Curly kale crisps

Crispy-kaleKale is one of those trendy celebrity super-foods tossed in nutribullets (TM) along with egg yolks and blueberries to produce a thick green mush with a texture and taste that sails dangerously close to the emetic. More prosaically, a pile of steamed curly kale can be served as a vegetable, where with a knob of butter it is at least edible, if somewhat uninspiring to certain members of my family.

So here is a wizz of an idea that transforms boring kale into a more-ish snack, or a classy accompaniment. It can be served as ‘Crunchy Kale Crisps’ – great for snacking (and way more healthy than the potato variety), or as a variety of the dish known as ‘crispy seaweed’ served as a side dish with a Chinese meal. Either way, I think you will find these a revelation: salty, crispy and satisfyingly crumbly and easy peasy to make. Who knew kale could be so much fun?

Crispy-kale3crispy, crunchy, salty, savoury, tasty, curly, kale crisps

Crispy-kale-ingredients
Just three ingredients: A bag of curly kale, olive oil and seasoning.

Use organic kale and remove the thick ribs (wash it first if it’s gritty, and thoroughly dry it). Place the leaves in an oven proof dish and sprinkle with a good quality olive oil like the unfiltered organic ex-virgin in the photo, and seasoning (I used Herbamare – a nice mix of herbs and sea salt which I stock in my clinic). Toss with your hands to ensure the kale is evenly coated.

Crispy-kale2

Preheat the oven (150 C, 300F, Gas mark 2). Place the dish in the oven for 15 minutes. If they are in a thick layer they might need tossing half way through so that they crisp evenly.

Remove from the oven, allow to cool for a few minutes and serve. They are a great snack as the olive oil provides some calories, but they are very low in carbohydrate, so won’t interfere with your low carb lifestyle. They also provide a goodly dose of micronutrients such as: beta carotene, calcium, B6, a bit of protein, Vit C, magnesium, iron, isothiocyanates and glucosinolates, manganese, various flavonoids, real folate (B9), Vit K, copper, B vitamins 1, 2 and 3, and Vit E, along with some good old fibre! It has everything going for it, so what’s stopping you? Go make some crisps!

Alternatively, just watch them looking lovely on Crispy Kale TV:

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Behind a healthy eating quiz – Australia’s nutritional mafia

busted

After reading this post, let us know what you think by clicking on our poll at the end of the post.

When I was writing February’s News Round Up I came across a ‘diet and lifestyle’ article in The Independent newspaper (Feb 24th) titled “How to scrap fad diets and lose weight the healthy way” with a subtitle “Clare Collins, Professor in Nutrition and Dietetics and the University of Newcastle, explains how to leave “quick-fix” regimes behind once and for all”. I was intrigued as it seemed to be taking a swipe at diets such as paleo, gluten-free and low carb without actually naming them. All of these diets get written off by journalists as ‘fad’ diets, despite the medical literature surrounding them, and they usually find some stooge with a PhD to trot out the usual trite advice – “it’s all about a balanced diet… blah blah… 5 a day… blah blah blah… eat less exercise more… blah”

The article encouraged readers to identify where their diet quality was lacking then introduce the missing ‘healthy’ parts bit by bit. Professor Clare Collins tells us “Improving your diet quality means eating more fruit and vegetables, lean meats, poultry, fish, eggs, tofu, nuts and seeds, legumes, dried beans, wholegrains and dairy”. Well, apart from the grains, tofu and beans I can more-or-less go along with that. It seemed on the face of it to be basically promoting real foods.

Helpfully, half way down the article was a link to a Healthy Food Quiz that allowed readers to identify ‘how healthy your diet is’. Healthy according to whom I wondered? The article suggest taking the quiz, which would provide a ‘healthy eating score’ along with feedback on what you could do to improve your diet. The idea is to make some improvements, and retest yourself to see if the score has gone up. Seemed like a bit of harmless fun. Thought I’d give it a go.

Now, I eat a kind of paleo/traditional diet which contains virtually no processed or industrialised foods. My main meals are cooked from fresh ingredients based around meat, fish and vegetables, with breakfast and lunches including salads, eggs, sea foods, nuts, fruit and dairy. Pretty much as per Professor Collins introductory list above, except with no grains, soy or vegetable oils, so I expected to gain a pretty high score.

I completed the quiz, filling in several pages of tick boxes. It took no more than a few minutes. Eventually the results… I clicked submit, and waited as the loading icon rotated hypnotically…

Overall diet score 23/73“. What? That’s only just over a third marks! “Needs work” Wow! Really?

It was at this point that I was told my diet was being compared to the National Guidelines for Australia. “Your total Australian Recommended Food Score is low.” Australia? First I was puzzled. Then I realised that the University of Newcastle mentioned in the heading was Newcastle Australia, not Newcastle UK which helpfully is called Newcastle University to make sure the two institutions don’t get muddled up. Silly me. Doesn’t it strike you as a bit odd that the Independent – a UK newspaper – didn’t mention the Aussie connection? It made me think they may have received some payment to run the article blind. But why?

quiz

Click above to try the quiz yourself. Afterwards, let us know what you think with our poll at the end of this post.

When I looked at the recommendations that this quiz produced for me I laughed. They were so wrong as to be  funny. At this point I might have put the whole thing aside as a bit of Sunday Newspaper info-tainment, but in the feedback section it stated that the results are being used for research by the University of Newcastle. The quiz website explains “our nutrition research team will use the results to find the healthiest eaters in Australia. Will it be the women, the men, children or adolescents?”.

OK. As a research question it’s not exactly up there with the pressing nutrition questions of our time, but it shows the authors of this quiz are actually using it as a survey to collect nutritional data which I assume they think will have scientific validity. So, it seems this isn’t a vague lifestyle quiz, but a variation of the much maligned research tool a food frequency questionnaire. Indeed one question in the quiz asks “Do you agree that your anonymous quiz answers may be used for research purposes?”, so they are clearly intending to do something with the data.

