Food For Thought at The Lighthouse

On the first Tuesday of each month I run a small but dedicated Food For Thought Group at the Lighthouse Recovery Centre together with Community Recovery Worker, Lesley Rhodes, and the centre’s food support staff and members

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Lesley and I with our offerings of Easy Oat Bites and Guacamole 

The Lighthouse is a referral only service that supports people with a personality disorder living in Brighton and Hove. It is a joint partnership between Sussex OakleafSussex Partnership Foundation Trust and Brighton and Hove Mind and is open for members 7 days a week.

The Food For Thought group is just one of many activities available to its members. We explore the health properties of particular foods and then try them out in different recipes.

The aim is not only to appreciate just how diverse and nourishing foods can be, but also to develop practical cooking skills through hands on experience – and to gain confidence preparing and eating unfamiliar ingredients. For example, in January’s workshop we focused on fennel (both bulb and seeds) and in February, we embraced the adaptable aubergine.

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Hands on Experience – Watercress, walnut, feta and roasted cauliflower salad

Workshops are held in the Lighthouse kitchen, which is a warm, bustling and friendly environment – usually filled with laughter, genial witticisms and delicious smells.

For me, this is the ideal setting in which to prepare food, as it feels more like a social event than a chore! Cooking and chatting together transforms what can often be seen as drudgery, into something fun and rewarding.

As well as the obvious advantage of strengthening social ties, the workshops are also designed to foster an awareness of nutrients crucial for optimal physical and mental health, i.e. health self-empowerment.

Educating people about nutrition and cooking skills can influence food related behaviour, as well as health (1,2,3). Fostering awareness about how the body works, for example the link between balanced blood sugar levels and emotional stability, or the crucial role of the liver, can also help nudge individuals towards making healthier food choices in their daily lives.

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Inspired ways to eat your rainbow-a-day – Thai Quinoa Salad with ginger and lime

 

And while there are no empirical studies looking at the relationship between nutrition and personality disorder, there is abundant evidence that nutrition and eating behaviour impact not only affective regulation (mood and emotion) (4-9) but also conative (motivation, intention, self-control) (10-12) and cognitive processes (13-15) .

 

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The emphasis is on simple, healthy and tasty – Smoked Mackerel Pate with horseradish and spring onions

 

 

The Food For Thought Group also offers a safe environment in which to explore individual challenges with food that may have developed in childhood, such as food or texture aversions or fear of specific foods, without any expectation or pressure to share personal experiences – or indeed to cook!

Members can drop in (or out) of the group as they please, though they might well be tempted back by the mouthwatering aromas and entertaining kitchen banter.

 

 

References:

  1. Hartmann, C., Dohle, S., & Siegrist, M. (2013). Importance of cooking skills for balanced food choices. Appetite, 65, 125-131.
  2. Harmon, B. E., Smith, N., Pirkey, P., Beets, M. W., & Blake, C. E. (2015). The Impact of Culinary Skills Training on the Dietary Attitudes and Behaviors of Children and Parents. American Journal of Health Education, 46(5), 283-292.
  3. Clark, A., Bezyak, J., & Testerman, N. (2015). Individuals with severe mental illnesses have improved eating behaviors and cooking skills after attending a 6-week nutrition cooking class. Psychiatric rehabilitation journal, 38(3), 276.
  4. Holt, M. E., Lee, J. W., Morton, K. R., & Tonstad, S. (2015). Trans fatty acid intake and emotion regulation. Journal of health psychology20(6), 785-793.
  5. Bushman, B. J., DeWall, C. N., Pond, R. S., & Hanus, M. D. (2014). Low glucose relates to greater aggression in married couples. Proceedings of the National Academy of Sciences111(17), 6254-6257.
  6. Jackson, D. B. (2016). The link between poor quality nutrition and childhood antisocial behavior: A genetically informative analysis. Journal of Criminal Justice44, 13-20.
  7. Pina-Camacho, L., Jensen, S. K., Gaysina, D., & Barker, E. D. (2015). Maternal depression symptoms, unhealthy diet and child emotional–behavioural dysregulation. Psychological medicine45(09), 1851-1860.
  8. Jacka F. N.Ystrom E.Brantsaeter A. L.Karevold E.Roth C.Haugen M.Meltzer H. M.Schjolberg S., & Berk M. (2013). Maternal and early postnatal nutrition and mental health of offspring by age 5 years: a prospective cohort studyJournal of the American Academy of Child and Adolescent Psychiatry 52(10): 10381047
  9. Jacka F. N.Mykletun A., & Berk M. (2012). Moving towards a population health approach to the primary prevention of common mental disordersBMC Medicine 10(1): 149.

