful
treatment would depend upon patients’
commitment to taking the supplements.
None of the authors declared any
personal financial interest in AREDS or
nutritional supplement products.
While the findings show a positive case
for supplementation, however, this should
only be undertaken with the supervision
of a qualified healthcare professional. The
NHS states: “Taking high doses of zinc
reduces the amount of copper the body
can absorb. This can lead to anaemia and
weakening of the bones.”2
Organic benefit
Lutein, one of the components of
formulation 2, has long been associated
with eye health. Along with zeaxanthin,
it has been found to help protect against
dry macular degeneration (AMD), and
is readily available through green leafy
vegetables, carrots, sweetcorn and eggs.
However, when it comes to lutein
content, not all eggs are created equally.
This is because lutein does not naturally
occur in eggs and only finds its way into
them through marigold in chicken feed,
where it contributes to the yellow colour
of the yolk. If an egg producer uses a
synthetic pigment in the chicken feed,
then the eggs will not contain lutein.
A spokesperson for egginfo.co.uk told
Optimum Nutrition: “Not all eggs will
contain lutein in the UK — our main cereal
which is used in hen feed, wheat, has no
colourant unlike maize as used in the USA,
for example, which does.
“Individual producers are free to choose
if they wish to use natural pigments
across all production types or synthetic
ones. However, organic regulations
specify that you cannot use synthetic
pigments so by default the colourant used
will be marigold.”
References:
1. Lee AY et al (2017). Cost-effectiveness of
age-related macular degeneration study
supplements in the UK: combined trial and
real-world outcomes data. British J of Ophthalmol
bjophthalmol-2017. bjo.bmj.com/content/
early/2017/08/26/bjophthalmol-2017-310939
2. www.nhs.uk/Conditions/vitamins-minerals/
Pages/Other-vitamins-minerals.aspx#zinc
AUTUMN 2017 | OPTIMUM NUTRITION 15
FEATURE
The modern breakfast is becoming an increasingly rushed affair, so Amelia Glean looks at the
health implications of hurrying what is still often called ‘the most important meal of the day’
T
he American writer John Gunther is
reputed to have said: “All happiness
depends on a leisurely breakfast.”
So why does the average Brit spend just
six minutes and 29 seconds wolfing down
their morning meal?1
The answer, however, could be as much
about the type of breakfast foods we are
choosing to eat, as it is about the speed at
which we are devouring them.
This is because the stereotypical Brit,
sat at the breakfast table with a home-
cooked breakfast, is becoming a figure of
the past, as convenient, on-the-go items
see an increase in sales.2 A survey by the
hotel chain Travelodge found that, these
days, convenience is king; with Londoners
16 OPTIMUM NUTRITION | AUTUMN 2017
preferring to munch on instant porridge,
southerners being partial to cereal options
like cornflakes, and a bacon sandwich
being favoured in the North East.1
Breakfast al-desko
Jane Bains, a nutritional therapist at The
Food Therapy Practice in Harpenden,
says many of her clients tend to opt
for quick and easy, on-the-go options,
typically purchased from a coffee shop or
a convenience store. “These include cereal
bars, muffins, croissants and coffee, or
instant porridge oats you can buy in pots.”
What these foods have in common is that
they can all be eaten when walking or sat
at a desk.
But how do these choices differ from
the British breakfast experience 50 years
ago?
Flahavan’s, a porridge oat producer,
found that a typical ‘60s breakfast would
have included home-cooked food such
as stove-cooked porridge, fresh boiled
eggs and soldiers, and toast and jam.3
Furthermore, says Bains: “Breakfast in the
‘60s would have seen families spending
more time sitting down together.
“This would involve preparing, planning,
and sitting at a table to eat and having a
conversation.
“Now, that seems to have disappeared,
people seem to sit and eat in isolation and
they don’t have that shared conversation

at the start of the day.”
According to Bains, as individuals, we
are less time-rich than 50 years ago.
This means a leisurely breakfast is often
abandoned to do a long commute, or in
favour of logging extra hours at work, or
just spending more time in bed due to
over-exhaustion.
“People are primed to be more
productive now, to multi-task,” she says.
“Very rarely do you have one partner
preparing the breakfast for the rest of the
family as it used to be. Instead, breakfast
has become an afterthought and the
stress we are loading onto ourselves is not
helpful.”
Lost tradition
Yet while a relaxed, homemade family
breakfast is a somewhat lost tradition
in most UK households, it is still a
fundamental aspect of the daily routine in
many other countries.
Egyptian-born Youssef Rizkana, a
London-based law student, says that
in Egypt, breakfast is still a great social
occasion and features many traditional
foods.
“A typical breakfast would include eggs,
falafel, freshly-made Egyptian bread,
cheeses, Egyptian beans called ‘foul’, and
salad,” he says.
“We eat this breakfast together at
the dining table at 7am every morning
before my dad goes to work, even if it is
the holidays and my brothers don’t have
school.“
Due to the nature of his degree, Youssef
has spent half the year in Egypt and half
in the UK for the last four years, giving
him the opportunity to compare the
real differences between both breakfast
experiences.
“Breakfast in Egypt is much more of a
social event than in the UK because all
“Britons are among
one of the nationalities
most likely to skip
breakfast... two
thirds of us do not eat
breakfast at all”
References:
1. Travelodge (2016). Britons’ breakfast choices
highlight a big north v south taste divide. www.
travelodge.co.uk/press-centre/press-releases/
Britons-breakfast-choices-highlight-big-north-
south-taste-divide
2. FoodDIVE (2016). The biggest driver of
sales growth in 2016: Convenience. www.
the family eats together and we all clean
up after the meal has ended. In the UK,
breakfast isn’t such a priority. I know that
many more people skip their breakfast,
but in Egypt that is rare.”
Indeed, a survey conducted by the food
company Dr Oetker suggests that Britons
are among one of the nationalities most
likely to skip breakfast, finding that two
thirds of us do not eat breakfast at all.4
Advocates of intermittent fasting
might say that this is a good thing —
as emerging research suggests that
avoiding breakfast may increase fat loss
and decrease inflammation — but such
benefits may depend on the individual’s
motive for skipping their morning meal,
says Bains.
“If someone is skipping breakfast
in order to make time for other
commitments, without being mindful
about how they are fuelling their bodies
later in the day, that is not helpful,”
she says. “But if avoiding breakfast is
a decision made in order to follow a
programme of intermittent fasting, then
the benefits may be seen.”
Haste = stress
Bains is less forgiving when it comes to
rushing breakfast, which she says triggers
our fight or flight mode, also known as our
stress response.
“Rushing breakfast means blood is
diverted out of the gut and transferred to
our muscles and our brain. Consequently,
our digestive health is compromised for
which the physical effects are likely to be
heartburn, bloating, and potential food
intolerances.”
Bains highly recommends allocating
time each morning just to eat breakfast,
as she believes this will trigger a number
of positive health effects.
“If you look at studies on longevity, one
of the similarities across other countries
is that social aspect of eating, sitting and
taking your time, and making it a priority,
rather than just something added onto
your day,” she says.
“This is something we have moved
away from in the UK. But now that we
are starting to experience more digestive
issues, I think to move back to that kind of
eating would be profound.”
But apart from not being great for our
fooddive.com/news/convenience-food-sales-
growth-2016/433092/
3. Flahavan’s (2013 & 2016). The Flahavan’s
Breakfast Survey. www.facebook.com/notes/
flahavans/nationwide-survey-uncovers-shift-
in-how-we-approach-breakfast/64584195878
9086/?fref=mentions
FEATURE
“If you look at studies
on longevity, one of
the similarities across
other countries is that
social aspect of eating,
sitting and taking time”
digestion, some on-the-go breakfasts can
also be nutritionally inferior to home-
prepared foods.
“Quick and easy options are typically
lacking in nutrients such as protein,
essential fats, minerals and other vital
ingredients, which isn’t helpful,” says
Bains. “Packaged foods are also likely to
contain ingredients that wouldn’t have
typically been used in a home-cooked
breakfast, such as refined grains and lots
of sugar. In the long term, eating these
types of foods are likely to contribute to
chronic inflammatory conditions, such as
diabetes and obesity.”
Correspondingly, a Diabetes UK review
looking at the sugar content of popular
cereal bars marked nine out of 10 as red
on the traffic light scale, as sugar content
ranged from 4g-13.3g of sugar per bar,
and many contained some form of added
sugar.5 Four bars contained more than 10g
of sugar — something to keep in mind
considering the maximum recommended
daily intake of sugar for a child is just 24g,
and 30g for adults (4g sugar = one tsp).
Be prepared
Bains recommends batch cooking to
ensure breakfast comprises a healthy
variety of nutrients. It can also be a lot
cheaper than buying something on the go.
“I ask a lot of my clients to batch cook
at the weekend. Little egg muffins are
great for this. Just grease a tray, beat the
eggs and pour them into the moulds, add
in some vegetables and then bake them
lightly for 10-15 minutes. These can be
kept in the fridge and grabbed before
work,” she says.
“Another on-the-go option would be
a homemade smoothie, with ingredients
like a spoonful of whey protein, natural
yoghurt, spinach, nut butter, fresh or
frozen berries and water or milk.”
4. Dr Oetker Onken (2012). Great British Breakfast
Survey. www.mediplacements.com/article-
19731847-dietician_issues_breakfast.html
5. Diabetes UK (2017). Cereal Bars. www.diabetes.
org.uk/Guide-to-diabetes/Enjoy-food/Eating-
with-diabetes/Diabetes-food-myths/Cereal-
bars/
AUTUMN 2017 | OPTIMUM NUTRITION 17
FEATURE
RETHINK YOUR BREAKFAST!
B
reakfast doesn’t have to be
complicated and these simple
takes on classics, by American food
blogger and author of The Colorful Kitchen,
Ilene Godofsky Moreno, will set you up for
the morning. These recipes are suitable
for vegetarians and anyone avoiding dairy.
The Colorful Kitchen: Simple Plant-Based
Recipes for Vibrancy, Inside and Out is
available on the 12th December, published
by BenBella Books.
ISBN-10: 1944648410
Visit Ilene’s website at:
Thecolorfulkitchen.com
JAZZY AVOCADO TOAST
TOTAL TIME: 5 MINUTES
MAKES: 2 SERVINGS
INGREDIENTS
• 2 slices of bread
• 1 avocado, sliced
• Juice of ½ lemon
• 2 tbsp pumpkin seeds
• Dash of red pepper flakes
• Dash of smoked paprika
• Dash of sesame seeds
• Dash of salt
• Dash of black pepper
METHOD
1. Toast the bread.
2. Layer the avocado slices on the toast.
3. Drizzle the lemon juice over the
avocado. Sprinkle the pumpkin seeds, red
pepper flakes, sesame seeds, salt, and
black pepper on top, to taste.
18 OPTIMUM NUTRITION | AUTUMN 2017
CLASSIC TOFU SCRAMBLE SWEET POTATO TOAST
TOTAL TIME: 45 MINUTES TOTAL TIME: 5 MINUTES
TIME: 15 MINUTES MAKES: 2 SERVINGS
MAKES: 4 SERVINGS
INGREDIENTS
INGREDIENTS • 2 slices of bread
• 1 (14oz/about 113g) pack firm tofu • 1 tbsp olive oil
• 1 tbsp olive oil • 1 handful baby spinach
• 1 small red onion, diced • 1 cup mashed sweet potato (both warm
• 1 clove garlic, minced and cold are delicious — leftover sweet
• 1 cup sliced button or cremini potato works well)
mushrooms • 2 tbsp sunflower seeds
• 2 cups baby spinach • 2 tbsp tahini
• 1 cup cherry tomatoes, sliced in half • 1 tbsp chopped fresh parsley
• 4 tsp tamari (or to taste) • Salt and black pepper, to taste
• 2 tbsp nutritional yeast
• ½ tsp ground turmeric METHOD
• ½ tsp paprika 1. Toast the bread.
• Salt and black pepper, to taste 2. Drizzle the olive oil on the toast. Spread
the spinach on top, then add the sweet
METHOD potato.
1. Cut the tofu into 2.5cm/1” slices. On 3. Sprinkle the sunflower seeds and drizzle
a cutting board, layer the slices between the tahini on top. Finish by topping with
paper towels or clean dishcloths. Place the parsley, salt, and pepper.
a heavy item (e.g. a kettle filled with
water) on top (or use a tofu press if you’ve
got one). Let the tofu sit for at least 30
minutes (or overnight for extra-amazing
texture). This will remove the excess
water from the tofu and give the scramble
a better texture.
2. Heat the olive oil in a pan over
medium heat. Add the onion, garlic, and
mushrooms and cook for 5 minutes,
stirring occasionally. Add the spinach and
cherry tomatoes and cook for about 2
more minutes, until the spinach wilts.
3. Use your hands to crumble the tofu
slices into the pan. Add the tamari,
nutritional yeast, turmeric, paprika,
salt, and pepper. Stir until everything
is combined, and cook for another 3–5
minutes, until the mixture is heated
through.
4. Transfer to plates and enjoy.
 FEATURE

As shared by nutritional therapists at the Institute for Optimum Nutrition

THE RESTED GUT, FASTING OPTION

Nothing

THE SMOOTH CHOICE

Smoothie with whey protein, frozen berries, half a banana, non-dairy milk & kale
Smoothie blended with almond butter, berries, natural yoghurt or almond milk
Smoothie made with berries, courgette, spinach, protein powder, acai, hemp milk,
flaxseeds, & a few porridge oats

FEELING FRUITY?
CARROT CAKE PORRIDGE Stewed apple with raisins & cinnamon, served with natural or Greek yoghurt
Grated apple mixed with ground flaxseeds, maca powder, cinnamon, served with
TOTAL TIME: 10 MINUTES coconut yoghurt, topped with nuts and seasonal berries
MAKES: 2 SERVINGS Seasonal choice: foraged wild plums, blackberries, & elderberries served with a
crumble of homemade blended granola & seeds
INGREDIENTS Fruit salad with plain bio Greek yoghurt, with ground seeds or homemade granola
• 1 cup rolled oats
• 1 cup non-dairy milk QUICK COMBOS
• 1 cup water Feta or cottage cheese, served with sliced tomato & avocado
• ½ cup shredded carrot Oatcakes topped with mashed banana, served with a sprinkling of milled seeds
• ¼ cup raisins Porridge ‘zoats’ (grated courgette) mixed with tahini, butter, & nuts (Brazil,
• ½ tsp vanilla extract walnut, hazelnut), flavoured with cinnamon, ginger, mace, barley grass, & flaxseed
• ½ tsp cinnamon
• ¼ tsp mixed spice OATY OPTIONS
• Dash of salt Porridge flavoured with summer fruits, served with Greek yoghurt & pine nuts
Toppings Jumbo oat porridge, with chopped apples, served with mixed seeds and flax
• 2 tbsp maple syrup
• ¼ cup chopped walnuts INDULGENT EGGS
• 2 tbsp shredded coconut Poached egg served with wilted spinach & avocado, or with steamed broccoli
Omelette filled with feta cheese, tomato, & watercress
METHOD Crispy fried egg with avocado, roasted cherry tomatoes, & a helping of raw
1. In a small pot over low heat, bring sauerkraut
the oats, non-dairy milk, and water to a Smashed avocado with chilli and lime, served on gluten-free toast,
simmer. topped with a fried egg (fried in coconut oil).
2. Stir in the carrot, raisins, vanilla extract, Served messy but delicious, with drizzling runny yolk
cinnamon, mixed spice, and salt. Continue Poached eggs with gently sautéed green plantain, steamed kale & tomato,
to simmer, stirring occasionally, until all followed by sauerkraut or kimchi
the liquid is absorbed (7–10 minutes). Speedy egg & banana pancakes with seeds & blueberries,
3. Transfer to bowls, drizzle with maple served with yoghurt & fruit
syrup, and add the walnuts and coconut “Indian eggs” made with two organic eggs, scrambled in coconut oil with red
on top. onion, garlic, cherry tomatoes and spinach, seasoned with garam masala, cumin,
turmeric and chilli powder
Optimum Nutrition tip
Using raisins can mean taking in a lot PACKING PROTEIN
of sugar because they are easy to eat in Smoked salmon with a boiled egg, spinach or watercress
large quantities! If you want to reduce the Roasted chicken breast served with steam-in-the-microwave vegetables
overall sugar content of your porridge, Salmon or prawns dressed in tamari (gluten-free soy sauce), sesame oil, a quick
use fewer raisins but chop them up before grating of fresh ginger, and a crack of black pepper. Served with a little leftover
adding them to the pan. rice/black rice, soya beans or peas, & avocado
Sardines & avocado on gluten-free brown rice sourdough/flaxseed toast
With thanks to ION nutritional therapists
for their breakfast ideas (right): Shirley
Briars, Valentina Cartago, Katie Clare, Kate Tweet us at #ion_nutrition to tell us about your own breakfast choices!
Delmar-Morgan, Shirley Edwards, Nicola
Moore, Ruth Taylor, Natascha Van Zyl, Paula
Werrett and Maria Zaretti.