As an aside, it seem a bit bizarre that an Australian nutrition survey has been promoted in a UK newspaper. It’s hardly going to help answer their research question if lots of Brits fill it in. How is that going to tell them about the healthiest eaters in Australia? I suspect they have not told us the real purposes of this data. And, call me cynical, but I can’t help feeling the data will be used to secure a grant or support a policy rather than promote nutritional knowledge. But hey ho, this is just a side issue in this decidedly dodgy data-gathering exercise, as you will see.

My Healthy Eating Quiz results

As I said, after completing the survey I received an overall rating of ‘needs more work’, scoring a measly 23 out of 73, and was advised I was some way off meeting the Australian dietary recommendations. Intriguing! What do they think I am missing? In what way do they think my diet is inadequate? The ‘How to improve your score’ feedback revealed the problem, but the issue, it quickly became clear, was with the survey, not with my diet.

Bizarrely, considering I have two or three meals per day based around fish/meat and vegetables and even eat my own home grown veggies, I was only given a ‘getting there’ ranking (12/21) for vegetables. Similarly for animal protein (4/7) ‘getting there’. This is bonkers. There are simply not enough meal opportunities in the day to eat more meat and veg. I eat the widest range of these foods of anyone I know! For example, last night I had fish (hake) with butternut squash, green beans, cheesy leaks and broccoli. What more do they want of me???

Ironically, I managed to gain an ‘excellent’ for vegetarian protein sources (3/6) – mainly due to eating eggs and nuts most days.

My worst categories, receiving zero scores were grains – no surprise there – but also dairy (0/11) and water intake (0/1). Considering water first: the only options on the survey were: “3 or less glasses per day” or “4 or more”. I probably only drink one or two glasses of water per day, BUT, I drink 8 cups of coffee/tea. What do they think coffee or tea are made with? Do they really think that water is only hydrating when it comes out of a bottle or tap? Water in beverages, fruit, veg and soups is completely and irrationally excluded from the survey!

According to the authors, the quiz is encouraging people to eat a wider range of foods. But is that true? In the vegetable section, for example, they provide a long list of veggies against which you have to choose either: “1. Less than once a week or never”, or “2. Once a week or more often”. By dividing up the options like this some strange outcomes are created. Take for example Mr A who eats a different vegetable each day of the week in rotation. He will identify seven veg that he eats once a week or more often. On the other hand, Mr B has a fortnightly rotation, eating 14 different veg over two weeks – far more diverse than Mr A, yet he would have to tick “Less than once a week or never for each vegetable” and would be classified as needing to eat a wider range of veg!

Similar problems occur in the meat sections, where inexplicably ‘mince’ is in a separate category to pork, whilst beef and lamb are put together in a third category. Trying to decide how many of each group one eats per week is quite tricky.

Results

Back to my results… I came out low for dairy because most of my milk intake is in hot drinks (I get through 3 litres of milk per week in this way) but for the option “How many glasses of milk do you drink” I was forced to put “less than 1 per day”, because I don’t drink milk by the glass nor put it on cereal which were the only things they asked about. As you can see, the questions themselves are creating incorrect dietary estimates.

For ice cream the survey options are “Less than 1 per week or never”, “Between 1 per week and 1 per day”, or “2 or more per day”. That middle range is way too large. The difference between someone who has ice cream once per week vs once per day is huge! Questions like that will encourage people who eat it only once per week to tick “Less than 1 per week or never” because they feel closer to that category and don’t want to be lumped in with people who eat ice cream every day. This is an example of how these surveys promote under-reporting.

For cheese the options were: “Less than 1 per day or never”, “Between 1 per day and 3 per day” and “4 or more portions per day”… What? Who eats cheese four or more portions per day – that’s two cups of cheese per day, which equals (click click click…) 240 grams or half a pound of cheese! I think that I eat quite large amounts of cheese per week, and I eat it most days, but not every day, so again I was forced to choose “zero or less than 1 per day”.

I also eat 50g of full-fat double cream (50% fat) most days, but there was no question about cream, only cream cheese, so this survey had me down as ‘low dairy’. The advice they gave me was  “Eating an adequate amount of dairy has also been linked with maintaining a healthy weight. Aim for 3 serves of reduced fat dairy foods per day.” Don’t they know that the healthy weight maintenance associated with dairy applies to full-fat dairy not low fat? [See our posts: ‘full fat milk less fattening than skimmed’ and ‘Why we pass on the semi skimmed and low fat dairy’]

In the grains section, the main question was “What kind of bread do you eat” and offered four options: Brown, White, Other or a combined “I’m not sure/I don’t eat bread”. Why are these last two rolled into one choice? If I was cynical I might think the survey has been deliberately designed to avoid revealing how many people have given up gluten/grains!

A similar question in the dairy section was handled differently, but equally bizarrely.
The three options for “what kind of milk do you drink” were: “1. Reduced fat milk, skim milk or soy milk”, “2. Full cream milk, rice milk or other milk” and “3. I don’t drink milk”. Why did “I don’t drink milk” get its own category this time but not for grains? And why the weird mixing of categories for the other two options? Seperating skimmed from full fat milk makes sense, perhaps, but why then include soy milk in with the skimmed, yet rice milk in with full-fat milk? There is no logic to that whatever, and it will just make any conclusions meaningless.

Has this survey been designed to obfuscate? Is it motivated by science or politics? Try it for yourself, then let us know. We have created our own mini-survey at the end of the post for you to express your thoughts about Professor Clare Collins quiz.

 

In my results they advise that “dairy is a good source of calcium”, yet allowing soya milk and rice milk to be conflated with cow’s milk makes any assessment of calcium intake meaningless. Indeed earlier this year we heard of a baby suffering scurvy due to being raised on almond milk. These milk substitutes do not have the same nutritional profile as dairy and should not be treated as equivalent.

