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Whereas some foods are considered healthy when they are anything but, others have acquired the most heinous of reputations, quite unjustifiably. Black pudding has a repute as black as its name, and in a gross miscarriage of justice, currently occupies one of the lower circles of health food hell. Let’s put the record straight: black pudding is a healthy, delicious and traditional British food that deserves to be formerly recognised as such. If it’s made properly, that is.

We may think of black pudding as quintessentially British but in fact most countries where pork is produced have their own version of this thrifty dish. Here in Britain quality black pudding is usually made with onions, pork fat, pork rind, pig’s blood, oatmeal, herbs and pepper, with a few slight variations thereof. If you can get over any initial but frankly irrational revulsion at the thought of consuming pig’s blood you have to admit that the finished product is indeed rather tasty. Think of all those indelicate body parts that go in to producing cheap sausages and you’ll soon recover from any aversion you may feel. Buy fresh red meat and there is plenty of blood running through it. What’s the problem?

My only concern with black pudding is the provenance of the blood. I always want to know where my food comes from, and animal welfare is of paramount importance. Buy black pudding from any given supermarket and, unless it is organic (and it won’t be), the dried blood it contains will be imported – from who knows where. I don’t like the thought of that, and for that reason won’t buy it. Indeed, I hadn’t eaten this food in years. However, for the purposes of ongoing research, I felt it incumbent upon me to give it a go. A quick Google led me to Laverstoke Park Farm, so I gave them a ring. They confirmed what I wanted to hear: their organic black pudding is made from the blood of their own, organically reared pigs. Phew.

Blood, as you’d expect, is highly nutritious, full of pre-digested nutrients, especially iron, protein, calcium and vitamin A. There is nothing new about humans consuming blood. It was, until fairly recently, a regular part of the diet of the Maasai of East Africa, along with meat, milk and yogurt. In fact they ate very little else, other than herbs, resulting in a diet consisting of a whopping 66 per cent fat. As recently as the 1970s their diet was considered something of a mystery. Despite all the blood and fat they consumed they were found to have consistently low blood cholesterol and fat levels. Post-mortem examinations reveal an absence of atherosclerosis – plaques on artery walls which are a sign of heart disease. That comes as no surprise – for more on the role of animal based foods in health and cardiovascular disease, see previous posts (here and here).

What about flavour? It was food heaven, after such a long period of abstinence. Smooth and nicely spiced it went down especially well with the nitrate-free bacon which accompanied it – more of which later.

Biss, K., Ho, K-J., Mikkelson, B. et al (1971). ‘Some unique biologic characteristics of the Masai of East Africa’, New England Journal of Medicine 284:694-699

Come the Apocalypse, how do you rate your chances of survival, assuming you made it through the worst? This is the scenario: there’s nothing man-made left on Earth – just you, some other hapless survivors and the natural environment. How are your basic human skills? You might want to think about honing them now, because you’ll need to be able to hunt (for skins as well as food), forage, build a shelter, light a fire and find drinking water. Good luck with all that.

Our forebears spent millions of years evolving these skills, and the absurdity is that most of us now can do none of the things that these so-called primitive hunter-gatherers excelled at. If they hadn’t, we wouldn’t be here today. We’re the primitive ones now: personally, some light foraging is all I would be able to offer my survival group, perhaps with a few short talks on nutrition for round-the-fire entertainment. We can operate machinery we don’t really understand and pass IT exams, but we have no idea how to be the human animals that we are.

These are the existential matters I’ve taken to ruminating on recently, what with rising food prices, peak oil, climate change and other looming disasters of our own making. I’ve come to the conclusion that self-sufficiency may well be the only way forward.

I’m not long back from Italy, where we have a house. It’s in a beautiful mountainous region; very rural, and very traditional. It is well known that Italians love food and love talking about food and how to cook it. In our village, which is fairly typical, the people are attuned to the seasons and the land and have impressive foraging and horticultural skills. If it grows and is edible, they know about it and they will find some creative way to incorporate it into their diet.

