Optimum Nutrition - Winter 2020 PREVIEW

Are you ready to build your career in
healthcare with nutrition?
Exciting new training opportunities for career changers, healthcare practitioners,
and nutritional therapists ready to expand their skillset
Faced with current health challenges, more and more people are interested in improving their
health and wellbeing, so this is an exciting time to improve your skills and grow your business.
CAREER CHANGERS
Ready for a career change?
Become a nutritional therapist
and enjoy a flexible, rewarding
career
HEALTHCARE
PRACTITIONERS
Integrate personalised nutrition
into your existing practice
NUTRITIONAL
THERAPISTS
Exciting fast-track degree access
for nutritional therapists — build
your business while honing your
skills
Qualify with the Institute for Optimum
Nutrition (ION), with its part-time,
flexible, online BSc (Hons) Nutritional
Therapy (validated by the University of
Portsmouth).
Be part of a growing industry and
make a difference to other people’s
lives.
To learn more, book your place on our
free webinar.
www.ion.ac.uk/webinar-open-event
A unique pathway has been created by
ION for qualified allied healthcare and
CAM professionals (with core sciences
and clinical experience) which enables
you to integrate the principles of
personalised and functional nutrition
into your current and future practice.
Through our Graduate Diploma in
Integrative Functional Nutrition,
validated by the University of
Portsmouth, you will understand
in-depth the role that nutrition and
lifestyle play in human health, and
develop skills to support your clients.
Join our free webinar to learn more
about this unique, fast track route to
integrate personalised nutrition into
your existing skill-set.
ION has launched a unique, fast-track
pathway for qualified nutritional
therapists to gain a BSc (Hons)
Nutritional Therapy (validated by the
University of Portsmouth). The only
one of its kind, the course is a bespoke
programme that uses prior certified
and/or experiential learning (RPL)
and is designed around your business
needs as a practising nutritional
therapist.
Learn practical and real-world skills
while gaining additional credibility
from an undergraduate degree. Untap
new opportunities for your business,
discovering fresh approaches to help
your clients change behaviours that
will make a difference to their lives.
Join our free webinar to learn about
this unique, cost effective way to reach
degree level in nutritional therapy in as
little as 18 months, while building up
your practical business skills.
www.ion.ac.uk/webinar-gdip-openevent
www.ion.ac.uk/webinar-top-up-openevent
Train with the Instute for Opmum Nutrion:
providing respected training in nutrional therapy for over 35 years.

IN THIS ISSUE
08
WHY GOOD HEALTH STARTS FROM WITHIN
Health messages often focus on cutting foods out, we look at the nutrient that most of us could do with adding in
04
COMMENT & NEWS
Why research may have looked at the
wrong vitamin D and in the wrong
place, plus the western diet and stress
12
RESEARCH UPDATE
The latest on emulsifiers and alcohol,
and whether they may affect our gut
health over time
From brain fog to cognitive decline,
could nutritional support make a
difference? Louise Wates writes
ABSORB THIS
What we absorb is just as important
as what we eat, when it comes to good
nutrition, writes Henri Davy
14 FOOD FACT FILE 16
An important part of many traditional
diets, fermented foods could be a tasty
way to support our gut health
20 FOODS FOR THOUGHTS 23 LITTLE LIVES
Alice Ball finds out how a nutritional
therapy approach can be used to
support children with ADHD
30 INTERVIEW 36 RHEUMATOID ARTHRITIS 38
Dr Rangan Chatterjee talks to us about
his new book and why it took him out of
his comfort zone
42
WORLD CUISINE
How the silk route was important to the
food of Afghanistan plus a traditional,
show-stopping recipe
How a nutritional and lifestyle
approach may help to ease symptoms of
rheumatoid arthritis
44 IN SEASON 45
Why rhubarb deserves more that
crumble; and even if you don’t like to
eat it, why you might like to hear it grow
Giulia Basana looks at exercise and
the immune system, and when it may be
best to rest
26 KIDS’ PAGES | 33 BOOK THERAPY | 40 PRODUCT NEWS
TRIAGE THEORY
If the brain prioritises immediate
survival over longevity, could nutrient
deficiencies lead to ill health over time?