Considering this is a healthy eating quiz it is strange, to say the least, that they fail to take account of any junk foods. My diet, for example, includes virtually no confectionery, sugar based foods, pastries, cakes or fizzy drinks, apart from a small amount of 70%+ cocao solids chocolate. Yet the quiz does not ask about these and would give me the same health ranking if I was regularly downing two litres of cola and three mars bars and a packet of biscuits every day. [O_o]

A similar oversight is the absence of questions about alcohol consumption. I could be drinking ten beers per day, or a bottle of vodka, and get the same healthy eating score. (I don’t do that BTW – I’m rather fond of my liver!). What kind of a healthy eating survey is this?

As you can see from the above, this survey is full of holes, and it is patently obvious that it has zero chance of providing an accurate assessment of the nutritional validity of one’s diet, yet… (get this) … at the end of the survey they promise that in future they will be adding the facilities to provide nutritional breakdown in terms of carbs/protein/fats etc based on the survey responses. They have got to be joking! Any such figures would be so far from reality as to be useless, and to even offer them to the public shows a criminal level of complacency and incompetence.

So who made this dreadful survey? A professor of nutrition no less! Indeed professor of nutrition and dietetics Professor Clare Collins, working ‘with the support of the world’s largest team of Accredited Practising Dietitian researchers at the University of Newcastle Australia’. Dietitians are the acceptable face of orthodox nutrition. Their role is to support the health service, but they are up to their necks in top-down policy. In Australia, Accredited Practicing Dietitians are required to provide nutrition recommendations that adhere to Australia’s Dietary Guidelines. They can’t think outside the box and almost never support any diet outside these guidelines.

Indeed, dietitians that step out of line can be disciplined or lose their license, such as the case of Jennifer Elliott, an Australian dietitian who was having a great deal of success treating diabetics with a lowish carb diet. Despite the fact that she had researched this approach extensively, and had doctors referring patients to her frequently, she was struck off.

Professor Clare Collins Heathy Diet Quiz is really no more than a piece of propaganda. As we have seen, it is not designed to answer any meaningful scientific question, and is incapable of assessing dietary quality. It can produce no valid nutritional data, yet claims to offer advice and, in the future, even a nutritional breakdown. It is fundementally irresponsible, ignores far more immediate dietary factors such as alcohol, sugar and junk food, and offers meaningless and impossible advice.

So how is Professor Clare Collins rewarded for this piece of nonsense/nonscience? According to her webpage (screen shot delow) she has secured a grant from the Australian Government’s National Health and Medical Research Council for $687,000.

funding

You don’t need a degree to see how flaky and scientifically invalid the Healthy Eating Quiz is, yet it appears Professor Clare Collins and her team was awarded “The 2012 Excellence in Research for Australia (ERA), an independent assessment of research excellence, awarded the nutrition and dietetics research group at the University of Newcastle a rating of 5 –  ‘well above world standard’ – one of only three Australian universities to receive the top ERA rating.” UNBELIEVABLE! How they reward their lackeys.

Below is a very glossy piece of self-promotion by Professor Clare Collins, explaining the thinking behind her Healthy Eating Quiz. A triumph of style over substance I think you’ll agree.

What makes me angry is that these professors have maintained their positions for the last three decades by hiding behind government recommendations. Despite the epidemic rise in obesity and diabetes that took place under those very recommendations they choose to stick with them, rather than question whether the guidelines actually contributed to the problem they were supposed to be addressing.

As obesity and diabetes rates exploded around them these self-anointed authorities attempted to suppress anyone who was off message, including those free-thinking researchers who had grasped the real issues about food and managed to grasp the right end of the dietary stick for a change.

I am thinking of people like the cardiologist Robert Atkins of low carb diet fame, who’s approach is now used worldwide in epilepsy (ref), neurodegenerative diseases, brain tumors (ref) and diabetes management (ref1, ref2), and Prof John Yudkin, author of now celebrated book Pure White and Deadly (1972) who tried to alert us to the dangers of sugar – now a political hot potato with a sugar tax being taken seriously at parliamentary level.

Both of these genuinely worthwhile scientists were metaphorically ‘thrown under a bus’ through a coordinated campaign to discredit them by dietetic and nutrition authorities of the day for daring to go against the government recommendations. The official dietary guidelines and their proponents made sure these effective ideas were sidelined for decades.

Professor Clare Collins, the University of Newcastle Nutrition and Dietetics dept and their Healthy Eating Quiz are no more than the continuing manifestation of this self-anointed, self-righteous, self-interested pretence at science.

Have a go at the Healthy Eating Quiz yourself. Think it’s rubbish? Email Professor Clare Collins and let her know what you think (clare.collins@newcastle.edu.au). I did.

Now leave some feedback!

What do you think of the Healthy Eating Quiz? Have a go at our survey to let us know.


 

 

February News Round-Up

It’s our news-round-up anniversary!

We first started blogging about nutrition in the news 12 months ago and have kept it up every month since. Something we really are proud of! It is interesting to look back at the topics we have covered – they have been very diverse indeed. And this month’s round-up is no exception…

Kicking off with New Scientist magazine (Feb 24th) which had a two page article looking at the use of a low-carb, high-fat ketogenic diet in cancer. We have previously blogged about this approach – see here.

Again in New Scientist (Feb 19th) – an opinion piece arguing for a sugar tax of between 20% to 50% on fizzy drinks. Susan Jebb, professor of diet and population health at the University of Oxford, says a sugar tax is a “no brainer”.

Linked to concerns about sugar came the revelation that many high street coffee shops’ are serving hot drinks laced with the stuff. The Guardian (Feb 17th) provides a good set of data, showing that some options have 10 to 20 teaspoons of sugar. Have a read and you can avoid the worst offenders.