Our house is a converted water mill, over 500 years old. It still houses the original grinding stones, and the beams are huge chestnut trunks. We have chestnut trees in our garden and they are rightly protected by law. The sweet chestnut (not to be confused with the inedible horse chestnut) is, or was, hugely important to the region. In fact the castagna ensured the survival of the people on the land for thousands of years, being the staple crop. Planting chestnut trees is an act of selfless consideration – they bear no fruit for at least 15 years, and it takes around 50 years before they produce a decent harvest.

Chestnuts are not cultivated; they fall to the ground when they are ready and are available to foragers. Edible, free and versatile, the chestnut can be eaten raw, roasted or baked. It is also nutritious: unusually for a nut it contains significant amounts of vitamin C, as well as potassium, calcium and folate. On the downside, they are low in fat and protein, but they have lots of fibre and a relatively low glycaemic value of around 54.

The most common chestnut product is flour; hence the preponderance of once-working mills such as ours in this region of Tuscany. Thankfully there are still a few working mills and chestnut flour is available in local shops. This is beautiful flour. Other than drying and grinding, the chestnuts undergo no refinement. The flour is ideal for coeliacs or anyone avoiding gluten and can be used to make pasta and pancakes, or polenta. Because it is slightly sweet, it lends itself well to desserts. Chestnut cake is a favourite in the area, and is known as castagnaccio. There are variations on the basic recipe, but I found this very good one, requiring no sugar but containing some other excellent ingredients such as pine nuts. See:

http://www.italyum.com/Bakery/poor-man-s-chestnut-cake-castagnaccio.html#.UXUz2IKfLWI

Chestnut flour can be bought on-line, so no need to travel too far too find it. I’ll be buying some chestnut flour on my next Italian trip. If it is still available – the locals were telling us that last autumn the chestnut trees failed to produce any chestnuts at all. Not one. The chestnut tree has been hit by a blight caused by the fungus Cryphonectria parasitica (C. parasitica) They had never known anything like it, and although they no longer depend on the chestnut for their survival, they were truly saddened by this loss. Imagine if this occurred at a time when the castagna was all people had to eat, I said to a neighbour, Luigi. His laughing face turned dark. Fame, he said. Hunger.

Italians have long memories when it comes to hardship which is why they revere food, and the land that produces it. That is also why, in rural areas, there are always so many festivals dedicated to the harvest of single crops. In October, when the chestnut harvest begins, you’ll find people celebrating the festa della castagna. I really hope there is one this year.

Chestnuts photo: nuchylee/freedigitalphotos.net

If you are partial to a cooked breakfast but worried about recent reports that it’ll kill you, don’t be. A cooked breakfast is one of the highlights of my weekend, definitely worth getting out of bed for, and so far I’ve survived. A regular diet of brassicas might have something to do with that.

This weekend was no exception and – since you ask – I had my usual: two slices of bacon, three chipolata sausages, an egg and some garlicky mushrooms with herbs, all cooked in extra virgin olive oil. This protein rich fest usually sees me through to the evening, with perhaps just some fruit in the afternoon. However, if I am to believe a recently published report, I am dicing with death.

 This report, a study by the European Prospective Investigation in Cancer and Nutrition (EPIC), found an association between processed meat consumption and risk of death (and there’s nowt as processed as bacon and sausage). The EPIC study was based on the diet questionnaires of over half a million people across ten European countries. It was found that the people most likely to die, as well as eating a lot processed meat, were also more likely to smoke, be overweight, eat fewer fruits and vegetables and exercise less and drink more than people who did not eat a lot of processed meat. They also tended to be older. Now, even though the researchers partially adjusted for all these confounding factors, they could not do so entirely because to eliminate everyone with bad habits and prone to ageing would have excluded virtually everyone.

Look at all those glucosinolates

It is the preservatives used in processed meats which are thought to be the main perpetrators of this food felony. These preservatives – nitrates – are a prime suspect in cancer, especially colon cancer. However, even though colon cancer is on the increase, there is nothing new about meat preservation. Even in Medieval times salt would be mixed with saltpetre (sodium or potassium nitrate) to cure pork. Some sausages also contain nitrites, but these are the cheaper ones: premium, high-meat content sausages usually contain no preservatives at all, and naturellement that is my sausage of choice. I do love bacon though, despite the nites.