ON YOUR PLATE
Three fabulous winter warmers with gut
health in mind, which may also save you
pennies and time
DIFFERENT STROKES
Elettra Scrivo looks to northern
Europe for tips on keeping cheerful
during the cold days and long nights
BREAKFAST LIKE A KING?
Some research shows there could be
benefits to prioritising breakfast — but
only for some of us
KITCHEN CHEMISTRY
If you are craving comfort foods this
winter, Emily Kerrigan has been
mixing and mashing in the kitchen
46 ALL ABOUT 48 MOVE IT
50 GRADUATE PAGE
The good, the bad and the ultraprocessed.
Alice Ball looks at whether
processed foods really are bad for us
10
11
28
Daniel O’Shaughnessy tells how a “light
bulb moment” led to focusing on the
LGBTQ+ community
OPTIMUM NUTRITION | WINTER 2020/21
3

Feature
IS MALABSORPTION
LEAVING YOU
TIRED?
Why illness, older age and nutrient ‘inhibitors’ can all affect the benefit we get from our food
Y
ou would be forgiven for
thinking that food, once
committed to your stomach,
trundles along to carry out its
designated job. However, your body
doesn’t have it that easy. Even if your
dinner successfully navigates the
intricate processes required to digest
and absorb nutrients into the blood
stream, the food itself may not have
high bioavailability.
Bioavailability
Bioavailability is the extent to
which nutrients can be used by the
body. While it’s usually high with
macronutrients (carbohydrates, fats
and proteins) it can vary widely
for micronutrients (vitamins and
minerals). Even in the best possible
circumstances, not everything you eat
will be absorbed.
Malabsorption
Malabsorption — when we don’t
absorb all of the nutrition from the
food we eat — can result in symptoms
such as tiredness or persistent
diarrhoea, along with deficiencies
in iron, folate, vitamin D or vitamin
B12. If insufficient energy is being
absorbed (possibly due to illness, food
intolerances or inflammatory bowel
disease), poor growth in children or
weight loss can also occur. As we get
older, we may also be at increased
risk of malabsorption as digestion can
become less efficient.
Where does it start?
Once food is in your mouth, digestive
enzymes and gastric juice start
their magic of making a nutrient
bioavailable. These secretions don’t
particularly benefit from life in
the fast lane, however, and can be
enhanced by slow, mindful eating and
proper chewing.
But even before we eat, food
preparation can have an impact.
Cooking vegetables such as carrots
and spinach, for example, has been
found to increase the bioavailability
of beta-carotene, which the body
converts to vitamin A.1
Inhibitors
Regardless of the food combinations
that we like to eat, some nutrients just
don’t work well together. Substances
known as inhibitors can reduce
nutrient bioavailability. Phytic acid,
for example, is an inhibitor found in
cereals, seeds, nuts, legumes and bran,
which can bind to minerals making
them less available to us.
Iron absorption can also be
inhibited by other nutrients; although
whether we are consuming haem iron
(from animal sources) or non-haem iron
(mainly found in plants) can make a
difference. Of the two types, non-haem
iron has less bioavailability, making
it an important nutrient to watch for
vegetarians and vegans.
Research has shown that calcium,
to a small degree, phytic acid, and
the tannins in green and black tea
can all have a negative effect on iron
absorption. In the case of tea, plantbased
compounds called catechins,
which are a beneficial nutrient in tea,
bind to the iron, reducing the benefits
of both. Haem iron is less affected.
