Optimum Nutrition - Spring 2021 - PREVIEW

IN THIS ISSUE
08
LONG COVID AND THE ROAD TO RECOVERY
For those still suffering weeks or months after infection, we look at a nutritional therapy approach to supporting post-viral fatigue
12
ARE YOU VACCINE READY?
How healthy habits, such as a good
night’s sleep, could help us get the best
out of vaccinations
20
RESEARCH UPDATE
Updates on dental health and why
caffeine consumption during pregnancy
may affect foetal development
14 ACTIVATING VITAMIN D 16
Why we may need good gut health to
get the most out of our body’s vitamin
D stores
DIFFERENT STROKES
Elettra Scrivo looks at how finding joy
in the most ordinary things could be key
to mental wellbeing
30 INTERVIEW
34 FROM ION
36
Paediatric endocrinologist and public
health campaigner Dr Robert Lustig
discusses his new book Metabolical
39
IN SEASON
Emily Kerrigan shares five ways to
cook spring greens, plus a how-to guide
for the ultimate green smoothie
What is nutritional therapy, and what
can clients and practitioners hope to
achieve from it?
WORLD CUISINE
A recipe from Michelin-starred chef
Daniel Galmiche, inspired by the
flavours of the French countryside
46 KITCHEN CHEMISTRY 48 MOVE IT
50
Research reveals that it’s not just what
goes into a smoothie that counts, but
also how it’s made
24
42
Giulia Basana looks at sports
supplements: what they are, what do
they do, and do we really need them?
04 COMMENT & NEWS | 26 KIDS’ PAGES | 40 BOOK THERAPY | 47 PRODUCT NEWS
ON YOUR PLATE
Three recipes to help you ‘eat the
rainbow’ from GP and ‘Plant Power
Doctor’ Dr Gemma Newman
28
LITTLE LIVES
Alice Ball finds out how good nutrition
can build resilience in children and
nourish anxious minds
ALL ABOUT
Whether you consume it, soak in it or
pop it in a pill, find out how topping up
magnesium may support relaxation
44
FOOD FACT FILE
How to put a healthy and cost-effective
spin on the US import that became a
great British favourite: the baked bean
GRADUATE PAGE
How a breast cancer diagnosis in Dawn
Waldron’s early thirties led her to a
career in nutritional therapy
OPTIMUM NUTRITION | SPRING 2021
3

Feature
BOOSTERS
FOR SHOTS
As millions receive vaccinations against Covid-19, researchers recommend a good night’s sleep
W
ith the rollout of Covid-19
vaccinations, never before in
human history have the health
implications of vaccines dominated
global consciousness. According
to researchers from Ohio State
University (OSU), USA, however, not
only could our health status at the
time of vaccination affect the severity
and duration of temporary side effects,
but also how quickly the vaccine
begins to work. 1
In a review of 49 vaccine studies
from the last three decades,
researchers looked at whether
psychological and behavioural factors
might affect immune responses to a
range of vaccines including influenza,
hepatitis B, typhoid and pneumonia.
(The study did not include any of the
Covid-19 vaccines.) They concluded
that various factors such as stress,
depression, loneliness, poor nutrition
and smoking could all contribute
to an impaired immune response to
vaccination.
Because of how vaccines work, the
immune response is key. Vaccines
contain weakened or inactive parts of
pathogens such as viruses which, when
introduced to the body, familiarise the
immune system to the pathogen. This
triggers the creation of antibodies
so that, should we be exposed to the
pathogen at a later date, the immune
system can recognise and fight it.
But, the review suggests, factors that
compromise the immune system or
cause inflammation may affect the
efficacy of vaccines or how well we feel
afterwards.
According to first author Annelise
…factors such as stress, depression, loneliness, poor nutrition and
smoking could all contribute to an impaired immune response…
Vaccination: originating in the 18th
century from the Latin vaccinus,
from vacca (cow), following early use
of the cowpox virus against smallpox.
(source: OED)
Madison, when we think of how well
a vaccine works, we usually only think
of the vaccine itself; yet we contribute
important health factors that can help
or hinder immune response.