 I’ll hazard a guess that many people who love a fry-up, smoke, drink excessively and generally slob about inactively do not fill up on brassicas every day. This is where they are going wrong. The brassica family, which includes broccoli, sprouts, cauliflower, cabbage and kale, are a source of glucosinolates, chemicals which are metabolised in the gut to form isothiocyanates and indole-3-carbinol. These chemicals are associated with a reduced risk of developing cancer. Indole-3-carbinol promotes the metabolism and breakdown of oestrogen in the liver. For this reason it is thought that it may be effective as a preventative measure against breast cancer. Indeed, studies have established that a high consumption of these brassicas leads to a decreased risk of developing other cancers too, relating to the lung, stomach, colon and rectum. (Johnson 2002).

 Most days of the week I eat at least one generous portion of leafy greens and brassica vegetables. For that reason I am not remotely concerned about this study – which, by the way, found no association between fresh red meat and risk of death, but as that finding has no shock value it didn’t make any headlines.

Reference

Johnson, I.T. (2002) Glucosinolates in the human diet. Bio availability and implications for health. Phytochemistry Reviews, 1:183-188.

Romanesco cauliflower photo: James Barker/FreeDigitalPhotos.net

Fluoride occurs naturally in water and strengthens bones and teeth. Who’d be mad enough to object to adding more of it to the water supply?

Fluoride, the thirteenth most abundant element in the Earth’s crust, is found naturally in rocks, soil, water and air. Our main exposure to fluoride is from drinking water. Fluoride may occur naturally, and be good for bones and teeth, but the act of adding fluoride to water – fluoridation – has long been a contentious issue. Only some areas of the UK have fluoridated water and it is up to each local health authority to decide whether or not to impose fluoridation of the water supply. Fluoridation is carried out because it is believed that fluoride can prevent tooth decay and help strengthen bones.

So what’s so contentious about fluoridation if it occurs naturally in water and strengthens teeth and bones? Well, a lot of people do object, and for a number of reasons.

First, there is the objection to being medicated, without consent. That’s the sort of thing that gets right up some people’s noses, however well-meaning the intent. Second, there is the issue of fluorosis. High levels (that is, concentrations over 1.5mg/litre) are known to cause dental fluorosis, skeletal fluorosis, bone fractures, lower birth rates, kidney stones, impaired thyroid function and reduced intellectual capacity in children.

There is a third, not insignificant objection. It’s not naturally-occuring fluoride that is added to water – instead, disodium hexafluorosilicate and fluorosilicic acid are the two permitted chemical compounds used to increase the fluoride content of drinking water in the UK, by to up to 1mg per litre.

Fluorosilicic acid – classified as a hazardous waste product – is a by-product of the phosphate fertiliser industry, and this, according to the campaigning organisation the Fluoride Action Network is what is used to fluoridate water in the UK. It is also added to dental products such as toothpaste and mouth washes. Fluoridated dental products are a significant source of fluoride intake, and it is estimated that children swallow around 0.50 – 0.75mg per day. Fluorosilicic acid is considered highly toxic wherever it is found, except, mysteriously, when it is added to drinking water. It is a highly corrosive acid and according to the Fluoride Action Network there are no available studies on the safety of this toxin in water.

In the UK, the government and the British Medical Association are big advocates of water fluoridation.According to the BMA, fluoridation of water by up to 1mg per litre, the amount more or less found naturally in water, would reduce dental ‘inequalities’ in the UK. Poor children have the worst diets, so if we put fluoride in everyone’s drinking water that would make us all dentally equal.

This is where it gets interesting. The argument in favour of fluoridation is based on just one review alone of available studies, published in 2000 in the British Medical Journal. The aim of this review was to determine whether or not fluoridation improved the level of decayed, missing and filled teeth in children.According to the British Medical Association this review “… concluded that the best available evidence supports the beneficial effect of water fluoridation on dental caries. It also found some evidence that it can help reduce inequalities in dental health across social classes in 5 to 12 year olds.”