Carriers of the APOE4 gene – a fat metabolism gene that is included in the genetic testing I offer – are known to be at an increased risk of Alzheimer’s disease. There has been some debate about what diet may best suit carriers of this gene. So it is good to see MedPage Today (Feb 2nd) report on an study that found seafood protective against Alzheimers disease, but only for people carrying the APOE4 gene.

In a recent trial, Vitamin-D supplementation reduced prostate cancer aggressiveness. MedPage Today (Feb 25th) provides good coverage.

boiled egg and keto-bread soldiers

Boiled eggs with keto-bread soldiers (recipe here)

Eggs got a lot of attention this month, with pregnant UK mums being told it is safe to eat runny egg yolks after all (TV3 Feb 1st). The diet doctor twins tell us ‘Here’s why the data don’t back those trying to vilify eggs’ (MedPage Today, 8th Feb). If you really want to try something different the Mail Online (14th Feb) tells us that Wiatrose is now selling Emu eggs for £23 per pop (ouch!). The emu eggs are bright blue, take 90 minutes to boil, and are each as large as a dozen hens eggs. Not sure I’ll be rushing out to buy them, but I do get duck eggs now and then, and goose eggs once or twice a year.

Finally, Crossbush farm shop (nr Arundel) is now offering gluten-free scotch eggs (of the hen not emu variety) – drop in and give them a try. We found them very satisfying as a travelling lunch when we went away recently. Not fully grain free – but they only use rice and potato flour which, once in a blue moon, won’t bust the physiology of most people.

Processed food, obesity and flagella

Emulsifiers used in processed foods from ice cream to baked products have been implicated in obesity. Earlier research in mice has now been extended using a model human gut, paving the way for human trials. Read on for the implications:

Emulsifiers and obesity

The relationship between processed foods, obesity and diabetes has not gone unnoticed. Societies that stick to traditional, unprocessed foods have lower levels of these diseases than countries that consume more industrial products.

Industrialisation of the food chain has increased the use of artificial additives including sweeteners, emulsifiers and preservatives. Many of these additives are hidden behind an inscrutable e-number. I remember throughout the 80’s and 90’s how ‘health nuts’, as their detractors labelled them, were criticised for their ‘uninformed’ avoidance of ‘e-numbers’. Yet evidence is slowly accumulating that some of these additives may in fact be contributing to the obesity epidemic.

The key factor informing this research is the recently discovered microbiome – the community of bacteria that live in the gut. The microbiome is increasingly seen as an essential and long-overlooked human organ. One example of recently discovered interactions between food additives and the microbiome was published in Nature in 2014. The paper’s title speaks for itself: ‘Artificial sweeteners induce glucose intolerance by altering the gut microbiota.

So it is interesting to hear of research into another class of additives – emulsifiers which adds to the story of issues around processed foods. Emulsifiers are added to food to promote mixing of oils and water. Traditional emulsifiers include egg and mustard, but synthetic emulsifiers are now widely used in processed foods (see full list here) .

Last year, Benoit Chassaing of Georgia State University published a paper in Nature, “Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome“. They reported that carboxymethylcellulose (E466) and polysorbate-80 (E433) induced low-grade inflammation and obesity / metabolic syndrome in normal mice, as well as promoting colitis in a predisposed mouse model.

An interesting finding from the study was that the emulsifiers only affected mice with an intact microbiome. Mice specially raised in sterile conditions so that they had no gut microbes did not become ill when fed the emulsifiers, demonstrating that the effect is caused by gut microbes. Mice made sick by the emulsifiers began to improve once emulsifier-feeding ceased and their microbiomes began to recover.

How relevant this is to human health remains to be seen. Whilst the study authors claimed the concentrations fed to the mice was “relatively low”, other researchers challenged the findings pointing out that the levels were hundreds of times higher than people typically consume.

Flagella

Bacterial tails, flagella, help them swim. They contain a protein, flagellin, which triggers a specific immune receptor TLR5.

Undaunted, Chassaing’s team has conducted a further study in which a model human digestive tract was used (I imagine that it looked something like the diagram at the top of this post!)

The two emulsifiers were added to a series of flasks that simulate the conditions of the digestive tract. The researchers observed raised levels of flagellin – a protein produced by bacteria with flagella (whip-like tails). Flagellin is known to cause inflammation in the gut via toll-like receptor 5 (TLR5). TLR5 is expressed on the basal surface of gut cells and forms part of the immune surveillance responding to gut content – specifically flagellin. Their presence on gut cells keeps bacteria with flagella in check, especially if they begin to breach the gut wall.

These receptors have previously been shown to be involved in microbiome-related obesity. In a paper published in Science in 2010 researchers found mice that lacked TLR5 were more prone to obesity, and that changes to the microbiome were responsible for this. Indeed when this microbiome was transferred into mice with intact TLR5 they too became hyperphagic – eating more and becoming obese which implies that once the microbiome is thus deranged even intact TLR5 are unable to restore normal control of flagellates. Even when calories were restricted to prevent obesity these mice became insulin resistant.

It would appear that these emulsifiers are able to reduce the effectiveness of TLR5 surveillance allowing pro-inflammatory bacteria to proliferate and contribute to obesity.

TLR5-Nature

(Left) Normal TLR5 respose: Detection of flagellated bacteria leads to rapid neutrophil recruitment. (Right) In TLR5 impairment invading bacteria replicate leading to a delayed response and greater inflammation. Nature, Mucosal Immunology (2009)

Digging a bit deeper I found this article from Cornell University: Bacteria tails implicated in gut inflammation. Ruth Ley, assistant professor of microbiology said:

“The gut pumps out six to 10 grams of antibodies a day directed against bacteria.”

These IgA antibodies attach to the flagella acting as a glue and preventing these bacteria swimming through the protective mucous layer that lines the gut. If TLR5 is knocked out these antibodies are not produced and bacteria can swim right up to the cells that line the gut, where they initiate inflammation. Synthetic emulsifiers appear to be hampering this natural defence system.