AUTUMN 2017 | OPTIMUM NUTRITION 19

INTERVIEW

Catherine Morgan speaks to

‘nutritional therapist to the
stars’ Amelia Freer

20 OPTIMUM NUTRITION | AUTUMN 2017


W “By walking around
ith an Instagram following
of more than 118k, A-list
celebrities beating a path to
her clinic door, and three best-selling
nutrition books under her belt, Amelia
Freer could be described as a poster-
woman for healthy eating. It would also
be easy to label her as part of the so-
called ‘clean-eating’ movement that took
the UK by storm, and which has more
recently seen a negative backlash. But as
a qualified nutritional therapist — she is
an alumna of the Institute for Optimum
Nutrition (ION), which is also the home
of Optimum Nutrition — Amelia is clear on
the difference between an enthusiastic
blogger and a qualified professional.
Common sense
“We need to bring a little common sense
to the clean-eating debate,” she says.
“Firstly, probably the most important
step is to drop the ‘clean’ label, because
what may have started out as a phrase
used to describe a diet that was free from
highly-processed or refined foods has
now become a value judgement with a
whole lot of emotional baggage attached
to it. This is unhelpful for everyone.
“Secondly, although the media may
have portrayed me as a part of the trend,
I would have to disagree. I am a qualified
and experienced nutrition professional
— and I take my role in promoting
the importance of good nutrition very
seriously indeed.
“I therefore feel that I am a different
entity to many of the other bloggers or
Instagram stars, who promote overly
restrictive nutrition and an unhealthy
body image, without any background in
nutritional science.”
The less savoury side of the clean-
eating movement is something that
Freer touches upon in her third best-
seller, Nourish and Glow: The 10-Day Plan,
writing that although the clean-eating
movement has “in some ways, been a
step in the right direction — with good
nutrition taking centre stage and easier
access to whole food ingredients” it “has
also created a lot of anxiety, fear and
confusion around food”.
Good nutrition, she believes, should
be a positive experience. Rather than
simply cutting foods out, she advises
clients or readers to take time to explore
the supermarket and look at all the good
things that are available.
“By walking around the supermarket
constantly telling yourself ‘don’t have
that’, ‘you can’t eat that’, ‘ignore that’, it
becomes a very negative experience,” she
says.
Freer also recognises that eating well
the supermarket
constantly telling
yourself ‘don’t have
that’, ‘you can’t eat
that’, ‘ignore that’,
it becomes a very
negative experience”
isn’t something that everyone can do
overnight, which is why her book covers
some of the psychological and social
aspects that surround food — “so it’s
great for emotional or stress eaters”.
Nourish & Glow, she says, is based on
a modified Mediterranean diet and “is a
great place to start for anyone looking to
improve their nutrition, but particularly
as a first line intervention for people
managing chronic symptoms or disease”,
as well as those who might want to
improve their weight. However, she adds:
“When people find that they need a little
more than this book offers, I encourage
them repeatedly to seek out professional
nutritional support.”
Igniting a passion
Looking at Freer’s glowing image smiling
out from the cover, it would be all too
easy to imagine that she has never had
to struggle with her own health. But like
many of her fellow ION graduates, Freer
discovered nutritional therapy when she
used it to improve her own health. But
even then, it did not come to her straight
away; she has spoken openly about being
initially resistant to suggestions that
there might be any connection between
what she ate and the way she felt. It was
only when she eventually tried nutritional
therapy for herself that it became her
passion.
“I think when you have experienced
first-hand what a difference good
nutrition can make to not only how you
look, but also how you feel, how you
sleep, how much energy you have and
your overall health, it is hard not to also
develop a passion for it,” she says. “The
best thing is definitely the satisfaction
of seeing a client transform their health
by changing their nutrition — with the
positive effects often sending ripples out
to all sorts of unexpected other areas of
their lives.”
But whilst Freer is passionate about
nutritional therapy, her glamorous image
is one that, for some, may imply ‘elite’.
Before studying at ION and changing
INTERVIEW
her career path, Freer worked as a PA to
Prince Charles; today she has a celebrity
partner (businessman and Dragons’ Den
star Nick Jenkins), and advises the likes
of Victoria Beckham and Sam Smith (she
does not discuss her clients, but many
have openly praised her). As she rubs
shoulders with the rich and famous, it
would be easy to assume that nutritional
therapy isn’t for the those of us who
could not afford her fees.
Currently, despite advocates such
as the BBC’s Doctor in the House, Dr
Rangan Chatterjee, nutritional therapy is
not available through the NHS and can
usually only be accessed through private
practitioners. But it is something that
Freer thinks should be more widely-
available.
“With the burden of chronic disease
that the NHS is facing, much of it
lifestyle-related, I can’t help thinking
that we cannot afford not to widen the
reach,” she says. Whilst she recognises
that integration of nutritional therapy into
the NHS would take greater regulation,
and standardisation of training and
professional development, she says that
it is her “dream” to see nutritional advice
available through every GP surgery before
too long. “I know many doctors who
are waking up to the power of nutrition
within healthcare, and they will need
the support of nutrition professionals to
deliver those services both to individuals
and to groups of patients.”
She dismisses the idea that good health
need be expensive, and that to eat well
it is essential to fill our cupboards with
expensive, exotic-sounding ingredients.
“Of course, these expensive ingredients
are not essential for healthy eating. Our
grandparents did not have access to
them, and yet many of them managed a
seasonal, plant-based and balanced diet
with readily-available ingredients.”
Health for all
What she would recommend for
everyone is “vegetables in all their
glorious shapes, varieties and colours…
Almost everyone I have ever met would
benefit from adding a few more portions
of vegetables into their weekly diet, and
particularly if you choose ones that are
in season, they are also cheap and easily
accessible.”
It is not essential, either, to buy
expensive supplements. “I am relatively
reluctant to use supplements without
having a specific reason and goal in
mind,” she says. “So, if a client has
a measured nutritional deficiency,
or genetic polymorphism that has
good quality evidence to support
AUTUMN 2017 | OPTIMUM NUTRITION 21
INTERVIEW
supplementation, then I will use them
judiciously.
“But I always prefer the food first
approach initially — I think you can go a
long way with improving the diet alone.”
The individual approach
Equally, though, Freer emphasises that
there is no one-size-fits-all approach.
This may be hard to digest, considering
that long-standing government-backed
advice around food tends to adhere to
a set of standards — for example, in the
Eatwell guide, or in how many calories
we need to eat in a day. Part of this
confusion, she explains, is because of the
difficulty in creating advice for a general
population rather than individuals.
“National guidelines are written for
whole populations,” she says. “But
22 OPTIMUM NUTRITION | AUTUMN 2017
applying them to an individual person
in front of you is much harder — as, by
definition, a national guideline cannot
take into account every individual’s
unique circumstances. Understanding
this key difference — that national
dietary guidelines may be appropriate for
millions of people all lumped together,
but then simply applying national
guidelines to a particular client may be
inappropriate — is critical.”
For Freer, as for many nutritional
therapists, this may mean giving advice
that differs from current public health
guidelines; and she acknowledges that,
because of this, there can be confusion
over official guidelines and new
approaches. Yet she also acknowledges
that guidelines being a step behind can
also be a useful mechanism for safety.
“National guidelines
are written for whole
populations, but
applying them to an
individual person in
front of you is much
harder”
“Official guidelines will always lag
behind the latest research, and this is
often for good reasons.
“When new research emerges, it
needs time to be tested, questioned,
and the unintended consequences to
be unearthed. Sometimes new research
turns out to be wrong. Therefore, this lag
— rather than a source of frustration —
could also be seen as an important safety
mechanism.
“However, with experience, you
also gain the ability to take that newer
research and apply it to individual clients
in a safe and sensible way.”
And rather than getting frustrated that
her advice to a client may differ from
generic public health advice, she says: “I
simply explain this difference and stick to
my guns”.
 INTERVIEW

Although nutritional therapy addresses overall health,

it is Freer’s involvement in several celebrity weight-loss
transformations that has received more attention. When asked
about the old adage of weight-loss being controlled by calories
in versus calories out, she replies: “It is certainly a lot more
complicated than that!
“But there are no ‘secrets’ — it is entirely dependent on the
individual,” she says. “The most important things to think about
are the underlying drivers of excessive weight — which is very
rarely simply about food. For one person, it might be a stress
problem, for another, dysbiosis of their microbiome [imbalance
of gut bacteria].” In other words, it is important to look at factors
that might be driving weight-gain, and not just reduce calories.
It is perhaps unsurprising, then, that Freer does not
recommend any particular food or diet when we ask for her
top nutrition tips. Instead, she recommends a healthy dose of
balance and awareness.

Positive nutrition
One of the tools that Freer uses to help her clients is her positive
nutrition pyramid.
“The positive nutrition pyramid is an easy tool to help people
know what to eat, rather than focusing on what not to eat —
which I find many traditional diets are rather fixated on,” she
says.
“It is a simple collection of tick boxes which cover the major
food groups, encouraging people to eat a wide variety of
nutrient-dense foods each day.
“In practice, I find I am using it more and more — often
drawing it out individually or modifying the basic pyramid to suit
each client. They often stick it up on their fridge door, where it
not only acts as a gentle, healthy eating prompt, but it is also
really helpful for meal planning. I’ve now got some handy free
printables of the original pyramid up on my website too.”
Freer’s pyramid puts fluids/water at the bottom, reminding us
of the importance of keeping hydrated.
The second largest layer is for vegetables, then followed by
fresh fruit, protein, complex carbohydrates, healthy fats, and,
lastly, nuts and seeds.

Eat for health and happiness

“Eat 90 per cent of the time for your body and physical health,
and eat the remaining 10 per cent of the time purely for your
social and emotional health,” she says. “They are both equally
important.”
Secondly, she advises: “Pay attention to the effect that food
has on you. Eat more of what makes you feel vibrant and alive,
and less of what makes you feel sluggish and uncomfortable.
That’s a good place to start listening to the cues your body is
trying to tell you about your nutritional choices.”
And finally, don’t expect quick fixes — they usually aren’t
long-lasting. With regards to her own journey, Freer admits it
has been a slow process. Yes, she has transformed her eating
habits, developed a consistent exercise regime, learnt to
meditate, “cleaned up” her cosmetics towards more natural
ingredients, and even worked on a sensible work-life balance,
but, she points out, it certainly hasn’t happened overnight.
“I should point out that this has been a slow process. I think
in our time-pressured world where we want everything done by
yesterday, we can find ourselves drawn to ‘quick-fixes’, including
when it comes to health. But slow and sustainable definitely
wins this race.”
It’s sensible advice from one who knows; and — it’s worth
noting — it won’t cost anything to follow it.
Follow Amelia @AMELIA FREER www.ameliafreer.com

SUMMER 2017 | OPTIMUM NUTRITION 23

ON YOUR PLATE

Nourish & Glow: The 10-Day Plan is

Amelia Freer’s new, best-selling
book written to help readers lose
weight, feel great and kick-start a
lifetime of healthy eating. More than
a collection of recipes, it sets out
an approach for healthy eating for
life, and with easy-to-follow recipes
shows that good food can be tasty
— and simple
MAKES: 6 portions
1 portion = 30g/ about 2-3 tbsp
INGREDIENTS
• 180g mixed seeds
• 1 tsp light olive oil
• ¼ tsp chilli powder, or 1 tsp curry
powder
• A generous pinch of sea salt and a few
grinds of black pepper
METHOD
Preheat the oven to 170C/150C fan/
Gas 3. Combine all the ingredients in
a bowl and mix well together. Spread
out thinly on a lined baking sheet and
bake for 10 minutes. Stir, then bake for
a further 7-10 minutes. Watch them
carefully, though, during the second half
of the cooking — they can burn quickly,
depending on the strength of your oven.
Remove once they are golden brown.
Allow to cool completely and store in
an airtight container for up to 10 days.
MAKES: 2 portions
INGREDIENTS
• 1 tbsp light olive oil
• 1 small onion, peeled and diced
• 1 small stick of celery, diced
• 1 small red pepper, diced
• 3 cloves of garlic, peeled and sliced
• 240g lean beef mince
• 3 tbsp tomato purée
• 100g cooked Puy lentils
• 1 bay leaf (optional)
• 1 sprig of fresh thyme, leaves picked
(optional)
• 200ml water or chicken stock
• 2 handfuls of seasonal greens,
finely sliced
For the mash:
• 200g sweet potato, peeled and diced
into 2-3cm pieces
• 2-3 large carrots, peeled and sliced
• 1 tbsp extra virgin olive oil
• A pinch of salt
METHOD
Heat the olive oil in a saucepan and
sauté the onion, celery, pepper and
garlic for 5 minutes, until soft but not
brown. Push the veg to one side of the
pan, then add the beef and brown for
a few minutes, breaking up any lumps
with a wooden spoon.
Add the tomato purée, then add the
lentils, bay leaf, thyme and the water or
stock. Bring the mixture to a boil, then
turn down the heat and cover with a lid.
Simmer for 15 minutes, then uncover
and simmer for another 15 minutes,
stirring occasionally, until the sauce has
thickened. Taste and season.
Meanwhile, steam your sweet potato
and carrots until they are very tender,
about 20-25 minutes, depending on
the size of the chunks. Drain and mash,
adding a swirl of extra virgin olive oil
and a pinch of salt. Leave in the pan and
keep warm.
Just before serving, add the greens to
the beef mixture and stir until wilted/
cooked.
Swirl half the mash around the
bottom of a shallow bowl, then fill the
centre with half the beef and lentil
mixture.
Place the remaining half of the
mixture and the mash into a small
ovenproof dish and leave to cool down.
Refrigerate overnight. Tomorrow
evening, just reheat it in the oven
until piping hot before serving with a
handful of steamed or blanched green
vegetables (use whatever you have left
over).
Amelia says:
“We all need a hearty comfort meal
up our sleeves, and this is it for me:
creamy sweet potato mash with a
rich and tender beef filling, bulked
out with lentils for their added fibre,
plant protein and minerals. This is
usually a huge hit with the little ones
too!”

