A quick tour of my clinic

I have just finished giving my consulting room a bit of a make-over and I’m pleased with the results. If you have a couple of minutes, I’d like to show you around…

Come in! … Yes, everyone comments on the smell of herbs – it’s nice isn’t it?
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The cabinets along the wall are new. Previously there were a random set of pine cupboards, filing cabinets and display cases there. The new white billy bookcases came from IKEA – thank goodness for IKEA eh? I keep my dried herbs in there. I think they look smart don’t you? Continue reading

WSHoMSoc 2015 lecture Nov 21st

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Nicholas Cambridge MD MRCS FSA FLS FRSA gave us a very interesting presentation about a chap I had never even heard of, a certain Dr Alfred Carpenter: ‘Archbishops, East India Company & Public Health: Life as a Busy Victorian GP’. Here is my precis of the event:

The first slide in the lecture showed an effigy of Dr Carpenter being burned during an outpouring of public anger in 1884. The cause of this outrage was due to this Victorian public health advocate’s vociferous support for the temperance movement and particularly the calling for pubs and taverns to be closed on Sundays. Brits, it seems, just don’t like being finger-wagged when it comes to traditions they hold so close to their hearts.

It was not always that way though. Dr Alfred Carpenter (1825 – 1892) started out as a humble son of a country apothecary who stood in for dad when he was ill and found he rather liked doing the doctorly thing. This led to him studying at a number of institutions where he gained many prizes for academic excellence, leading finally to his occupation as a general practitioner in Croydon, which, in the 1850s, was a small town outside London boasting eighteen doctors, one for every 1000 townspeople.

It was here that he made his home and his reputation in the subsequent four decades. During this period he cared for the physical wellbeing of no less than four archbishops, which must surely be a record. They were John Bird Sumner, Charles Thomas Longley, Campbell Tait (whose whole family suffered rather disastrous health outcomes) and lastly Archbishop Benson, after whom a school in Truro is currently named.

Probably the most important and lasting effect of Carpenter’s work in Croydon was due to his abiding interest in public health. Indeed he had written a book ‘The Principle and Practice of Public Hygiene’ in 1848, before arriving Surrey, so was able to work to bring about things like sewers in Croydon which had hitherto had none and, as a rapidly growing town, suffered waves of epidemics of cholera, typhoid and smallpox. We were shown a remarkable picture of the newly built domed reservoir for the town (see below) which was opened by the Archbishop of Canterbury. Although everyone was very hopeful that such population threatening diseases would now be a thing of the past, Croydon went on to lose 10% of its inhabitants to typhoid fever in 1852, leading to repairs and further improvements to the infrastructure. Even so, another outbreak of 1200 cases of typhoid, in 1875, lead to a lot of head scratching.

This domed reservoir is a remarkable example of Victorian public health infrastructure that was promoted by Dr Alfred Carpenter (1825-1892)

Public baths were set up, which must have given a boost to to personal hygiene, but smallpox struck in 1879 leading to a lot of controversy about smallpox inoculations, with Dr Carpenter fining parents 5 or 10 shillings if they declined to have their children vaccinated, so certain was he of their efficacy. Interestingly, the term ‘conscientious objector’ was coined in describing those people (many of whom were doctors) who did not acquiesce to the pressure to vaccinate their children.

Following his exposure to the progressive work of John B Lawes FRS in a talk titled ‘The Sewerage of London’ Dr Carpenter worked on the concept of sending Croydon’s sewage to the fields of ryegrass nearby, to grow grass good enough feed local dairy cows. This process was a complete success, and no taint of microbes from the human sewage was found in the milk when tested independently. Everyone was mightily impressed with this.

Alfred Carpenter, who died a wealthy man at the age of just 66 of ‘cerebral exhaustion’, had a hand in many good works, including an involvement in ‘schools for ragged children’, on hospital boards, with the temperance movement, as president of the local cricket club (though a non player), the church choir (though a non singer) and with charities of all sorts, but to me his involvement in sewers and fresh piped water places him in a genuinely important historical position.

Here in Chichester we were twenty years behind Croydon, building our sewers only in the 1870s and it took us until the 1890s for water pipes to reach this little town. Well done Dr Alfred Carpenter for getting this process up and running so much sooner in Croydon.

 

Second lecture: ‘Sir Henry Wellcome’ by Professor Tilli Tansey OBE PhD PhD DSc FMedSci FRCP

Henry Wellcome almost needs no introduction as we all know the importance and influence of this handsome and extraordinary man, but hearing about his origins, personal journey, obsessions and achievements was really wonderful.
I had not realized that he was born in the era of covered wagons and efforts to claim the land from the natives in northern USA (Wisconsin, 1853). The son of an itinerant missionary his family and others literally arranged the wagons in a circle round a fire in the evening and set a watch in case of attack by the local Sioux Indians who were trying to drive out these imigrants from their lands! To go from that unprepossessing start to the status of a man of immense wealth, head of his own super successful pharmaceutical company and outstanding world renowned museum is quite something! I am afraid the Sioux did not do so well from this clash of cultures.