Because this review is so frequently cited by those in favour of fluoridation, I thought it would be appropriate to have a proper read of it. I’m glad I did, because what it actually says is that, of the 214 studies reviewed, all were of ‘low to moderate’ quality. Not one of them was considered of high quality. In other words, they weren’t very good studies. Indeed they were described as lacking appropriate design and analysis, but they were used because there was nothing better available. Many were conducted in the 1940s and 1950s and even those that were carried out after that time were described as lacking any adequate tool for analysis. What they gleaned from these poor studies was that “Overall, reductions in the incidence of caries were found, but they were smaller than previously reported.”So, the evidence for artificially fluoridating water is based on poor, outdated studies with underwhelming results. Hardly scientific, and hardly what we would expect of scientists charged with informing policy we are supposed to swallow.

And Venice … but it’s natural.

References

McDonagh M.S, Whiting P.F., Wilson, P.M. et al (2000) Systematic review of water fluoridation. British Medical Journal, 321:855.

British Medical Association. Fluoridation of water. www.bma.org.uk Accessed June 2011.

Look out, everyone – we’re about to be deluged by a tidal wave of old people. According to a House of Lords report published last week, the UK is “woefully underprepared” for this ageing population explosion. Moving like a slowly advancing army, old people equipped with an assortment of mobility aids are spreading across the horizon, with longevity and long-term care in their sights.

There have been plenty of warnings of this impending threat to our welfare reserves in the press recently. Or, more positively, of what the Lords committee describes as “the gift of longer life”. The gift that keeps on giving, unfortunately for the NHS and pension funds.The Office for National Statistics predicts a 50 per cent rise in the number of over 65s and a doubling of over 85s between now and 2030. Furthermore, according to the marvelously optimistic ONS, twenty year-olds today are twice as likely as their parents to reach the age of 100 – and three times more likely than their grandparents.

Whilst such a sunny outlook is usually welcome, in this case it is blindingly unrealistic. I’m not disputing the fact that people are currently enjoying longer life and we have more over 80s than ever. But these are the war generation, people who were brought up in an era when ready-meals and microwaves were barely a glint in the eye of the food giants. These are the people brought up on simple home cooking and regular physical activity.

The same cannot be said for much of the post-war generations. Swivel round and take a look at the opposite horizon. There’s another tidal wave looming, and it’s even bigger than the first. It is made up of children, adolescents and young people born in the late 1970s onwards, and they are wobbling slowly towards us, not waving their sticks but cramming their fat fingers into packets of heavily salted or sugared snacks.

Other predictions may be more reliable. It is projected that by 2020, 41% of men and 36% of women aged 20-65 will be obese. Obese people do not go on to celebrate their 100th birthdays. They do not go on to enjoy a long and happy retirement. Instead, they go on to develop heart disease, type 2 diabetes and cancer. Since 1996 the number of people diagnosed with type 2 diabetes has doubled. By 2025 it is estimated that 5 million will be affected. Cancer incidence rates in Great Britain have risen by 22% in men and by 42% in women since the mid-1970s. Even so, the biggest killer in the UK remains coronary heart disease.

Despite the joy and optimism of the House of Lords and the Office for National Statistics, I predict an entirely different, dystopian future, unless we get a grip. A future of obese, chronically sick people lucky to make it past their 60s. No “gift of longer life” for these victims of a society in which the food industry is self-regulating and leans heavily on any government that might contemplate legislative control, and has successfully seduced generations into a diet of junk food, in the same way that an unregulated tobacco industry once seduced so many into an equally destructive addiction of a different nature.

Anyone who thinks that the NHS can prolong the lives of such chronically ill people is seriously deluded. Apart from the fact that it will not be able to cope with the oncoming burden in terms of sheer numbers, it simply does not possess the miracle cures required to prolong the lives of the junk food generations. Expecting the NHS to keep sick people alive and well for lengthy periods of time is like expecting the police to eliminate all crime and keep us all safe. Damage limitation is limited; we have to look after our own health as best we can, and lock our doors at night.