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    Scrumptious Snacks, gluten, dairy and sugar free – Coconut Cocoa-nut Balls

  10. Gailliot, M. T., & Baumeister, R. F. (2007). The physiology of willpower: Linking blood glucose to self-control. Personality and Social Psychology Review11(4), 303-327.
  11. Tan, C. C., & Holub, S. C. (2015). Emotion Regulation Feeding Practices Link Parents’ Emotional Eating to Children’s Emotional Eating: A Moderated Mediation Study. Journal of pediatric psychology40(7), 657-663.
  12. Berland, C., Cansell, C., Hnasko, T. S., Magnan, C., & Luquet, S. (2016). Dietary triglycerides as signaling molecules that influence reward and motivation. Current Opinion in Behavioral Sciences.
  13. Bellisle, F. (2004). Effects of diet on behaviour and cognition in children. British Journal of Nutrition92(S2), S227-S232.
  14. Lucassen, P. J., Naninck, E. F., van Goudoever, J. B., Fitzsimons, C., Joels, M., & Korosi, A. (2013). Perinatal programming of adult hippocampal structure and function; emerging roles of stress, nutrition and epigenetics. Trends in neurosciences36(11), 621-631.
  15. Morley, J. E. (2014). Cognition and nutrition. Current Opinion in Clinical Nutrition & Metabolic Care17(1), 1-4.
  16. Walker, J. G., Batterham, P. J., Mackinnon, A. J., Jorm, A. F., Hickie, I., Fenech, M., … & Christensen, H. (2012). Oral folic acid and vitamin B-12 supplementation to prevent cognitive decline in community-dwelling older adults with depressive symptoms—the Beyond Ageing Project: a randomized controlled trial. The American journal of clinical nutrition95(1), 194-203.
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Eat well, feel well (or at least, a bit better…)Winter Immune Booster Soup

Nutrition and Mental Health – Part 1

“First Do No Harm” ….so let’s rule out the obvious stuff first

Research increasingly points to the importance of adequate nutrient intake for mental health, especially with regard to inflammation, oxidative stress, gut microbiota and mitochondrial health. Despite this, the first line of approach for individuals suffering from mental health problems is rarely multidisciplinary and even with everything we now know, still gives scant, if any, any consideration to an individual’s diet.

Sometimes this failing can be spectacular, as demonstrated during a talk given by Professor Malcolm Peet, Consultant Psychiatrist (now retired) at a Food and Behaviour Research conference in 2013. A nutritionist, newly recruited to work for the NHS in northern England, joined the discussion by satellite link, and cited the case of a young man in his thirties who had been suffering from auditory and visual hallucinations, apathy, severe depression and suicidal thoughts. This man had been on numerous medications (5 or 6) for a number of years, and had been assigned a number of nursing and support staff over this time to help him deal with not only with the physical problems, but also his emotional and financial challenges. He had never managed to hold down a job for more than a few months and found it impossible to maintain any meaningful relationships, despite his wish for a long-term partner. Nothing was said about his genetic predisposition, possible childhood / adult traumas, stress levels, lifestyle or any other possible known contributors to his mental health problems – but throughout those years in and out of hospital, no one had ever asked him one simple question:

“What do you eat?”

As it happens this was a crucial piece of information.

For breakfast, and throughout the rest of the day, he would eat up to 10 packets of crips, washed down with a 2 litre bottle of sweetened fizzy drink. He also drank about 10 coffees (each with 2tsp sugar), and in the evenings, a bottle of 20% alc. coffee liqueur. His only source of real food came in the form of an occasional kebab.

It wasn’t clear how long he’d been eating like this, which is obviously relevant, but a worst case scenario envisages that his diet had been woefully deficient since he left home 12 years earlier – and possibly before that. Even on a continuum of bad dietary choices, this case may seem extreme, but how would we ever know if we don’t ask?

In dietary analysis it is accepted that food diaries, food frequency questionnaires and 24-hour recalls (even with multiple pass follow up) are only ever “best estimates” (people often misjudge their intake, or just lie) – but as this case shows, you don’t need to spend much time questioning someone to realise there’s a serious problem.

It’s not always easy for people, with or without mental health problems, to accept just how critical good nutrition is for brain function. Changing eating habits is difficult for anyone, even if motivated. For those with mental health challenges this can be especially true, and a vicious cycle can quickly ensue.

Initially, this man didn’t accept that food could be related to his symptoms, and so he resisted any dietary changes. However he did agree to take a daily multi vitamin and mineral supplement, as well as fish oil. All supplements were within the daily recommendations.

After a few months, his situation had dramatically improved. His sense of perception and reality had normalised (no more hallucinations), and he had managed to come off all but one medication. He now also needed only one support person. The changes he saw motivated him, so that he eventually welcomed nutritional counselling. For the first time in his life he realised that what he ate profoundly affected how he felt.

The financial implications for the NHS of cases like this are obvious, but for individuals concerned it can be nothing short of life altering. In this case the young man also managed to find himself a steady job, as well as a stable relationship.