An impaired immune response may
cause three types of effect: the vaccine
taking longer to work; protection
being shorter lived; or intensification
of side effects (e.g. aching arm, feeling
nauseous, feverish, tired, etc.).
However, Madison believes that
if we can take steps to improve our
health whilst we are still waiting
for the Covid-19 vaccine, there is a
chance to make the response to the
vaccine quicker, more robust, and
lasting.
12 OPTIMUM NUTRITION | SPRING 2021

Feature
“…someone who is chronically stressed may have more side effects
after vaccination, take longer to develop immunity, and have a
shorter duration of immunity…”
Chronic stress, for example, is
known to affect health status, so it is
perhaps unsurprising that the study’s
authors found it can also affect the
efficacy of vaccinations.
Stress
One of the papers the authors
reviewed included a study on the
immune responses of medical students
who were given a “highly effective”
hepatitis B vaccine. Although all of
the students eventually developed
antibodies to hepatitis B, those who
were stressed or anxious about exams
around the time they were given the
vaccine took significantly longer to
develop protective antibodies.
Another study looked at older
adults’ responses to a pneumococcal
pneumonia vaccine. Whilst all
participants quickly developed
antibodies, it was found that in
those who were chronically stressed
caregivers looking after spouses with
dementia, the antibody response
diminished over the next three to six
months.
These particular studies had been
led by Professor Janice Kiecolt-Glaser,
the senior author of the current
review, and her late husband Professor
Ronald Glaser.
Kiecolt-Glaser, director of Ohio
State’s Institute for Behavioral
Medicine Research, and Glaser, an
immunologist, had led research into
how stress impairs physical health
primarily by hampering the human
immune response. Several studies
from Kiecolt-Glaser’s lab were
included in the current review along
with studies from other laboratories.
Risk factors
Commenting, Kiecolt-Glaser said the
review’s findings suggested that with
the Covid-19 vaccine, if people were
more stressed and anxious, it may take
a little longer to develop antibodies.
“So they should probably allow a
little more time before they assume
they’re protected,” she said. “Another
possibility is that stress may erode
protection more rapidly.”
Past research from her lab has
also reportedly shown that people
who were depressed at the time
of vaccination experienced side
effects such as lethargy, malaise and
irritability for a longer period of time.
Side effects, however, are a normal
reaction to vaccination. “Side effects
are from an inflammatory response to
the vaccine, which is a good thing,”
said Kiecolt-Glaser. “You want to
see a strong response to the vaccine.
That’s one reason we know the
vaccine is effective. On the other hand,
the absence of a response doesn’t
mean it’s not effective.”
A problem highlighted by the study,
however, is that the pandemic has
worsened many of the factors that may
negatively affect immune response.
“Many risk factors for a weaker
vaccine response, such as chronic
stress, depression, anxiety, lack of
social connection, poor nutrition,
sedentariness, excessive alcohol use,
PREPAPRATION TIPS
According to Madison et al, massage
and expressive writing for stress
management, short and long term
physical activity including 25 minutes
of arm exercises before injection,
and nutritional supplementation all
helped increase antibody response or
reduce side effects in past studies.
and poor sleep are all very prevalent
during the pandemic,” says Madison.
“Fortunately, the Pfizer and
Moderna vaccines are highly
efficacious, and therefore most people
who are vaccinated will develop
immunity. That being said, these
factors can still affect side effect
profiles, the length of time it takes
to develop immunity, and duration
of immunity. For instance, someone
who is chronically stressed may have
more side effects after vaccination,
take longer to develop immunity, and
OVERALL DIET AND GUT HEALTH MAY SUPPORT VACCINE RESPONSE
According to Madison et al, diet and nutrition are relatively unexplored in
relation to vaccine responses among healthy adults. Most of the research
in this area has focused on undernourished populations such as children in
developing countries and older adults. While malnourished children would
generally have a sufficiently protective immune response upon vaccination,
the “extend and duration may be less than ideal”.
