The Universe 5th August 2016

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u • HEALTH 10 FRIDAY 05.08.16 Stone me! So it seems the weather gods finally got the memo that it’s summer – hurrah! Of course, no sooner does the sun come out, than those heatwave health warnings come flooding in. All very sensible – skin cancer rates have seen alarming rises over recent decades in the UK, and if you’re not careful, heat exhaustion can turn into a medical emergency, so slap on the SPF, don’t overdo it in the midday sun, and stay well hydrated. And, if you need another reason to hit that eight-glasses-a-day water intake minimum that experts advise – consider this: dehydration could be putting you at risk of kidney stones... What are kidney stones? As the name suggests, kidney stones are small (or sometimes not so small!) stones that form in the kidneys. There are different types, but usually they’re made up of deposits of calcium, ammonia, uric acid (one of the by-products from when the body breaks down food) and the amino acid cysteine. The medical term for them is nephrolithiasis. uHealth By Abi Jackson and climates,” adds Wadhwa. “For example, taxi drivers, chefs – people who tend to go long hours without drinking. And the highest incidence of kidney stones at the moment is in Dubai; you’ve got hot weather so people get dehydrated, and they tend to eat a lot of animal protein.” What causes them? As Wadhwa explains, while kidney stones can be common, there’s a reason some people are more prone to them. “One of the main causes of kidney stones is not drinking enough fluid,” he says. Put simply, fluids help flush the kidneys and keep things in healthy working order, while diets high Those tiny tubes aren’t designed to have hard, bulky stones pass through them, so they can trigger an intense pain response that spreads across the back and abdomen. “Ladies always say it’s more painful than childbirth,” says Wadhwa. “It’s excruciating if the stone lodges in the urethra. The kidney’s trying to excrete urine, and it can’t. The main symptom is a sharp intermittent pain in the back, radiating around to the front.” ‘‘ Put simply, fluids help flush the kidneys and keep things in healthy working order, while diets high in animal proteins can lead to an increase in uric acid, which may cause stones. Who gets them? As Mr Vivek Wadhwa, a consultant urologist at Spire Parkway Hospital in Solihull (www.spirehealthcare.com), notes, kidney stones are quite common and seen across all ages, from children through to the elderly. “But the peak age is about 20-50,” he adds. NHS figures suggest men are slightly more prone to them, with around three in 20 men, and two in 20 women, developing them at some stage. “And we tend to see patterns within certain occupations, and also geographical locations in animal proteins can lead to an increase in uric acid, which may cause stones. Higher rates can run in families too, and certain medications are also associated with kidney stones. Sometimes pre-existing conditions, certain inherited conditions or a history of kidney problems can also mean you’re more at risk. Are they really that painful? Some stones are so tiny, they can easily go unnoticed, but generally, they are known to be extremely painful. Can it be serious? While agonising, often kidney stones are a short-term problem and not serious. However, Wadhwa stresses it’s important for anybody who experiences extreme, acute pain to seek medical attention. Firstly, “you still have to rule out other things, like appendicitis, pancreatitis, ectopic pregnancy, aneurism... Quite often, until we’ve done a scan, we don’t know what we’re dealing with”. Secondly, if a kidney stone causes a blockage or obstruction, this can rapidly turn very serious. “If you get a complete blockage then the kidney has nowhere to drain and you can get an acute infected obstructed system, and people do die from that,” Wadhwa says. So if you also have a high temperature and fever and are very unwell, it’s important to get to hospital urgently. How are kidney stones treated? Treatment usually starts, says Wadhwa, with adequate fluid and pain relief. Often this is all that’s required, but more problematic and larger stones might need further treatment. “If the kidney’s obstructed, you have to de-obstruct the kidney by putting a tube in the back, and then you have to deal with the stone – it all depends on the size and position,” Wadhwa explains. “If the stone’s in the kidney and it’s small, usually it’s shock wave lithotripsy (ESWL, a non-invasive treatment that breaks up stones with shockwaves), and patients will be in and out within an hour. “Options for bigger stones include using a laser to break them up, and if the stone’s really big, then you do percutaneous nephrolithotomy (PCNL), which means putting a tube directly into the kidney, breaking up the stone and sucking it out. This used to mean cutting open the tummy, but now it can all be done with minimally invasive techniques.” How can I prevent them? Once you’ve had a kidney stone, you are at greater risk of having more. However, much of the advice for avoiding kidney stones applies to everybody, since they can be so common. “In the old days, we used to tell patients things like, ‘Don’t drink milk, avoid dairy products etc’, but we don’t tend to do that any more,” says Wadhwa. “What we do say is it’s about a healthy diet, plenty of fluids, high fibre and low salt – those are the main things. I tell my patients to drink at least two to three litres of fluid a day.”