For sure, the answer to the mental health crisis won’t be found in a bottle of supplements – or even three healthy meals a day.

But clearly, ruling out malnutrition and severe deficiencies is a logical and cost-effective place to start.

Offering dietary support and motivational guidance to individuals who may have slipped through the nutritional net, either through lack of knowledge or (self) neglect, is a low-cost but potentially life changing adjunct to talking therapy or targeted pharmaceutical interventions.

Who knows, in some cases, little else may be needed. But one thing is certain – if we don’t ask, we’ll never know.

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Brighten Up!

 

  1. Felicitous Fare

Foods can lift your spirits. Some do so more effectively, and for longer, than others. So while you may be tempted to reach for the usual emotionally comforting suspects (chocolate, crisps, ice cream, doughy products, sweets and deep fried foods) take just 1 minute before doing so, to mindfully connect with why you’re making that choice. If you’ve learned healthy self-regulation at a younger age, aligning your choice with your needs (physical or emotional) is easy. If self-regulation is not your forte, this technique can help promote more helpful habits in an environment where you may have to make as many as 200 food related choices a day! 32

 

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  1. Step Out

Although the UK is not generally blessed with sunny winters, there are some beautiful, bright days to be had in between those dismal grey ones. Make the most of them. It might not have much impact on your Vitamin D levels until the days get longer, but it can still improve your overall feelings of well-being. 33

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  1. Infect Others

Happiness and health are natural partners. 34-37 And as happiness seems to be contagious 38 try to spend time with happy people, and then infecting others with your own happiness.
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Tighten Up!

  1. Jump to it!

It takes half a second, or less, to make that decision to get out of bed and be active. So when you have the thought – jump to it! Don’t spend time weighing up the pros and cons (weather, mood, physical state, etc.); by the time you’ve talked yourself into rolling back over to sleep you could have taken a brisk 20min walk! Bear in mind that planning in advance and exercising regularly increase the likelihood that you’ll stay motivated. 30

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  1. Run, jog, walk

Run, or just walk, out of your front door and into the new day. Practice reframing your reasons for taking exercise – self-determination again… i.e. because you want to, not because you have to. Do this by focusing on how lucky you are to be alive, experiencing this new day, and to be healthy enough to be able to move your body, see the sun, feel the rain and wind. If you’re depressed, ill or in pain this will be difficult. But try to get up and move in whatever way you can. Get help. Resolve to keep trying, however tiny the steps. Positive habits can transform destructive cycles of mental energy into constructive ones – but it will take time, effort and support if you’re not used to thinking that way.

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  1. Good, Better, Best

Change the way you make your decision to exercise by re-imagining the activity with focused visualisation. Instead of concentrating on the blast of icy air that hits you when you open the door, focus instead on the warm glow you’ll feel when you get back indoors, the wonderful invigorating shower or the delicious breakfast. And if you don’t manage it – don’t feel guilty. Just be kind to yourself and resolve to do it the following day. Self-compassion rather than guilt is more likely to improve your motivation. 31

 

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References

(30) Schmeichel, B. J., Harmon-Jones, C., & Harmon-Jones, E. (2010). Exercising self-control increases approach motivation. Journal of personality and social psychology, 99(1), 162.

(31) Breines, J. G., & Chen, S. (2012). Self-compassion increases self-improvement motivation. Personality and Social Psychology Bulletin, 38(9), 1133-1143.

 

Lighten Up!

  1. Re-adjust Your Goals

It’s believed that two thirds of us in the UK will be overweight by 2025, so we need to get serious about shedding excess weight. But if you focus on looking slim – rather than being healthy – it might actually work against you.1,2 Losing weight to look good, rather than optimising health, just doesn’t seem to be as effective long-term.3 This is borne out by what we know about parents unwittingly putting their child at an increased risk for eating disorders later in life by focusing on their child’s weight, rather than giving positive messages about healthy eating in general. Might this also explain why some adults have struggled with weight issues since adolescence?4 The self-determination theory suggests that having full autonomy in the choices we make, rather than feeling controlled, can make all the difference when it comes to weight loss. 5,6,7 This means that wanting to lose weight because of how you think others perceive you is less effective than deciding to lose weight because you yourself want to be healthy. So, although it sounds counter intuitive, lightening up about your size, and genuinely embracing improved health might be the first step you need to take.

 

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  1. Forget Fad Diets

Fad diets abound. A library’s worth of new dieting books will be hitting the bookshelves for 2016! The titles are designed to entice all types of dieters – promising the world, but for most, failing to deliver in the long term. In fact this kind of  approach often leading to increased weight gain. 8,9,10 So save your money, forget the “miracle diet” and spend your time doing something more fun, interesting and worthwhile….