The next stage is human trials and Chassaing is in the process of enrolling patients. Whilst I don’t fancy being a volunteer myself, I am looking forward to the results. Whatever the outcome, artificial emulsifiers are a non-essential part of the diet, and are easy to avoid if you stick to pure or real foods. As we so often see, the health of the gut depends on a healthy mucosa and healthy microbial balance.

To ensure your microbiota is as healthy as possible:

  • Avoid processed and refined foods
  • Avoid unnecessary antibiotic use
  • Eat plenty of organic vegetables – especially home grown
  • Do some gardening and don’t wash your hands before eating (!)
  • Eat live fermented foods such as yoghurt, kefir and kimchi
  • Supplement with quality probiotics

– x –

Part 2: where this becomes a multi-tailed tale!

Noodlymirabilis

P. mirabilis – a flagellated bacterium – is normally found in the human intestine. It is, however, able to survive outside where its numerous flagella help it quickly swarm over surfaces. (MicrobeWiki)

In looking for information on flagellated intestinal bacteria I came across the species above Proteus mirabilis. Although it is a normal denizen of the human gut, it is very good at colonising surfaces outside the body, using those spaghetti like flagella to swarm across solid surfaces. During its swarming phase, groups of these bacteria come together to make rafts which swim along surfaces using the combined force of their flagella.

P. mirabilis has contaminated most hospitals and their workers, colonising skin and surfaces, and has become resistant to many antimicrobials. It is the prime cause of catheter associated urinary tract infections (CAUTIs), which is now the most common hospital acquired infection worldwide. Alarmingly it has become resistant to many antimicrobials and several antibiotics.

So does P. mirabilis do its mass swarming trick in the gut? Not usually, presumably because of those gut released antibodies that stop flagella working. However, research in 2010 from Harvard School of Public Health found that it plays a pivotal role in inflammatory bowel disease (IBD) – which includes ulcerative colitis (UC)and Crohn’s disease (CD).

In short, researchers identified two factors that took place together. (1) dysbiosis – disruptions of the entire microbial community and (2) Proliferation of P. mirabilis and Klebsiella pneumoniae a non-swimming bacteria.

This is interesting, demonstrating the role of flagellated bacteria in a disease, but does this link back to the TLR5 and flagellin story we started with? Oh yes it does!

Bringing us full circle: a paper in PlosOne (Dec 2015) found that Crohn’s disease risk was increased in people with a TLR5 genetic polymorphism, whilst another paper found polymorphisms in TLR5 genes were significantly associated with the UC. Indeed the link between flagellated bacteria and IBD has recently led to the development of a colitis vaccine (March 2016) which boosts antibodies against the flagellin proteins.

Perhaps the most famous gut pathogen is the one associated with stomach ulcers, Helicobacter pylori. It too is flagellated, but evades detection by TLR5 as it has evolved a different protein sequence on its flagellum such that it does not trigger a TLR5 innate immune response.

h-pylori-TLR5

To wrap up this romp through flagellated gut microbes I’d like to pull together several related threads. When H pylori was first accepted as the ’cause’ of stomach ulcers in the 1990’s the treatment of choice immediately became antibiotics. The mentality was H pylori is the baddy, so kill it.

Since then our understanding of gut pathogens has become more sophisticated. Many pathogens are now recognised as ubiquitous, inhabiting the gut of healthy people in a benign, or even beneficial way. The rest of the microbiome, along with our immune system, holds them in check, and even makes use of them. As we saw with the Harvard IBD paper pathology requires disequilibrium in the wider microbiome before these bacteria turn nasty and cause disease.

The final part of the puzzle is the environmental stimuli – diet, stress etc – that lead to dis-regulation of the microbiome in the first place. Diet is a big part of this, including the role of additives in processed foods. The use of antibiotics is an even bigger concern, which along with caesarean births may be changing the microbiome irreversibly. As we have seen in this post, conventional treatments such as hospital disinfectants, antibiotics, and colitis vaccine are all dealing with the wrong end of the problem – the effects.

What is worse is that those interventions may actually be major drivers of dysbiosis in the population. We need much more focus on dealing with the causes: Reducing antibiotic use, improving diets and reducing additives and processed foods; At the start of life, avoiding unnecessary cesarean births and encouraging breast-feeding are obvious requirements. If we can get these things right the discovery of the microbiome will prove to be the biggest breakthrough in the history of medicine.

Further reading:

Credits

Vector images by Keir Watson, adapted from http://www.freepik.com/

Lamb shanks with celeriac mash

Lamb shank 1

As a dish, lamb shanks provide one of the finest spectacles to place in front of any keen carnivorous diner, reminding them instantly of why they enjoy meat so much. There it stands, dramatically upright on the plate, with the bone rising proudly from a tempting hunk of succulent meat.

In this recipe, the lamb is slow cooked with vegetables and bone broth until it is a melt-in-the mouth savoury sensation. The celeriac mash and peas provide the perfect accompaniment. I’m sure no chef worth his salt would serve such a superb dish with common or garden peas, but put aside such snobbery as they provide colour and a sweet popping texture like nothing else. Call them petits pois and it’ll be immediately acceptable.

UK lamb is pretty well, free-range grass-pastured by default, however buying organic will ensure high welfare and minimal antibiotic use. Ours came from the Goodwood estate where we buy most of our meat as they are local, and where, in the spring, we visit to observe the lovely lambing and chat with the shepherd and his girls who are wonderful examples of skilful, knowledgeable and straightforward young women.

Recipe, Lamb shanks with celeriac mash 

The quantities below will vary depending on the number of shanks and size of your pot, but none are very crucial:

  • One lamb shank per person
  • Ghee, lard or dripping (approx. 1 – 3 tbsp)
  • Stock or bone broth (approx. 2 – 3 ladles)
  • Red wine (optional, approx. 200 – 500 ml, depending..)
  • Carrots, celery, onion
  • Bay leaves, rosemary, salt and pepper
  • Celeriac

Lamb-shanks-1Melt a goodly amount of ghee, lard or dripping in a large cast iron oven-proof enamelled pan, such as Le Creuset, on a medium heat. Salt and pepper the lamb shanks all over and add to the hot oil for a few minutes, turning to brown and seal on all sides.