Amelia says:
“You can buy packets of
flavoured toasted seeds in super-
markets and health food shops, but
at great expense, and I always think
a homemade version tastes better.
It’s great to have a jar of them in the
cupboard, to throw on top of soups
or salads. I like a mix of pumpkin,
Photography credit: Susan Bell, 2017

linseed and sunflower seeds, but feel

free to use whatever you fancy — or
indeed, have in your cupboard! You
can always play around with the
flavours too — I sometimes make
them using a harissa spice mix, or
paprika, which is equally delicious,
so feel free to use whatever herbs
and spices you have lying around”

24 OPTIMUM NUTRITION | AUTUMN 2017

 ON YOUR PLATE

INGREDIENTS
• 100g smoked mackerel, skin and
bones removed
• Zest and juice of ½ a lime
• 3 tbsp finely chopped fresh coriander
• 1 fresh red chilli, deseeded and finely
chopped
• 2cm fresh ginger peeled and finely
grated
• 2 tbsp dairy-free coconut yoghurt (or
1 tbsp full-fat organic mayonnaise)
• 1 tbsp coconut aminos (available in
health food shops and online)
• 2 spring onions, finely sliced
• Sea salt and black pepper
To serve:
• 2 or 3 gluten-free oatcakes
• 1 apple, sliced
• 3 portions of raw vegetable crudités
(a handful of asparagus tips, some
endive leaves and ½ sliced pepper,
for example)
• 2 tbsp Spiced Seed Sprinkle (see page
24 for recipe)

METHOD
Mix all the pâté ingredients together with a
fork, tasting and seasoning accordingly.
Spoon the pâté into a bowl and serve
with the oatcakes, sliced apple, vegetable
crudités and a generous sprinkling of
toasted seeds.

Amelia says:
“This spicy, zingy take on
classic smoked mackerel pâté is a
sure-fire hit. I love it in a bowl for
lunch with lots of bits and pieces for
dipping, but you could also pile it
into lettuce cups, or even spread it
on some gluten-free toast
for an alternative breakfast”
Photography credit: Susan Bell, 2017

AUTUMN 2017 | OPTIMUM NUTRITION 25

ON YOUR PLATE

MAKES: 3 portions
INGREDIENTS
• 1 medium raw beetroot (about 200g).
If you are strapped for time, you can
use pre-cooked ones.
• 10g chopped fresh or 2 tsp dried dill
• 1 clove of garlic
• 1 x 400g tin of chickpeas, drained and
rinsed
• 3 tbsp tahini
• ½ tsp salt
• Juice and zest of 1 lemon

METHOD
Preheat oven to 170C/150C fan/Gas
3. Wrap the whole beet individually in
small squares of foil lined with baking
parchment and place on a tray in the
oven for 60-90 minutes (the baking
time will vary depending on the size of
the beetroot), or until a sharp knife slips
easily into the centre. I usually do this
when I have something else in the oven.
When cool enough to handle, use
kitchen paper to slip the skin off the
beets (see tip). Place one peeled
beetroot in the food processor along
with any juices in the foil and the dill.
Add all the other houmous ingredients.
Blend for 3-4 minutes, until really
smooth. You may need to add a tiny
splash of cold water if your mixture is
looking very thick. Taste and adjust the
seasoning as necessary.
TIP: When handling beetroot, use
olive oil as you would use hand cream
to form a skin barrier, then hold the
beets with kitchen paper and the skins
should slip off easily, without staining
your hands.

Variations
Using houmous base ingredients
(chickpeas, tahini, garlic, lemon and
salt), add your choice for the following
flavour combinations before blitzing in
your food processor:
Photography credit: Susan Bell, 2017

• Paprika: 1 tsp paprika/smoked paprika

• Traditional: 1 tsp (smoked) paprika
• Green: a handful of rocket
• Pesto: ½ bunch fresh basil (remove
stems), 2 tbsp olive oil, 2 tbsp pine nuts
• Parsley: ½ bunch of fresh parsley
(stems removed) and 1 tsp lemon zest
• Guacamole: ½ a ripe avocado, extra
zest and juice of ½ a lemon, ¼ of a
bunch of fresh coriander leaves, ½ tsp
chilli powder (optional)

26 OPTIMUM NUTRITION | AUTUMN 2017


MAKES: 1 portion
INGREDIENTS
• 2 large eggs
• 1 spring onion, finely sliced
• Zest of ½ a lemon
• A sprinkling of chopped fresh chives
• ½ stick of celery, finely chopped
• A handful of cherry tomatoes,
quartered
• ¼ avocado, peeled and chopped
• A handful of rocket, rinsed
• 1 tbsp olive oil
• Sea salt and freshly ground black
pepper
To serve:
• 1 slice of gluten-free bread
METHOD
Boil the eggs for 6 minutes, then rinse under
cold water to stop them cooking. Peel the
Photography credit: Susan Bell, 2017
ON YOUR PLATE
eggs and finely chop them. You could do this
the night before if you know you’ll be busy in
the morning.
Put the eggs into a bowl with the spring
onion, lemon zest, chives, celery, cherry
tomatoes, avocado and rocket. Add the olive
oil and salt and pepper, and mix well.
Toast the slice of bread, and load it up with
the salad.
Amelia says:
“New ways of enjoying
classic eggs and toast are
always welcome at breakfast —
I hope you like this version
as much as I do”
All recipes extracted with kind permission
from: Nourish & Glow: The 10 — Day Plan by
Amelia Freer, published by Michael Joseph,
2017. ISBN 978-0-718-18723-1 £16.99
AUTUMN 2017 | OPTIMUM NUTRITION 27
KITCHEN CHEMISTRY
If the whiff of fish is putting you off getting some omega-3 into
your diet, read on. Yeshi Dolma writes
H
as cooking fish got you
floundering? Being the bacteria-
loving person that I am, I feel I
should point out that there are millions of
bacteria and enzymes whose sole goal is
to make your fish stink.
This is because marine fish contain
varying amounts of something
called trimethylamine oxide in their
muscles. What’s so important about
trimethylamine oxide? A lot. Marine fish
need trimethylamine oxide because it
contains several key amino acids that help
fish stay alive in salty water. Of course this
is great for the fish — just not so great for
us; because once a marine fish joins Davy
Jones, the bacteria and enzymes living on
its body do their chemical reaction magic,
and convert the trimethylamine oxide into
trimethylamine — the stuff that causes
fish to stink.
And it is this stink that puts so many
people off eating fish. The aroma of just
one fish dish that was cooked, eaten
and enjoyed only once, can hang around
a kitchen for days, like some ghostly
reminder. It’s enough to put anyone off.
So it’s unsurprising that many end up
avoiding eating fish and as a result miss
out on all that lovely nutritious protein,
omega-3s, iodine and various other
nutrients.
However, the fresher the fish, the less
likely it is to stink. So one option is to go
fishing yourself. If that doesn’t appeal, or
if your Atlantic-going trawler is currently
out of action, then the next best thing is
to buy your fish straight off a fishmonger
at the docks. Failing that, your local fish
market will suffice. Or failing that, your
local supermarket — but find out when
your catch was caught.
When choosing a fish, you want it as
28 OPTIMUM NUTRITION | AUTUMN 2017
fresh as possible and to have been kept as
close as possible to freezing; 4C at max.
When inspecting your future fillet, its
fleshy bits should be firm and shiny and its
smell should be fresh, almost algae-like;
never fishy, nor like urine, both of which
are indicators that your fish is on its way
to being food for your garden, not you.
If you’ve purchased a fish that smells
a bit strong, or you’ve dug it out of your
freezer, there are some ways you can
de-stinkify it. The best possible way is to
use the magic of science, in this case the
power of protein (casein) in milk. Soak
your fish in a bowl of any animal milk,
the casein grabs the trimethylamine, and
binds it in the milk. Once the fish has
soaked for 20 minutes, take it out, rinse it
off, and pat it dry with kitchen paper. Your
fish should now smell fresh, lovely, and —
most importantly — edible!
If you can’t possibly use animal milks,
there are other ways to treat your fish to
rid it of the stink. One option is to soak it
in a mild solution of water and common
store cupboard ingredients such as
vinegar, lime juice, or lemon juice. After
soaking, rinse the fish off — although it
may still take on the taste of the solution.
Cooking method will also make a
difference; frying fish will invariably cause
a stink, whereas baking fish in foil should
lessen any odour.
If, after all that, you still find that
your kitchen is rather more fishy than
you would like, boiling water with some
vinegar is one time-old method of
cleaning the air.
Preparing fish needn’t be a discouraging
task. If you try out these methods, not
only will your meal smell delightful, but
you might find yourself stuffed to the gills
as a result.
O
f course, the classic side for fish is
chips; and so it seemed imperative
that I whip some up.
But I didn’t want just ordinary spud
chips; I wanted something a little fancier
— and so only courgette and pumpkin
would do.
The poor pumpkin fared the worst; it
got skinned. Then, both pumpkin and
courgette were cut into chips no more
than ½” (12mm) thick (so they would
cook quickly), thrown together into a
batter of flour and water with a little salt,
and tossed until they were well-coated.
After frying, these produced chips that
were crispy on the outside and soft on the
inside. My honest opinion? The courgettes
were fabulous prepared in this way, so
I would do this again, but the pumpkin
chips were a little bitter — for my taste,
at least.
The next time, though, having
previously noshed down fried chips, I
thought it best to experiment with making
baked chips instead. To do this, I used an
egg dip, flour, and bread crumbs to create
a thick, crunchy crust. First, I used a two-
step procedure to get rid of some of the
moisture — to minimise the chances of a
soggy chip. After patting the chips down
with kitchen paper, I dusted them in the
flour. They were then dipped into the egg
wash, before being coated in the bread
crumbs.
After baking, the resulting chips had
a thicker crust than the fried chips, but
I preferred them because the crust had
more bite and crunch to it. The pumpkin
flavour was more pronounced and the
chips were physically bigger because of
the breading, which is great for holding
more sauce.
Butternut squash is another vegetable
that commonly gets chipped, but what
some find disappointing is that no matter
how much it’s cooked, it just doesn’t
make a crispy-on-the-outside-soft-in-
the-middle chip. My go-to recipe is to
not bother peeling the squash — the
skin can be eaten — cutting it into slim
chips for quicker baking (chunky chips
will need longer), drizzling with olive or
rapeseed oil and sprinkling with paprika
(other herbs and spices can be used!).
Heat the oven to 190C/375F/Gas mark 5,
and bake the ‘chips’ at the top of the oven
— they will need to be flipped during the
cooking process and should take about 30
minutes. Then.. enjoy!
Yeshi Dolma

Christian Billinghurst finds out that the devil’s in the detail when it comes to health benefits
I
f one food group has left us confused,
it’s fat; and possibly none more so than
coconut oil. Hailed as a panacea for
a range of health problems, coconut oil
has recently been the new wonder-kid on
the so-called superfood block, finding its
way into processed foods such as vegan
cheeses, and into our own kitchen pans.
But if anything could have thrown its
health halo into doubt, it was a statement
this June from the American Heart
Association (AHA) that saturated fat was
detrimental to cardiovascular health.1 The
statement followed a review of studies
into saturated fat in general, but coconut
oil was singled out for attention: bad news
for the coconut oil industry, and confusing
for those of us who just want to know if
we should eat it or not.
Health claims
Not only has coconut oil been claimed to
be good for skincare or dental health (the
latter when used for ‘pulling’ which means
swooshing it for several minutes around
the mouth — said to remove harmful
bacteria), but it has even been claimed
to help with weight-loss. This is down to
it containing medium-chain triglycerides
(MCTs), types of fatty acids, which are
transported directly to the liver during
the digestion process, where they are
quickly metabolised, and so avoid getting
deposited in fatty tissue.
Overstated?
However, Linda Main, a dietetic advisor
for Heart UK, says that coconut oil’s many
perceived health benefits have been over-
stated. “Some of the suggested health
effects of coconut oil have been attributed
to medium-chain triglycerides [MCTs],”
she says. “MCTs are a kind of fat that is
metabolised differently in the body. MCTs
have been shown to be better at satisfying
appetite, are lower in energy and are
thought to help facilitate weight control
when substituted for more traditional fats
in the diet.”
Some studies have stated that coconut
oil can be as much as 60 per cent
medium-chain fatty acids (MCFAs).²,³
However, there is some disagreement
as to what should be referred to as an
MCFA. Main cites an article which states:
“If both of these fatty acids [caproic and
lauric acid] are included in the definition,
coconut oil could be described as
FOOD FACT FILE
containing around 65 per cent MCFAs.
However, it seems unlikely that lauric
acid is oxidised immediately in the liver,
a characteristic of C8–C10 fatty acids,
because of its potent cholesterol-raising
potential”.4
Main says that only 14 per cent of
coconut oil’s fat “can truly be described
[as] MCT”. And until there is consensus
on coconut oil’s MCT content, the case for
weight-loss benefits is yet to be closed.
But coconut oil is said to have other
qualities. It has a slow spoil-time and
is resistant to the rancidity process.
Despite this, however, the World Health
Organization (WHO) has promoted the
use of vegetable oils in its place.
According to Heart UK, “studies have
shown that the greatest cholesterol
lowering occurs when saturated fats are
replaced with unsaturated fats” and so is
“concerned” about recent discussion and
promotion of coconut oil in the press.
It states: “Coconut oil, unlike most
vegetable oils, is predominately a
saturated fat (85 per cent saturated fat)
and has been shown to have a negative
effect on circulating cholesterol levels
— a known independent risk factor for
AUTUMN 2017 | OPTIMUM NUTRITION 29
FOOD FACT FILE
cardiovascular disease [CVD].” It goes
on to state: “As much as 90 per cent of
the fat in coconut oil is saturated, 6 per
cent monounsaturated and 1.5 per cent
polyunsaturated fat.
“Compare this with the saturated fat
content of butter (52 per cent) and palm
oil (50 per cent).”
A cholesterol conundrum
Policy guidelines promoted by the WHO
and the AHA state that saturated fats
such as coconut oil raise cholesterol and
therefore increase the risk of CVD.
However, whilst human trials have
demonstrated that coconut oil increases
both total cholesterol and LDL (so-called
‘bad’ cholesterol) levels, one review stated
that better indicators for measuring
CVD risk (such as LDL-HDL ratio and
triglyceride levels) were not affected even
when comparing coconut oil to ‘healthy’
vegetable oils and ‘unhealthy’ butter.5
So, confusingly for the consumer, there
is a growing opinion that the evidence
associating saturated fats and CVD is
inconclusive, as emerging studies appear
to debunk traditional thinking.6
Following the AHA’s statement, some
doctors and scientists were quick to
question it. One critic is cardiologist and
co-author of The Pioppi Diet, Dr Aseem
Malhotra, who told Optimum Nutrition:
“My responsibility is to patients and
scientific integrity, and when you look at
the evidence the first thing to say is that
there is no evidence at all that saturated
fats clog the arteries.” That “myth”, he
says, has been “busted”.
Using coconut oil needs
to be taken in the context
of “a healthy eating
package”
30 OPTIMUM NUTRITION | AUTUMN 2017
He also questions the AHA’s statement
as being based on “poor science” and
cherry picked studies from decades
ago — although ‘cherry picking’ data is a
common accusation from both sides of
the fat debate.
Busted?
“Of course coconut oil will affect
[cholesterol],” says Malhotra. “It varies
from person to person.” But data, he
says, shows that when it raises LDL,
it also increases HDL (so-called good
cholesterol). And a high LDL level is not
necessarily associated with heart disease.
Coconut oil consumption needs to be
taken in the context of “a healthy eating
package”, he says. “So that as long as you
are following what I recommend, which
is kind of a low refined carbohydrate
Mediterranean diet, having some coconut
oil is not going to cause you a problem.”
Malhotra also questions the economic
background to the AHA’s report. “You
have to question their motives when
they are an organisation that receives a
considerable amount of money from the
drug industry. There is a huge industry
that has developed around cholesterol-
lowering drugs.”
This is an observation put forward
by other critics, as it is noted that the
AHA review was part-funded by major
manufacturers of cholesterol-lowering
medications, the Canola Oil Council, and
the California Walnut Commission1 (all of
which was declared).
“The other thing that is really
concerning,” says Malhotra, “is promoting
the consumption of vegetable oils or
industrial seed oils on the basis that
they lower cholesterol as effectively as
statins.” He says that trials that lowered
cholesterol by dietary changes, such as
increasing vegetable oil consumption,
did not reduce death rate, heart attack or
the risk of stroke. Beyond the cholesterol
debate, however, Malhotra says he can
only look at the best available evidence
that is there. “Like anything obviously
consumed in moderate amounts, it is not
harmful.
“I have a tablespoon of coconut oil in
my coffee every morning. It keeps me
full, it gives me energy... whatever, a nice
replacement for sugar which is obviously
much worse.”
Good for all?
Claims of other health benefits include
coconut oil being associated with a
reduced risk of Alzheimer’s disease.
One study found that anti-inflammatory
components in coconut oil can pass the
blood-brain barrier with neuroprotective
effects.7 However, the study in question
only focussed on populations that already
consumed large amounts of coconut oil.
Similarly, studies that have associated
coconut oil consumption with reduced
cancer risk have tended to be conducted
on animal models or non-western
populations where overall diet and
lifestyle may differ from that in the west.
Lifestyle factors may make all the
difference. For example, whilst coconut
oil is said to be better for cooking than
other vegetable oils because it is resistant
to oxidation and polymerisation (when
small molecules join together to make
long molecules, so result in a change in
the chemical structure), this benefit is lost
when cooking at high temperatures —
such as in deep frying. Despite its stability,
coconut oil also has a low smoke point
(171C/350F)8 which is the temperature at
which it produces smoke and toxins, so is
only suitable for gentle or mid-heat frying.
As for beneficial antimicrobial
properties, research has shown coconut
oil can inhibit the growth of harmful
bacteria at a cellular level which, in theory,
 FOOD FACT FILE