 

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  1. …Create, don’t Vegetate

“Veggin’ out” in front of a screen encourages increased food intake, poorer food choices and increased weight. 11-16 Regular junk food / TV binges can become a bad habit, eating up hours, adding pounds to the waistline and increasing your chances of chronic disease, binge eating and depression.17-22 Action TV in particular is associated with a greater intake of poor quality food, 23 a fact that will come as no surprise to the “popcorn inhalers” at the movies. The average Brit spends 3 hours and 40mins per day watching TV, and it’s thought that longer viewing binges (back-to-back Nordic Noir box sets, anyone?) may be taking its toll on the nation’s cognitive health.24 Maybe you are just chilling for a few hours, in which case, enjoy! But if you find yourself habitually using screen time to distract yourself from stress or problems – tuning in, to tune out – you might be creating more problems in the long run. On the flip side, being creative can improve brain function and quality of life as we age. 25-29 Start swapping screen time for something new a few hours a week, it could be the start of better health, and a more interesting, creative and happier life.

 

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References

(1) Cheskin, L. J., & Donze, L. F. (2001). Appearance vs health as motivators for weight loss. JAMA, 286(17), 2160-2160.

(2) Calder, R. K., & Mussap, A. J. (2015). Factors influencing women’s choice of weight-loss diet. Journal of health psychology, 20(5), 612-624.

(3) Putterman, E., & Linden, W. (2004). Appearance versus health: does the reason for dieting affect dieting behavior?. Journal of Behavioral Medicine, 27(2), 185-204.

(4) Berge, J. M., MacLehose, R., Loth, K. A., Eisenberg, M., Bucchianeri, M. M., & Neumark-Sztainer, D. (2013). Parent conversations about healthful eating and weight: associations with adolescent disordered eating behaviors. JAMA pediatrics, 167(8), 746-753.

(5) Teixeira, P. J., Silva, M. N., Mata, J., Palmeira, A. L., & Markland, D. (2012). Motivation, self-determination, and long-term weight control. International Journal of Behavioral Nutrition and Physical Activity, 9(1), 22.

(6) Georgiadis, M. M., Biddle, S. J., & Stavrou, N. A. (2006). Motivation for weight-loss diets: A clustering, longitudinal field study using self-esteem and self-determination theory perspectives. Health Education Journal, 65(1), 53-72.

(7) Theory of Motivation Guides Our Approach To Helping People. University of Rochester Medical Centre https://www.urmc.rochester.edu/community-health/programs-services/healthy-living-center/self-determination-theory.aspx

(8) Pietiläinen, K. H., Saarni, S. E., Kaprio, J., & Rissanen, A. (2012). Does dieting make you fat? A twin study. International Journal of Obesity, 36(3), 456-464.

(9) Siahpush, M., Tibbits, M., Shaikh, R. A., Singh, G. K., Kessler, A. S., & Huang, T. T. K. (2015). Dieting Increases the Likelihood of Subsequent Obesity and BMI Gain: Results from a Prospective Study of an Australian National Sample. International journal of behavioral medicine, 22(5), 662-671.

(10) Dulloo, A. G., Jacquet, J., Montani, J. P., & Schutz, Y. (2015). How dieting makes the lean fatter: from a perspective of body composition autoregulation through adipostats and proteinstats awaiting discovery. Obesity Reviews, 16(S1), 25-35.

(11) Börnhorst, C., Wijnhoven, T. M., Kunešová, M., Yngve, A., Rito, A. I., Lissner, L., … & Breda, J. (2015). WHO European Childhood Obesity Surveillance Initiative: associations between sleep duration, screen time and food consumption frequencies. BMC public health, 15(1), 1.

(12) Boulos, R., Vikre, E. K., Oppenheimer, S., Chang, H., & Kanarek, R. B. (2012). ObesiTV: how television is influencing the obesity epidemic. Physiology & behavior, 107(1), 146-153.

(13) Ciccone, J., Woodruff, S. J., Fryer, K., Campbell, T., & Cole, M. (2013). Associations among evening snacking, screen time, weight status, and overall diet quality in young adolescents. Applied Physiology, Nutrition, and Metabolism, 38(7), 789-794.

(14) Tucker, L. A., & Bagwell, M. (1991). Television viewing and obesity in adult females. American Journal of Public Health, 81(7), 908-911.

(15) Tucker, L. A., & Friedman, G. M. (1989). Television viewing and obesity in adult males. American Journal of Public Health, 79(4), 516-518.

(16) Braude, L., & Stevenson, R. J. (2014). Watching television while eating increases energy intake. Examining the mechanisms in female participants. Appetite, 76, 9-16.

(17) Zhai, L., Zhang, Y., & Zhang, D. (2014). Sedentary behaviour and the risk of depression: a meta-analysis. British journal of sports medicine, bjsports-2014.

