Optimum Nutrition - Summer 2020 PREVIEW

THIS ISSUE
16
Interview
Bariatric surgeon Dr Andrew Jenkinson talks to Alice Ball about why diets don’t work and what we can do about it (without surgery)
08
36
Research update
Recent research suggests that low levels
of some nutrients may be implicated in a
higher risk of severe COVID-19 symptoms
or risk of mortality from the disease
24 Little lives
Why some experts believe that “stigma
and misunderstanding” among doctors is
causing under-diagnosis of chronic fatigue
syndrome (CFS/ME) in children
Feature
Sugary snacks can be soothing during
difficult times, but could reaching for fruit
and veg be better for our mental health,
long-term? Louise Wates writes
46 Different strokes
COVID-19 has raised concerns that
smokers, should they catch it, could be
hard-hit by the disease. Elettra Scrivo
looks at ways to quit
Contents
12 Feature
COVID-19: Stay alert to the ‘snake oil’.
Alice Ball looks at some of the home
remedies that went viral and finds out if
they are helpful, toxic or a waste of time
28
Little lives
As we try to deal with the ‘new normal’,
many parents are putting on brave faces
despite anxiety and worry. But could this
have an unintended effect?
40 World cuisine
When it comes to cuisine, Canada is
home to much more than maple syrup
and butter tarts, as two friends discovered
on the trip of a lifetime
20
48 Move it 50
Giulia Basana asks whether knowing
about our DNA can help us to improve our
fitness levels, or whether it’s environment
that wins the day
45
All about
Inflammation: Louise Wates looks at what
it is, why the body needs it, and why it
can become a problem when it creates a
storm
30
On your plate
Try three vibrant recipes from around
the world and a take on a children’s
teatime favourite, from The mymuybueno®
Cookbook by Justine Murphy
Food fact file
We look at some of the potential health
benefits associated with walnuts — and if
you don’t know what to do with them, try
our recipes to get you started
Graduate story
Olga Hamilton tells us how redundancy
gave her the freedom to study nutritional
therapy, taking her to a new and varied
career — and even delivering a Tedx talk
04 Comment / news | 19 Book therapy | 26 Kids’ pages
34 Product news | 39 Kitchen chemistry | 45 In season
SUMMER 2020 | OPTIMUM NUTRITION
3

INTERVIEW
Dr Andrew Jenkinson talks to Alice Ball about the complexities of weight-loss and how he
hopes the current pandemic will inspire a major public health campaign on obesity
16 OPTIMUM NUTRITION | SUMMER 2020

INTERVIEW
W
hen we meet over a video call,
Dr Andrew Jenkinson, author
of Why We Eat (Too Much): The
New Science of Appetite, is on his day
off as a bariatric and general surgeon
at University London College Hospital.
The UK is in the midst of lockdown and
a subject close to Jenkinson’s heart
— obesity — is in the news. Evidence
reveals obesity to be one of the risk
factors for severity of COVID-19; a stark
reality for the UK. According to latest
NHS figures, 64 per cent of adults in
England alone are overweight or obese,
and 29 per cent are obese. 1 However,
obesity can be a difficult subject to
discuss.
“At the moment, the perception of
anyone who’s fat is that it’s their choice,”
says Jenkinson.
Yet it is not a view that he holds,
despite having performed weight-loss
surgery on more than 3,000 patients
over two decades. Instead, Jenkinson
is sympathetic towards those who are
struggling with their weight — something
that he says wasn’t always the case.
Not only are there some people who are
genetically predisposed to gaining weight
more easily, he points out, but he is also
critical of the western diet. “A western
diet causes a population to become
fat and have cardiovascular disease,”
he says. “That is then a serious risk for
having complications from coronavirus.”
One of the links between obesity
and a higher risk of severe COVID-19
symptoms is oxidative stress; an
inflammatory state characterised
by an imbalance of free radicals and
antioxidants that leads to cell damage —
including to the immune system’s T cells,
making them less effective.
“[The virus] attacks the S2 receptor
in our lungs and cardiovascular system,”
he explains. “The S2 receptor is really
important in…oxidative stress. If S2 is
malfunctioning, we have more oxidative
stress which can cause cardiovascular
disease, clotting problems, cardiac arrest
and respiratory problems.”
Jenkinson says that many people in
western countries already have oxidative
stress due to western diseases such as
obesity, and are more susceptible to
becoming critically ill if they do catch the
virus.