However, it may still be best to
indulge in your cuppa about an hour
before or after meals to avoid any
potential interference. Polyphenols
in coffee have also been found to
reduce iron absorption, but to a lesser
degree.2
Positive pairings
One way to support nutrient
absorption is by focusing on positive
pairings. In the case of iron, for
instance, vitamin C can work wonders
— so a bell pepper and tomato salad,
for example, would support iron
10 OPTIMUM NUTRITION | WINTER 2020/21

Feature
Possible causes of leaky gut include irritants such as alcohol, aspirin,
non-steroidal anti-inflammatory drugs
absorption from both vegetarian and
non-vegetarian sources.
Vitamin D, found in oily fish, helps to
support calcium absorption — although
recent research shows that uptake may
depend upon gut health status. (See
p.5) Or fat, which we have been warned
off eating for the last few decades, is
essential for absorbing the fat soluble
vitamins A, D, E and K, as well as other
nutrients — so that consuming a salad
with a high fat dressing, versus a fat
free one has been found to significantly
increase absorption of carotenoids
(colourful beneficial pigments in fruit
and vegetables).3
Pre-treatment methods such as
fermentation, soaking and germination
can also reduce the effect of inhibitors;
so soaking nuts and seeds overnight if
making bircher, for instance, is thought
to increase bioavailability.
Folic acid (B9)
Vitamin B9, more commonly known
as folate, has been found to be more
bioavailable in its synthetic form as
folic acid.5 Folic acid supplementation
is recommended for women who are
planning to become pregnant or who
are pregnant. However, the NHS
states that folic acid supplements
are not suitable for everyone and to
consult a GP.
A ‘TRIAGE THEORY’ OF NUTRITION
The concept of ‘triage’ is something we would encounter in a hospital A&E.
While urgent cases are rushed through, those of us who have merely got into an
argument with a wheelie bin on a Saturday night will have to go to the back of the
queue. Put simply, triage is a system of assessment and prioritisation.
In 2006, Dr Bruce Ames, an American biochemist, published his ‘triage theory’
of nutrition, arguing that the body directs vitamins and minerals to where they
are needed most urgently — potentially to the detriment of other biological
processes when there aren’t enough nutrients to go around. His hypothesis was
that evolution always prioritises what is needed for immediate survival. A simple
illustration would be to say that we could survive with bad skin or brittle hair,
which can be signs of poor nutrition, but we won’t survive if vital organs and
processes aren’t maintained. However, Ames proposed that optimal levels of
vitamins and minerals were needed to prevent diseases that may develop because
of ongoing deficiencies.
For people who are suffering with malabsorption, deficiencies in certain
nutrients can be common. If you are concerned, speak to your GP or consult a
registered nutritional therapist.
References:
1. Doi.org//10.1093/jn/128.5.913
2. pubmed.ncbi.nlm.nih.gov/6896705
3. Doi.org//10.1093/ajcn/80.2.396
4. Doi.org//10.1093/ajcn/80.4.911
Vitamin B12
Vitamin B12 has a complex pathway
to reach cells where it is needed; its
route involving a sequence of binding
and release from proteins produced
in the mucosal stomach lining.
Because the efficiency of this stomach
lining declines with age or with some
illnesses, it can lead to impaired
bioavailability of vitamin B12. For this
reason, B12 supplementation may be
recommended as we age.
Smoking and alcohol
It is no surprise that smoking and
excessive alcohol consumption may
do nothing to enhance nutrient
absorption. Both have been found to
interfere with the balance between
vitamin D and calcium, which can
lead to bone loss and fracture.6
Smokers may also need more vitamin
C in their diet.
You are what you absorb?
Although you may often hear ‘you
are what you eat’, perhaps a more
accurate version could be ‘you are
what you absorb’. If you are concerned
about your nutrient status, a registered
nutritional therapist should be able
to advise on testing and support for
potential nutrient deficiencies.
Henri Davy
5. Doi.org//10.2741/e575
6. Doi.org//10.1038/s42255-020-0261-2
7. Doi.org//10.1093/ajcn/nqaa085
LEAKY GUT: CAUSES AND CAUTIONS
A single layer of cells called the
intestinal epithelium acts as a
protective barrier against harmful
molecules while allowing nutrients and
water to be absorbed. It is also involved
in regulating immune function and
communicating with gut bacteria.