(18) Kremer, P., Elshaug, C., Leslie, E., Toumbourou, J. W., Patton, G. C., & Williams, J. (2014). Physical activity, leisure-time screen use and depression among children and young adolescents. Journal of Science and Medicine in Sport, 17(2), 183-187.

 (19) Breland, J. Y., Fox, A. M., & Horowitz, C. R. (2013). Screen time, physical activity and depression risk in minority women. Mental health and physical activity, 6(1), 10-15.

(20) Davies, C. A., Vandelanotte, C., Duncan, M. J., & van Uffelen, J. G. (2012). Associations of physical activity and screen-time on health related quality of life in adults. Preventive medicine, 55(1), 46-49.

(21) Hamer, M., Poole, L., & Messerli-Bürgy, N. (2013). Television viewing, C-reactive protein, and depressive symptoms in older adults. Brain, behavior, and immunity, 33, 29-32.

(22) Burmeister, J. M., & Carels, R. A. (2014). Television use and binge eating in adults seeking weight loss treatment. Eating behaviors, 15(1), 83-86.

 (23) Tal, A., Zuckerman, S., & Wansink, B. (2014). Watch what you eat: action-related television content increases food intake. JAMA Internal Medicine, 174(11), 1842-1843.

(23) Hoang, T. D., Reis, J., Zhu, N., Jacobs, D. R., Launer, L. J., Whitmer, R. A., … & Yaffe, K. (2016). Effect of Early Adult Patterns of Physical Activity and Television Viewing on Midlife Cognitive Function. JAMA psychiatry, 73(1), 73-79.

(24) Fisher, N., Lattimore, P., & Malinowski, P. (2016). Attention with a mindful attitude attenuates subjective appetitive reactions and food intake following food-cue exposure. Appetite, 99, 10-16.

(25) Greaves, C. J., & Farbus, L. (2006). Effects of creative and social activity on the health and well-being of socially isolated older people: outcomes from a multi-method observational study. The Journal of the Royal Society for the Promotion of Health, 126(3), 134-142.

(26) Leckey, J. (2011). The therapeutic effectiveness of creative activities on mental well‐being: a systematic review of the literature. Journal of psychiatric and mental health nursing, 18(6), 501-509.

(27) Ueno, K., Takahashi, T., Takahashi, K., Mizukami, K., Tanaka, Y., & Wada, Y. (2015). Neurophysiological basis of creativity in healthy elderly people: A multiscale entropy approach. Clinical Neurophysiology, 126(3), 524-531.

(28) Kongkasuwan, R., Voraakhom, K., Pisolayabutra, P., Maneechai, P., Boonin, J., & Kuptniratsaikul, V. (2015). Creative art therapy to enhance rehabilitation for stroke patients: A randomized controlled trial. Clinical rehabilitation, 0269215515607072.

(29) Uttley, L., Scope, A., Stevenson, M., Rawdin, A., Buck, E. T., Sutton, A., … & Wood, C. (2015). Clinical effectiveness of art therapy: quantitative systematic review.

 

Going On …. As You Meant to Start

If you began 2016 with great and noble plans to lose weight, eat less junk/carbs, more veg, detox, take part in “Dry January” etc. … or just a vague idea of improving your health – now, as February begins, might be the time your resolve starts flagging. Fading memories of December’s excesses and a month of dietary penance, can wither your willpower, sabotaging the best-laid plans and kick starting another year of yo-yo dieting or erratic eating – feast or famine, depending on mood, upcoming event or the need to “reward” yourself.

So, how can you stay motivated to make changes not just for the rest of the year, but the rest of your life?

The next three blog posts will offer up some mind/body ideas to chew on –

 

 

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A Question of Taste – (Part 3) – Bitter? Moi?

Taste is rarely discussed when people talk to me about nutrition, as if it wasn’t a fundamental factor in what we choose to eat. But let’s face facts – if cabbage tasted like chocolate would we be facing an obesity crisis? Or, if Bitter Gourd tasted like those warm sugary doughnuts on Brighton Pier might we be more successful in stemming the rising tide of Diabetes Type 2?

A few months ago while pondering the importance of taste in making food choices, I faced my latest taste hump. I was discussing various medicinal foods with a Sri Lankan friend while waiting to collect our sons from school. I raised the subject of the above mentioned bitter gourd also known as bitter melon, balsam pear, karela – or to give it its scientific name, Momordica charantia. I’d read about its use in traditional medicine in many countries in Asia and Africa, as well as Turkey and Jamaica to address complaints as diverse as digestive disorders, rheumatism, gout, skin diseases, parasites and diabetes. A quick glance through some recent research literature revealed claims about its many health benefits to be more than mere folklore. For example, the pathways through which the bitter gourd exerts its preventive effects against insulin resistance – at least in rats – are now partially understood and its potential use as a therapeutic agent for breastliver, and kidney & colon, among other cancers is being actively investigated.