Top Photo: Suat Eman/FreeDigitalPhotos.net

Hospital food is as bad as ever, despite the government spending over £54 million on 21 initiatives since 1992 to improve standards. That’s the news we heard last week from the Campaign for Better Hospital Food, as it despaired of the “meetings, speeches and gimmicks” that had achieved nothing.

We’ve all been there, either as a patient or as an anguished visitor, watching a loved one’s crushed expression on peeling back the lid of some wretched concoction masquerading as a meal. I predict that absolutely nothing will change (other than the mobilisation of yet another celebrity chef to lead yet another doomed campaign to drive up standards). Nothing, that is, until two things happen. First, the government needs to learn from those who know how to do quality institutional catering without breaking the budget, and second, it needs the backbone to introduce compulsory standards.

This is not hospital food

If you want to know how to do really good food in an institution, despite these challenges, have a word with the armed forces. They excel in this field. In 2009 myself and co-author Barbara MacDonald published Nutrition in Institutions, in which we describe the provision of food in schools, hospitals, care homes, prisons and the armed forces. Researching all five was an eye-opener, and none more so than the armed forces.

The provision of food in the armed forces is considered a matter of paramount importance, which is why catering is an integral part of the forces, provided by its own members, rather than by an-outsourced service. Standards are in place and these are monitored and met. Food is valued not only as a source of fuel but also for its role in building morale. Providing good food is also a matter of pride, and being naturally competitive, the forces organise various culinary competitions to ensure that creativity and standards are constantly driven upwards.

Even prisons have made sterling efforts to improve the food they provide. Should you ever find yourself in choky, you might be pleasantly surprised by the standard of prison food. Mandatory food standards are in place, thanks to the 1990 prison riots in Strangeways which triggered protests and disturbances in prisons throughout the country. A report into the riots found that the poor quality food was the most common complain from prisoners. By and large standards are now met.

Nor is this. But why not?

So surely the time has come for efforts to finally focus on hospitals. What we learned from our research for Nutrition in Institutions was that food was at its best where there were stringent, well monitored standards in place. The worst service is where there are no compulsory standards, and the service is out-sourced to the cheapest bidder. All too frequently, catering staff, especially those who are not employed in-house, are poorly paid and poorly trained. There is, in some establishments, a small but growing trend towards bringing the catering service back in-house, after having previously out-sourced contracts to private commercial companies. In-house catering, just like the old days when Cook was in charge of the kitchen, can also be more economical: in the long term it is cheaper to buy in raw ingredients and pay someone to cook them than leave the whole service to an outside organisation.

The armed forces were quick to understand the provision of food as being crucial to the smooth running of the military machine and constitute the only institution to consistently value the link between diet and health and performance. But it is clear that, without standards and genuine government commitment, those who are most vulnerable and unable to stand up for themselves (quite literally), or riot on rooftops, are those most likely to receive the poorest quality food service.

Photos: Top: nuttakit, middle: marcus, bottom: Dino de Luca/www.FreeDigitalPhoto.net

Yogurt can be a great speedy breakfast, if it is live (bio) and sugar-free. It is made by the bacterial fermentation of milk. Live yogurt contains lactic acid bacteria which populate your gut and do no end of good, from strengthening immunity to improving bowel function and reducing the risk of colon cancer. By creating an acid environment in the gut, lactic acid bacteria – L. acidophilus – inhibit pathogens and prevent them from flourishing. If you’re dairy intolerant you may find that you can tolerate live yogurt. That is because the lactic acid bacteria in yogurt pre-digest the lactose (milk sugar). The protein in yogurt is also partially digested by bacterial fermentation, so if you are sensitive to the protein content rather than the lactose, again you may find that you can tolerate yogurt without developing any symptoms. Yogurt drinks on the other hand are a watered down, sugary derivative sold in multiples of dinky pots at exorbitant prices. I personally don’t see the point of them, other than their obvious convenience factor. Yes, they contain friendly bacteria, but so does yogurt in its original and much cheaper form. They also contain lashings of sugar, which to my mind negates any benefits the product had to start with.