Yet for anyone who wants to lose
weight, Jenkinson does not believe that
going on a diet is the answer. He isn’t
swift to recommend bariatric surgery
either. Published in January, his book
explores the concept of weight set-point
and why this causes diets to fail. Many
dieters may be familiar with the idea, at
least in a hypothetical sense, when they
find that whatever they do to lose weight,
their body seems to be hell-bent on
getting back to where it was.
First proposed by researchers in
America, the concept of a weight
set-point suggests that the body is
programmed to maintain a weight
range — and will fight to do so. However,
Jenkinson says this description of weight
set-point was “quite simplified” and
didn’t fit with real life. His experience
of patients, along with research into the
relationship between the gut and the
brain being carried out by colleagues at
University London College Hospital, led
him to expand on the idea.
“There is a homeostasis or a
negative feedback,” he says. “The body
can increase or decrease its energy
expenditure depending on how much
excess fat or excess energy storage
you’ve got.”
What this means, he explains, is that
the more diets you’ve been on, the higher
your weight set-point will rise and the
slower your metabolism will become,
as your body fights to protect itself
from future ‘famine’. Essentially, says
Jenkinson, dieting is counterproductive
to weight-loss.
It’s this knowledge, he says, that
gave him a new-found empathy when
interacting with clients. They, in turn,
responded positively to his explanation
as to why they were trapped in their
condition. Now he is a “total geek” about
appetite and metabolism, having spent
five years researching everything he
could. “The patient’s stories were really
my inspiration,” he says.
Yet when Jenkinson started out as
a doctor, he had no interest in obesity
and it wasn’t a conscious decision
to go into bariatric surgery. “When I
was at medical school, obesity wasn’t
a major problem and my interest in
diet and nutrition was zero. I guess
you sort of fall into things.” He recalls
receiving “maybe an hour’s worth” of
lecture time on weight regulation while
...many people in western countries already have oxidative stress due
to western diseases such as obesity...
“...the figures don’t add up. How can people eat so much and not put
weight on? It’s the same when people starve themselves and don’t
lose as much weight as they want”
studying at Southampton Medical
School. “Medics aren’t taught much
about it,” he says. “What we are taught
is a very old fashioned and simplified
way of how people can lose weight; just
energy in and energy out. We look at
different systems such as the respiratory
breathing system and the urinary system,
but we don’t study the weight regulation
system.”
He admits that in his first few years as
a bariatric surgeon, he was prejudiced
towards his patients’ problems. “I think I
had a very similar preconception to most
people in society,” he says. “Why have
you got no willpower? Why don’t you get
help and sort yourself out? I was quite
judgemental before the penny dropped.”
As months and years passed, however,
his outpatient clinic became increasingly
swamped with patients telling a similar
tale: they’d tried to lose weight, but every
time they did the weight crept back on —
and then some.
“When you’re hearing these stories all
the time, you start to think that maybe
there’s something they’re saying that we
don’t understand.”
What didn’t make sense to Jenkinson
was that if the dogma of calories in,
calories out was correct, people should
have actually been much bigger. In
the book he writes that looking at the
evidence for how much people eat and
analysing it with a very simplified energy
in and energy out formula, we should be
putting on four stone a year. “Obviously
something is happening because the
figures don’t add up,” he says. “How can
people eat so much and not put weight
on? It’s the same when people starve
themselves and don’t lose as much
weight as they want.”
Investigating these questions, his
book explores not only metabolism and
genetics. It also explores the evolution of
how humans ate up until what he calls
the “industrialisation of food”.
“Finally, you have the hijacking of our
food advice by scientists who were paid
by the food industry,” he says, echoing
many other healthcare professionals who
worry that big business wields too much
influence over dietary advice. Jenkinson
has what he calls a “healthy cynicism”
for research. He suggests, for example,
that in the west we became scared of
saturated fat because of industry bias.
“The sugar industry would give payments
SUMMER 2020 | OPTIMUM NUTRITION
17

ALL ABOUT
Most of us will have taken anti-inflammatory medication at some point in our life, but what is
inflammation? Why do we get it? And is it really always a bad thing? Louise Wates writes
M
any
of us will have heard the term
‘inflammatory disease’ for the
first time during the pandemic.