Dietary deficiencies in single nutrients, in children, were reported to have
little to no effect on vaccine response. However, overall diet and gut health
may be important. Obesity related inflammation, caused by a diet high in
fat, refined sugars and processed foods, could reduce the immune system’s
“ability to mount an effective response”. Research had also indicated that
the gut microbiome determined response to vaccines. Dietary fibre (found
in wholegrains, fruit, vegetables, nuts, seeds and legumes) which promotes a
greater abundance of bacteria like Bifidobacteria that produce short-chain
fatty acids, was reported to support antibody responses.
OPTIMUM NUTRITION | SPRING 2021
13

On Your Plate
DIY POT NOODLES
Gemma says:
“If you are looking for a quick lunchtime option, this DIY Pot Noodle recipe fits the bill. I’ve found the best noodles to use are instant
wholegrain rice noodles because they soften in the right time. You can use whatever vegetables you have to hand. For example, one
pack of stir fry veg can easily feed four. Aim to get as many types of veggies and colours as you can into yours.”
Makes 4 portions
Ingredients
• 4 small nests of instant wholegrain rice
noodles
• A sheet of nori (seaweed), shredded
• 1 small courgette, cut into matchsticks
• 1 small carrot, cut into matchsticks
• 1 red pepper, finely sliced
• 4 large kale leaves, finely shredded
• 4 spring onions
• 4 mushrooms
• 4 tbsp frozen peas
For the sauce
• 4 tbsp miso paste
• 4 tbsp tamari or light soy sauce
• 2 garlic cloves
• 10g piece of ginger, grated
• ½ tsp ground turmeric
• ½ tsp Chinese 5 spice
Method
Take 4 large jars or round screw top
Tupperware. Layer them up with the
noodles on the bottom, followed by the
seaweed and vegetables. Mix all the sauce
ingredients together and spoon over the
vegetables. Seal until ready to cook.
When you are ready to cook the
noodles, boil a kettle. Add the freshly
boiled water to around halfway up the
jar if you want it fairly dry, to the top if
you want it soupier. Leave to stand for
around 3 minutes, then give it a good
stir with chopsticks, pulling the noodles
up from the base to make sure they are
cooked.
18 OPTIMUM NUTRITION | SPRING 2021

Interview
A DOCTOR’S
CHALLENGE TO
FOOD, PHARMA
AND ‘THE FEDS’
Dr Robert Lustig speaks to Alice Ball about his new book, why he believes processed food is
ruining our health, economy and environment, and his hopes for a global food reckoning
30 OPTIMUM NUTRITION | SPRING 2021

Interview
D
r Robert Lustig isn’t afraid
of controversy. Twelve years
ago, the emeritus professor of
paediatric endocrinology waged a war
on sugar with his lecture, Sugar: The
Bitter Truth. Since then, it’s had over
12 million views on YouTube while his
first book, Fat Chance, also an attack
on sugar, became a New York Times’
best seller. Neither earned him friends
in the food industry and his new book,
Metabolical, is likely to ruffle even more
feathers.
“Whatever I wrote, somebody was
going to take offence,” he says during
our transatlantic video call. “Whether
it be an academic debate or a personal
affront, somebody wasn’t going to be
happy.”
He is, however, entirely unapologetic.
“You know what?” he says, “The truth
hurts. And that’s what this book is; the
dirty, unvarnished and disgusting truth.”
In Metabolical, Lustig presents the
case that many modern day illnesses
can be avoided, treated or reversed by
food. He regards “eight pathologies that
belie all chronic conditions” as being
“foodable” — but not “druggable”.
However, for Lustig — a paediatric
endocrinologist for more than 40 years
— this understanding of nutrition’s role
in treating chronic disease was a latter
day rediscovery.
Before joining medical school in
1976, Lustig majored in nutrition
and food science from the prestigious
Massachusetts Institute of Technology
(MIT). “I sort of hit the wall when I
graduated and they were telling me
all this biochemistry,” he says. “I then
entered medical school and they said,
‘oh that biochemistry is useless here…
this is how you do it and it’s all about
calories’. So I had that dichotomy
already visited upon me in my
‘childhood’ as it were.”
He recalls one of his first lectures at
medical school. “They said, ‘50% of
what we teach you is wrong, we just
don’t know which 50%’. I think the rest
of my classmates basically took that as
a throwaway. I didn’t. I kept thinking
that I needed to sift through everything
and work out what was real and what
wasn’t.”