Henry (back left) with brother George and parents Solomon and Mary in about 1876.

Starting with selling invisible ink at the age of 16 (yes, it was just lemon juice, as you and I have used) to becoming the most brilliant salesman possibly of the century, this chap really recognised gaps in the market to exploit like no one else. His ability to present his drugs was striking, and he introduced the concept of drug reps, and customer feedback, all totally innovative and game changing.

Henry’s life was about collecting, as well as marketing. He loved medical equipment from all corners and cultures of the globe; he was fascinated with collecting herbal medicines, statues, mummies, and archeological artifacts of every sort. Travelling must have taken decades of his life, as he went all over South America, many parts of Africa, including setting up a large archeological excavation in the Sudan, and all over the globe, collecting and collecting as he went. They say that when he died in 1936 at the age of 82 there were warehouses filled with crates of items he had caused to be brought to England. Indeed it is reckoned that every museum in the UK, and probably many abroad too, house artifacts directly from his sources.

Henry Wellcome and his wife Syrie, daughter of Dr Barnardo, are shown here in an awkward pose, representing their awkward and unsuccessful marriage which lasted from 1901, when she was just eighteen, to 1910 when she left him though the divorce was not finalized until 1916, amidst great media interest. She had been having an affair with the writer W Somerset Maugham, and became his wife, producing a daughter with him. The son she had with Henry, called Mounteney, was something of a disappointment to him as he did not have a head for business or running the extraordinary emporium that his father had created. However he did enjoy the life of a farmer which he settled to in one of the Home Counties.


↑Henry Wellcome with some of the Sudanese workers at the archaeological site there.
Wellcome_in_SudanWellcome surveying the Sudanese archeological site. ↑

 

The museum built and paid for my Henry Wellcome to house his astounding collection is as grand and wonderful now as it was when it was opened in 1931, situated as it is at 183 Euston Road, London. Here it is lit up for Christmas, looking utterly inviting.

A trip to this exciting and fantastical place is highly recommended.

Here is a glimpse of part of the interior:

Thank you Professor Tansey for your enlightening presentation.

 

 

WSHoMSoc 2015 lecture Nov 7th

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We were treated to a pair of lectures about the First World War since this meeting was so close to Remembrance Day, and what lectures they were!

Who better than Professor Christine Hallett who holds not only a PhD in nursing but another PhD in history RGN FRSM FRSA to be given the opportunity to take the podium and present the subject “Veiled Warriors: Allied Nurses of the First World War”. The description which followed of the work these women performed was riveting, and delivered at break neck speed, leaving me scribbling in darkness, trying to take notes in order write for you, dear reader, such that you get a feel for the event.

Professor Hallett described the various ranks and requirements of the many nurses that served in this new type of war, previously unseen in the history of mankind.

There was a 2-3 year training course which produced the professional and highly proficient nurses, often drawn from the higher social classes and they wore the gorgeous and readily recognised uniform you see here in an original black and white photo, but you can see a museum mock up of it to the right.

These Professional Nurses worked closely with the VAD (Volunteer Aid Detachment) nurses, who’s uniform became the icon of the ‘nurse’, with the pale blue dress, white full apron, short white veil worn quite far back on the head, and the large red cross on the front of the apron. I even found this child’s nurses costume available on Amazon, which demonstrates just how clearly we all know this uniform for what it represents and alongside it is a photo of one of these brave and dedicated young women from WW1.

 

 

 

 

 

 

 

The nurses of Australia, New Zealand and the Allies of Belgium and France were organised in their own manner, in similar ways to our own, but in some countries nursing was primarily done by nuns,
or simply volunteer women. It was probably this war, more than any other, that established the importance of the role of the nurse in every country in the world.

The circumstances and conditions that these women were plunged into could not have been anticipated and many became casualties along with the soldiers they tended as field hospitals were hit by shells, hospital ships torpedoed or trucks ferrying soldiers away from the front line were attacked. It was due to the experiences of this war that the need for medical care far closer to the front line was recognised, and became a priority. This continues today, with mobile helicopter medical teams that fly in, collect casualties, treat them sufficiently for maintenance of life and deliver them to better equipped land based hospitals further away from the action. In this way we now have a vastly improved survival rate following what would otherwise have been fatal injuries. In WW1 these were called Casualty Clearing Stations (CCSs) and as these were developed, with immense input from the nurses, the terrible rate of fatalities that shocked Whitehall in the earliest months of the war did reduce significantly.