A plump green or wrinkly black olive is the perfect amuse-bouche for pre-dinner loafing. Olives are a relatively recent addition to the UK snack smorgasbord, and a very welcome one at that. They make an ideal snack food, not just because of their suggestion of sophistication but because of their high monounsaturated fat, fibre and vitamin E content. They also boast an exceptionally high level of polyphenols, those excellent antioxidants so beloved of your heart and other essential organs. Furthermore, despite being a fruit,the olive contains virtually no carbohydrate.

Image courtesy of Dusky/FreeDigitalPhotos.net

Someone tell her

The medical establishment has finally turned its gaze to sugary soft drinks in its efforts to halt the tide of obesity that is threatening to overwhelm us. The Academy of Medical Royal Colleges, which represents Britain’s 220,000 doctors, is demanding that the government impose a 20% tax on the cost of sugary drinks. With one in four adults in England classified as obese, and that figure predicted to rise to 55% by 2050, there isn’t much time left for action.

These drinks have rightly been singled out for public vilification. ‘Soft’ sounds innocuous enough, but it belies the true nature of these baby-faced beverages. It is well established that sugar-sweetened soft drinks are associated with tooth decay. That is just the start of it: they have also been shown, in numerous large studies, to be associated with weight gain, type two diabetes and heart disease. There can be no doubting the significant contribution that sugary soft drinks make to the obesity epidemic. They have a unique characteristic: despite all the sugar and calories they contain, soft drinks have very little impact on appetite. So no matter how much you drink you will not feel any more full, or want to eat any less. What you will have, without having actually eaten anything, is high circulating glucose and insulin. Primed for obesity, there’s only one place all that glucose is heading, and that’s straight to your fat cells. High circulating glucose – followed by insulin – can lead not only to obesity but also to inflammation, insulin resistance and ultimately metabolic syndrome. All this between meals.

Switching to a ‘lite’ version of your favourite pop, sweetened with artificial chemicals, seems like a neat solution that does not require sacrificing your sweet fix. One of the perceived benefits of a sugar-free drink is that it won’t affect blood sugar levels, so must be good for diabetics and weight watchers. However, studies have, paradoxically, put paid to this theory. One study of 14 men with type two diabetes who were given a variety of different meals at different times, including high sugar, high fat, low carbohydrate, and aspartame sweetened meals, found, ‘contrary to all expectations’, that the aspartame meal induced a similar rise in glucose and insulin levels as the sugary meals.

It beats me that anyone would choose to imbibe something whose cloying brassiness so traumatises the taste-buds and makes the stomach wince. But there are plenty of people who do, and who show no signs of cutting back. The British Soft Drinks Association reported that in 2011 the market continued to grow, despite the economic climate, and that 14,685 million litres of the stuff was consumed. The government has no appetite for regulating a powerful and, what’s more, lucrative business. Nor has the Food Standards Agency, ostensibly working on behalf of the consumer but in reality enjoying a cosy relationship with the food industry, which it is reluctant to police. This much has been made clear from the current horse meat scandal. Will the government heed the call from Britain’s GPs to take any action at all? Fat chance.

References

Malik, V.S., Popkin, B.M., Bray, G.A. et al (2010) Sugar-sweetened beverages, obesity, type 2 diabetes mellitus and cardiovascular disease risk. Circulation, 121:1356-1364.

Malik, V.S., Schulze, M.B. & Hu, F.B. (2006) Intake of sugar-sweetened beverages and weight gain: a systematic review. American Journal of Clinical Nutrition, 84(2):274-288.

Ferland, A., Brassard, P. & Poirier, P. (2007) Is aspartame really safer in reducing the risk of hypoglycemia during exercise in patients with type 2 diabetes? Diabetes Care, 30(7)e59.

Photo: Ambro/www.FreeDigitalPhotos.net

Amuse-bouche #18. Water, and the shrinking human.

Other than breast milk, the only drink anyone needs is water. Everything else is surplus to human requirements, but a life with nothing else to drink might be a tad dull. Every metabolic process in the body requires water, which is nothing more than two parts hydrogen to one part oxygen, multiplied by a great deal. The body is 55-78% water, although babies can be up to 75% water. We really do dry up as we age – elderly people are around a mere 55% water.