However, using the medical approach
of calories for almost 17 years, he
found his patients never seemed to get
much better. Then in 1995, he began
He recalls one of his first lectures at medical school. “They said,
‘50% of what we teach you is wrong, we just don’t know which
50%’…”
FRUCTOSE: A TOXIC TRIAD
According to Lustig, fructose, a sugar molecule often found in sugary drinks,
is “poisonous” for three reasons.
Firstly, it goes straight to the liver where it gets turned into fat. This liver fat
drives insulin resistance, which in turn causes type-2 diabetes.
Secondly, it causes the Maillard or ‘browning’ reaction, which contributes
to cataracts and wrinkles. The Maillard reaction is what we see every time
we brown meat or toast bread. When it occurs, it releases a reactive oxygen
species. Antioxidants in your cells, says Lustig, are supposed to quench these
oxidants. But if you’re eating processed food you don’t have enough of them so
you end up developing inflammation.
Finally, fructose is addictive. “It keeps us wanting more,” he says. “Take
those three things together and you have this vicious cycle of consumption and
disease.”
working at St Jude Children’s Research
Hospital as a neuro endocrinologist,
treating children who had survived brain
tumours. Here, there was a particular
group of children who had become
massively obese.
He says it became “painfully clear”
to him that what he’d learned about
calories at medical school was “a joke”;
his patients weren’t getting any thinner
and many were insulin resistant — a
precursor for type 2 diabetes.
“Diving for a sunken boat…”
“When it came down to it, I realised
that I learnt [everything] back in 1975,”
he says. He describes the retrieval of his
nutrition training at MIT as “diving for
a sunken boat…bringing it back up from
the depths”.
When Lustig moved away from the
calories in, calories out approach, he
found that not only did his patients
begin to lose weight, they also improved
their insulin sensitivity. This paved the
way for his team’s ground-breaking
review into fructose and non-alcoholic
fatty liver disease. 1
“I realised that what they were telling
me [at medical school] was worse
than garbage — it was detrimental,”
he adds. “It put the pejorative and the
onus on the patient rather than on the
biochemistry or the food.
“This was around 2009 when I
delivered Sugar: The Bitter Truth.”
Since then, Lustig has mostly focused
on sugar. But Metabolical (a blend of
‘metabolic’, for the workings of the
body, and ‘diabolical’, for the workings
of “food, pharma and the Feds”) is a
cynical exposé of processed food and
his view on how it has come to ruin our
health, economy and environment.
Why the leap from sugar to processed
foods in general? “Sugar is the marker
for processed food,” he says. “But there
are very specific things in processed
food other than sugar that are also
problematic. From doing the research, it
became clear that there are two criteria
to determine whether a food is healthy:
protect the liver, feed the gut.”
Throughout Metabolical, these six
words form something of a mantra.
Sugar, he says, is “the big bad guy”
because it floods the liver and starves the
gut. But even without sugar, processed
food would still be a problem.
“It’s not what’s in the food, it’s what’s
been done to the food,” he says. “That’s
not on the food label because the food
industry doesn’t want you to know.”
He takes a similar view of the meat
industry with “what we have done to
the [animals]” being the problem rather
than the farmers or cattle ranchers.
“People say that animals are a
problem because they produce methane,
but so do we,” he says. “Except we
didn’t use to make so much methane
and neither did they.”
“It’s not the cows, it’s what we
did…”
He points to wide scale intensive
farming in which cattle are largely
kept indoors and fed corn rather
than pasture. “So there’s no manure
fertilising the farm because the animals
are not on the farm,” he says. “Instead,
you’ve got corn in Iowa that has to be
sprayed with nitrogen fertiliser, creating
nitrous oxide. Then the nitrogen runs off
and creates all of these dead zones.”
Meanwhile, he says, the cows —
despite being fattened for market
— are malnourished because they
are only eating corn. “They don’t get
the antioxidants they need to fight off
infection, so they need antibiotics just to
survive. Now in their intestines, the good
bacteria have all died off and [the ones]
OPTIMUM NUTRITION | SPRING 2021
31