“I would not go as far

as to say that it’s a
superfood and it has all
C
these other properties”
would help with diarrhoea caused by
antibiotic use.9 However, such studies
have so far only been in small lab tests,
and human studies have not shown
any significant beneficial changes. It is
perhaps no wonder that Heart UK states
that the “health benefits of coconut oil are
definitely over hyped”.
“I would not go as far as to say that
it’s a superfood and it has all these other
properties,” says Malhotra. “There may be
some evidence there, but I can’t go that
far. But what I can say — as a cardiologist
— is that consuming coconut oil in
moderation as a part of what I call a low
refined carbohydrate Mediterranean diet,
will not do you any harm.
“I wouldn’t go as far as saying that I can
tell you it is very good for you — that it
is good for your health, but it can be very
much part of a healthy diet.”
And it is probably such advice that we
need to keep in mind. Coconut oil is only
a tiny part of a much bigger picture, and
if we are living on a diet of chips and little
else, then frying them in coconut oil isn’t
going to turn them into a healthy option.
old pressed, virgin or extra virgin? If you have wondered which to buy, you are
not alone. We contacted several coconut oil companies to find out what the
difference was between these labels but received little response. One industry
insider who did not wish to be named said that there was “almost no difference”
between extra virgin and virgin coconut oil. Another said that extra virgin coconut oil
was higher quality, but was unable to elaborate as to why. Still confused, we resorted to
the internet.
One commentator, writing in coconutoil.com, says: “the only truly ‘unrefined’ coconut
oil you can consume is the oil still inside the coconut meat from a fresh coconut just
picked off the tree”,10 and that coconut oil can only be produced by three different
methods: refined, bleached and deodorised (RBD); cold pressed; or wet milled.
Wet milled is considered to be the best because it does not require drying and heavy
refinement. Research has shown that wet milled coconut oil contains higher amounts of
antioxidants, but health comes at a price because this tends to be the most expensive.11
At the other end of the spectrum; RBD uses higher temperatures to extract the oil
from the coconut meat (between 70-80C), and then treatment with chemicals to get rid
of impurities and to deodorise it, but it is also the cheapest.
Cold pressed extraction is similar to RBD but uses lower temperatures to extract the
oil (<48C) and therefore prevents some of the undesirable consequences of rancidity.
This oil is generally marketed as virgin.
However, unlike olive oil, coconut oil quality is not classified through the term ‘virgin’.
Effectively, anyone can label their coconut oil as virgin because standardisation currently
does not exist. It may seem like a marketing ploy, but virgin coconut oil is usually cold
pressed so considered higher quality. However, there is nothing to stop companies
labelling RBD oil as virgin, which is why consumers should look for ‘cold pressed’ or ‘wet
milled’ on the labels. The term ‘extra virgin’ appears to be irrelevant.
Until there is standardisation across the industry, method of processing appears to be
the better indicator of quality, with organic wet milled reflecting higher quality and cold
pressed a reasonable alternative.

References:
1. Sacks FM et al (2017). Dietary fats and
cardiovascular disease: a presidential advisory
from the AHA. Circulation, 135(25).
2. Bhatnagar AS et al (2009). Fatty acid
composition, oxidative stability, and radical
scavenging activity of vegetable oil blends
with coconut oil. J Am Oil Chem Soc. 86:991–
999.
3. Boateng L et al (2016). Coconut oil and palm
oil’s role in nutr, health and nat dev: A review.
Ghana Med J, 50.3 (2016): 189-196.
4. C Lockyer S & Stanner S (2016). Coconut oil —
a nutty idea? Nutr. Bulletin. onlinelibrary.wiley.
com/doi/10.1111/nbu.12188/full
5. Eyres L et al (2016). Coconut oil consumption
and cardiovascular risk factors in humans.
Nutr Rev, 74(4), 267-280.
6. Chowdhury R et al (2014). Association of
dietary, circulating, and supplementing fatty
acids with coronary risk: a systematic review
and meta-analysis. Annals of Internal Med,
160(6), 398-406.
7. Fernando W et al (2015). The role of dietary
coconut for the prevention and treatment of
Alzheimer’s disease: potential mechanisms of
action. British J of Nutr, 114(1), 1-14.
8. coconut-merchant.com/oil-smoke-points/
9. Shilling M et al (2013). Antimicrobial effects of
virgin coconut oil and its medium-chain fatty
acids on Clostridium difficile. J of Med Food,
16(12), 1079-1085.
10. coconutoil.com/what-type-of-coconut-oil-is-
best-how-to-choose-a-coconut-oil/
11. Marina AM et al (2009). Antioxidant capacity
and phenolic acids of virgin coconut oil. Int J of
Food Sciences and Nutr, 60, 114-123.

AUTUMN 2017 | OPTIMUM NUTRITION 31

WORLD CUISINE
RECIPES FROM THE HEART
Raised in the ancient city of Jerusalem, Reem Kassis recalls
the exciting flavours and aromas of her childhood and tells
us about The Palestinian Table, a decade-long labour of love
Who was your biggest kitchen inspiration?
“My mother and both my grandmothers.
I didn’t see this growing up... I took them
all for granted and assumed what we were
eating at home was the norm. I didn’t
realise just how special their cooking was
or how much I was learning from them
until I left home and went to university
in the US. I found myself going back to
recipes they had shown me, to pieces of
advice they had given me, and through
those things, I stayed connected to my
roots, my home, and my family. Much
of what I learned about the nuances of
Palestinian cooking came from observing
these three women in action. I picked
up many tips and secrets to the best
Palestinian home cooking from snippets
of conversation: ‘never stop stirring the
yoghurt you’re cooking or it will curdle’,
‘rice dishes always have to rest before
plating’, ‘add yoghurt to tahini sauces to
break their richness’, and so on. But if I’ve
learned one thing from cooking with these
remarkable women, it’s that the real secret
to good cooking is love: love for what
you’re doing, love for the ingredients, love
for the process, and most of all, love for
the people you are feeding.“
Was it easy to write down family recipes?
“The process started more than a decade
ago, before the idea for this book was even
in my mind. Ever since I left home at 17
and started cooking on my own, I would
call my mother regularly with cooking
questions. I would ask her to call other
relatives or friends for particular dishes
and I would keep notes. Almost 10 years
later, I found myself not only with recipes
from my mother, grandmothers, aunts,
neighbours, friends, and relatives, but with
recipes from different neighbourhoods,
villages and cities, and with every recipe
there was a story, a snapshot of life,
history, and family.
“My youngest daughter was a new-born
and my oldest in pre-school for only a few
hours a day, so much of my writing was
done in 15-minute increments... it allowed
me to mull over every single thing I wrote
for a long time, like a slow cooked meal.”
What makes Palestinian cuisine special?
“Its ingredients and the way these
ingredients are used.... things like maftool,
a large grain couscous… musakhan, the
32 OPTIMUM NUTRITION | AUTUMN 2017 image by: Dan Perez
combination of sumac and onions, and
olive oil with taboon bread and chicken is
not encountered the same way in other
cultures. Another wonderful thing about
our cuisine is that it is a very healthy one.
It is not a ‘diet’ cuisine, but it is extremely
healthy because the core elements of
our food are whole grains, legumes, and
vegetables, and good quality olive oil. We
use meat, of course, but on a daily basis
it is rarely the main component of the
meal: instead it is used in tandem with
vegetables and grains to create a truly
holistic and healthy dining experience.”
In your family village, what home-cooked
dish do you look forward to?
“If I visit my mother’s village, Jaljulya, it is
definitely maqlubeh (when a pot is ‘flipped
over’ after cooking to reveal a cake shaped
dish of rice, meat and vegetables) — my
Teta Fatima’s signature dish. If it’s my
father’s village, Rameh, it’s the sfeeha
(pastry or bread with meat) that my Teta
Asma and Teta Salma made their entire
lives. At home, it’s my mother’s rice
stuffed chicken, unequivocally and by far
my favourite dish of all times!”
Is there any street food you look forward to?
“Definitely! I most looked forward to the
Jerusalem sesame bagels and falafel in the
Old City. When I was a child, my mother
and I would go there in the morning on
days off from school, we would purchase
the falafel from one vendor, the sesame
bagels from another and then take them to
this hole-in-the-wall hummus place, a real
hidden gem, and have our breakfast there
like that — falafel, sesame bagels, and
hummus with sweet mint tea.”
Which staples/spices do you always have?
“We always have za’atar and duqqa and
olive oil in three bowls in my kitchen. The
other main item is my mother’s nine-spice
mix. My pantry is filled with whole spices,
because I grind my own on a weekly basis,
and the nine-spice mix is my go-to one
which I use to add flavour to almost every
meat-based dish I make.”
Are the health benefits of food important?
“I truly believe you are what you eat so I
cannot overstate the importance of eating
well. I think one issue we have is confusing
healthy food with diet food, and those

two are not the same. Palestinian food is
extremely healthy, but it does generously
use grains and olive oil in addition to
vegetables and meats. So, the key is to
enjoy everything in moderation.”
What are your tips for buying olive oil?
“Invest in a good bottle of olive oil and
use it for everything except deep-frying.
You may be tempted to purchase a more
affordable bottle because it also says
extra-virgin, but oils are not created equal
and price is often a good indicator. My
family produces our own olive oil, so I
have rarely had to purchase it. When I
do, I choose an oil that is darker in colour,
packaged in darker bottles or tins, has a
date of harvest or pressing on it, is not
mass marketed, and is either Palestinian or
has a protected designation of origin.”
What would be your go-to dish at home?
“Freekeh pilaf (made from a cracked,
roasted green wheat) with a side of
tomato, garlic, and sumac salad. Both
dishes are extremely simple to make
but the flavours, especially when eaten
together, are so rich, fresh, and satisfying.”
If you had to choose one recipe to pass on to
others, what would it be?
“That’s a hard one! There are so many
wonderful recipes in the book that would
each appeal to a different audience —
meat lovers, vegetarians, even vegans!
The kafta and tahini bake is a very popular
one...”
PREPARATION TIME: 5 minutes
COOKING TIME: 15 minutes
MAKES ABOUT: 3½oz/100g
INGREDIENTS
• 6 tbsp allspice berries
• 6 cassia bark or cinnamon sticks
• 3 tbsp coriander seeds
• 1 tbsp black peppercorns
• 1 tsp cardamom seeds
• ½ tsp cumin seeds
• 10 cloves
• 2 blades of mace
• ½ nutmeg, crushed
METHOD
Place ingredients in a large skillet/frying
pan over medium-low heat. Stir with a
wooden spoon periodically to ensure the
spices do not burn, until you begin to
smell the aroma of the spices, about 10
minutes. Remove from heat and set aside
to cool completely. This step is crucial
because if the spices are not cooled
properly, they will form a paste when
ground rather than a powder.
Place the roasted spices into a heavy-
duty spice grinder and grind until you
achieve a fine powder consistency. Store
in an airtight container. It will keep for
several months although the aroma will
fade with time.
Note: Feel free to adjust to suit your
taste, or substitute with store-bought
baharat or Lebanese seven spice mix for
an equally tasty, albeit slightly different,
flavour profile.
PREPARATION TIME: 30 minutes
COOKING TIME: 30–40 minutes
SERVES 6–8
INGREDIENTS
• 1¾lb/800g coarsely ground
(minced) meat (beef, lamb, veal, or a
combination)
• 3½oz/100g pitta bread or white bread
with crust removed, roughly torn
• 1 tomato, quartered
• 1 small onion, coarsely chopped
• 2 cloves garlic
• 1 green chilli (optional)
• 2 tbsp chopped cilantro (coriander)
• 2 tbsp chopped flat-leaf parsley
• 1 tbsp olive oil
• 1 tbsp salt
• 1 tbsp nine spice mix (see recipe)
• 2¼lb/1kg potatoes, sliced into thick
wedges
For the sauce
• 1 cup (8oz/225g) tahini
• ½ cup (4oz/120g) yoghurt
• 3 cups (25floz/750ml) water
• 4–5 tbsp freshly squeezed lemon juice
• 1 tsp salt
To serve
• 1 tbsp toasted pine nuts
• Chopped flat-leaf parsley and red chilli
flakes
• Vermicelli rice
METHOD
Preheat oven to 425F/220C/Gas Mark
7. Place about one quarter of the meat
in a large mixing bowl and set aside. In a
separate bowl, soak the bread in enough
water to cover it and set aside.
WORLD CUISINE
Image by: Dan Perez
In a food processor combine the
tomato, onion, garlic, chilli, coriander
(cilantro), parsley, olive oil, salt, and
spice mix, and pulse to a coarse paste.
Drain the bread, squeezing any excess
moisture with your hands, and add to
the food processor, pulsing to evenly
combine. Alternatively, very finely chop
or grate everything by hand and mix
together with the bread, mashing with a
spoon as you mix.
Pour the mixture over the quarter of
the meat in the bowl and mix very well
with your hands until fully combined.
Add in the remaining meat and mix very
gently with your hands, just until evenly
distributed. Avoid mixing any more than
necessary.
Shape the meat mixture into about
15 mini sausage shapes. Place the meat
and potatoes in a single flat layer on the
baking sheet and insert into the oven.
Cook until they have started to brown,
about 15–20 minutes. If the baking sheet
is not large enough to accommodate the
meat and potatoes in a single layer then
you can divide them between two baking
sheets or brown them successively. In
the meantime, whisk all the ingredients
for the sauce together, season to taste,
and set aside.
Remove the baking sheet from the
oven and transfer the kafta and potatoes,
along with any juices, into a large baking
dish. Arrange them upright at an angle,
alternating between the potatoes and
meat. Pour the sauce over the meat and
return to the oven until it starts to get
patches of golden brown colour, about
10–15 minutes. Scatter with toasted pine
nuts, parsley, and red chilli flakes and
serve with vermicelli rice.
The Palestinian Table by Reem Kassis is
published by Phaidon Press, available in
hardcover £24.95. ISBN-10: 0714874965
AUTUMN 2017 | OPTIMUM NUTRITION 33
DIFFERENT STROKES
Snoring causes sleepless nights for millions, negatively impacting physical and mental health.
But help could be at hand. Louise Wates found out how singing exercises may be the solution
T
he thought of snuggling up during
the night can be very appealing,
but for many the reality can be far
from romantic. It is estimated that 40 per
cent of the UK’s adult population snores,
resulting in sleepless nights and misery for
the lighter sleeper, and even for the snorer
who ends up being elbowed awake by a
tired and irritated partner.
Caused by vibration within the airway,
snoring can be exacerbated by smoking,
alcohol, and weight-gain; but it is basically
sound created by tissue vibrating in
moving air. Imagine, for example, a paper
streamer tied to a desk fan and the rattle
it would make; then imagine the soft
palate vibrating as we breathe, creating
the snore.
Snoring is also big business. Products
aimed at preventing it include throat
sprays and mouthwashes designed to firm
up the soft palate, mouthpieces designed
to bring the lower jaw forward to keep
the tongue away from the back of the
throat, nasal strips to be worn at night to
make it easier to breathe, and even finger
rings based on Chinese acupuncture.
For the more desperate, depending upon
the cause of the snore, there is always
surgery.
In 2013, however, a study carried out by
researchers at the Royal Devon and Exeter
NHS Foundation Trust1 found that singing
exercises designed to strengthen the
muscles in the throat could be a potential
alternative for some snorers. Although
the study was small (127 participants)
with only 73 per cent completing, an
analysis by Bazian for the NHS stated:
34 OPTIMUM NUTRITION | AUTUMN 2017
“Overall, these results give preliminary
evidence that regular singing exercises
may help people who snore or have mild
to moderate sleep apnoea”.2
The exercises, which make up a
three-month programme called Singing
for Snorers, were designed by singing
instructor and choir leader Alise Ojay,
after a friend told her how his snoring
was affecting his relationships. She said:
“He demonstrated his snoring noise and
I immediately thought how lax his soft
palate sounded.”
Muscle tone
Whilst a lax soft palate is likely to vibrate
when we sleep, we are also likely to snore
if our nose is blocked. This is because
when we breathe through the mouth,
air hits the soft palate at the back of
the throat, which is bypassed when we
breathe through the nose. Lack of muscle
tone in the throat can also cause the
airway to collapse, causing sleep apnoea
— defined as not breathing for more than
10 seconds more than five times every
hour.3 According to the British Snoring
& Sleep Apnoea Association, prolonged
snoring can also damage the upper
airway’s muscles, making them even more
prone to collapse.3
Ojay, who had learned to adapt
her throat to reproduce the “vocal
placements” used in different cultures’
folk songs, thought singing exercises could
be used to tone up the soft palate so that
it was less likely to vibrate. After writing
to her GP to ask if she could try her idea
with some of his snoring patients, she was
put in touch with Edzard Ernst who, at the
time, was a professor of complementary
medicine at the University of Exeter.
“By chance Professor Ernst had done
experiments using electrodes to stimulate
the soft palate, so thought there might be
something in my idea,” says Ojay. “With
his help I received local funding from the
Northcott Devon Medical Foundation to
do a pilot study.”
After a “very encouraging” pilot
trial, Ojay then spent the next two
years designing and producing Singing
for Snorers; but wanted to have the
programme properly tested. “I tried in vain
to get funding for a larger randomised
controlled trial,” she says. “I ended up
initially testing them myself on a small
group of snorers, two of whom were
referred to me by the local hospital.”
These two, she says, both felt they no
longer needed treatment after following
her exercise programme.
Finally, “after much soul-searching”
Ojay launched Singing for Snorers, making
it clear that there had only been one pilot
study and asking for feedback to help her
win the case for clinical research.
It was positive feedback from snorers
and sleep apnoea sufferers, she says,
that eventually led to the 2013 clinical
randomised controlled trial at the Royal
Devon & Exeter Hospital, which found
that those who did the singing exercises
for three months reported less daytime
sleepiness and less frequent snoring than
those who didn’t.
And if it tempts you to sing out loud
in the shower, then go for it — but plain