FRIDAY 05.08.16 u • FOOD 11 A taste of Rio With all eyes on Rio this summer, as the 2016 Olympics limber up, it’s little wonder there’s such an appetite for all things Brazilian right now. And if you’re in the mood to jazz up dinnertimes in celebration of the Games, look no further than Carnival! –the first ‘definitive guide to throwing an authentic Brasilian street party’ – where you’ll find all the right ingredients to dish up some Rio-ready fare. “Not only will it give you a feel of what Team GB are eating on the ground, but the tastes and flavours will whisk you away and have you dreaming of Brazilian beach and street parties,” promises co-author Lizzy Barber, who penned the title with her brother Jamie Barber and Rio-born David Ponte. The colourful little book covers everything from vibrant, Brazilian finger food and BBQ recipes, to refreshing cocktails – Caipirinha being the tipple of choice – and even features tips on dancing the Samba. And Barber and her co-writers certainly know a thing or two about local customs, doubling up as the restaurateur team behind the popular and ever-expanding UK chain of Cabana Brasilian Barbecue restaurants. “No Brazilian party would be complete without some Samba tunes,” she says. “You’ll see Brazilians breaking out these moves, impromptu, whenever the mood takes them. “Cachaca [Brazil’s national, rumlike spirit] is vital for recreating the Rio vibes,” she adds. “Brazilians add it to anything – rumour has it some even run their cars on it – and it’s equally good in a cocktail or a marinade.” But the most vital ingredient of all? “It’s got to be meat!” Barber quips. “Brazilians are famous for their steaks, especially Picanha (cap of rump), which is their favourite cut. We marinate ours in chilli and cumin, or for the ultimate Cabana flavour, u Food By Gemma Dunn marinate chicken in our signature Spicy Malagueta sauce. “So whether you’re planning a barbecue in the garden or are rained in watching all the Olympic action on TV,” she finishes, “you can make like a Carioca – that’s a Rio local – and imagine you’re on Copacabana Beach.” Certainly sounds tempting. Here are three Carnival! recipes to get you in the spirit... Caipirinha ‘beer can’ chicken (Serves 4) 1 medium chicken (about 1.5-1.8kg) Olive oil, for drizzling 5 sage leaves, finely chopped 2tbsp cachaca 1tbsp soft brown sugar Sea salt and freshly ground black pepper Half a lime (use the juice for the marinade) For the steam marinade: Juice of 2 large limes 2tbsp soft brown sugar 3tbsp cachaca 3 garlic cloves, finely chopped or crushed 1/2tsp sea salt 2tbsp olive or rapeseed oil 5-6 large sage leaves, finely chopped Light the barbecue (preferably one with a lid), and let the flames die down before starting to cook, or preheat the oven to 200C/Gas mark 6 (if using charcoal, put most of the hot coals around the edges so there is indirect but even heat in the middle. If using a gas barbecue, set it to medium). Remove and discard the giblets and any excess fat in the cavity of the chicken. Rub it with a little olive oil, then rub it inside and outside with salt, pepper and chopped sage. Put all the ingredients for the steam marinade in a jug and stir to dissolve the sugar. Take an empty can and peel off any labels. Wash it out well, then pour in the marinade ingredients. Wrap the outside of a small heavy-based roasting tin with kitchen foil, then place the can in the middle. Sit the chicken on the can so that the top of it enters the cavity and the bird is upright. Spread out the legs to support the bird’s weight. Take a squeezed lime half and pop it into the neck of the chicken to make a plug, or cover the neck cavity with foil to prevent the steam escaping while it cooks. Roast for 45-55 minutes, until the chicken is almost cooked. Mix the remaining cachaca and sugar and brush it over the chicken. Cook for 10-15 minutes, until golden and the juices run clear. Remove and let rest for 10- 15 minutes. Carefully transfer to a serving plate, carve and serve it drizzled with the marinade, which will have reduced to a thick and tasty sauce. Malagueta jumbo prawns (Serves 4) 12 large tiger prawns or 20 ordinary prawns 4tbsp Spicy Malagueta Marinade (see recipe below) Sea salt and freshly ground black pepper Lime wedges, to serve Peel and devein the prawns, but leave the tail ends on. Place them in a bowl and add three tablespoons of Spicy Malagueta Marinade. Toss to coat, cover with cling-film and leave to marinate in the fridge for a couple of hours. Light the barbecue and let the flames die down before starting to cook. If cooking indoors, preheat the grill to high and place the grill rack at the highest level. Thread the prawns on to four metal skewers, then brush with the remaining marinade and season with salt and pepper. Barbecue or grill for two to three minutes on each side, until they have turned opaque and are just cooked through. Serve with lime wedges on the side. They’re delicious with Biro Biro or coconut rice and a side salad. Cabana’s signature spicy malagueta marinade (Makes approx 275ml) 70g small red chillies (preferably malagueta) 5 garlic cloves, lightly crushed 70ml light olive or sunflower oil 2tbsp lemon juice 2 1 /2tsp tomato puree 2 1 /2tsp caster sugar 1/2tsp dried chilli flakes 1tbsp (heaped) sweet paprika 2tsp sea salt Pinch of dried oregano Preheat the oven to 180C/Gas mark 4. Split the chillies lengthways and place them in a small roasting tray with the garlic and oil. Roast for 10 minutes. Leave to cool for a few minutes, then put the chillies, garlic and oil in a small food processor or blender and add the rest of the ingredients. Blend to a smooth puree. Transfer to a clean jar, seal and keep refrigerated for up to a week. Stir-fried greens with garlic (Serves 4) 400g seasonal greens (such as mustard greens, Swiss chard, sweetheart cabbage, spinach or young kale) 2tbsp olive oil 3 large garlic cloves, finely chopped Butter, for cooking Sea salt and freshly ground black pepper Wash the greens well, then remove any tough stalks and chop or shred the leaves. Heat the oil in a large pan or wok over a medium heat. Add the garlic and let it gently infuse with the oil for a few minutes, without allowing it to burn. When you begin to smell the aroma of the garlic, and before it begins to colour, add the greens a handful at a time, stirring well each time. Season with salt and pepper and add a tiny splash of water. Stir well and cover with a lid. Cook until just tender (cooking time will vary from two to 10 minutes, depending on the type of greens, so taste a little every few minutes to check). Stir in the butter and check the seasoning. Transfer to warmed bowls and serve immediately. Carnival! by David Ponte, Lizzy Barber & Jamie Barber, photography by Martin Poole, is published by Quadrille, priced £10.
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The Universe 5th August 2016

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