Optimum Nutrition - Summer 2021 - PREVIEW

Discover a world of nutrition
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Th e
Optimum
Nutrition
Podcast
From the Instute for Opmum Nutrion
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IN THIS ISSUE
08
SHOULD YOU CHANGE BEFORE THE CHANGE?
Alice Ball looks at whether women should begin to prepare for the menopause years ahead of time
12
LOVE YOUR HEART
Why lowering inflammation rather than
fixating on cholesterol may help heart
health. Alice Ball writes
14 BEING STROKE AWARE 16
Louise Wates looks at why we should all
know the signs of a stroke but why they
can be easy to miss
20 INTERVIEW
24 DIFFERENT STROKES 28
Former airline pilot Emma Henderson
talks to Alice Ball about supporting the
NHS with Project Wingman
30
RESEARCH UPDATE
The compound that might protect
against neurological disease and the
impact of stress on the immune system
38
KITCHEN CHEMISTRY
We’ve gone from drizzling olive oil in
ears for ear ache to drizzling it on salad,
so what should we be buying?
44
FOOD FACT FILE
Giulia Basana finds out about
‘functional foods’ and why we might all
think about what our food does
Why even getting online for a virtual
choir could be beneficial for health.
Elettra Scrivo writes
34 FROM ION
36
Nutrition gets personal: why similar
symptoms may be rooted in different
problems
39
IN SEASON
Why courgettes hit the headlines last
year, and how they can be used for
much more than ‘courgetti’
48 MOVE IT
50
Tendinitis can affect anyone, whether
we exercise or not. Giulia Basana finds
out why it happens and how to recover
04 COMMENT & NEWS | 26 KIDS’ PAGES | 40 BOOK THERAPY | 47 PRODUCT NEWS
ON YOUR PLATE
Dr Rupy Aujla’s Doctor’s Kitchen 3-2-1,
plus why he believes good nutrition is
important for the future of healthcare
LITTLE LIVES
Henri Davy considers the summertime
conundrum of how to top up vitamin D
in kids — without sunburn
ALL ABOUT
Alice Ball finds out why a growing
waistline is harmful to health and if diet
and lifestyle can help to blitz belly fat
42
WORLD CUISINE
Hawaii-born chef Sheldon Simeon tells
us about the fusions that make up the
island’s modern cuisine
GRADUATE PAGE
Diana Warrings tells us how her food
blog evolved from a hobby into a full
time career in recipe development
OPTIMUM NUTRITION | SUMMER 2021
3

Feature
WHY WE SHOULD
ALL BE AWARE OF THE
SIGNS OF A STROKE
Image: Kateryna Kon © 123RF.com
Louise Wates looks at the signs of stroke and why prevention is better than intervention
I
n June, there was a news story
about a man who was looking
for the ‘guardian angel’ who
helped him when he was suffering
from a stroke. Mathew O’Toole, 47,
was reported to be sitting on a bench
outside a coffee shop in London when
he began vomiting and sweating. A
nurse who happened to be passing by,
recognised that O’Toole was having
a stroke and called an ambulance,
probably saving his life.
This was a story that resonated with
me. A decade ago, I spent about a year
volunteering for a charity set up to
help people who had survived a stroke.
Once a week we would get together, the
aim being to help survivors with their
communication skills, which are often
devastated after a stroke. There would
be light activities designed to encourage
communication skills, although the
social aspect was also important.
During this learning curve I met
men and women from a variety of
backgrounds and careers; a highranking
police officer, business owners,
a cartographer, teachers and so on, all
of whom were trying to regain their life
skills.