Those who did the
singing exercises...
reported less daytime
sleepiness and less
frequent snoring than
those who didn’t
singing may not be enough for a good
night’s sleep. Ojay explains: “Whilst all
singing is wonderfully good for you on so
many levels, many singers still snore.”
Normal singing might protect some
people against snoring, she says, but
many of her clients already sing regularly.
Some are even professional singers who
began to snore as they got older.
Working out
Ojay explains that in normal singing, the
throat moves from one sound to another,
but usually without intense, repeated
effort in the throat. Her exercises, she
says, are a workout for those throat
muscles that help keep the airway open
and unobstructed. “Only here the ‘gym
equipment’ consists of special sound
combinations which engage, move and
work the muscles of the throat.”
Despite the potential benefits, however,
many of us may be more afraid of our
own singing voices than a sleepless night.
Three people recorded in the 2013 trial
didn’t even open the box, perhaps for
References:
1. Hilton MP et al (2013). Singing exercises
improve sleepiness and frequency of snoring
among snorers — a randomised controlled
trial. Int J of Otolaryng and Head and Neck
that reason — we can only guess. But,
Ojay says, being able to hold a tune is
unimportant.
On that encouraging note, I decide
to try a couple of exercises, which
Ojay explains to me. In one, which she
demonstrates on her website, I can feel
how my soft palate is brought down to
make contact with my tongue, and that
the muscles would become tired if I did
it as a full exercise. During the second
exercise (which is demonstrated on her
website with a film of the inside of her
throat, and which I try in private), I can
feel my throat changing shape — and I (so
I am told) am not an habitual snorer. As
for sounding good, well, Adele can sleep
easy for now.
“It really doesn’t matter whether you’re
singing [the exercises] in tune,” says Ojay.
“In some… the pitch changes are part
of what makes the exercise especially
effective, but it never matters whether the
pitch is precise. It is far more important
that you simply give the tune a go with
gusto and carefully attend to accurately
making the sounds which shape your
throat.”
Finding your voice
Despite many of her customers describing
themselves as unable to hold a note, Ojay
says that some find that they do have
a voice, and discover a love of singing.
“Many of my non-singing customers have
gone on to join choirs, increasing their
new-found joy of singing by taking it into
Surgery, Vol.2 No.3(2013), Article ID:31850.
file.scirp.org/Html/5-2460085_31850.htm
2. Singing exercises may help control snoring
(2013). www.nhs.uk/news/2013/08August/
DIFFERENT STROKES
a social context,” she says. “As a choir-
director who is very aware of the health
and social benefits of singing in a choir,
this news always gives me a special thrill.
“At the other end of the spectrum,
people who are already singers, including
some professional singers and many
amateurs… regularly tell me that their
singing voices have improved in terms of
tone quality, range, agility and volume.”
Although Ojay says that more than
8,000 people have voluntarily tried
Singing for Snorers and she has received
positive feedback, she is keen for ENT
specialists to carry out clinical trials
into her work. “Several ENT doctors
have shown interest and I am already in
discussion with one over the best ways to
proceed,” she says.
For anyone who snores, however,
addressing lifestyle factors can make a
difference. By losing excess weight that
puts pressure on the throat muscles,
quitting smoking, and even cutting alcohol
or sedatives which cause the throat
muscles to relax, we can reduce our
chances of snoring. When some people
resort to painful surgery, it is comforting
to know that there are some less drastic,
non-intervention methods that may allow
a partner to sleep peacefully, and for
habitual snorers to sleep without being
elbowed awake!
Alise can be contacted through:
www.singingforsnorers.com
Pages/Singing-exercises-may-help-control-
snoring.aspx
3. www.britishsnoring.co.uk/why_do_i_snore/
tongue_base_snorer.php
AUTUMN 2017 | OPTIMUM NUTRITION 35
ALL ABOUT
Requiring time and patience to get right (plus a little help from some invisible friends) a properly
fermented sourdough loaf demands appreciation, writes Catherine Morgan
I
n the 2016 Netflix series Cooked,
journalist and author Michael Pollan
argues that, when it comes to our daily
bread, industrialisation may have been
a step in the wrong direction. “Often in
the rush to make something cheaper we
overlook the reason why it was done in
the somewhat more painstaking way,”
he says. “In the case of bread, what we
may have overlooked is the importance
of a long slow sourdough fermentation.”
This process, he hypothesises, is why
traditional sourdough bread may be easier
to digest than the mass produced loaves
made by today’s bread-making methods.
“A lot of us think of sourdough as a style
of bread,” he says. “But what sourdough is,
is the traditional way all bread was made
until only about 100 years ago. Sourdough
is the proper way to make bread.”
Fermentation
Transforming three basic ingredients —
flour, water and salt — into a traditional
crusty sourdough loaf requires a starter
culture (also called a ‘mother’, ‘chief’ or
‘leaven’), the aforementioned “invisible
friends” and an ecosystem of wild yeast
and lactic acid bacteria that are naturally
present in flour and the environment.
It is these fermenting bugs that give
sourdough its distinctive flavour and
character, through the production of
compounds such as carbon dioxide,
36 OPTIMUM NUTRITION | AUTUMN 2017
alcohol, and organic acids as they feast off
the flour.
Getting started
To create a starter, mix some flour and
water into a paste, and then wait for the
microbes to do their thing; no special
ingredients required, just a little patience
and the right conditions. It sounds simple,
but keeping a living, breathing ingredient
and maintaining its microbial stability
does require a certain amount of tender
loving care — and feeding (with more
flour and water). Once it’s a bubbly, frothy
mass, it’s ready to use to make tangy
loaves of sourdough bread that are full of
holes and flavour. A portion of the starter
can then be kept back and refreshed for
the next bake; in fact, starters can be
maintained indefinitely, handed down
from generation to generation and shared
as they grow and expand.
Vanessa Kimbell, a baker and chef
who runs The Sourdough School in
Northamptonshire, says that humans
have been fermenting bread this way for
thousands of years. “The first written
evidence is in the Egyptian tombs,
about three and a half thousand years
ago, but there is evidence of fermenting
grains from over 10,000 years ago from
archaeological discoveries.”
Kimbell started working in her village’s
bakery in the Dordogne, south-west
France, at the tender age of 11, with great
bread at “the heart of every meal” she
ate while growing up. Despite sourdough
sounding difficult and time-consuming
to make, she assures us it’s not. “It is a
process that takes about 20 minutes of
total work over 36 hours. Like with any
new skill it takes time to really make
beautifully crafted bread, but learning is
half the fun.” And for a bread with “a soft,
chewy voluptuous cream interior, with a
mild tang, and robust golden crust” she
believes it is worth the effort.
“Sourfaux”
In contrast to the live sourdough starters
that teem with billions of wild yeasts
and bacteria, a fast-acting commercial
Baker’s yeast that is used in today’s
standard factory loaves comprises a
single species of Saccharomyces cerevisiae,
which was bred for speedy growth. That’s
not to say supermarkets don’t stock
sourdough breads — they do; but not all
so-called sourdoughs are made equal.
According to the Real Bread Campaign,
part of the charity Sustain (the alliance
for better food and farming), some of
them should not be labelled as sourdough
at all. Referring to some mass-marketed
sourdoughs as “sourfaux”, the Real Bread
Campaign’s aim is for a legal definition for
the name, so that shoppers know exactly
what they’re buying.

Benefits?
Flavour aside, many sourdough fans say
that there are real benefits to swapping
your standard loaf for a sourdough bake.
“Sourdough,” says Kimbell, “when made
properly and with some wholegrain flour,
will give you more nutrients — both
vitamins and minerals — than a yeasted
bread, and will also help lower blood
sugar response, provide higher levels of
resistant starch, and keep you fuller for
longer.” She also says that the breads
may contain higher levels of bioactive
peptides, which have been associated
with a number of health benefits. “We are
not talking about a total health revolution
the first time you have a slice of toast, but
over time small daily decisions add up…
and it is also delicious.”
Evidence, however, is mixed. A 2008
study found that participants with
impaired glucose tolerance produced a
significantly lower glucose and insulin
response when given sourdough bread,
compared to those given ordinary
bread leavened with Baker’s yeast.1 The
authors concluded: “This effect is likely
due to the lactic acid produced during
dough leavening as well as the reduced
availability of simple carbohydrates.”
But a more recent study painted a
different picture and suggested that
only some people will experience
these blood sugar benefits — with it
dependant on gut bacteria.2 No significant
difference was found in any of the health
parameters studied, including glycaemic
control, between traditionally-made
One of the advantages
of the long sourdough
fermentation is that it
allows the bacteria to
break down the gluten,
but this does not mean it
is gluten-free
sourdough-leavened wholegrain bread
and industrially-made white bread when
eaten for one-week each. And looking
at individual responses, it was found
that some people responded better to
sourdough bread, while others responded
better to white bread. Interestingly,
a person’s microbiome (types of gut
bacteria) was an indicator of response.
But before all the sourdough-
enthusiasts raise their (crusty) batons in
fury, it should be noted that the study was
small and short, observing just 20 people
for two weeks. However, it may mean that
any health benefits to sourdough depend
upon the individual.
Another ascribed benefit is that
sourdough is easier to digest, and that it
might be suitable for those who consider
1. Maioli M et al (2008). Sourdough-leavened
themselves gluten-sensitive. This does
not include anyone with coeliac disease
— nutritional therapist Christine Bailey
told Optimum Nutrition: “I would be very
2. Korem T et al (2017). Bread affects clinical
cautious about recommending sourdough
to anyone with a diagnosed reaction
to gluten including NCGS (non-coeliac
ALL ABOUT
gluten sensitivity).”
While there are small studies into
sourdough and coeliac disease, current
advice remains that anyone with the
condition should not eat any food
containing gluten — including sourdough.
An advantage to the long sourdough
fermentation is that it allows the bacteria
to break down gluten, but this does not
make it gluten-free (unless, of course, it is
made with a gluten-free flour). “We teach
our students how they can ferment bread
to get the maximum gluten degradation in
wheat, which does contain gluten, but you
cannot call this gluten-free,” says Kimbell.
With its thousands of years of history,
a long fermentation time seems almost
fitting. And sourdough has certainly stood
the test of time. Today, people are willing
to pay that bit extra for their artisanal
label, providing, of course, it’s the real
deal. And, according to the experts, baking
your own slow-fermented loaf isn’t really
so difficult; as said by the philosopher
Jean-Jacques Rousseau — or was it the
writer John Chardin? — “patience is bitter,
but the fruit is sweet” (or, in this case,
tangy).
References:
bread improves postprandial glucose and
insulin plasma levels in subjects with
impaired glucose tolerance. Acta Diabetol,
45(2), 91-96.
parameters and induces gut microbiome-
associated personal glycemic responses. Cell
Metab, 25(6), 1243-1253.
AUTUMN 2017 | OPTIMUM NUTRITION 37
ALL ABOUT
MAKES: One traditionally French shaped
sourdough boule. Allow yourself about
3-4 hours for the dough to be mixed,
folded and shaped ready to place in
the coldest part of the fridge to prove
overnight. (If you are new to bread
making, you can, instead of shaping the
dough and putting it into a banneton,
grease a 2lb bread tin liberally with butter,
let the dough rise in it overnight in the
fridge and then bake as per the recipe
instructions below.)
EQUIPMENT:
• A large mixing bowl
• A round cane banneton (bread proofing
basket)
• 2 clean tea towels
• A baking stone or a Dutch oven or La
Cloche
• A large heatproof pan
• A sharp knife or ‘lame’ to slash the
dough with
INGREDIENTS:
• 300g water
• 100g sourdough leaven/starter*
• 100g of stoneground organic
38 OPTIMUM NUTRITION | AUTUMN 2017
wholemeal flour
• 400g organic strong white flour
• 10g fine sea salt mixed with 15g of cold
water
• 25g rice flour mixed with 25g of stone
ground white flour (for dusting your
banneton)
• Semolina to dust the bottom of the
baking surface
DIRECTIONS:
Late afternoon
Mix: In a large bowl whisk your water and
starter and mix well. Add all the flour and
mix until all the ingredients come together
into a large ball.
Cover with a clean damp cloth and let
the dough rest on the side in the kitchen
for between 30 minutes and 2 hours —
this is what bakers call autolyse.
Fold: Add the salt mixed with the water
and dimple your fingers into the dough to
allow the salty water and salt to distribute
evenly throughout the dough. Leave for
10 minutes. Next lift and fold your dough
over, do a quarter turn of your bowl and
repeat three more times. Repeat three
times at 30 minute intervals with a final 15
minute rest at the end.
Shape: Shape the dough lightly into a ball
then place into a round banneton dusted
with flour (if you don’t have a banneton
then use a clean tea towel dusted with
flour inside a colander). Dust the top with
flour, then cover with a damp tea-towel.
Prove: Leave your dough to one side until
it is 50 per cent bigger then transfer to the
fridge and leave to prove for 8-12 hours.
The following morning
Bake: Preheat your oven to 220C/428F for
at least 30 minutes before you are ready
to bake. Place your cloche or baking stone
in the oven with a large pan of boiling
water underneath (or use a Dutch oven).
The hydration helps form a beautiful crust.
Once the oven is up to full heat,
carefully remove the baking stone
from the oven. Dust with a fine layer of
semolina, which stops the bread sticking,
then put your dough onto the baking
stone and slash the top with your blade.
This decides where the bread will tear as
it rises. Bake for an hour.
Turn the heat down to 180C/356F (and
remove the lid if you are using a Dutch
oven) and bake for another 10-15 minutes.
You need to choose just how dark you like
your crust. Vanessa suggests baking until
it is a dark brown for a better taste.
Storage: Sourdough is really best left to
cool completely before slicing and is even
better if left for a day to let the full flavour
develop. Once your sourdough has cooled,
store in a linen or cotton bread bag, or
wrapped in a clean tea towel.
Note: If you don’t like a crunchy crust on
your sourdough bread, simply wrap your
bread in a clean tea towel whilst it is still
warm.
*To make 100g of leaven/starter, use two
tablespoons of leaven/starter**, 50g of
filtered water and 50g of strong white
flour, mix well and leave, covered, on the
side in the kitchen in the morning. It will
be lively and bubbly and ready to bake
by the evening. **If you cannot obtain
leaven/starter from a friend or friendly
baker, follow the instructions on Vanessa’s
website: www.sourdough.co.uk/how-
to-make-starter-to-make-sourdough-
bread/
Images and recipe reproduced with kind
permission from Vanessa Kimbell
To find out about Vanessa’s sourdough
courses, visit: www.sourdough.co.uk/
 BOOK THERAPY