Coarse chop carrot, onion and celery, I did them in chunky batons on this occasion, which looked great. Add these around the meat, along with rosemary and bay, and turn so they are sautéing in hot oil for a bit.

Lamb-shanks-3

Add a few ladles of stock (I had a pot of bone broth on the go at the time) and some red wine, if you like, and I like, so that the liquid is about one third the way up the meat. Put the lid on and bring to boiling point.

Pre-heat the oven to 140C (gas mark 1, 275F) and transfer the pot from the hob to the oven. Cook for about 4 hours. If you want to slow cook for much longer – while you are at work, or over night for example – reduce the temperature to 100 or 120C (gas mark ½, 250F) to ensure a melting finish without ending up with a burnt offering.

Celeriac mash

About 45 minutes before you want to serve the meal, peel and chop one large or two smaller celeriac roots. Place the chunks in a pan of water and bring to the boil. Simmer with a lid on for 10-20 minutes depending on the size of the chunks, but until they are soft when tried with the point of a knife. Drain very well, then mash thoroughly and add whatever fresh herbs, spices or seasonings you prefer. We used fresh thyme, sea salt and freshly ground black pepper here, but marjoram or herbs de provence would be great too. Add some good quality olive oil (such as Sainsbury’s organic, extra virgin unfiltered) or butter/ghee as these are superb additions. (By the by, the addition of butter, cream and grated cheese in quite large amount to mashed celariac render it a superb dish in itself, rich in quality nutrients and a great way to feed fussy, undernourished or convalescing people and works well as a topping for cottage pies and the like. It is a very low carbohydrate root vegetable, unlike potato, so can be eaten regularly).Serve alongside the lamb shank, with it’s glossy, gorgeous vegetables and juices, and add some quickly boiled petite pois to the plate too. A robust organic red wine ensures that this is a meal to remember! (Other green vegetables would do just as well, such as fine green beans, asparagus tips, broccoli spears or Brussels sprouts, or all of these.)

Bon appetite!Lamb-shanks-4

 

January News Round-Up

Which is worse for the heart, sugar or saturated fat?

It’s amazing isn’t it? For anyone who checks literature the answer to this question has been clear for years, but for much of the public and medical community they can’t quite believe it. Medical Daily (January 14th) explains that a review of a half century of data shows that “sugar consumption, particularly in the form of refined added sugars, are (sic) a greater contributor to (coronary heart disease) than saturated fats.” Uh ha. A good one to email to any doubting Thomas you know. The funniest bit of this ‘no sh*t sherlock’ review is that it is came from the Albert Einstein College of Medicine! Who’d ‘ve thunk it?

High Carb v High Fat diet for endurance athletes

As it happens, I’m meeting a young endurance athlete this weekend who is excited about the possibilities of a high fat diet to improve his performance. The work of Jeff Volek (The Art and Science of Low Carb Performance) has demonstrated that high fat diets can offer considerable performance advantages compared to the high-carb approach recommended by traditional sports scientists.

The debate amongst performance athletes has been heated. The Guardian (January 19th) has a nice blog piece on this topic should you want to learn more.

Low fat v high fat weight loss diets

On the general theme of high fat v low fat, BBC Health (January 5th) had a good article considering both. They referred to recent researchers from Harvard School of Public Health in the United States who reviewed 53 weight loss trials involving 68,128 people.

The results, published in the Lancet medical journal, showed that both low-carb and low-fat approaches led to decent weight-loss. But those eating relatively more fat actually lost marginally more weight. Dr Deirdre Tobias, who led that study, said “Fat has been villainised because there’s a mentality that ‘fat makes you fat’. I think our evidence pretty much puts a nail in that coffin.”

Baby develops scurvy from ‘vegan milk’

A highly cited article in The Telegraph (January 21st) reported on a Spanish baby that developed scurvy (vitamin C deficiency), after being raised on almond milk instead of breast milk or formula milk. Breast milk contains vitamin C, and it is added to formula milk but not to almond milk. Glad we know that now.

Modern diets may be destroying our gut microbes ‘over generations’

mouse_neurons_gut_bacteria_595

National Geographic: An introduction to the microbiome provides a good primer on this revolutionary field

The discovery of a new human organ – the microbiome –  is profoundly changing our view of medicine. As one medic recently said: “Who would want to go to mars when we have the microbiome to explore?”

Science Daily (Januray 13th) reports on a recent paper that found a low plant fibre diet in mice led to depletion in gut bacterial diversity similar to the differences seen between industrialised peoples and hunter-gatherers. Interestingly, the low-fibre mice microbiomes did not recover fully when returned to a normal diet, and their offspring had less diversity too. All this suggests that simply eating a better diet may not be enough to restore a fully functioning microbiome.

“The extremely low-fibre intake in industrialized countries has occurred relatively recently,” noted Justin Sonnenburg. “Is it possible that over the next few generations we’ll lose even more species in our gut? And what will the ramifications be for our health?” Simple tweaks in our cultural practices — for example, not washing our hands after gardening or petting our dogs — could be a step in the right direction, and steering away from overuse of antibiotics certainly is, he said.

Human trials of one solution, faecal transplants, are soon to start with the aim of reversing obesity, according to MD Magazine (January 20th) . In another article Infants’ Long-Term Health Affected by Delivery Method and Diet they report on a study that found C-section delivery changed the infant microbiome even more than diet!

Gluten introduction raises babies risk of Coeliac disease

The physicians news journal MD Magazine (January 28th) reports on a Swedish study that looked at the quantity of gluten in the diets of 400 babies, followed for two years. They found that the greater the exposure to gluten the greater the risk of coeliac disease.