Notably, it was used when small numbers
of children in Europe and the USA were
reported to have fallen ill with a rare illness
linked to COVID-19, displaying symptoms of
toxic shock syndrome. The Lancet described
the condition as a “Kawasaki-like disease”;
20 OPTIMUM NUTRITION | SUMMER 2020

ALL ABOUT
likening it to a rare condition that was first
identified in 1960’s Japan. But that doesn’t
tell us anything about inflammation.
If you have ever taken an ibuprofen then
you have taken an anti-inflammatory. In
fact, the over-the-counter and prescription
market is awash with various types of
anti-inflammatory medications — which
surely tells us that inflammation must be
a bad thing. Although, in itself, it isn’t. In
fact, inflammation is an essential part of the
immune system and the healing process.
Acute vs. chronic
If we bash a knee or cut a finger, the affected
area may become hot and swollen. These
are signs that the body’s immune system is
on the case, deploying white blood cells to
protect the injured area and to get rid of any
damaged cells.
This is acute inflammation in action,
which should pass once the body has
healed. Without it, we wouldn’t survive.
Chronic inflammation, however, is
associated with metabolic syndrome
and a variety of other diseases including
heart disease, rheumatoid arthritis, stroke,
inflammatory bowel disease, cancer, and
Alzheimer’s. While all of these diseases are
rooted in a variety of causes, inflammation
will have been present, potentially for a long
time, before the disease ‘appeared’.
Just like acute inflammation, chronic
inflammation is triggered by some form of
harm or ‘insult’ that activates the immune
system. However, rather than standing
down once the harm is no longer present
(such as after a one-off bash on the knee)
and once the body has healed, the immune
system remains activated as it continues
to tackle persistent problems such as, for
example, regular exposure to toxins such as
tobacco smoke, air pollution or chemicals.
Whereas the example of a bash on the knee
is a short-term, one-off insult to the body,
many factors such as tobacco smoke or air
pollution are often regular, daily insults that
the immune system cannot resolve because
the problem does not go away. Imagine
what it would feel like if you bashed your
knee every hour, every day. The immune
system would be constantly activated yet
the injured knee wouldn’t properly heal.
Pro-inflammatory
This is a very simplistic explanation
of inflammation and of how different
types of harm can contribute to chronic
inflammation without us realising. Even
conditions that are thought of as illnesses in
themselves, such as high cholesterol, may
occur because of inflammation. In 2017,
for example, a trial of an anti-inflammatory
drug found that the drug reduced the risk
of heart attack, cardiovascular-related
INFLAMMATION AND THE BRAIN
Inflammation can affect every part of the human body, including the brain, becoming
a factor in diseases such as depression, dementia and Alzheimer’s. One recent study
suggested inflammation is an underlying cause of ‘brain fog’, which is often described as
sluggishness or mental fatigue. 3 In a controlled study, 20 volunteers were injected with
either a placebo or a salmonella typhoid vaccine, which causes temporary inflammation
but has few other side effects. After being tested for cognitive responses, it was found that
when the volunteers received the vaccination, inflammation affected brain activity related to
staying alert.
Another study, carried out on mice, found that in the presence of systemic inflammation,
the brain’s immune cells (microglia) initially protect the blood-brain barrier before going into
hyperdrive and attacking it. 4 The blood-brain barrier prevents potentially harmful molecules
reaching the brain. The attack from microglia causes permeability, however, enabling
molecules into the brain where they can cause widespread inflammation and damage to
neurons (cells of the nerves). Although plaques and tangles in the brain have long been
associated with Alzheimer’s, experts now say that it is inflammation — caused by plaques
and tangles — that kills neurons and leads to cognitive decline.
Another study that looked at brain scans of veterans who had served in the 1991 Gulf War
found that veterans who suffered from Gulf War Syndrome (GWI), compared with healthy
controls and veterans without GWI, had extensive inflammation “particularly in the cortical
regions, which are involved in ‘higher-order’ functions, such as memory, concentration and
reasoning”. 5
Although the cause of GWI is still unknown, possible causes have been identified as
exposure to nerve gas (as well as medicine given to protect against nerve gas); exposure to
pesticides; and stress from extreme temperature changes, sleep deprivation and physical
exertion. 5 Symptoms include fatigue, chronic pain, and cognitive problems such as memoryloss.