Struggling to stand on one leg for more than 20 seconds, it was
reported, was linked to an increased risk for stroke…
Signs and symptoms
On its website,1 the NHS describes
a stroke as a serious life-threatening
14 OPTIMUM NUTRITION | SUMMER 2021

Feature
There was a moment that I was left with the phone in my hand,
wondering whether to make a fuss
medical condition that happens when
the blood supply to part of the brain
is cut off. Symptoms of risk include
obesity, insulin resistance, high blood
pressure and high cholesterol. In 2014,
a study from the Kyoto University
Graduate School of Medicine, Japan,
also found a more curious sign to
indicate higher risk. Struggling to stand
on one leg for more than 20 seconds,
it was reported, was linked to an
increased risk for stroke, small blood
vessel damage in the brain, and reduced
cognitive function in otherwise healthy
people.2
Knowing the signs of a stroke can
help to save a person’s life or reduce
the stroke’s impact. If you suspect you
or someone else is having a stroke, you
need to act quickly, as illustrated with
the ‘FAST’ campaign that lists common
signs:
• Face – the face may have dropped on
one side, the person may not be able
to smile, or their mouth or eye may
have dropped.
• Arms – the person with suspected
stroke may not be able to lift both
arms and keep them there because of
weakness or numbness in one arm.
• Speech – their speech may be slurred
or garbled, or the person may not be
able to talk at all despite appearing
to be awake; they may also have
problems understanding what you’re
saying to them.
• Time – it’s time to dial 999
immediately if you see any of these
signs or symptoms.
Mini stroke
Yet people can also experience what is
called transient ischaemic attack (TIA
or mini stroke), which can occur in the
weeks before a major stroke. Seeking
medical help after a TIA can help to
prevent a major stroke; but recognising
the signs can be difficult. One of the
stroke survivors I would chat with told
me that he had suffered a TIA about
three weeks before suffering from the
major stroke, but he hadn’t realised
what it was, thinking he had just had a
“funny turn”.
It was a situation I would later relate
to when a relative (let’s call her J)
suffered a TIA in front of me. Standing
up, she momentarily lost her balance
but quickly corrected herself. Because
she had been suffering with an ear
infection at the time, she thought that
had been the reason for her momentary
stumble. But just for a split moment, I
saw her mouth droop.
Knowing that a mouth drooping to
one side was a sign of stroke, I picked
up the phone to call for an ambulance.
J, however, feeling and suddenly looking
absolutely fine, protested and told me I
was being ridiculous.
There was a moment when I was left
with the phone in my hand, wondering
whether to make a fuss. I decided to
call 999. When the ambulance arrived,
paramedics found J’s blood pressure
to be dangerously high and gently
persuaded her that she really did need
to go to hospital.
It comes and goes
By the time I arrived at the hospital
and found her in A&E, J was already
sitting up in bed looking fit as a fiddle.
She was also getting thoroughly bored
and talking about discharging herself.
But then her face suddenly drooped
completely on one side. Terrified,
I looked for help but by the time I
returned with a nurse in tow, J was
looking absolutely fine and a picture of
health.
“Her mouth was drooping!” I told the
nurse, thinking that she must have taken
me for an idiot.
“Oh, it’s coming and going is it?” the
nurse said calmly.
“It can do that?” I asked. Nothing
in the ‘FAST’ ads or even what I had
learnt on my volunteering days had
taught me that.
Thankfully, 11 years on J is alive and
well. But after that incident, I became
somewhat evangelical about people
understanding the signs and symptoms
of stroke. As I learnt, even though I
had an idea of what a stroke might look
like, I didn’t understand the range of
ways they can present — and it is only
because of that momentary mouth
droop that I called for help.
In an ideal world, any one of us
should be able to recognise the signs
and people like Mathew O’Toole
wouldn’t have needed a nurse to call
for help. Unfortunately, it can be all too
easy to think that a stroke sufferer is
drunk.
Gut microbiome
For any of us, prevention is always
better than intervention. A healthy diet,
ACT FAST
• Face – the face may have dropped on
one side, the person may not be able
to smile, or their mouth or eye may
have dropped.
• Arms – the person with suspected
stroke may not be able to lift both
arms and keep them there because of
weakness or numbness in one arm.
• Speech – their speech may be slurred
or garbled, or the person may not be
able to talk at all despite appearing
to be awake; they may also have
problems understanding what you’re
saying to them.