I was excited to see they were part of Sri Lankan cuisine. Did my friend personally eat them? “Yes,” she giggled, with a twinkle in her eye.

Some days later her son handed me a carrier bag containing three bitter gourds. They nestled in the bottom of the bag looking like cucumbers afflicted with a serious dose of leprosy. I couldn’t wait to take them home and try them! My friend had also provided a link to a recipe for Bitter Gourd Masala “just in case you want to disguise their taste” she said, smiling. I was making a curry that night so it seemed like the perfect accompaniment. I decided to boil some as well, so we could try them without masking their natural flavour, and I’d read you could drink the juice they’d been boiled in for added health benefits.

A few days later I saw my friend again. She read my expression from a distance of ten feet and we both erupted in laughter. “I had no idea they would be so…..um..bitter,” I say, trying not to hurt her feelings.

“It’s really terrible, isn’t it? ” she laughed, seeing through my attempt at politeness. “We don’t often have them because no one except me really wants to eat them,” she explained, adding,  “I think you have to grow up with the taste to really appreciate it – and also to know that it’s doing you some good.”

Bitter might not be the most helpful word to describe this vegetable. I’m thinking more along the lines of – poisonous, acrid, heart-rendingly nasty, or just plain cruel. If I hadn’t expected it to be quite such a challenge (I’d done my homework) I’d have seriously wondered whether I’d eaten a lump of pesticide residue. It was actually so bitter I worried it might be potentially harmful (it is, if you are pregnant or take diabetes meds – so beware). I also wondered whether I might risk poisoning my family…..

I needn’t have worried.

My husband nibbled a minuscule piece before looking at me in disbelief, shaking his head and slinking out of the kitchen. “Come on, dad! Be brave. You only tried, like, a few atoms” taunted my son, who, hats off to him, tried slightly more than a few atoms worth. His response was to give a Munchian Silent Scream and fall to the floor laughing hysterically while kicking his legs in the air. He then clasped his hands around his throat, widened his eyes and shook his head in disbelief. Watching this dramatic, unbridled expression of unadulterated disgust from a 9yr old was amusing, but disappointing. He’s usually up for anything on the taste front. I turn back to the gourd sighing, “I guess that’s a no!”

The bitter-gourd masala sat in the fridge for quite a few days before we dared try it again. Oddly, it didn’t taste quite so bad. Bitter, yes sure, but not quite as potentially lethal. I ate a few mouthfuls – determined to find some way to outsmart my tastebuds. I was sure reason could trump senses. Sadly, most of it went straight in the bin.

I’m determined to try it again soon. I conquered Brussels Sprouts – and even learned to enjoy them, so I know can do the same with this. Taste avoidance and taste aversion are apparently different processes. The point being that as long as a food doesn’t produce physical symptoms of illness (e.g. nausea) it suggests avoidance can be overcome – or unlearned. My learned associations with respect to Bitter Gourd’s taste are negative, because to me it tastes just like bile. But knowing that it’s a learned association, that it has health benefits and that it won’t make me sick means I can potentially conquer this Pidurutalagala of taste humps.

I’ll keep you posted. I simply refuse to be defeated by a warty, green (healthy) vegetable!

Obesity: The role of parents – and nutritional therapy

The recent news that obesity is the new smoking is not so much news, as a new way of saying the same thing that’s been said for years. I understand the chief executive of NHS England – Simon Stevens’ – point, and agree that tackling obesity, as with smoking, needs to be a concerted effort involving producers and advertisers. However, as behaviours go, there’s a huge difference between eating and smoking that needs to be recognised, and that is –  we need to eat!

According to the World health Organisation worldwide obesity has more than doubled since 1980. Most of the world’s population now lives in countries where being overweight or obese kills more people than being underweight. How many ways will we frame this problem before changing our approach? Evidently, telling people to “eat less” and  “take more exercise” isn’t working.

As a Nutritional Therapist I often meet people who are overweight or obese, or who have diseases directly related to these conditions – or related to a poor quality diet. Usually weight gain in adults is the symptom of a deeper underlying (often emotional) issue. Patients often say they feel unable to control their cravings, sometimes citing feelings of addiction when it comes to particular foods – the Holy Trinity often being doughy products, crisps and chocolate. Whether this is mainly a physiological addiction – or more of a psychological need for gratification – is debated, but it seems both play a role. Other common issues are: defiance, boredom, denial, lack of self-discipline, bad habits, apathy, low self-esteem (often stemming from childhood), stress, depression, relationship woes, work pressures, loneliness, unhappiness, lack of meaning, spiritual emptiness, family stress, use of food as a pleasurable reward, thoughtlessness ….or any combination of these, including others I’m sure I’ve missed. Unlike smoking, eating has an added level of complexity because the drive is so primal. Restricting food intake only increases our desire to eat, trumping conscious control of our intake. The hungrier we are, the more likely it is we’ll choose palatable (high fat, high sugar, high salt) foods.