According to the study’s authors, neuroinflammation in veterans with GWI looks very
similar to widespread cortical inflammation also detected in fibromyalgia patients.
death or stroke despite having no impact
on cholesterol levels. 1 This indicated that
inflammation — rather than high cholesterol
— was the risk factor for heart attack and
stroke. An implication, therefore, is that
raised cholesterol (unless somebody has an
hereditary predisposition for it) may be a
response to disease rather than a cause.
Obesity
In the UK, possibly one of the leading
causes of chronic inflammation is metabolic
syndrome, which combines obesity, high
blood pressure and type 2 diabetes. Obesity
is particularly problematic with the presence
of visceral fat. This is the fat that wraps
around internal organs and can give us a
bigger tummy; although even slim people
can have it without knowing because it isn’t
as obvious as subcutaneous fat, which lies
under the skin. Visceral fat is associated
with various health problems, one being the
production of pro-inflammatory cytokines.
(Cytokines are molecules that spread
throughout the body and signal the immune
system.) For example, according to one
2016 study, overeating causes visceral fat
cells to become stressed, causing them to
produce pro-inflammatory cytokines which
then go on to attack healthy cells. 2
This particular study highlighted the
role that weight and diet can play in
inflammation. However, inflammation
can occur even in the absence of
obesity because even those of us who
are at a healthy weight can suffer from
inflammatory diseases.
What we eat, as well as how much, is also
an important contributor to inflammatory
disease. A pro-inflammatory diet is
usually considered to be one high in sugar
and unhealthy fats such as trans fats. Its
opposite — an anti-inflammatory diet,
rich in antioxidants — is considered to be
high in good quality protein, healthy fats,
vegetables, legumes, fruits, nuts and seeds.
The is also mounting evidence for the
health benefits of such a diet. In 2019, one
study looking at 1,852 cases of colorectal
cancer and 1,567 cases of breast cancer
(against 3,447 and 1,487 control cases,
respectively) found a correlation between
both diseases and a pro-inflammatory diet,
with a strong association for increased
colorectal cancer risk. 6 Although the study
did not investigate the reasons why diet
might affect inflammation and disease, the
authors pointed to “inflammatory potential”.
Increasingly, this is something that is
linked to the western diet, which is high in
processed and fast foods.
Empty calories
Unless they are fortified, many processed
foods common to the western diet are high
in calories and low in nutrients such as fibre,
essential fatty acids, vitamins and minerals,
leading to the description of ‘empty calories’
SUMMER 2020 | OPTIMUM NUTRITION
21

ON YOUR PLATE
Prawns
with chilli,
ginger
and garlic
butter
Serves: 4
Justine says:
“Cooked on the barbecue or griddle,
these are quick and easy to prepare, and
a wonderful way to enjoy prawns and get
stuck in.”
Ingredients
• 100 g unsalted butter, chopped and
softened
• 2 cloves of garlic, peeled and grated
• 1 cm ginger, peeled and grated
• ½ red bird’s eye chilli, finely chopped
• ½ tsp flaked sea salt
• 1-2 tbsp fresh parsley, finely chopped
• 1 tbsp sunflower oil (Our swap: olive oil)
• 16 large raw prawns, deveined with
shells on
• Grind of black pepper
• 1 lemon, cut into wedges
Method
Place the butter, garlic, ginger, chilli, and
salt in a small saucepan over a medium
heat until the butter is bubbling. Remove
from the heat and stir in a tbsp of chopped
parsley. Heat a barbecue or griddle pan and
using a silicone brush, brush the grill rack
or pan with the oil.
Thread the prawns onto 16 metal
skewers from the tail, so the heads are at
the top of the skewer. Place each prawn
skewer on the heat and cook for 3 mins
on each side, until they are pink and you
can see some charring. Brush the prawns
while cooking with your flavoured butter.
If they are really large prawns, you can
cook them for a little longer, but it’s
better to undercook fresh prawns, as the
residual heat will finish the process, than
to overcook them, making them hard and
dry. (Our note: ensure prawns are cooked
through before serving. Undercooked shell
fish can cause food poisoning.)
Place the cooked prawn skewers onto
a platter, and pour over the remaining
flavoured butter. Top with parsley, a pinch
of salt and a grind of black pepper.
Serve with the lemon wedges. These are
delicious peeled and dipped in aioli. Have a
finger bowl and kitchen paper available.
SUMMER 2020 | OPTIMUM NUTRITION
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