• Time – it’s time to dial 999
immediately if you see any of these
signs or symptoms.
regular exercise, not exceeding more
than 14 units of alcohol a week, and not
smoking are all considered to be ways of
reducing our risk. Stress is also a known
risk factor, as is sleep apnoea. Health
in childhood can also be important
— a recent study found that a higher
BMI in late adolescence is associated
with a “significantly higher risk of first
ischaemic stroke in men and women
under age 50, regardless of whether they
had type 2 diabetes”.3
Another recent study also found
that the gut microbiome may impact
the severity of stokes and the level of
functional impairment afterwards.4 The
authors found that dietary choline and
TMAO (trimethylamine N-oxide) — a
by-product produced when gut bacteria
digest certain nutrients abundant in
red meat and other animal products
— “produced greater stroke size and
severity, and poorer outcomes in animal
models”. Whilst further research would
be needed to translate the findings to
humans, a wholefood diet with plant
proteins, leafy green vegetables, fruit
and wholegrains is associated with
reduced risk. The NHS also says that for
most people, at least 150 minutes (two
and a half hours) of moderate-intensity
aerobic activity, such as cycling or fast
walking, every week is recommended.
For individuals who are recovering from
a stroke it is recommended to discuss
any exercise plans with a rehabilitation
team.
References:
1. nhs.uk/conditions/stroke
2. Doi.org//10.1161/
STROKEAHA.114.006704
3. Doi.org//10.1161/
STROKEAHA.120.033595
4. Doi.org//10.1016/j.chom.2021.05.002
OPTIMUM NUTRITION | SUMMER 2021
15

On Your Plate
JUST WHAT THE DOCTOR ORDERED
Dr Rupy Aujla, NHS doctor and founder of ‘The Doctor’s Kitchen’, takes us
back to basics with his new book Doctor’s Kitchen 3-2-1. Each recipe is designed
to give three portions of fruit and vegetables per person, serving two people, and
all made in one pan. We have chosen three easy recipes to whet your appetite
FENNEL, LEEK AND BEANS
WITH BASIL PESTO
Dr Rupy says:
“Sometimes, a store-bought jar of
pesto or other paste adds all the
flavour you need to make a beautifully
balanced and speedy meal. I always
have jarred flavour enhancers like this
to hand.”
Extracted with permission from
Doctor’s Kitchen 3-2-1
by Dr Rupy Aujla (@doctors_kitchen)
(Harper Thorsons, £16.99)
Prep 10 mins / cook 35 mins
Ingredients
• 160g fennel (about 1 small bulb),
sliced into thin wedges
• 400g tin flageolet beans, drained and
rinsed
• 160g leeks (1 large or 2 small), sliced
• 2 tbsp extra-virgin olive oil
• 100g fresh basil pesto
• Finely grated zest and juice of 1
lemon
• Sea salt and freshly ground black
pepper
To serve
• Warm crusty bread
• 20g hazelnuts, chopped
• 10g fresh basil leaves
Method
Preheat the oven to 190C/170C fan/
gas 5.
Toss the fennel, beans and leeks in a
roasting tray with the oil, pesto, lemon
zest and juice and plenty of salt and
pepper.
Roast in the oven for about 30–35
minutes.
Remove from the oven and serve the
baked vegetables and beans scattered
with chopped hazelnuts and basil leaves,
with some warm crusty bread.
Variation
Try using a different pesto, such as
red pepper pesto or even a homemade
walnut version if you have time.
16 OPTIMUM NUTRITION | SUMMER 2021

On Your Plate
Image: © Andrew Burton
AN APPLE A DAY?…
Dr Rupy Aujla talks about recipes, nutrition and healthcare
How did you become interested in
nutrition?
“I’ve been taught by my family to
appreciate different cuisines and we’ve
been hooked on food programmes since
as early as I can remember. But at the
age of 12, I witnessed my mother take
control of her medical condition, which
had baffled multiple physicians, by
changing her diet and lifestyle. She used
to suffer random anaphylaxis attacks; the
worst form of allergy where your airway
can close and your blood pressure drops.
No cause was found and as a last resort,
doctors recommended lifelong allergy
medications. Unfortunately, these have a
range of side effects.