When damage occurs, known as
gut permeability or leaky gut, bacteria
and molecules can pass through the
intestinal epithelium into the blood
stream, leading to inflammation and
contributing to chronic diseases.
It is suggested that leaky gut may
contribute to autoimmune conditions.
Possible causes of leaky gut
include excess use of irritants such as
alcohol, aspirin, non-steroidal antiinflammatory
drugs (NSAIDs) such
as ibuprofen, gluten, food sensitivities,
imbalance of gut bacteria, stress, and
endurance exercise.
Some experts propose that altering
the diet may reverse leaky gut in some
circumstances, but that this is not a
‘cure’ for inflammatory or ulcerative
conditions because leaky gut may be
a symptom rather than a cause of the
disease.
The NHS’ position is cautious,
stating on its website: “While it’s true
that some conditions and medications
can cause a “leaky” gut (what scientists
call increased intestinal permeability),
there is currently little evidence to
support the theory that a porous bowel
is the direct cause of any significant,
widespread problems.”
Meanwhile, a 2020 study on mice
reported that leaky gut caused by
excessive fructose consumption,
commonly found in sugary drinks,
could contribute to non-alcoholic
fatty liver disease (NAFLD). The
study found that excessive fructose
reduced production of proteins that
maintain the gut barrier and led to gut
permeability.
The study’s first author said that
by “deteriorating the barrier and
increasing its permeability, excessive
fructose consumption can result in
a chronic inflammatory condition
called endotoxaemia, which has been
documented in both experimental
animals and paediatric NAFLD
patients.” The study found endotoxins
(harmful molecules) reaching the liver
provoked increased inflammation.7
Another 2020 study found that
participants with endotoxins in their
blood, which are markers of leaky gut,
had poorer concentration after eating.8
OPTIMUM NUTRITION | WINTER 2020/21
11

Interview
THE BOOK THAT
PROVOKED
ACCUSATIONS
OF SELLING
OUT
Before anyone had read his new book, Dr Rangan Chatterjee was already criticised for writing it.
He tells Louise Wates why it is his best, and what he would tell his younger, medical student self
W
hen Dr Rangan Chatterjee and
I last spoke, he had just finished
recording a second series of the
BBC’s Doctor in the House and was busy
writing his first book. Three years on, he
has three best-selling books, a podcast
that reaches a worldwide audience of
350,000 listeners each week, and is a
co-educator on a successful lifestyle
medicine-focused course for doctors. By
the time this issue of Optimum Nutrition
is out, I fully expect his fourth book, Feel
Great Lose Weight, to be on the best seller
list as well. It is, he feels, his best book
yet.
“Of course I’m biased,” he says. “But
if I don’t think that now after spending
nine months of slogging to try to get it
done, what would have been the point?”
When we meet online during the
November lockdown, it’s his first press
interview and Chatterjee is as proud as
a new dad who hopes his baby will do
good in the world — even though the
30 OPTIMUM NUTRITION | WINTER 2020/21

Interview
baby hasn’t been entirely welcomed.
“I had some criticism from some of
my hardcore followers saying, ‘really
surprised you’ve written a book like
this’,” he says. “Which is interesting
because they’ve not read [it] yet.”
The cause of this displeasure is
Chatterjee’s venture into the world
of weight loss which, because of the
industry surrounding celebrity diets, is
often perceived as encouraging fad diets
while cashing in on success.
Has he been accused of selling out?
“One hundred per cent,” he says. “I’ve
had to wrestle with this because I think
that is the perception some people have,
and some people have sent me some
quite nasty DMs [direct messages] about
this.”
“I want sustainable change”
Sticking to health and wellbeing and
avoiding weight loss would have been the
“safe” option, he says, but he wanted to
reach people who would never usually
pick up such a book.
“There’s an audience out there who
will only pick up diet books every
January. I need them to pick up my book
and not a celebrity diet book,” he says.