Below is a photo of Miss Kate Evelyn Luard who was a supervisor of an advanced abdominal surgery ward. She was one of the most responsible and also most at risk nurses at a CCS during the Battle of Passchendaele. Below is a book of her letters written from the front.

This is one of the beautifully ordered wards, with soldier patients, doctors and nurses posing for the photo. Trench warfare conditions presented appalling challenges to survival. Even without the shelling, gas attacks, shooting, dysentery, typhus and frost bite, there was the dreaded ‘trench foot’ to contend with! Oh, and shell shock, of course. Nurses had to handle all this and the actual war itself, and they too fell ill with the same contagious diseases as the men, or just from utter exhaustion.

The horrors of WW1 can be seen from many different standpoints, and the experiences of nurses is a very close perspective indeed. Their care made a very significant contribution to the outcome for countless people.

The second lecture “Wounded – The Long Journey Home from The Great War” was by Dr Emily Mayhew MSc PhD.

The subject Dr Mayhew brought to our attention is illustrated in the book cover, left; the Unknown Warriors  were the Stretcher Bearers.

Dr Mayhew is a Military Historian and Historian in Residence at the Royal British Legion Centre for Blast Injury Studies at Imperial College London and in recent years has focused on this thoroughly overlooked aspect of the Great War. Stretcher bearers were absolutely vital to the survival of our troops on the front line. Frequently recruited from the conscientious objector community, including Quakers, these men were put through a six-week training to ensure physical capability and strength, which involved carrying 10 stone (63.5 kg) weights, on stretchers, up and down Box Hill in Surrey (the very same has more recently been used by Sir Bradley Wiggins in his training for the Tour de France and Olympics).

They were also taught life saving skills that could be employed right there in the field or in the trenches, and the number saved through their ministrations cannot be known. Another aspect of their work was that of kindness, reassurance and compassion in hand holding, gentle words and deep understanding, which is truly immeasurable in its impact to a wounded or dying young man.

It is very easy to overlook certain vital factors in how things actually work. For example, to a great extent we overlook and ignore the connective tissue in our bodies, even though nothing could function without it, as it connects all the other more identifiable tissues, organs and structures. In the same way we, en masse, have somehow overlooked the essential role that the stretcher bearers played. And not only have we overlooked their active work but also some of the vitally important innovations they brought to medicine.

Dr Mayhew used no images, but none were needed as her verbal illustration, knowledge, and passion conveyed all one needed. Having said that, stretcher bearers are not really invisible, it is just that it has not been discussed before. Many, many images of the Great War actually do show these heroes, who not only saved others but were frequently casualties themselves, being easy slow moving targets once they had their charges in their stretchers. They simply have not hitherto been focused on even though theirs was a pivotal role.

Here then are classic First World War photographs, but this time I want you to focus on these men and note how you, as I, recognise that their role has been overlooked and their images interpreted as impersonal images of that war. I need write no more, as the pictures tell the tale far better.

Thank you Dr Mayhew for opening my eyes to the labour, goodness and sacrifice of these unsung heroes.

 

 

 

 

 

 

 

November News Round-Up

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  • Gluten free diets benefit otherwise healthy people
  • Pasture fed meat – Dexter cattle and Dartmoor ponies
  • Ketogenic diet for better brain function, weight loss and endurance sports
  • A plethora of Vitamin D studies
  • ‘False alarm’ over red meat and cancer
  • Chocolate prices to soar

New UK study vindicates gluten-free diets in otherwise healthy people

Just creeping into this month’s round up – The Daily Mail (30th November) reports on the ‘Going Gluten Free’ study organised by Aberdeen University’s Rowett Institute of Nutrition and Health.

It found that 3 weeks on a gluten free diet reduced bloating, flatulence and fatigue in otherwise healthy participants. Dr Alexandra Johnstone, of the Rowett Institute of Nutrition and Health, said: ‘It was interesting to discover that a gluten-free diet improves feelings of fatigue, with participants reporting much higher energy levels during the gluten-free period of the study.

‘The fact that they were able to start tasks quicker, concentrate better and think clearer during this time, and felt the need to rest less, all point towards the idea that sensitivity to gluten does exist for some individuals who don’t have coeliac disease.

Gluten free diets have been linked with poor dietary habits as individuals head for the gluten-free aisles, but recent promotion of real foods may have paid off: in this study participants overall dietary quality improved with consumption of more fruit and vegetables and an increased fibre consumption! I’ve highlighted that as we have been arguing on this blog that a proper gluten-free diet should improve the overall diet and lead to increased fibre intake.