“Not content with being reliant on
drugs which weren’t completely working,
she decided to make radical changes to
her daily routine. Her Indian upbringing
had instilled in her the value of food. I
watched her completely overhaul her
diet and lifestyle; her daily ‘prescription’
included a wholefood diet packed with
vegetables, a good sleep pattern, exercise
and meditation. She became more
confident, stronger and gradually came
off all medication with the support of her
doctors.
“It was my mother’s experience that
drove me to want to be a doctor and to
appreciate food and medicine.”
What inspired The Doctor’s Kitchen?
“About eight years ago I fell ill. I was
suffering from atrial fibrillation (an
irregular and often abnormally fast
heartbeat) and after many tests, I was
told to have an ablation procedure. It
was this that sparked a change in my
own lifestyle.
“The power of food and healthy living
isn’t taught in medical school, and it took
my own experience to realise just how
much of an impact nutrition can have.
“The driving force behind The
Doctor’s Kitchen was the idea of creating
motivating, exciting, and accessible
recipes that encourage people to
recognise food as an important health
intervention. Now, I’m trying to
understand how we can equip the
modern doctor to feel confident having
conversations about food in a clinical
environment.”
“I witnessed my mother take control of her medical condition, which
had baffled multiple physicians, by changing her diet and lifestyle”
How is Doctor’s Kitchen 3-2-1
different to your first two books?
“3-2-1: three portions of fruit and
vegetables per person, two servings per
recipe (just double the ingredients for a
family), one pan. [It] is an easy-to-follow
health prescription. This daily dose of
fresh ingredients, quality fats, whole
grains and plenty of fibre lowers the risk
of disease.
“My core principles of healthy eating
remain the same — keep plant-focused,
eat lots of fibre, plenty of colourful
vegetables and wholefoods. As a busy
doctor, I know that one of the main
reasons people choose not to cook at
home is lack of time as well as the effort
to cook it. In my new book I promise you
flavourful dishes that consistently look
after our bodies, helping to beat illness
by optimising our food choices.
“Every one of the recipes has been
specially formulated to pack in the
maximum amount of healthy fruit and
vegetables using as little equipment as
possible. Making cooking quick, simple
and minimising prep time and washing
up.”
Is 3-2-1 the formula for how you eat?
“It’s important not to look at food too
prescriptively. Rather than looking
at food like a pill, see it as part of a
process of putting your body in the right
environment that allows it to look after
itself. The body has an incredible ability
to maintain balance and function. We
just need to feed it the right fuel and
food is a very important part of lifestyle
change that can achieve some incredible
things.”
What are your hopes for the future
of integrated healthcare?
“I truly believe that the answer to
our overburdened healthcare systems
lies in the quality of our community
care where food plays a pivotal
role. Practising good nutrition and
lifestyle medicine means we can
pre-empt disease rather than react
to it in the emergency department.
An accumulation of poor dietary and
lifestyle choices often leads patients to
the emergency room and it’s partly my
own experience in A&E that’s brought
me on this journey. Separating diet and
lifestyle from acute medicine blinds us
to the solution for our overburdened
healthcare systems.
“To put it bluntly, we need to bring
the cost of fresh fruit and veg down, we
need to invest heavily in food education
from childhood to adulthood and we
need to teach our doctors nutrition.”
OPTIMUM NUTRITION | SUMMER 2021
19

Interview
EVERY CLOUD...
When former airline captain Emma Henderson MBE found herself grounded by the pandemic,
she wondered what she could do to support the NHS. She spoke to Alice Ball about Project
Wingman and the thousands of aircrew-turned-volunteers who helped it to take flight
20 OPTIMUM NUTRITION | SUMMER 2021

Interview
I
t’s impossible not to feel
inspired by Emma Henderson,
MBE. When the former
airline pilot found herself grounded
at the beginning of the pandemic, her
immediate concern was the wellbeing
of her colleagues and the thousands of
NHS staff working tirelessly around
the clock. So alongside Professor
Robert Bor, a clinical and aviation
psychologist, and Dave Fielding, a
British Airways captain, she co-founded
Project Wingman; a charity through
which furloughed aircrew have spent
the pandemic helping to provide respite
spaces in hospitals for frontline NHS
staff.