He hopes that once people start reading
it, they will realise there is more to it than
weight loss. The title, he adds, was very
important to him because of its emphasis
on feeling well — notably, on the cover,
Feel Great is in bold type. And while
writing it took him out of his comfort
zone, it was a risk he felt he had to take.
“If I want to change [people’s health]
I need to reach those communities
and populations who will go round the
supermarket on the second of January
thinking ‘which diet book am I going to
pick up off the shelf?’
“I want them to pick up this book.
I want them to have access to holistic
health and wellbeing because most of
the books they’re picking up are giving
them the 21-day diet plan, the punishing
workout regime, the drop a dress size
in two weeks narrative. Those can work
for some people, but my approach is
to help people, yes, in January but also
in February, March, April, May. I want
sustainable change for people.”
The book, he says, and his entire
career — whether television, books
or podcasts — has resulted from him
following his passion for health and
wellbeing. “This is something that people
probably aren’t aware of,” he says. “I
People don’t need a new diet, he says. They need to understand
why they make choices…
“…if doctors don’t understand how powerful nutrition can be for
a variety of different conditions, we’re never even going to refer
on to a nutrition professional”
have very powerful emotional reasons
that have driven me to really try and help
change the health landscape and help
people improve their lives.”
He has spoken about one of those
reasons before. As a baby, his son
suffered a hypocalcaemia-induced
convulsion, which is a symptom of
low calcium levels that can be caused
by vitamin D deficiency. Despite his
training, Chatterjee hadn’t known
a vitamin deficiency could cause
something so serious and was shocked
by the event. It was a powerful trigger to
learn more about nutrition. And while it
might be easier to sidestep the issue of
weight, the pandemic as an event on its
own has highlighted just how much of a
problem it is for health and wellbeing.
Fresh approach, old problem
“I think once the dust settles, and who
knows when that will be, I feel a lot of
people are going to go ‘right ok we get
it, if you are overweight or obese your
chances of getting ill from COVID-19
or anything else are dramatically
increased’.”
This new book, he says, is a fresh
approach to the old problem of weight.
“The narrative around weight often
tends to be ‘you should do this, you
should be eating this’. Most people who
are trying to lose weight or trying to
improve their health, they kind of know
that too much sugar or biscuits and
crisps in front of Netflix every evening is
not helping them. But they’re still doing
it. So, for a lot of people ‘what we eat’ is
not a problem. It’s ‘why we eat’.”
The pandemic, he says, is a case in
point. “Is it called the corona stone?
Essentially, a lot of people have been
putting on weight. There was an article
in The Guardian… that showed chocolate
sales are up 50% — and that says it all.
We have had one of the most stressful
years in living memory and, for many
people, the way we dealt with that is to
eat more — I did, and I promote health
and wellbeing. But it was serving a
purpose for me, it was helping me deal
with what was going on in society.”
It is perhaps this ability to relate
to others who are struggling that has
helped to make Chatterjee so successful.
When we met in 2017, I had told him
about noticing a young mum on the bus
feeding a large, sugary doughnut to her
small child, and had asked him what he
thought. Instead of giving me a lovely
sound bite about the evils of sugar, he
had responded thoughtfully that the
mum would have been trying to do the
best she could at that time, and how
difficult it is to eat well in our modern
environment — a problem he discusses
in the new book.
The Three Fs
People don’t need a new diet, he says.
They need to understand why they make
choices. The book sets out a ‘freedom
exercise’, called ‘The Three Fs’,
designed to deal with this.
“The first F is feel; what are you
feeling? Are you hungry or have you
just had a row with your partner? Have
you had a crap day at work? The second
F is feed; how does food feed that
feeling? The third F is find; can you find
an alternative behaviour to sooth that
feeling?”
It’s an exercise Chatterjee uses with his
patients but calls ‘The Three Fs’ in the
book to help it stick in people’s heads. “I
think it’s the most important exercise,”
he says. “It’s helped me and I don’t have
to lose weight.”