For an adult, trying to lose weight or admitting to having an “over-eating” disorder can be extremely difficult without recognising the interplay of the above issues – each will be as individual as its owner. Taking time to listen to people and discover how other areas of their lives influence their eating behaviour, as well as fostering a deeper understanding of their own physiological drives, are often overlooked. I believe they are important links in solving the obesity puzzle. How can someone “fix” something if they don’t know where it broke, and why?

My training involved a good deal of listening and open questioning. We were taught to ask about past health history and diet, of course, but also about how the patient feels – and all that this word encompasses in their lives. Also, how much do they understand about the way their bodies and minds work? It’s not rocket science – it’s actually more complicated than that because we’re dealing with human beings and, as listed above, their vast repertoires of emotion and individual experiences.

We’re also dealing with food and someone’s ability to nurture themselves. Depending on how we view it, food can be delicious, joyful and potentially healing or guilt-ridden, forbidden and poisonous.  Most of us tend towards the positive end of that spectrum of “good” to “bad” – which is helpful because without food we die.

Self-nurturing is often confused with self-gratification or hedonism. Being constantly told to “live in the moment” may only add to the confusion. For some, being totally in the moment means gobbling an entire family sized bar of Dairy Milk in one sitting. For others it means savouring the taste and texture of one delicious square of Divine 70% dark chocolate.

Acknowledging behavioural complexities always brings someone closer to understanding themselves  – and IMHO will always beat handing someone a leaflet instructing them to “Eat-5-A-Day”! Unfortunately, this kind of support takes some time and consistency. Perhaps because of this it isn’t (yet) widely available on the NHS. More’s the pity as it would undoubtedly save money in the long term.

A questioning & listening approach to tackle obesity in children, called  Motivational Interviewing, is currently being researched. Motivational Interviewing (MI) encourages the child to think differently about themselves. It fosters self-belief and provides, as the name suggests, motivational support to help them make positive and lasting changes. It often includes education of the parent as well as the child. So far, results from MI have been largely positive. To those of us already using similar approaches this is good news.

Education is key, and can be a great motivator when personalised. Most children could probably guess that doughnuts are not as healthy as tomatoes, but unless it means something to them, it’s just an obvious, boring and irrelevant fact. Again, consistency of messages – and time – are crucial factors.

It’s disheartening that children should have to think about their body size at all. As parents we believe we can shield our children from such grown-up concerns. But we’re often swimming against a tide of negative influences (from the food and advertising industries, TV and other media, friends and family, etc.) that erode our confidence and ability to parent as effectively as we’d like. Sometimes parents struggle with food themselves, unaware that this may be influencing their children too.

For a child it’s even more difficult to deal with weight gain than adults, because although there may well be some underlying issues at play, the biggest problem seems to be a lack of recognition that they are overweight at all! A study in March revealed, parents rarely spot that their own child is overweight or obese, let alone decide to do something about it. This is very worrying.

If you can’t tell whether your child is overweight by looking at them – check their BMI. The sooner you admit there’s an issue, the sooner you can help them. You don’t need to discuss it with younger children at all – but you should start considering action.  That may mean looking first at your own attitudes and behaviour around food, and taking it from there. If they’re a teenager raise the issue of weight in the context of health, not looks.  Be gentle, but honest. Make sure your partner and other family members are on board – and get professional support if you need it.  Overcoming denial and accepting the well established consequences of overweight and obesity on quality – and length – of your child’s adult life are crucial in helping your child take increasing responsibility for their own future health.

As with smoking, simply telling people not to do something because it’s bad for them is unlikely to work long term.

Helping them to understanding the reasons for their behaviour, and motivating them to appreciate good food, their bodies and their lives, probably will.

 

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A Question of Taste – (Part 2) – aka Questionable Tastes

As mentioned in an earlier post, natto was my biggest “taste hump” in recent years, my most significant challenge since being urged to “come on – just try” the sheep’s brains my mum had scrambled with some eggs for lunch for me one afternoon when I was a teenager. I’m aware that the idea of eating brains is abhorrent to many, but I’m interested in the importance of cultural and historical context in taste preferences, so bear with me.

My mum grew up as a post-war child in 1950s Australia where scrambled brains represented a cheap nutritious meal. While not so popular there now, or the UK, in large part due to its links with BSE, it is still the norm in other cultures (Cuba, the Middle East, Pakistan, Bangladesh, China and France to name a few).

My brain eating experience took place in the mid ’80s. The Cold War was a constant background hum in our lives, women were chaining themselves to the fence at Greenham Common, the chilling TV drama Threads was being aired, along with disturbing documentaries such as On the 8th Day.