Just a pity it was part-funded by a gluten-free food manufacturer.

Pasture-fed meat #1: Cattle help preserve rare South Downs grassland

The role of large herbivores in the landscape is increasingly being recognised for their environmental benefits. The meat from such animals is also considered healthier – higher in omega-3 fats, vitamin A and E. So it was pleasing to read in The West Sussex Gazette (31st October) of the recent introduction of Dexter cattle – a short stocky breed – to maintain endangered South Downs grassland at Steyning, West Sussex. What is more, the meat from these animals is available from Garlic Wood Farm butchers.

“My aim was to establish an efficient and sustainable farming system, producing a quality product raised solely on pasture that would benefit both the environment and human health.” – Frances Sedgwick, Cattle Breeder

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Pasture-fed meat #2: Dartmoor Ponies

Also looking at the intersection of conservation and food was Radio 4’s Hardeep’s Sunday Lunch (29th November) which addressed a controversial topic: the proposal that we should encourage the use of Dartmoor hill ponies for meat.

Dartmoor and Exmoor have semi-wild pony populations that helped create those iconic landscapes, but economics mean that their numbers are dwindling. One proposal to keep this ancient form of land management viable is to encourage eating of pony meat. You can listen again until 28th December to this thoughtful and heart felt radio documentary.

Closer to home, the Knepp rewilding project also has herds of Exmoor ponies that look for all the world like the 17,000 year old cave paintings from Lascaux in France. Knepp too is facing the thorny question of whether it is right that these magnificent animals should go to waste when their population needs culling, rather than sold as prime pasture-fed meat. I’m sure the cave painters wouldn’t have any doubts.

Knepp_Exmoor_Ponies

Ketogenic diet: Caproic acid

New Scientist (25th November – you need to register to read it) has an article on the ketogenic diet for epilepsy, but also touches on its uses in other brain disorders and cancer. It’s worth a look as it provides a reasonable overview of some of the basics of the diet. However, the news bit is that researchers recently found (in rats at least) that the saturated fatty acid known as decanoic or caproic acid suppressed epileptic brain activity rather than the ketones.

Caproic acid is present in coconut oil (10%) and butter (2%), both of which can be used in the ketogenic diet. Unfortunately, neither the paper, nor New Scientist point out that in humans seizure control has be achieved without the use of this medium chain triglyceride, indicating that there is more to the ketogenic diet than caproic acid. Both ketones and low-glucose/insulin levels induced by the diet have been shown to have multiple protective effects on the brain.

Meanwhile the ketogenic diet for weight loss featured in The Express (23rd November) with typically tabloid panache: ‘Woman shed a THIRD of her bodyweight eating MORE bacon and butter’.

The ketogenic diet is increasingly being used in endurance sport as reported in Men’s Fitness (17th November), based on a study by world expert Jeff Volek, in which the fat burning levels of athletes on the ketogenic diet was found to be twice that of carb loading athletes.

Vitamin D

It’s been a big month for vitamin D research with a host of stories making the newspapers:

In previous posts we have advocated maximising vitamin D levels from midday sun exposure short of burning (Why April 15th is D-Day in the south of England) so as to gain the highest UVB:UVA ratio. So it is gratifying to see researchers from the University of Oslo come to the same conclusion in a paper published this month:

The best way to obtain a given dose of vitamin D with minimal carcinogenic risk is through a non-burning exposure in the middle of the day, rather than in the afternoon or morning. Grigalavicius et al, International journal of dermatology (Nov, 2015)

 

Here at Rosemary Cottage Clinic patients avail themselves of the wall mounted UVB 311nm narrowband light box on a weekly basis throughout the autumn and winter months to ensure they retain healthy levels of vitamin D to keep them well.

For those who wish to check their vitamin D levels I now have sealed test kits in stock at just £28 each, supplied by a specialist vitamin D test centre. So if you want to do a ‘before and after’ test get in contact to arrange it.

A false alarm on red meat and cancer

Following last month’s panic when the WHO classified red meat as a possible carcinogen the UK saw double digit falls in sales for three weeks. So it’s nice to see The Financial Times (24th November) taking a critical look at the quality of the data, like we did, and concluding that it was a ‘false alarm’.

Gordon Guyatt, an epidemiologist and professor of medicine at Hamilton’s McMaster University said “Two large trials have tested for evidence and the WHO ignored both of them.” He claims the WHO evidence is “very modest” and might easily be attributable to other confounding factors observational studies can’t fully adjust for (The National Post, 29th October).

It has also come to light that one of the leading advisors to the WHO is a lifelong vegetarian who has voiced moral and environmental objections to meat eating – how objective is that?