“When we first talked about it, I think
we thought it would involve a couple
of hundred people and three or four
hospitals in London,” she says. “Now
I find myself as the figurehead of the
charity.”
Project Wingman was conceptualised
back in March 2020 after Bor and
Henderson talked about how people
were going to cope with the (then)
upcoming pandemic. “One of the
conversations I had with [Bor] was that
there were going to be so many people
grounded and available, and the NHS
was going to have a really hard time
if all the reports were to be believed.
There had to be a way in which we
could help.”
Bor introduced Henderson to
Fielding, who had been thinking along
the same lines. “We chatted about our
ideas on the phone and hit upon the
idea of creating lounges that aircrew
could go into to provide the sort of
chat you get on board an aircraft. We
described it as being able to provide a
warm blanket of wellbeing around our
NHS colleagues.”
“We all think we’re coping but it’s not until you stop and stand
still that you realise you’re not coping at all”
would regularly turn up at hospitals
from companies and individuals
wanting to help.
“They had a terrible problem
distributing it fairly without it being a
‘smash and grab’ type situation,” she
says. This led to the creation of the
charity’s “first class lounges”, decorated
with plants, sound systems, flower walls,
balloon arches and banners.
“The idea was to make it a really
different space from the stark reality,
which, for some, was coming off a shift
where they had lost nine or 10 people.”
In time, Project Wingman attracted
even more volunteers; reaching 6,500
during its peak. To date, there have been
104 lounges in England, Scotland and
Wales, two in New York and one mobile
bus-based lounge.
“We estimate that we’ve provided
about 46 years of wellbeing support
to the NHS,” she says. “That’s mind
blowing to even say. It’s changed the
working culture of some hospitals
because of the model they’ve adopted.”
“A huge honour”
In January 2021, Henderson was
awarded an MBE in the New Year
Honours list, in recognition of her work.
“It was a complete surprise to me,” she
says. “I was in a meeting and this little
square popped up on my emails. It had
quite a formal title so I thought ‘I’m
going to look at that’ and I read it and
thought ‘oh my goodness’.
“It is a huge honour for me, but it’s
a huge honour for the charity as well. It
reflects the work that has been done by
the thousands of volunteers.”
Although Henderson has been
fascinated by flight since she was a
child — joining the Royal Society for
the Protection of Birds as a ‘young
ornithologist’, and deciding at the age
of eight that she was going to be an
astronaut — she has folded up her wings
for now. After enjoying 11 years working
as an airline pilot for easyJet and having
been one of a handful of women to
be made captain, she took voluntary
redundancy last September; walking
away from a career she loved, but saving
the jobs of two employees in the process.
“[Project] Wingman was, and still is, a
massive lifeline for me,” she says. “I was
so busy focusing on that, I didn’t have
time to think about how sad it was that I
was having to change my career.”
Being grounded has also had a
welcome impact on her physical and
mental wellbeing. “I used to work five
days on, four days off; five days on,
three days off. It absolutely wrecked my
sleeping pattern.” It’s only now that she
has been getting good quality sleep, she
says.
“We all think we’re coping but it’s not
until you stop and stand still that you
realise you’re not coping at all.”
Living near a beach, she spends a
lot of her time outside, in the water or
working on her garden.
“It’s been good for me, and it’s been
good for my soul,” she says. Realising
how her own health and wellbeing has
benefited from being on the ground,
“Call to arms”
A “call to arms” was put out to airline
staff and within only four days, more
than 700 people had signed up to
volunteer. For Henderson, the scale of
the project soon became apparent. “I
was spending every waking moment
transferring people’s emails into a
spreadsheet,” she says.
The initial plan for Project Wingman,
she explains, was “tea and empathy”,
but the British public was so generous
towards the NHS that “boxes of stuff”
“We estimate that we’ve
provided about 46 years of
wellbeing support to the NHS...
that’s mind blowing to say”
OPTIMUM NUTRITION | SUMMER 2021
21