Supperlove
David Bez
Quadrille
ISBN: 978-1-84949-964-4

B ez writes: “There’s nothing completely new or completely strange in this book”, but that isn’t strictly true.
Unlike many recipe books, this one assumes you know your way around the kitchen, at least a little bit. Bez
is no Delia Smith, holding your hand through every process. Some required techniques can be found at the
beginning of the book; otherwise, each recipe involves combining a list of ingredients. If you know how to boil
rice, spiralise vegetables or toast nuts, then you’re good to go.
Each dish is beautifully illustrated but there is no ‘method’ to speak of; the clues are in the ingredients. If the
recipe calls for a warm broth, you heat it up. If it requires cooked rice or quinoa, then assume that you need to
cook rice or quinoa in advance. Each supper bowl is also enough for one person, so ingredients only need be
increased as required.
A word of caution: a colleague who looked over my shoulder wasn’t convinced it would work for her because
she likes more prescriptive instructions. But if you are confident in the kitchen, then these are no-fuss suppers
ranging from simple store-cupboard meals to something that requires a bit more planning (well, do you usually
have squid knocking around your fridge?). And if you’re confident enough to deviate from the ingredients list, it
could serve well as inspiration to turn leftovers and odds and ends into something delicious.
Louise Wates

Real Food by Mike: Seasonal Wholefood Recipes for Wellbeing

Mike McEnearney
Hardie Grant Books
ISBN: 978-1743792629

B y Australian chef Mike McEnearney, this is a cookery book that is a pleasure to curl up with. Divided into
seasons, it starts with summer and ends in spring with recipes that aren’t too ‘cheffy’, either.
McEnearney doesn’t claim to be a nutrition expert, just a curious chef; yet he includes recipes that wouldn’t
be out of place on a nutritional therapist’s table, such as sheep’s kefir with gooseberries and lemon verbena, or
kombucha — a fermented drink with gut-friendly properties. There is a touch of luxury to the recipes, too; in the
sumptuous names or the emphasis on quality ingredients. After all, McEnearney is a chef.
One slight downside to the book, from a UK-perspective, is that one or two ingredients may be difficult to
source. I had to look up choko, a type of… actually I’m still not sure… but when I looked for where I could buy
it, my internet search brought up Australian websites. So, it may be no-go for the recipe on page 202. You may
also have to substitute leather jackets (the fish, not the garment) for something else. However, there is still
plenty to choose from. There is also an interesting larder section with short recipes for mixes, flavoured oils,
and gluten-free doughs. Considering Australia’s cosmopolitan food culture, it is unsurprising that many cultures
are represented; and that is one of the real delights of this book, to be in Europe on one page and then Asia the
next. There are also gluten-free recipes, which is a welcome addition to a book where fine cuisine is the aim.
Louise Wates

What’s Cooking?
By Joshua David Stein. Illustrated by Julia Rothman
Phaidon Press
ISBN: 978-0714875095

A imed at children who will be just learning to read, this delightful read-aloud book takes a little journey into
the big, wide world of the kitchen with a child’s eye and curiosity, showing how it is possible to experiment
with words as well as foods.
“Can I can clams? Can I can jams? Can I jam clams? Clams you can can…” or “If I eat left overs, can I eat left
unders?” The food-related questions can be practical or simply whimsical, but — perhaps from a child’s point
of view — are very reasonable things to ask; all of which are asked in large, friendly writing and illustrated with
homely, jolly drawings.
As with every children’s book there is, of course, a hidden agenda. In this case it isn’t just to get children
playing with words, it is to introduce them to the world of food in a simple, fun way, and to get them engaged
in food as a wider topic to be explored. One page even gives three different countries’ names for dumplings,
introducing children to the concept that food is something that unites cultures.
But be prepared. If your little one does have their curiosity truly piqued you may find yourself having to
experiment in the kitchen — yes, you can fry gelato, Stein tells his readers. So good luck with that one! But a
definite bonus is that there is also the opportunity to talk about who gets to do the washing up, too, and it’s
never too early to start with that!
Louise Wates

AUTUMN 2017 | OPTIMUM NUTRITION 39

PRODUCT NEWS

US-brand Califia Farms ready-to-drink

Concentrated Cold Brew Coffee can be
drunk cold in an iced coffee or heated up
for a warm brew. Califia Farms says it uses
only 100 per cent Arabica beans, sourced
from Colombia and Central America,
which are steeped in cold water “until all
the complex flavours are released”. Can
be mixed with water or milk. Available
from Wholefoods. *£5.99 for 946ml.

Adonis ‘low sugar’ bars come in two

flavours: ‘Coconut Vanilla Acai Berry’ and
‘Pecan Goji Berry Cocoa’. Compared with
many bars on the market they are lower
in sugar (just over 5g of carb per bar, 1.7g
of which sugars) and sweetness. The
sweetness comes from erythritol, a sugar
alcohol, which doesn’t dominate the taste.
*£9.90 for a mixed box of five.
www.adonis-foods.com

Creative Nature Chia & Mulberry Muffin

Mix made nine large, gluten-free, dairy-
free muffins. Our tasters (aged 9 to
77) reported favourably, commenting
that (in their opinion) the muffins were
very tasty and “not too sweet”. Note,
although the packet says ‘no refined
sugar’, the ingredients do include
unrefined cane sugar (so, sugar) and so
the end product should be treated as
any other sugary snack. *£4.99. www.
creativenaturesuperfoods.co.uk

Hurly Burly fermented, raw and organic

slaws come in three flavours: Jalapeño &
Oregano, Turmeric & Cumin, and Lemon
& Ginger. All three got a positive reaction
from our tasters — our only gripe was
the difficulty in opening the jars. A firm
hand and a jar-opener is a must. Available
from Wholefoods, Planet Organic, and As
Nature Intended. *£5.75 for a 410g pot.
www.hurlyburlyfoods.com

40 OPTIMUM NUTRITION | AUTUMN 2017

 PRODUCT NEWS

Wellaby’s Simple Bakes are gluten-free

and vegan, so could be a helpful solution
when you need something to go with the
party dips at Christmas. Available in three
flavours: Spicy Chilli, Smoky BBQ, and Salt
& Pepper. *£1.79 for a 120g sharing bag,
available online at Ocado and Amazon.
www.wellabys.com

Chikko Not Coffee made from roasted

chicory is a caffeine-free alternative to
coffee. One taster who regularly enjoys
chicory instead of coffee felt that it was
the closest to coffee she had tried so
far. As chicory is a source of fibre, it’s a
gut-friendly option, too. Available through
Amazon priced *£8.50 incl. delivery or
check the website for nearby stores.
www.not-coffee.com/en/stores

Hipsters may love the vintage-style

packaging of Lyons coffee bags. Inside,
each bag comes in its own foil pouch for
fresh coffee as you need it. We tried No3
‘Rich & Full Bodied’, which went down well
with those who preferred a milder brew.
*£2.70 for a box of 18 bags. Available in
supermarkets and online.

Hackit is a kitchen hand tool created by

Erling Sundal, a Michelin Star chef. It can
be used for roughly chopping fruits and
vegetables, but our tester enjoyed using
it to cut vegetables such as mushrooms
into decorative shapes. She also liked it
for chopping up garlic, and for roughly
mashing up soups and stews — saving
the need for a hand-blender. Dishwasher
safe, and can stand up to 210C. *£7.99.
www.2tech.co.uk and www.lakeland.
co.uk * Prices may vary
All reviews are based on individual
opinion and do not reflect the views
of ION or Optimum Nutrition

AUTUMN 2017 | OPTIMUM NUTRITION 41

CASE STUDY

Nicola Moore looks at supporting Sharon, who has little interest in food, but wants to put on weight

S
haron, 47, feels healthy but feels
tired most days, putting this down
to her busy schedule. “I wake early,
and don’t go to bed before midnight most
nights, so usually have about five to six
hours’ sleep. I often feel like I burn the
candle at both ends.” She takes vitamin
D supplements (when she remembers)
having previously been diagnosed with
a vitamin D deficiency — she had been
suffering with pains in her hip which
radiated down to her knee and shin.
At 5’7’’ and weighing 7st 10lbs, she
would like to put on weight, but with a
nutritionally-balanced diet. She has been
tested for hyperthyroidism (over-active
thyroid) but this has come back normal.
“I struggle to put on weight and would
love advice on how to do so. I feel thin and
bony, and hate it when people comment
on how thin I look.”
She has a small appetite, and although
she tries to eat breakfast, she says after
that, “things can be hit and miss”. She has

Day Breakfast Lunch Dinner Snacks/Drinks

Co-op sweet and sour chicken 3 teas + 1 sugar in each

2 peppermint teas with honey
1 bowl of Honey Loops with
1 skimmed milk
4 salt & pepper crackers filled
with Dairylea spread
with rice ready meal
2 strawberry and raspberry fruit
teas with honey
2 Oreo biscuits
1 pkt cheese & onion crisps
1 Müller Fruit Corner yoghurt
Handful of jelly sweets and
chocolate Jazzies

2 peppermint teas with honey
1 bowl of Honey Loops with
2 skimmed milk
8 salt & pepper crackers filled
with Dairylea spread
Baked salmon, new potatoes, 2 Hobnob snack bars
sautéed asparagus and baby 1 pkt cheese & onion crisps
sweetcorn 5 Oreo biscuits
5 Lady Grey teas with 1 sugar

1 bottle of water 6 chicken nuggets in a bread roll 3 Lady Grey teas with sugar
2 peppermint teas with honey 1 egg custard 1 strawberry and raspberry fruit
3 1 bacon roll 1 Hobnob bar tea with honey

2 peppermint teas with honey 1 sausage roll Chicken supreme casserole, 2 Lady Greys teas with sugar
1 bowl of Honey Nut Shredded 1 packet salt & vinegar crisps roasted new potatoes, sautéed 2 Curly Whirlies
4 Wheat with skimmed milk fresh veg (baby sweetcorn,
broccoli, asparagus)

2 peppermint teas with honey Takeaway curry 1 Picnic chocolate bar

1 egg and fried mushroom roll
1 bowl of Honey Nut Shredded Strawberry tart 2 Lady Grey teas with sugar
5 Wheat with skimmed milk 2 strawberry and raspberry fruit
1 bacon roll teas with honey