As if to make up for damage done, The Daily Mail (2nd November) had a pretty good article reviewing many of the health benefits associated with meat.

Chocolate prices to soar

Sorry to end on a bad note but forecasters are predicting chocolate prices will rise next year thanks to poor harvests in West Africa and strong winds caused by the El Nino weather system. If you can bear to read more, The Telegraph (30th November) give the full gory details.

Right Royal Rashers – we rate the best bacon buys ★★★★★

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Bacon is part of traditional English cooked breakfasts but is also a versatile ingredient that imparts an unmistakable flavour and texture to other dishes. Its famous irresistibility has been the downfall of many a vegan wannabe. Bacon has developed something of a bad-boy reputation with a raft of (unwarranted) nutritional concerns that get between you and it: Continue reading

Omega-6 and Omega-3 PUFAs: Five recent research papers

Their is a great deal of research coming out about the essential polyunsaturated fatty acids (PUFAs) and I want to share some of the latest papers with you.

Paleo platter

Hunter-gatherer diets based around wild foods contained roughly equal proportions of omega-6 and omega-3 PUFAs. By comparison modern diets tend to be deficient in omega-3 but with an excess of omega-6 oils.

Background

There are two families of essential polyunsaturated fatty acids (PUFAs) that are needed in the diet. The main source of omega-3 PUFAs in the human diet are from oily fish and shellfish (DHA and EPA) but the short-chain precursor (ALA) is found in significant quantities in some nuts (e.g. walnuts) and seeds (e.g. linseed). The omega-6 PUFAs are found in modest quantities in fish and meat (AA), whilst the plant-source precursor (LA) comes mainly from grains and vegetable oils.

Modern hunter-gatherer diets as well as historical pre-agricultural diets are believed to have provided roughly equal proportions of these two PUFAs. A shift to eating more processed foods over the last 100 years has led to the typical western diet being deficient in omega-3 whilst the quantity of omega-6 has increased enormously. Changes in animal husbandry – especially through using soy and grains as a food source rather than grass – has led to a similar imbalance in PUFAs in meat, eggs and farmed fish.

A detailed explanation of these essential dietary PUFAs can be found in the first half of the video of our seafood talk below.

The Latest Research

Paper 1: Increasing mother’s omega 3 prevents pre-term lung injury (Sep 2015)

It is a miracle of modern medicine that very prem babies now survive where once they would have simply died. The most common complication, however, is bronchopulmonary dysplasia (BPD), a chronic lung disorder of infants and children first described in 1967. It is more common in infants with low birth weight and those who receive prolonged mechanical ventilation to treat respiratory distress syndrome.

As our video above explains, omega-3 fats are critical during pregnancy as they are pivotal in the baby’s brain development. This critical period of omega-3 intake is further underscored by the work in this paper which found that a high omega-3 PUFA diet reduced the damage of BPD in rats. Omega-6 supplementation failed to reduce the damage.

The authors conclude: “In clinical settings, maternal PUFA omega-3 supplementation during pregnancy and during lactation may prevent BPD development after premature birth.”

Paper 2: Plant based omega 3’s reduced inflammation and oxidative markers (Nov 2015) 

This paper examined whether the benefits of a low omega-6 to 3 ratio would still be evident if the principle source of omega-3 fats came from plant sources (ALA) instead of the more usual fish oils (EPA and DHA).

Rats were given one of three diets with omega 6 to 3 ratios of 1:1, 5:1 and 20:1. That’s a pretty good range, as 1:1 is close to our long-term evolutionary diet, whereas 20:1 is close to the typical western diet. It’s good they included a 5:1 ratio as this is an achievable goal if you cut out omega 6 vegetable oils (e.g. sunflower & corn oil).

So what did they find?

The 1:1 and 5:1 ratio groups had significantly decreased serum levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, and proinflammatory cytokines compared with the 20:1 group. Interestingly, the 20:1 group had many markers of oxidative stress, whereas the 1:1 group had significantly decreased lipid peroxide levels.

These results fit nicely with the simple idea that omega-6’s are pro-inflammatory, whereas omega-3’s are anti-inflammatory. So put down that pot of sun-dried tomatoes in sunflower oil and pick up that Alaskan wild salmon steak!

Paper 3: Omega 3’s may treat autoimmunity and inflammation (Jul 2015)

This is an important paper for anyone suffering with an autoimmune disease. The researchers wanted to find out how long term supplementation with omega-3 PUFAs affected regulatory T-cells (Tregs). These immune-modulating cells actively suppress immune system over-activity and prevent pathological self-reactivity, i.e. autoimmune disease.