Results from other studies have been mixed, but a position paper, published this month by The European Society For Paediatric Gastroenterology, Hepatology & Nutrition recommend gradual introduction:

…consumption of large quantities of gluten should be avoided during the first weeks after gluten introduction and during infancy.

Optimum diet for weight loss and muscle gain?

Recently, I have been researching the importance of dietary protein for muscle health and intend to write a post about it soon. So a piece in The Independent (January 28th) caught my attention. The study they report on claims to have found  the perfect way for men to gain muscle and lose fat quickly: 40% reduction in calories, six day workout routine and increased protein, for a month. In the trial, split between normal and high protein intake, both groups lost fat mass, but only the high protein group increased muscle mass.

The authors point out that the diet is probably too extreme to be maintained in a non-supervised setting. Like most crash diets it is also not suitable for long term weight loss with many studies finding that almost all weight lost is regained in the long run, with no overall benefit. However, raised protein diets are now seen as important from middle age onwards, and have been shown to prevent age related muscle loss. Keep a look out for the article that we are working on re protein and muscle retention.

Paleo or Mediterranean diets to reverse diabetes?

Would you Adam and Eve it? You wait all year for a diabetes diet book to come along, then two arrive at once!

biabetes_diet_books

The Mirror (January 20th) tells the story of Eddy Marshall, director of BBC’s Holby City and Channel 4’s Hollyoaks, who’s diabetes was reversed using a version of the paleo diet, advocated by David Hack, author of a new book ‘The Back to Basics Diet’. I haven’t read it as it is only out this month, but from the Mirror article, it seems to be advocating a proper paleo diet: “organic meat, poultry, eggs, fish, and “plentiful volumes” of vegetables, salads and nuts” to reverse diabetes. Sounds about right to me.

Meanwhile in the DailyMail (January 18th) TV presenter Michael Mosley promotes his new diabetes-busting book. His diet is based around a version of the Mediterranean diet. So what do these two books have in common? Both avoid processed foods, sugar and sweeteners. Both are lowish-carbs. Both encourage real foods such as meat, fish, eggs and vegetables.

BTW: I’m not recommending either of these books – I haven’t read them.

More on diabetes, potatoes and mum’s to be

This month several papers carried the story that mothers that ate more potatoes in the lead up to pregnancy had a higher risk of gestational diabetes. NHS choices (January 13th) critiques the articles. Potatoes or course, are high glycaemic foods, ramping up blood sugar rapidly after consumption. The more portions of potatoes the women ate per week the higher their risk of diabetes. This shouldn’t surprise anyone, as it is basic physiology.

Should you avoid nightshade foods?

Some of my patients need to be on a Solanaceous (nightshade-family) – free diet. This means no tomatoes, peppers, aubergines, chillies, potatoes or paprika. It’s rare to see any articles about this subject, but Health Magazine’s website (January 28th) has a pretty good one on the subject this month. Take a look.

Nitrates and eye health

The Daily Mail (January 15th) reported on a study indicating that dietary nitrates reduce the risk of glaucoma, cutting the ‘risk of a leading cause of blindness by 30%’. Whilst this is interesting in its own right, I thought it was telling that the article only referred to ‘nitrates from green leafy veg’. Nitrates are also found in bacon and cured ham. Why didn’t they mention that? (see our post on pork for more about nitrates in bacon)

Guardian recipes Jan 2016

Recipes

To finish off, here are a few interesting grain-free vegetable dishes to inspire you, courtesy of the Guardian:

UK vegetarians DON’T live longer than meat eaters study finds

UK_vegetarians_all_cause_mortality

A UK based study into the health benefits of vegetarian diets – the largest of it’s kind to date – has just published its findings in The American Journal of Clinical Nutrition showing that long-term diets reducing or eliminating meat and other animal products did not lead to significant reductions in early death. Not only does this call into question the claimed health benefits of vegetarian diets, but is also challenges recent warnings about the risks of eating meat.

The study by Appleby et al at the Cancer Epidemiology Unit at the University of Oxford wanted to find out if previous evidence indicating protective effects of vegetarian diets against certain chronic diseases actually translated into extended life (i.e. reduced mortality).

They used data from two UK based studies that tracked a total of 60,310 persons recruited between 1980 and 1993 and tracked until 2014, representing a total of over 1 million person-years of follow-up.

Based on a simple questionnaire participants were categorised to one of five dietary groups: Regular meat eaters – who ate meat 5 or more times per week; Reduced meat eaters – who ate meat less than 5 times per week; Fish eaters – who avoided meat but ate fish; Vegetarians – who ate eggs and/or dairy products but no meat or fish; and vegans who ate no food of animal origin at all. These dietary patterns were rechecked every five years.

During the study period over 5000 deaths were recorded, providing data to estimate the relative risk of death among each group. The graph above shows the relative risk of death for each group after adjustments for the usual suspects: smoking, alcohol, age, marital status, supplements etc. As you can see there was very little difference between the groups.

Although the vegans appear to have a raised risk, there is more uncertainty in the association as they were the smallest diet group. This is indicated by the larger 95% confidence interval whiskers, so the apparent increase is actually non-significant. It might be tempting to use these data to criticise vegan diets, but that would not be statistically valid.

This is still interesting, as the vegan group had several dietary factors which conventional wisdom would expect to be in their favour: they consumed the lowest level of saturated fat and had the highest intakes of fruit, vegetables and fibre. All of these would usually be considered part of a healthy diet. In contrast, the meat eaters had the highest levels of saturated fat and the lowest levels of fruit and vegetables, yet their all-cause mortality was similar to that of the vegans.

So what about earlier studies which found evidence for protective effects from vegetarian diets, and those that indicated an increased risk of bowel cancer from red meat – you know – the ones that made the headlines and six o’clock news? How do we square those with the ‘no overall difference’ found in this study? The answer appears to be that each diet increases risks of some diseases whilst reducing risk of others.