Sharon’s pre-consultation food diary

42 OPTIMUM NUTRITION | AUTUMN 2017


always been slim and says her father was
“like a string bean”.
“I struggle to eat larger portions. I get
full quickly and think my stomach must
just be small, as is my appetite. I have
tried smoothies to try to consume more
calories but got bored with those quickly.
I have tried to snack on nuts and dried
fruits, but found this boring after a while. I
don’t think I eat that much chocolate and
often refuse dessert, as I am already full. I
thought about protein shakes, but do not
want to resort to this, as it feels fake.”
There are no foods that she avoids, but
she finds it hard to make food choices.
“I am not a foodie and find it hard to
be inspired when shopping. My husband
works away during the week, so I buy
Nutritional Therapist: Nicola MOORE
I
would like to understand more about
Sharon’s routine and, in particular, why
she goes to bed so late. The importance
of sleep is massively underestimated,
but increasing sleeping hours can have
a profound impact on so many things,
including appetite and eating behaviours.
She says she has a small appetite, and
I wonder if she really engages with the
sensations of eating. Being disconnected
with food is understandable if you don’t
feel like eating. So, I would like to learn
more about Sharon’s zinc status as
deficiencies in this mineral are linked to
loss of appetite and issues with detecting
taste and smell. This may require a private
test if not available through the NHS.
If she is deficient in zinc, I would
recommend supplements in the first
instance as she already has problems
eating. However, zinc supplements at high
doses can impact copper absorption, so
should not be taken without supervision.
Natural sources of zinc include meat,
shellfish, pumpkin seeds and spinach.
My aim would be to see her relationship
with food transform to one of delight,
anticipation and pleasure! But I’d also like
to check her ferritin, B12 and folate status
and get an up-to-date vitamin D level, all
of which could be checked by her GP, and
which may be making her feel tired.
It can be hard to prioritise food when
it’s seen as a chore. But we would look to
identify opportunities to make small but
significant changes.
Every day doesn’t need to be ‘perfect’
— that’s unrealistic for most people,
including me! I’d aim to assist Sharon
with ideas and solutions that can work
for her in a way that don’t overwhelm her
The Optimum Nutrition Clinic can be contacted on T: 020 8614 7822 and E: clinic@ion.ac.uk
Nicola can be contacted at www.nicola-moore.com
minimal groceries on a weekly basis. If I
am eating alone I resort to ready meals.”
She eats with friends twice a week. “We
each take turns in cooking, so we try to
eat proper home cooked meals. Of course,
we also resort to takeaways together too!
“I rarely eat fruit for some reason, and
probably should eat more, as I do like
it, but I hate it when it goes off. I will
sometimes forego an evening meal if I get
in late, or think it is too late to eat, and will
perhaps have a piece of toast instead.”
She believes the obstacles for her are
a lack of time to do “little and often”
food shopping. Because she’s on her own
during the week, she doesn’t see the point
of a big food shop. Also, she says, there’s
a lack of motivation.
or cause stress. So, for example, simply
changing her breakfast time — maybe
pushing it back by an hour — may have a
positive knock-on effect on her appetite
and food choices for the rest of the day.
Sharon is using quite a lot of sweeteners
in the form of sugar and honey. I’d like to
start reducing her desire for sweetness, as
this could be the key to unlocking some of
the challenges she faces.
For example, although she is eating
regularly, her day is punctuated by sweet
foods and drinks which may be dulling her
appetite and perpetuating a sweet tooth
that makes savoury flavours unappealing.
If she can reduce her snacks to allow
herself to get hungry, and reduce her
intake of sweet foods, she may become
ready for more savoury flavours and
slightly larger portions. Then, I would like
to get in more nutritious, savoury foods
such as vegetables, meats, fish, or other
sources of protein, which will give the best
opportunity for weight gain and energy.
I would encourage her to ask herself
where her proteins, natural fats, carbs
and vegetables are coming from. Over
time, it’s possible to get into the habit of
checking these things off as you put a
meal together, and it need not be overly
taxing. Simply adding some rocket leaves
and avocado to the top of her lunchtime
cracker would be an excellent start.
A sweet tooth can be hard to change,
especially if one isn’t fully-engaged with
food. Rather than telling her to cut out
sweet foods, we would look at making
slight changes. So, for example, she might
adapt her breakfast slightly to a low-sugar,
crunchy granola, to which she could add
nuts and seeds. She likes fruit, so she
CASE STUDY
“When it comes to meal choices; I feel
like I sometimes eat the same things week
in week out. Most recipes feed more than
one, and I just don’t have time to batch
cook and freeze dinners anyway.
“It’s hard to talk to people about my
weight, as most people would love to
be as slim as I am. It’s not as rosy as
they think though; currently I can’t find
anything to fit me, so my clothes are held
together with safety pins. I worry about
the risks of osteoporosis, too, as I’m older
and menopausal.
“After keeping a food diary for five
days it’s clear I’m not consuming enough
calories in relation to the amount of
exercise I do, but I find it really hard to eat
more than I do!”
could add defrosted frozen berries, too —
frozen fruit and vegetables are quick, easy,
and reduce waste, which is something
she’s keen to do.
Ready meals are a real help in the
week when her husband is away, and
there are some good choices available.
But we could look at food labelling to
help her make the best choices so, for
example, choosing nutritious meals that
are lower in sugar and have more natural
ingredients. And while her ready meal is
cooking I’d get her to cook some frozen
peas to add to the plate. Cooking for one
can be quick and easy. I am a big fan of
steamers — a salmon fillet, broccoli, and
green beans can be cooked all together.
Quick, and with minimal washing up!
I would challenge Sharon’s assumption
that there’s no point in a ‘big shop’. From
what I can see, the current situation isn’t
working for her as she doesn’t have time
for the ‘little and often’ shopping she has
decided works best. So I would encourage
her to build up a supply of store cupboard
and freezer staples that are perfect for
quick meals. We could figure out what
items she’d be best to include in a weekly
or bi-weekly online food delivery. Then
she could pop to the shops to ‘top-up’
if need be. This would mean she could
make quick meals like sardines on toast,
or a homemade bruschetta by toasting
a frozen wholemeal pitta and topping
it with pesto, pine nuts, olive oil, cherry
tomatoes, and avocado.
By finding achievable changes that are
workable and enjoyable, and building
in nutrient-dense meals over time,
I am confident we’d be able to see
improvements in how Sharon feels.
AUTUMN 2017 | OPTIMUM NUTRITION 43
LITTLE LIVES
Do you panic if your bag is not fully-loaded with snacks on stand-by to silence your child’s
rumbling tummy? If so, read on. Jenna Sinclair writes
A
fter years of limited options, the
snack world is changing. Slowly, the
packets of crisps, confectionery,
and sweets that dominated the last
decade through shameless eye-level
marketing at children are being replaced
by vegetable crisps, unsalted nuts, dried
fruits, and other products boasting ‘no
added sugar’ and ‘no artificial colours
or preservatives’. We have turned a
monumental corner and it seems all-good.
Some larger supermarkets now even place
free fruit near their entrances for children
to munch — hopefully avoiding a hunger-
fuelled tantrum around the cake aisle.
So, does this mean that children are
always hungry? Perhaps not: just that
supermarkets are aware of how placating
snacks can be on children’s moods and,
consequently, behaviour. We’re all aware
of the fearful state of being tired and
hungry, especially when we are doing the
after-work food shop and familiar scenes
unfold; we’re hungry after work, they’re
44 OPTIMUM NUTRITION | AUTUMN 2017
hungry after school, and chaos ensues.
In the western world, however, most
of us are fortunate enough to not know
real hunger. We probably know mild
discomfort having not eaten for a few
hours — whilst knowing that food is within
a 30-minute radius thanks to the rise of a
convenience culture and a got-to-have-it-
now mentality.
Empty energy
Snack culture has grown significantly
since the 1970s. Research has shown
that between 1977 and 1996, the number
of calories that children consume from
snacks has increased by 120 calories per
day.1 According to a 2010 study from the
University of North Carolina, 98 per cent
of children in the US snack at least once a
day; an increase from 74 per cent in 1978.
More concerning, though, is that they
now consume almost 600 calories from
snacks per day. While calorie needs will
vary, depending upon the child, their age
and activity, for some children that figure
translates to around a quarter of their
recommended daily intake — which might
explain some of those unfinished dinners
and lunches.
It’s also worth bearing in mind that
many sugary snacks contain what are
often described as ‘empty’ calories,
i.e. that the calories consumed are not
accompanied by beneficial nutrients.
So, if kids are filling up on in-between
nibbles, is the children’s snack market
really necessary, or just something that
has been created by clever marketing
aimed at cautious (and weary) parents?
And how do parents decide what is best,
in a culture where they may be scared
to leave their child hungry for even a
little while? Aside from having their
competency challenged, many parents
often don’t want to be unpopular with their
children — and refusing snacks could be
seen as being mean at the very least, and
neglectful at worse.

“If a child doesn’t eat
well at one meal, the
next meal isn’t that far
away! So, there is no
need to fill your child up
with snacks...”
The World Health Organisation has little
to say on children’s snacking. However, it
does maintain that children should lean
towards unsaturated fats and generally
increase their consumption of fruits and
whole grains.2 And the Centre for Science
in the Public Interest is all for children
having snacks, providing they are mostly
fruit and vegetables, stating: “Serving
healthy snacks to children is important
to providing good nutrition, supporting
lifelong healthy eating habits, and helping
to prevent costly and potentially-disabling
diseases, such as heart disease, cancer,
diabetes, high blood pressure, and
obesity”.3
Give it a rest?
Ironically, however, whilst snack culture
for children has increased, many adults
have gone the opposite way, following
intermittent fasting instead — something
that has been practised in some cultures
for generations. Just as our ancestors
— some not that many decades ago,
either — would not have access to food
all the time, fasting is based on the
concept of feast and famine, and how we
are biologically programmed to survive
periods of little or no food. In modern
terms, fasting may involve between 12 to
18 hours (or more) of fasting, for example
from 8pm until 8am the following day,
allowing the gut to have a break from its
day job.
Giving the gut a rest has many proven
health benefits such as increased mental
alertness, reduced inflammation, weight-
loss, decreased insulin production,
improved fat burning, and prevention of
diseases such as cancer.4
Despite this, however, many adults
are reluctant to allow their children to go
without food between meals, let alone
to skip meals entirely — although some
Muslim or Jewish children may begin to
try fasting during Ramadan or Yom Kippur
from around the age of 12 or 13.
Kate Delmar-Morgan, a nutritional
References:
1. Piernas C & Popkin B (2010). Trends In Snacking
Among US Children, Health Affairs, 29(3), 398-
404.
therapist who specialises in children’s
nutrition, says that the question of
snacking for children isn’t straightforward
because it depends upon the age, weight,
appetite and the needs of the child, plus
timings of meals. “Toddlers, for example,
have small tummies so require smaller
portions and therefore might not obtain all
their requirements from three meals,” she
says. “Those at school are using up lots
of energy, and the stretch between their
lunch at school and dinner at home might
be too long for them to manage.” This
is when an after-school snack might be
appropriate, she says, particularly if a child
is going through a growth spurt or doing
lots of sport.
But the real issue, says Delmar-Morgan,
is the types of snacks on offer — many
of which are refined foods that are high
in sugar and unhealthy fats. “This is
encouraging poor food choices at an early
age and these habits die hard.”
Quality of meals, she says, will make a
difference to how much children need to
snack. “Better quality meals will provide
them with longer lasting energy and more
nutrients,” she says. “At any age, children
need a balanced and nutritious diet, based
on all the food groups, due to their growth,
development and activity needs. So it
is best to concentrate on good nutrient
content of main meals rather than lots of
snacks to supplement these meals.
“If a child doesn’t eat well at one meal,
the next meal isn’t that far away! So, there
is no need to fill your child up with snacks
and drinks in the interim to compensate
as this may alter their appetite regulation
system.”
If a snack is needed, Delmar-Morgan
encourages parents to make swaps to
healthier choices. “But I would ask them
to consider whether it is absolutely
necessary.”
And just as us adults are capable of
reaching for the biscuit barrel without a
thought, maybe in future we might also
ask how much of ’I’m hungry’ actually just
means ’I’m bored’.
Additional reporting by Maggie
Charlesworth.
Jenna Sinclair is one of Jamie
Oliver’s Food Revolution
Ambassadors who runs the food
blog www.rawrhubarb.co.uk and is
also a life coach based in Brighton.
2. www.who.int/dietphysicalactivity/childhood_
diet/en/
3. http://cspinet.org/protecting-our-health/
LITTLE LIVES
HEALTHIER SNACK ATTACKS!
• Fresh fruit served with a small
palmful of nuts
• Homemade smoothie with yoghurt
and crushed seeds
• Raisins and a small palmful of nuts
• Avocado chunks
• Savoury wholemeal or buckwheat
muffin (e.g. apple & cheese, feta,
seeds, etc.)
• Falafels
• Chicken nibbles (preferably from
home-cooked, fresh chicken)
• Mashed hard-boiled egg on
cracker/toast with cress
• Cucumber, peppers, carrots with
hummus or yoghurt dip
• Spiced nuts
• Unroasted/unsalted nuts and seeds
• Coconut pieces
• Sliced apple with nut butter
• Celery sticks stuffed with cream
cheese or nut butter
• Small pot of natural yoghurt with a
dollop of home-cooked stewed fruit
• Slices of tofu
• Slice of frittata (omelette)
• Chunks of very good quality
sausage
• Small bowl of no-added sugar
muesli
• Homemade nut biscuits or seed
flapjacks
• Mug of soup which contains protein
(e.g. chicken, lentil, ham)
• Wholegrain bread sticks with dip
• Homemade popcorn with cinnamon
• Oatcakes/Ryvita/wholemeal
toast with: cheese (cottage/
cream/Cheddar); red/green pesto;
hummus; smoked mackerel/salmon
pâté; mashed sardines; reduced-
sugar baked beans; peanut butter
(no added salt/sugar); nut butters
(almond/cashew); mixed seed
butters; or bean dip
Caution: Always check with the parent
or guardian for any potential allergies
before offering snacks. Be aware of
the risk of choking in young children.
(Reproduced with kind permission from
Kate Delmar-Morgan)
nutrition/healthy-school-snacks
4. www.healthline.com/nutrition/10-health-
benefits-of-intermittent-fasting#section8
AUTUMN 2017 | OPTIMUM NUTRITION 45
LITTLE LIVES
Having a child that seems to barely eat can be worrying, so mum-of-two Catherine Morgan
investigates whether cajoling her eldest to take one more bite is really necessary
M
y friend’s toddler can put away
three Weetabix in one sitting —
and then want toast. I’m lucky
if my eldest (aged three) will have more
than a few mouthfuls before declaring
“finished” and vanishing into a sea of
brightly coloured plastic toys. My pleas
of “just one more spoonful” usually go
unheard (ignored) and I fight against
a mother’s instinct to “feed him up”.
My youngest (aged two), on the other
hand, loves his grub; so much so that it
isn’t unusual for his nursery food chart
to read “eaten all, plus seconds” — and
sometimes thirds if they have enough
left over to satisfy his demands. Whilst
both boys are within their normal weight
ranges for their age, the eldest is much
slighter and more delicate in appearance
than the youngest, who has a strong, solid
build — and a temperament to match. So
naturally, my worry lies more with Child 1
when it comes to eating habits.
But, going back to the start, would I
want him to devour three Weetabix for
breakfast? Probably not. I wouldn’t even
have that much myself. But I do want
him to be eating enough. Which raises
an obvious question: just how much is
enough? What is an ideal portion size for
children?
In my quest for answers, I came
across a really useful portion size guide
from The Infant & Toddler Forum (ITF),
an organisation that brings together a
team of experts from disciplines such
as paediatrics, dietetics, and child
psychology to debate the latest thinking in
infant and toddler nutrition. According to
their recommendations for children aged
one to four,1 Child 1 is actually doing just
fine when it comes to his food intake. If he
eats half an apple, great (recommended
portion: a quarter to a half an apple), a
cheese sandwich should be made with
half to one slice of bread (not two), his
eggy goals need only be a half to one egg,
and a quarter to one medium sausage is
46 OPTIMUM NUTRITION | AUTUMN 2017
right on track. As for the burning question:
a half to one Weetabix is about right for
one- to four-year-olds. So, the lesson
learnt? I had been suffering from a serious
case of portion distortion, and it seems
I’m not the only one.
A recent ITF survey2 revealed that the
vast majority of parents are unwittingly
giving their toddlers too much food,
rather than too little. When 1,000 UK
parents were asked to look at images of
portion sizes, it was found that 79 per
cent would routinely offer portions bigger
than the recommended size range for
pre-schoolers when serving popular meals
(e.g. spaghetti bolognaise or chicken
nuggets with chips), drinks and treats.
Furthermore, 73 per cent of parents were
more concerned that their child did not
eat enough — twice as likely as they were
to be concerned that their child ate too
much. Also, interestingly, only 25 per cent
of parents worried that their child might
become overweight in the future.
Gill Harris, a child and clinical
psychologist and member of the ITF, says
it’s never too early to start promoting
healthy eating habits. “Most toddlers are
naturally better than older children and
adults at regulating their food intake,”
she says. “They usually only eat what
they need and don’t overeat”. However,
she points out that portion size is critical.
“It’s one of the main ways in which, as
parents, we can inadvertently override
children’s self-regulation systems. Larger
portions form our acceptance about
what is an appropriate amount to eat and
this becomes the norm. In other words,
how much you offer often determines
how much your child will eat, and habits
learned in early life generally tend to
persist.”
Nutritional therapist Kate Delmar-
Morgan, a specialist in children’s health,
points out that focus should also be on
quality, not quantity.
“At this, or indeed any age, children
need a balanced and nutritious diet
based on all the food groups. But when
they are toddlers their tummies are quite
small still so try to concentrate on good
nutrient content of meals rather than large
portions,” she says. “Toddlers are going
through rapid growth and development
and are often quite physically active
so they do require a good variety of
nutrients.”
Delmar-Morgan recommends limiting
foods high in sugar and lacking nutrients,
and advises against using bribes of
pudding to get children to eat (something
I swore I’d never do, but of course have).
There is also no need to panic if a child
doesn’t eat well at one meal, she says,
as the next meal isn’t that far away —
but do avoid using snacks and drinks to
compensate as this will fill toddlers up
and may alter their appetite regulation
system.
Another really important thing to
remember, as Delmar-Morgan points out,
is that toddler appetites do vary from day
to day — and indeed from meal to meal —
and it is best to allow them to eat to their
appetite, allowing them to finish when
they have had enough.
So, for now at least, I feel reassured.
Or maybe not… Perhaps I ought to
transfer my concerns to the very hearty
appetite of Child 2? Joking aside, as a
parent, I want to encourage my boys
to develop a healthy relationship with
food — I want them to be aware of their
natural appetites and to eat accordingly.
I also need to lead by example, so I will
be paying close attention to the size of
my own meals too — after all, portion
distortion certainly isn’t something limited
to the plates of our toddlers.
References:
1. www.infantandtoddlerforum.org/portion-sizes-
table-2015
2. www.prnewswire.co.uk/news-releases/
the-supersized-issue-why-uk-parents-are-
overfeeding-585434001.html