It is very interesting, therefore, that in this paper researchers showed that omega-3 (DHA) increased Treg production in a dose-dependent manner. Unfortunately, this was only demonstrated in the test tube – how it will pan out in humans remains to be seen. But it suggests that an increased omega-3 intake my help prevent or treat autoimmunity.

The researchers also studied the benefits of omega-3 on liver damage in mice, as a deficiency of Tregs is recognised as playing an important role in the development of autoimmune hepatitis and has effects on hepatocellular carcinoma and liver transplant.

Dietary n-3 PUFA protected mice from… liver injury through Tregs expansion as well as increased PPAR-γ expression and subsequently down-regulation of pro-inflammatory cytokines expression. This finding provided a promising potential therapeutic method in treating inflammatory and autoimmune disease.

Paper 4: Vitamin E requirements depend on PUFA intake (Oct 2015)

This is a great review of the important role played by vitamin E in relation to dietary PUFAs.

PUFAs are naturally prone to oxidation – we all know how oils, nuts and especially fish oils go rancid – yet the omega-3’s and especially the long chain EPA and DHA are rapidly incorporated into cell membranes. To prevent them causing oxidative damage these molecules are effectively chaparoned by the antioxidant α-tocopherol, which is the most important of the eight vitamin E isoforms. Hence, it is important to include sufficient vitamin E-rich foods to ensure dietary PUFAs do not lead to increased oxidative stress.

a-tocopherol_in_lipid_membrane

α-tocopherol (red) is rapidly incorporated into the phospholipid bilayer of cell membranes where it effectively defends omega 3 and 6 lipids from oxidative damage. – Daniel Raederstorff et al, (Oct 2015)

The paper also points out that low levels of α-tocopherol during embryo growth limit the amout of DHA and AA that can be incorporated in the brain. Another newly identified function of membrane vitamin E is that it promotes cell membrane repair.

Apart from green leafy vegetables, some of the best sources of vitamin E are seeds and nuts. Unfortunately, when seed oils are refined the vitamin E is removed. Consequently, unrefined, extra-virgin and cold-pressed oils are best. Extra-virgin olive oil and cold-pressed rapeseed oils are suitable. Compared to refined oils they have distinctive flavours imparted by the presence of phytonutrients that refining removes.

Fortunately, as well as having a better PUFA balance, grass fed meat, game and wild fish generally have higher levels of vitamin E than their intensively farmed equivalents. In the case of grass-fed meat, vitamin E levels have been found to be up to 4 times higher.

So, how much vitamin E do we need? Raederstorff et al point to research suggesting that “a vitamin E:PUFA ratio of 0·6 mg RRR-α-tocopherol for each gram of PUFA is necessary to protect against vitamin E deficiency.” Taking a look at Wild Atlantic Salmon, I find that 4oz serving contains 1.44 g of PUFAs and 1.04 mg α-tocopherol equivalent, giving a ratio of 0.72 mg/g, whilst extra virgin olive oil has an even better ratio of 2 mg α-tocopherol equivalent per gram of PUFA.

Paper 5: Maternal omega-3 supplementation increases gestation length and reduces pre-term delivery (Aug 2015)

It has previously been shown that mothers delivering pre-term babies have lower levels of omega-3 in their blood and higher levels of omega-6. This study set out to establish if supplementation would reduce the risk of pre-term delivery.

Women at 20 weeks pregnancy were randomly assigned to 300 or 600 mg DHA per day, olive oil (placebo) or given dietary advice to increase intake of dietary sources of omega-3 PUFAs.

There was a significant increase in the gestational length with increasing DHA supplementation, with an average increase of 4 to 4.5 days in the 600 mg DHA per day group.

I was pleased to see a section of this paper making the point that fish oil and DHA supplements are not as effective as eating fish. In fact I think it’s worth quoting the whole section here:

Overall, small to moderate fish consumption has a greater impact on preterm delivery than fish oil supplements. Studies of FO supplementation had greatest effects on women who eat little or no fish and tend to have no effect on gestational length in women with high baseline intakes of fish. FO or DHA supplements may not fully take the place of eating fish. In the maternal-fetal network study, moderate fish intake decreased risk for reoccurrence of preterm birth, although the fish oil supplement did not. One reason may be that fish contain Vitamin D. Vitamin D deficiency has been associated with an increased risk for pre-term delivery. Fish contain DHA, Vitamin D, and other nutrients which may be more effective than FO or DHA alone in reducing preterm delivery and promoting optimum neurocognitive development. For this reason, the 2010 Dietary Guidelines for Americans recommend that pregnant and breastfeeding women consume 8 to 12 ounces of fish per week.