When Appleby et al looked at the causes of death between the groups they found some clearly significant differences, which we will look at below. This is somewhat surprising considering that the overall mortality was so similar between groups, but it highlights how focussing on a single cause of death can lead to mistaken conclusions. Let’s take a look at some of those between-group differences.

Colorectal cancer

Following October’s media frenzy surrounding the decision of the WHO to classify red meat as a ‘probable carcinogen’ and processed meat as a ‘definite carcinogen’ statistics appeared in many papers claiming to quantify the increased risk of colon cancer caused by consuming red or processed meat. One such from the Guardian on the 26th October 2015 said:

An analysis of data from 10 studies estimated that every 50 gram portion of processed meat, if eaten daily, increases the risk of colorectal cancer by about 18%… [whilst] data from the same studies suggest that the risk of colorectal cancer could increase by 17% for every 100 gram portion of red meat eaten daily.

Fortunately, we can put these claims to the test as in the new study Appleby’s group gives us the daily intake of processed meat for each diet group:

g/day Regular meat eaters Reduced meat eaters Fish eaters Vegetarians and vegans
Red meat 70 21 0 0
Processed meat 24 8 0 0

If the stats in the Guardian are to be believed, then the regular meat eaters should have about a 20% increased incidence of colorectal cancer than the non-meat eaters. But what did the Oxford study find?

UK_vegetarians_colorectal_cancer_mortalityNote: vegetarians and vegans had to be combined in this sub-analysis as the sample size would otherwise have been too small.

Of the non-meat eaters, only the fish eaters had a significantly reduced risk of dying from colorectal cancer, a whopping 40% fewer fish eaters dying of that cause. Yet contrary to expectations, the vegetarians and vegans gained no significant benefit from avoiding meat. This is weird. And it challenges many of the putative mechansisms by which meat might initiate cancer. The front runner in the cancer-inducing steaks (pun intended) is thought to be the oxidation of fatty acids by heme iron (from fatty red meats), but if that were the chief mechanism then vegetarians should be protected from colon cancer to the same extent as fish eaters.

One possibility would be that fish may contain protective factors, rather than red meat containing harmful ones. But this seems unlikely, as the regular and reduced meat eaters ate similar amounts of fish per week as the pescetarians. There is something fishy going on here…

Looking at deaths from all kinds of malignant cancers it is possible to distinguish between vegetarians and vegans, and the picture again is much of a muchness. The fish diet is the only group showing a significant difference:

UK_vegetarians_malignant_cancer_mortality

The second biggest killer after cancer is cardiovascular disease, so lets take a look at what this study found.

Cardiovascular disease

It is commonly assumed that meat eating is associated with heart disease. Indeed meat, animal fats and saturated fats are often conflated, and in many people’s minds all contribute to cardiovascular disease. Yet in this study there was no statistical difference between the diet groups for deaths from cardiovascular disease in general or ischaemic heart disease in particular.

In the case of cerebrovascular disease (which includes stroke), however, an interesting picture emerges:

UK_vegetarians_cerebrovascular_mortality

In this case meat eating appears to be protective, with the vegan’s having a significantly increased risk of dying from cerebrovascular disease. There is possibly a smaller raised risk for fish eaters too, although the broad 95% confidence intervals make it hard to draw any firm conclusions. These findings are strange as there were no obvious dietary differences between the vegans and fish eaters when it came to the usual ‘culprits’ saturated fat, total fat, fruit/vegetable consumption etc. As the authors conclude:

Differences found for specific causes of death merit further investigation.

Strengths and weaknesses of this study

Usually observational studies can be criticised because they can only demonstrate correlation not causation. However, when a sufficiently powered observational study like this one finds no correlation (all 5 diets being essentially equal with respect to mortality) then de-facto there can be no causation.

Conclusion

The take home messages seems to be:

  1. Vegetarian and vegan diets do not appear to be especially protective, and meat eating is not especially harmful.
  2. Fears about red and processed meat and colorectal cancers appear unfounded.
  3. Whilst choices around vegetarian v non-vegetarian diets can indeed change risk factors in relation to specific diseases, they are unlikely to affect overall life expectancy.

Does this mean there is no point in trying to eat a healthier diet? No. For one thing, if you have a heightened risk of a particular disease – because you have a specific medical condition, genetic weakness, or family history for example – then it makes sense to eat a diet that minimises that risk. In such a case it will improve your overall mortality risk.

Secondly, the participants in this study were all eating ‘standard’ versions of these diets with macronutrient ratios close to the national norms, i.e. high-carb with lowish protein and fat. Below I have listed the participants’ macro nutrient consumptions and compared them to the national average taken from NDNS data 2011/12. You can see from the variations (+/- figures) that none of the participants’ diets varied much from this norm.

Baseline diet; All participants  Energy, % UK average (NDNS 2012)
Protein 14.6 ± 2.8 17
Carbohydrate 48.9 ± 7.1 50
Total fat 31.5 ± 6.0 35
Saturated fat 11.1 ± 3.5 12.6

So this study tells us nothing about the long term benefits of a low-carb, gluten-free or paleo diet. What it does show though, is that there is little reason to worry about your meat intake and even less reason to be distracted by vegetarian or vegan health rhetoric.

Cinnamon coconut macaroons

macaroon1
✓Gluten-free ✓Grain-free ✓Low sugar ✓Low-carb ✓Dairy-free ✓Nut-free

I’ve never been a big fan of coconut macaroons, mainly, I think, because of the fibrous texture of dessicated coconut strands. So it was a revelation when my daughter made me these little cakes one evening. Because the dessicated coconut had been ground down to a coarse flour the resulting texture was far more like a moist cake. The hint of cinnamon could almost be missed, but it gave a distinct ‘baked goods’ aroma that only added to my surprise – “Really? These are made with coconut?”. I was intrigued. Continue reading