The book also addresses how social
pressures can influence food choices,
sharing his own experience. “Back in
the days when we could go out with
our friends and do things…we were
sitting in a Thai restaurant and my mate
made some disparaging comment, ‘Oh
Rangan’s going to do his healthy thing
now and not have dessert’. At the time I
felt a bit uncomfortable and thought I’ll
just have it so I’m like everyone else —
you know, we want to fit in.” He didn’t
have dessert in the end, but understands
the pressures.
“I will have dessert plenty of times, I
just didn’t want it on that day,” he says.
“I think you’ve really got to understand
that the problem isn’t with you, it’s with
that other person. If you’re out and
other people are drinking [alcohol] but
you choose not to drink, you can make
people feel uncomfortable. Why should
someone else be uncomfortable whether
I have an alcoholic drink or not?
“I think you’ve got to realise that it’s
the other people’s insecurities that are
showing up. What you do shouldn’t
affect anyone else at all.” However,
because of the many emotions involved,
OPTIMUM NUTRITION | WINTER 2020/21
31

On Your Plate
ASH RESHTEH (PERSIAN NOODLE SOUP)
Jackie says:
“If you’re looking to clean out
the cupboard and the garden
simultaneously, and have an awesome
meal to boot, then this is the soup
for you. Four different legumes, four
different herbs, and I haven’t even
mentioned the veggies and spices (oh,
wait, I just did). One would think
that with this many beans and herbs,
the soup would be heavy and dense.
Nothing is further from the truth! Even
though it is a full meal on its own,
the soup is light, refreshing, and has a
surprisingly bright ending with a splash
of lemon juice and all of that herby
goodness.
“Traditionally, this soup, served
around the Persian New Year, is made
with a special type of noodle and
yoghurt. However, we’re cheating a bit
and using plain ol’ boxed linguine and
a dollop of Greek yoghurt. If you’re
looking to go gluten-free (per the
request of my mom), see the recipe note
to swap out the noodles with rice.”
Serves: 6-8
Ingredients
Note: 1 US cup = 240ml
• 2 tbsp oil (e.g. light olive oil)
• 2 large white onions, thinly sliced
• 4 medium cloves garlic, minced
• 1 tsp ground turmeric
• Salt
• 1½ cups cooked chickpeas
• 1½ cups cooked pinto beans
• 1½ cups cooked kidney beans
• ¼ cup dried brown lentils (soaked
and cooked according to instructions)
• 6 cups vegetable stock
• 110g dried linguine, broken into 5cm
lengths
• 1 cup packed fresh baby spinach
• 1 cup chopped fresh parsley
• ½ cup chopped fresh chives
• ¼ cup chopped fresh mint
• ¼ cup chopped fresh dill
• 2 to 3 tbsp freshly squeezed lemon
juice
• Freshly ground black pepper
• Greek yoghurt, for serving (optional)
Method
In a large stockpot over medium heat,
heat the oil. Add the onions, reduce
the heat to medium low, and cook
until golden brown and almost melted
(caramelised), stirring often, about 25
minutes. Stir in the garlic, turmeric, and
salt to taste; cook until fragrant, about 2
minutes.
Add the chickpeas, pinto beans,
kidney beans and lentils. Pour in the
stock and bring to a boil. Reduce the
heat to a simmer, partially cover, and
cook for about 10 minutes.
Add the linguine, cover, and cook
until the pasta is al dente, and the lentils
are tender, about 10-12 minutes. Stir in
the spinach, parsley, chives, mint and
dill, and stir to wilt.
Season to taste with lemon juice, salt,
and pepper.
Divide between bowls and top with a
dollop of yoghurt.
Make it gluten-free
Instead of using noodles, add ½ cup
rinsed and drained basmati rice along
with the lentils, and a splash more
stock. Bring to a boil, reduce the heat to
a simmer, and cook, partially covered,
until the lentils and rice are tender,
about 20 minutes.
OPTIMUM NUTRITION | WINTER 2020/21
17