To get a better understanding of how the full range of nutrients in fish contribute to health, and to choose fish and seafood with low levels of mercury, watch our video:

References

Paper 1: Maternal PUFA ω-3 Supplementation Prevents Neonatal Lung Injuries Induced by Hyperoxia in Newborn Rats. Sharma D et al. International journal of molecular sciences (Sep 2015) Full text

Paper 2: Low n-6/n-3 PUFA Ratio Improves Lipid Metabolism, Inflammation, Oxidative Stress and Endothelial Function in Rats Using Plant Oils as n-3 Fatty Acid Source. Yang LG et al, Lipids (Nov 2015) Abstract

Paper 3: Dietary n-3 PUFA Protects Mice from Con A Induced Liver Injury by Modulating Regulatory T Cells and PPAR-γ Expression. Lian M et al, PlosOne (Jul 2015)

Paper 4: Vitamin E function and requirements in relation to PUFA
Daniel Raederstorff et al, The British Journal of Nutrition (Oct 2015) Full Text

Paper 5: The Effect of Omega-3 Docosahexaenoic Acid Supplementation on Gestational Length: Randomized Trial of Supplementation Compared to Nutrition Education for Increasing n-3 Intake from Foods, Mary A. Harris, BioMed Research International (Aug 2015) Full Text

WSHoMSoc 2015 lecture Oct 24th

WSHOMS_logoA Very Unromantic Disease: Tuberculous Lives from Smollet to Orwell

Dr Helen Bynum BSc MSc PhD

The 2015 season of WSHOMSoc talks started a fortnight ago but I was unable to attend the first event, so I am very glad that I was able to make it to this, the second meeting.

The first speaker, Helen Bynum explored the thinking behind the historical treatments for consumption – which is now always taken to mean tuberculosis since mycobacterium tuberculosis was identified in 1882 – by considering the lives of three historical figures, Toby Smollet (1721-1771), John Keats (1795-1821) and George Orwell (1903-1950) Continue reading

October News Round-Up

In this months round up:

  • Raw milk ‘revolution’
  • Study recommends grass-fed organic beef
  • Protein not carbs for breakfast
  • Weight loss and weight gain
  • Benefits of a Mediterranean diet
  • Ethical Seafoods
  • Artificial light and central heating suppress seasonal gene expression
  • Cutting sugar ‘can improve health in nine days’
  • WHO classifies red meat as a ‘probable carcinogen’

Raw milk ‘revolution’

At the beginning of the month The Telegraph (October 7th) ran an unusually positive article about raw milk. It’s worth a look. (We get our organic raw milk from Goodwood – and it does taste better than anything in the supermarket). A nice quote from the article:

“According to the FSA, there has not been a single reported illness associated with drinking raw milk in the UK since 2002. Since then, in excess of 10m litres has been drunk.”

Study recommends grass-fed organic beef

The New York Times (October 23rd) has an article on grass-fed beef, and reports on an interesting study in which 300 samples of beef purchased at stores across the United States were tested, revealing that beef from conventionally raised cows was three times as likely as grass-fed beef to contain bacteria resistant to multiple antibiotics, posing a food poisoning threat. The report recommended that consumers choose grass-fed organic beef “whenever possible.”

Protein not carbs for breakfast

The Daily Mail (October 25th) says breakfasts should be based around proteins not carbs to help maintain a healthy weight. I’d agree with this and the evidence base is quite strong. In fact we have written about this before (see: Calorie counting vs meal timing).

They go on to rate various breakfasts, giving scrambled egg and smoked salmon top marks. Some of their suggestions, unfortunately, are based around grains, so I’d suggest taking a look at our 10 low carb breakfast ideas, which are all high in protein.

Weight loss and weight gain

The Guardian (October 4th) asks Why eating more fruit and veg doesn’t always help you lose weight. Worth a look, but it’s pretty obvious stuff – avoid potatoes and fruit juice.

More interesting is a meta-analysis reported in Medpage Today (October 29th) saying that low fat diets are no better than other diets. (In fact low carb diets came out as most effective, but only by a small amount). The authors conclude:”Health and nutrition guidelines should cease recommending low-fat diets for weight loss in view of the clear absence of long-term efficacy when compared with other similar intensity dietary interventions,”

Meanwhile Professor Brian Wansink claims that the design of your kitchen determines whether you are likely to over eat or not. The Daily Mail (October 28th) explains his ideas clearly and provides lots of ideas to help control food urges and portion sizes – many of them working subconsciously. They are all easy to implement, so take a look.

Also in the The Daily Mail (October 28th)  is a report on a key new study showing how antibiotics in childhood  increase the risk of weight gain later in life: the more antibiotics the greater the likelihood.