A basic rule in our house when I was growing up had been – “You eat what’s on your plate”. I’d managed to negotiate two opt-out tickets (Brussels Sprouts and liver) on the basis of “being an individual with different tastes” and, I suppose, a lot of tears and whining. However, now that I was a teenager my fussiness, as they saw it, seemed relevant to what was going on in the world. “What if there was a nuclear war and this kind of food was all we had to eat?” they reasoned. Part of me (undoubtedly the part that had been psychologically assaulted by aforementioned TV programmes) knew they were right….(just watch the movie if you don’t believe me).

But also, it was still quite easy to buy tongue, tripe, sweetbreads (thymus and pancreas), oxtail and bones in the supermarket in those days, so it wasn’t a massive leap from there to buying a bag of brains from the butcher (I suppose).

The cultural implications of offal availability in large supermarket chains wasn’t what was on my mind, however, as I stared at the plate in front of me. Every minute that ticked by saw the food transmogrify from a small plate of potentially edible hot scrambled eggs – with a smattering of brains – into a gargantuan platter of brains that were cooling (to brain temperature) and congealing (to brain texture). The scrambled egg component (now also cold), by contrast, becoming diminishingly imperceptible.

I mustered all my courage and lifted the fork to my mouth, but the undeniable smell of something-I-didn’t-recognise-but-understood-to-be-brain, made me retch. Nope. No can do.  “I’ll make a deal. If there is a nuclear war I’ll eat brains” I promised, adding “if I really have to,” to ensure an escape route hadn’t been entirely ruled out.

Thankfully they didn’t push the issue and I got away with “just trying” a tiny mouthful. To this day I can still remember that taste and texture. This was no hump, this was my Mount Everest. Lucy Martin’s description of her experiences eating brain on her Homesick and Heatstruck blog struck a chord with me. Especially when she says, “the texture was unnervingly creamy and soft. I don’t think I’ve ever used the word negatively before, but I can’t think of a better one: it was silky. Eerily silky. Like a limp, moist handshake. Or a shaved cat. Or the soft voice of a psychopath”.

I’m not saying this experience was directly related to my support for CND, or necessarily led to my increased interest in Gorbachev’s rise to power. But it seems to tally with Højlund’s opinion (Højlund, 2015) that cultural taste sharing “is related to the situational as well as to the geographical, political and historical context.”

 

Iodine in Organic v Conventional Milk

Does the news that organic milk contains less iodine than non-organic mean mean you should switch? Headlines about a recent study from Reading University being cited in the Guardian and Telegraph today would certainly make you think so. While the journalists themselves have attempted to balance the story with quotes from some experts, it seems sub editors just can’t stop themselves from penning frightening didactic headlines.

The fact that this isn’t actually news,  but evidence to be added to an ongoing area of study is rarely mentioned in the stories either. Food science is a continuum, and the problem with pumping out stories that represent one piece of a large and ever growing puzzle does little for consumer confidence or understanding. Whether it results in positive behavioural change could also be debated. My experience is that it usually confuses people or radicalises them to choose one or other side of the debate without consideration of all the facts. As a nutritional therapist trying to advise people on how to improve their diet while taking many differing factors (preferences, micronutrient needs, personal ethics) into account, this can be incredibly frustrating.

To see how complicated this can be let’s just take a random review study from 1979 , which pointed out that iodine feed supplement had caused an increase in milk iodine levels and warned that adults consuming more than even ½  litre could supply more than the recommended adult daily dose. It’s an old study and by no means gold standard, but I’m cherry picking to illustrate a point – that being, are there some additional questions we might want to ask when deciding what to make of media reports.

For example, have things changed markedly since the late 70s in the dairy industry? How do accepted levels of iodine then compare with today? Is there a recommended level of iodine in milk that has been agreed on by public heath experts?  If so, does this take individuals’ widely varying needs into consideration? Does focusing on iodine levels in milk detract from other potential sources in a healthy diet? Are the benefits of increased iodine offset in any way? Or even a basic question such as – does supplemented grain feed trump grass fed milk across a variety of important nutrients? The Soil Association thinks not.

You can begin to see how it would take years of study and and a PhD in dairy farming and food science to begin unravelling answers to these questions. Thankfully, there are people trained to do just that.

My point isn’t that we should ignore such studies – I personally find them fascinating. It’s just that we should expect the media to be more responsible about reporting them because what many will take from the articles is not a balanced review of the pros and cons of organic v non-organic or the importance of including other food sources of iodine etc., but a sense that somehow they will be damaging their child’s intelligence if they give them organic milk!

Journalists could begin by acknowledging the background to an issue and placing latest results of one particular study into context. Scary headlines about a complicated subject (especially those directed towards pregnant women who have enough to deal with already) need a longer, more intelligent analysis. Issues that involve financial interests on both sides of the organic v inorganic farming debate are especially troublesome. And if the journalist hasn’t got enough time to devote to this then they should either provide more links in the story to those that do and have a stern word with their sub-editors.