I I
n the UK, the festive period presents
certain challenges: buying presents,
speaking to the in-laws, and Brussels
sprouts.
Unsurprisingly, the Brussels sprout
gained its name in the Belgian city,
and has been a winter staple since the
16th century. Fans describe its taste as
sweet and nutty; others say it is bitter.
Around 70 per cent of us carry a gene
that enhances bitter tastes, which may
explain why, as a perennial on the British
Christmas menu, this unpretentious
vegetable divides opinion every winter.
If you aren’t a fan but force yourself
to eat them out of politeness, you
may find solace in knowing that this
little cruciferous has high amounts of
vitamin A, B9 (folate), C and K as well
as a hefty quantity of fibre. But they also
contain sulforaphane, a chemical which,
when boiled, produces a strong odour
that resembles rotten eggs and which,
importantly, has been found to target
cancer stem cells — its positive effects are
particularly effective in conjunction with
chemotherapy.1
From a cancer prevention perspective,
the cruciferous family tends to contain
high quantities of sulforaphane,
antioxidants and fibre; all of which have
shown an overall reduction in cancer
risk. This may be because of enhanced
detoxification enzymes, as this pathway
was discovered to be associated
with reducing colorectal cancer risk.2
Additionally, cruciferous vegetables have
been shown to significantly reduce the
risk of gastric cancer.3
Despite all these advantages, the
humble sprout often remains unloved
and untouched, especially by children, on
many Christmas dinner plates. Yet as one
study has found, it is possible for children
to be conditioned to enjoy Brussels
References:
1. Li Y & Zhang T (2013). Targeting cancer stem
cells with sulforaphane, a dietary component
from broccoli and broccoli sprouts. Future Oncol
9(8), 1097-1103.
2. Nijhoff WA et al (1995). Effects of consumption
of Brussels sprouts on intestinal and
lymphocytic glutathione S-transferases in
humans. Carcinogenesis 16(9), 2125-2128.
3. Wu QJ et al (2013). Cruciferous vegetable
consumption and gastric cancer risk: a meta-
analysis of epidemiological studies. Cancer Sci
104(8), 1067-1073.
4. Capaldi-Phillips ED & Wadhera D (2014).
Associative conditioning can increase liking
for and consumption of brussels sprouts in
children aged 3 to 5 years. J of the Acad of Nutr
and Dietetics 114(8), 1236-1241.
IN SEASON
sprouts from a young age. Researchers in n the coming months of winter, lay
the US used “associative conditioning”, foundations to get ahead for next year,
in which two contrasting food items such and make a few sowings for spring
as Brussels sprouts and cream cheese harvests.
were paired.4 It was found that the pairing During autumn, there is a residue
increased liking more than repeated of summer’s warmth in the soil, even
exposure to plain sprouts. until Christmas, and new sowings use
So if you want your little ones to like that to establish a root system. Visible
sprouts — or want to like them more growth is small, but come the first mild
yourself — serving them with a favourite, weather next year, new leaves can use
non-bitter flavour could be the way the established root system to develop
forward. And it must work because it’s quickly.
not just us here at Optimum Nutrition who If the soil is weedy, now is a fine
are eating them! More than two thirds of moment to sort it, so you are ready for
Brussels sprouts are eaten outside the sowing and planting next year. Rather
festive period, which shows how popular than digging, simply spread a mulch on
they are. And now we know that we can top to feed the soil, improve its structure,
do more than just boil them, perhaps even multiply the living organisms and weaken
sprouts sceptics might be persuaded to or clear weeds.
investigate the range of delicious recipes. If there are just a few weeds, remove
Christian Billinghurst them to the compost heap, then mulch
with 1–2in (3–5cm) of compost. If there
WARM BRUSSELS SPROUTS SALAD is a mass of weeds, spread the compost
WITH POMEGRANATE first and then cover ground with black
By Christine Bailey MSc PGCE MBANT CNHC polythene until next April.
Start now to grow healthy produce
Difficulty: Easy next year, more simply and with less time
Time: 2-3 minutes cooking needed.
Serves: 4
Seasonal updates available through
INGREDIENTS www.charlesdowding.co.uk
• 1 tbsp coconut oil
• 1 red onion, diced
• 300g Brussels sprouts, shredded
• 60g pomegranate seeds
• 30g goji berries
• 30g toasted mixed seeds
Dressing
• 3 tbsp raspberry vinegar
• 6 tbsp olive oil
• 1 tsp Dijon mustard
• Sea salt and black pepper
INSTRUCTIONS
To make the dressing, simply whisk all the
ingredients together. You can put all the
ingredients in a glass jar and shake well.
Shred the Brussels sprouts finely. Place
in a bowl. Heat the coconut oil in a large
pan or wok and sauté the red onion for
1-2 minutes. Add the Brussels sprouts
and stir for 1-2 minutes to soften. Throw
in the remaining ingredients including the
dressing and stir to warm through. Serve
warm or leave to cool.
Recipe extracted with kind
permission from
www.christinebailey.co.uk
AUTUMN 2017 | OPTIMUM NUTRITION 47
MOVE IT
Former fitness-phobe Alice Ball takes a look at why Sport England wants to get women of all
ages moving with the This Girl Can campaign, and speaks to some women who did
T “High intensity exercise
hroughout my teenage years, I saw
exercise as a chore or something
only naturally athletic people
could enjoy, and I avoided any activity
that involved getting remotely sweaty.
Nowadays, I’m the gym bunny amongst
my friends; I own more active wear than
regular clothes and gain satisfaction from
getting a sweat on. Yet many women
admit to avoiding exercise. Before it
launched its This Girl Can campaign
in 2015, Sport England found that two
million fewer females aged 14-40 played
regular sport, compared to men, despite
75 per cent admitting that they wanted
to be more active.1 This Girl Can aimed to
change all that.
You may have seen the adverts: women
of all ages and abilities sweating and
jiggling during sport, with no idealised,
stylised images of traditional sporting
figures. And this was the campaign’s
goal, to help women overcome their main
concern about exercise: fear of judgement
of their shape, weight and sporting ability.
But it was about more than overcoming
a fear of lycra and perspiration. This Girl
Can aims to prevent many of the health
concerns related to physical inactivity,
including type 2 diabetes, breast and
48 OPTIMUM NUTRITION | AUTUMN 2017
involves myokines... a
cell signalling protein
produced by muscle
fibres that protects
against metabolic
syndrome”
colon cancer, and cardiovascular disease
— the leading cause of death from
inactivity.
Whilst obesity has doubled in the
UK over the past 30 years, it is higher
amongst women than men. Being
overweight and inactive significantly
increases the likelihood of developing
other conditions, which is why women are
being specifically targeted. So it’s not so
much about us losing weight and looking
good; it’s about living healthily for longer.
Dr Tamsin Lewis, a former professional
triathlete and 2014 Ironman champion,
told Optimum Nutrition: “Being overweight
increases the risk of diabetes, especially
in women as they are more susceptible to
it. It also substantially increases the risk of
major cancers such as post-menopausal
breast cancer. This is because fat tissue
produces excess amounts of oestrogen.”
She says that other risks include
heart disease and stroke, increased
inflammation, and mental illness.
“High intensity exercise involves
myokines,” says Lewis. “This is a cell
signalling protein produced by muscle
fibres that protects against metabolic
syndrome — a group of conditions
including high blood sugar — that raises
your risk of diabetes and heart disease.”
Lewis recommends “staying active
throughout the day and finding something
you enjoy” as well as high intensity
interval training (HIIT) workouts to burn
body fat.
Healthy body, healthy mind
For some of us, however, the prospect
of dripping in sweat for an hour just
isn’t as appealing as a night in front of
the television with a glass of wine and
a takeaway. But the body and mind
are interlinked; when we take care of
ourselves physically, we help the whole
system. Exercise produces a relaxation
response which enhances mood and

decreases stress levels, due to the release
of chemicals in the brain such as serotonin
and dopamine which boost mood. So
whilst exercise might not seem like the
most relaxing activity to do after a long
day at work, it can actually be what our
mind needs to brighten our mood.
Exercise has also been shown to
improve brain function. In one study, a
positive relationship was found between
physical activity and cognitive function in
school children aged four to 18, suggesting
that exercise may also be linked to
cognition during development. Exercise
participation was specifically related to
increased performance in areas such
as verbal tests, mathematics tests and
developmental level.2
But the mental benefits of physical
activity aren’t just limited to the younger
generation. In one study, elderly
participants were split into two groups;
one received a six-month aerobic exercise
intervention (i.e. walking) whilst the
other received a stretching and toning
intervention. Brain volume increased in
adults who participated in the aerobic
fitness training, particularly areas involved
with attention and memory processes.
These findings were not observed for
those in the non-aerobic training group,3
suggesting that getting moving physically
really does help, mentally.
Overcoming judgement
But to get women moving more, they first
had to be persuaded to stop feeling shy.
So Sport England looked very carefully at
why women felt sport and exercise was
not for them — perhaps unsurprisingly,
worries about being judged for being the
wrong size, not fit enough, and not skilled
enough came up time and again.4 To
It adopted ballsy
slogans, including
“Sweating like a pig,
feeling like a fox” and “I
kick balls, deal with it”
combat this, the television advertisement
‘street-cast’ women from gyms, parks and
sports teams across the country to appear
in the campaign. It also adopted ballsy
slogans, including “Sweating like a pig,
feeling like a fox” and “I kick balls, deal
with it” to encourage ordinary women to
get active.
Since its launch, the campaign has
gained more than 8,000 supporters,
ranging from local sports clubs to major
organisations, it has teamed up with
Marks & Spencer to produce a This
Girl Can exercise-clothing collection
for women, and has featured a filter on
Snapchat encouraging women to post
their sweaty selfies. But the real proof
of success is in the figures: in 2016 it
reported that 7.21 million women now do
regular physical activity, an increase of
250,000 since This Girl Can launched,
whilst the gender gap between men and
women who exercise has narrowed from
over two million to 1.55m.
Despite these encouraging figures,
however, overcoming fear of judgement
is difficult, says Kate Dale, campaign
manager for This Girl Can. “As well as
measuring increases in the number of
women taking part, helping to reduce
the gender gap, we also measure the
campaign’s effect on women’s sense of
confidence and belonging — the two
MOVE IT
things that help us manage our fear of
judgement. This takes longer to shift and
can be more fragile.”
“The change in action comes before the
change in attitude — you do something,
find it was okay and then how you feel
begins to shift.
“But we have seen measurable
increases in how confident women feel
about getting active and their ability to
manage the fear of judgement.”
However, This Girl Can cannot work
single-handedly to diminish the image
of perfection in the fitness industry. Dale
says that future plans include “working
with partners from the sporting and non-
sporting, public and private sector worlds
to help activate the campaign” and to
continue to share the community’s stories,
images and conversations.
So whether you’ve got a pair of DDs,
feel wobbly around the edges or get out of
breath from walking up a flight of stairs,
don’t be afraid to sweat. This Girl Can
shows that exercise is for every woman,
no matter what shape, size or sporting
ability.
Take it from a former couch potato.
References:
1. www.sportengland.org/our-work/women/
this-girl-can/
2. Sibley BA, Etnier JL (2003). The relationship
between physical activity and cognition in
children: A meta-analysis. Pediatr Exerc Sci.
2003;15:243–256.
3. Colcombe SJ et al (2006). Aerobic exercise
training increases brain volume in aging
humans. J Gerontol A Biol Sci Med Sci.
61(11):1166-70.
4. www.sportengland.org/news-and-features/
news/2016/december/8/record-numbers-
of-women-getting-active/
AUTUMN 2017 | OPTIMUM NUTRITION 49
MOVE IT

Climbing high
This Girl Can encourages women to get active, no matter how they do it. Until last year,
Olivia Ford, 19, a student from Bournemouth University, hated most sports.
“I never used to be an active person, but I was interested in doing rock climbing for
years because I liked heights and adrenaline, and you could set your own pace,” she says.
Ford decided to join the Bournemouth University Climbing Club where she is now the
vice president and social secretary. The club goes bouldering (short walls without ropes)
twice a week and top ropes (higher walls using a rope and harness) every other week.
Climbing requires both agility and strength.
“I find overhang climbs particularly difficult as I lack upper body strength,” Ford explains,
“My goal is to be able to do an unassisted pull up which will help with these overhangs.”
She adds: “It took me 18 years to find my sport, but I love how sociable climbing is and the
amount of team work that it involves. I think a great time to try new activities is through
societies at university as there will be many newcomers in the same boat.”

Pounding pavements
University can be a useful starting point for young females looking to try their hand at sport, but there are more ways women can get
active. Julie Scott, 51, is training for her seventh marathon in September. She completed her first marathon just three years ago, in memory
of her daughter.
“I started running around the boating lake at my local park,” says Scott. “Like every beginner I had to walk a lot of the time. I then
entered a five-mile race to give me the incentive to carry on running and joined my local running club for support.”
Scott has since competed in many events, including a 38-mile ‘ultra’ marathon last October and a 50km run in March. “I would
encourage anyone to have a go at running,” she says. “I’m not built to run but it’s not about speed; it’s about enjoyment. The most
important thing is that age is not a barrier; you can take up running at any age, even without a sporting background.”

Spellbinding sport
Alisha Raithatha, 20, also fell in love with a new sport when she started university. Fans of the Harry Potter franchise will be familiar with
the magical sport of quidditch: a semi-contact game played on flying broomsticks. But the sport is no longer a fictitious fantasy. Quidditch
is a recognised sport in many countries, consisting of a hybrid of handball, rugby, dodgeball and tag. Raithatha plays for the Liverpuddly
Cannons at Liverpool University. She was instantly drawn to the sport because it “wasn’t overly competitive and seemed encouraging and
friendly”.
There are seven members on each quidditch team and four different positions, each requiring players of varying shapes, sizes and skills.
Raithatha plays the position of beater, along with Freya Brooks, 19. “Being a beater entails throwing dodgeballs at the other team in order
to momentarily get them out of the game and give your team the opportunity to score,” they explain. “This is made more difficult by all
players being mounted on brooms, which act as a handicap.”
Raithatha says that the best thing about quidditch is that “it’s good for busy or non-sporty people”. “We don’t have try outs on our
team and we don’t shun people who don’t come to practice regularly,” she adds. “We understand people have other commitments; our
main aim is to ensure everyone has fun and to encourage people to play sport when they might not otherwise.” And teammate, Chloe
Hemingway, 19, agrees. “Quidditch is a sport that embraces people who might not usually be interested or feel welcome in sports teams
because of the ‘lad’ culture surrounding traditional university sports,” she says. “The amazing community spirit and sense of genuine
friendship is easily the best thing about it.”

Boxing clever
Helen, 50, says she was always never happier than when she was sitting on the sofa either reading or working on a puzzle book, and
admits that that is still how she likes to unwind. But after starting a job where there was a free gym with thrown-in exercise classes, she
says she has become addicted to her regular workouts. “If a class is cancelled for any reason I get really annoyed because it is something I
look forward to.
“Since joining the gym I have taken up boxercise — which is fantastic for getting all my stresses out — although it has been difficult
when I’ve been partnered up with some massive bloke who is twice my size and twice as strong. I tend to sign up for a variety of classes
because I actually find them a mental challenge as well as a physical one. I’m quite stubborn as a person, so if there is a class that I think I
might not be able to do, I stick at it just through sheer bloody-mindedness!
“I had been quite a couch potato before, so it has turned around how I feel about myself. I haven’t tried out my fitness levels outside of
the gym, but I had to throw out a whole load of clothes because they started hanging off me, so my body shape has definitely changed.”

50 OPTIMUM NUTRITION | AUTUMN 2017