“Your BMI may be forever altered by the antibiotics you take as a child. Our data suggest that every time we give an antibiotic to kids they gain weight faster over time”
Professor Brian Schwartz

This effect is suspected to be due to long term changes in gut microbes (the microbiome). It is interesting that French doctors routinely prescribe probiotics (good bacteria) alongside antibiotics, to reduce the harmful effects.

Benefits of a Mediterranean diet

Mediterranean-diet

The Mediterranean diet is based around real foods, including fish, fruit, nuts and vegetables and olive oil.

The ‘Mediterranean diet’ is not the product of any trend or A-list best selling diet plan. It’s actually a fiction of the scientific community vaguely based on the traditional diet of Southern Europe, particularly Greece. This month it has made the headlines on a number of fronts:

The Telegraph (October 21st) headlines with “Mediterranean diet slows ageing of brain, study shows

The Guardian has two reports: (October 21st) “Mediterranean diet ‘may slow the ageing process by five years” and one I missed last month (September 2nd) “Mediterranean diet ‘as effective as statins’ in reducing heart attack risk”

The Express (October 25th) reports on a campaign by world leading cardiologist, Dr Aseem Malhotra and backed by Jamie Oliver and Keith Vaz, MP. They claim that the “true secret” to longevity is the Mediterranean approach to life – moderate exercise, time outdoors, socializing, and regular sex – alongside a high fat Mediterranean diet.

Why does the Mediterranean diet work? Because its full of real foods, cooked from scratch, utilising a braod range of animal and plant foods. In many respects it is close to paleo / ancestral diet. In studies paleo diets achieve similar results. [For example see here, here and here] – yet none of these studies made the headlines!

Ethical seafood increasing

If you attended our seafood talks or watched the videos, you will know how important sea foods are for health. So it is good to see that “Sustainable seafood sales soar as ethical choices of TV chefs go mainstream” as the The Herald Scotland (October 31st) put it.

Artificial light and central heating suppress seasonal gene expression

In our post on the importance of sleep we looked at how artificial light, especially blue light from screens and some LED bulbs, can interfere with the body’s circadian rhythms. An article in The Telegraph (October 14th) reports on studies that extend these ideas to include how central heating and lighting together prevent changes in gene expression that should vary with the seasons. Dr Tyler Stevenson, a senior lecturer at the University of Aberdeen. sounded more like an old hippie rather than a researcher when he said:

“Seasonal changes in environmental variables play a significant role in the regulation of many physiological and behavioural processes. Presently many of us no longer live in accordance with the naturally occurring variation in geophysical rhythms.”

Cutting sugar ‘can improve health in nine days’

The Telegraph (October 27th) reports on a study in which obese children had significantly lower blood pressure and cholesterol in less than two weeks when sugar in their diet was reduced by two thirds, but calories were not restricted. One of the authors said “I have never seen results as striking or significant in our human studies”.

The article included this infographic which I thought illustrated the relative importance of nutrition compared to other factors, in world health

Causes of ill health

WHO classifies meat as a carcinogen

The big story this month that hit all the papers, radio and TV was the report that the World Health Organisation has declared meat to be a probable carcinogen and processed meat a definite carcinogen.

The initial response of the media was to be expected, with Monday’s The Guardian (October 26th) headlining “Processed meats pose same cancer risk as smoking and asbestos, reports say”. By Thursday more reflective articles appeared, with The Independent (October 29th) providing a rather sober, balanced overview of the stats. By Friday Gregory Härtl, a spokesman for WHO, issued clarification:

“We’re not saying stop eating processed meats altogether. Do not cut out meat completely as it has nutrients,” he said. – (The Irish Times October 30th)

For clarification, The WHO tweeted: “Meat provides a number of essential nutrients and, when consumed in moderation, has a place in a healthy diet. We do not want to compare meat to tobacco and asbestos. Tobacco and asbestos have no safe levels of exposure”

I’d like to give a full rebuttal at some point, but for the moment lets just look at the figures in a commentary on the WHO report by Cancer Research UK (October 26th). Their figures make clear that among people eating the highest levels of red and processed meat (about 160g a day) 6.1% will get bowel cancer at some point in their lifetime. For those eating the least processed and red meat (25g per day), about 5.6% will go on to get the disease. An absolute risk difference of 0.5%.

Another way of saying that is that for 93.9% of people, the quantity of red and processed meats they eat will have no effect as they will not get bowel cancer in any case. For 5.6% of the population, they will get bowel cancer regardless even if they are vegan. That’s assuming you trust the statistics all of this is based on, which I don’t as it is primarily from observational studies that cannot separate out cause and correlation. Indeed Cancer Research UK refer to these numbers as “ball park figures” and point out that “there are many different factors at play”.

In case I don’t get round to doing a full post on this ‘meaty’ issue here are some rebuttals from other bloggers to take a look at: