Optimum Nutrition - Autumn 2021 - PREVIEW

IN THIS ISSUE
8
A NUTRITIONAL THERAPY APPROACH TO POLYCYSTIC OVARY SYNDROME (PCOS)
Alice Ball finds out how nutrition and lifestyle can help to support symptoms
12
DIFFERENT STROKES
Breeze through winter by looking after
the physical, intellectual, emotional and
social you
20 RESEARCH UPDATE 24
A fresh look at the ‘hygiene hypothesis’
and recent findings on omega-3s,
headaches and heart health
KITCHEN CHEMISTRY
14 ALL ABOUT
16
Food colouring E171 may not be safe
for human consumption. Here’s why
and how to identify it on the label
FUELLING UP
Driving home for Christmas? Find out
how fuelling up with good nutrition
may help you behind the wheel
30 INTERVIEW
STORECUPBOARD HERO 36
Community chef Sanjay Kumar talks to
us about slow food, and working with
people living in food poverty
38
Judith Orrick looks at how cooking
methods can help to maximise the
health benefits of a Mediterranean diet
44
FOOD FACT FILE
Wholegrain, multigrain and wholemeal;
what’s the difference and are they for
everyone? Louise Wates writes
33
Why the humble can of salmon deserves
a mention for affordable and versatile
nutrition
39
IN SEASON
Find out how fennel bulb can add a
touch of Italy to your table, and about
the many uses of fennel seeds
48 MOVE IT
50
Giulia Basana and Alice Ball look at
whether it’s wise to get a little bit fitter
— before trying to get fit
ON YOUR PLATE
Three teaser recipes from Shelf Love,
the new book freshly served from the
Ottolenghi Test Kitchen
LITTLE LIVES
Catherine Morgan finds out how
insisting children clear their plate could
lead to disordered eating later in life
A MIRACLE PILL?
The old adage goes that exercise
promotes weight loss. Alice Ball looks
at why this is fundamentally wrong
WORLD CUISINE
Food writer Uyen Luu tells us about the
flavours of Vietnam and shares a recipe
from her latest cookbook
GRADUATE STORY
Find out how Joy Skipper went from
photographing horses to nutritional
therapy — via MasterChef on the way
04 COMMENT & NEWS | 26 KIDS’ PAGES | 34 FROM ION | 40 BOOK THERAPY | 47 PRODUCT NEWS
28
42
OPTIMUM NUTRITION | AUTUMN 2021
3

Feature
POLYCYSTIC OVARY
SYNDROME:
Image: orawanpat © 123RF.com
A NUTRITIONAL
THERAPY
APPROACH
Alice Ball looks at the complexities of polycystic ovary syndrome, which is thought to affect
one in 10 women, and how nutrition and lifestyle may help to manage symptoms
M
y acne started when I was
“ a teenager and I was told I
had high testosterone. I was
immediately put on a birth control
pill which I remained on for about 10
years.” Registered nutritional therapist
Lauren Lovell didn’t know she had
polycystic ovary syndrome (PCOS)
until her late twenties. It was only when
her sister was diagnosed as an adult that
she decided to get investigated, due to
the chronic and persistent acne she was
experiencing.
“It took some convincing to get
a referral for an ultrasound but I
eventually did, and multiple cysts were
found on my ovaries,” she says. “This,
coupled with the high testosterone, led
to the diagnosis.”
PCOS is thought to be one of the
most common hormonal conditions,
affecting around one in 10 women.
Yet it is also often overlooked and
under-managed. A survey of 1,385
women from 48 different countries
who had been diagnosed with PCOS
revealed that it had taken one third
(33.6%) more than two years to receive
a diagnosis; nearly half (47.1%) had
seen three or more health professionals
before receiving a diagnosis; and only
15.6% said they were satisfied with the
information they received. 1
It’s an experience to which Lovell can
relate. “I wasn’t offered any treatment
IN BRIEF
• Whilst there is no ‘cure’ for PCOS,
a healthy lifestyle can help to
reduce symptoms and long term
health risks.
• Between 50-70% of women with
PCOS have insulin resistance.
• An anti-inflammatory,
Mediterranean-style diet
with plenty of colourful fruits
and vegetables for fibre,
micronutrients and antioxidants,
plus good quality protein and
healthy fats can support PCOS.
• Omega-3 fatty acids, vitamin D,
zinc and vitamin A can support
inflammation, skin and gut health
to better manage PCOS.
• Managing stress and maintaining a
healthy weight are also key.
as I didn’t have insulin resistance nor
was I trying to conceive,” she says.
Lovell isn’t alone. Mimi Hawary, 28,
told Optimum Nutrition that it took five
years to receive a PCOS diagnosis. “I
didn’t get my first period until I was
around 15,” she says. “When it started,
it was so erratic and horrendously
painful. I could go six months without a
period but the doctors always said I was
young and it would settle.”
She was eventually sent for blood
tests six months after her 20th birthday.
“But they came back ‘inconclusive’ so
the GP asked me to do a blood test
on the first day of my cycle,” she says.
“This was really frustrating because
my periods were so irregular I couldn’t
predict when the first day would be.”
Hawary also had an ultrasound done
privately. “The technician literally said,
‘I’ve lost count of how many cysts are
on your ovaries’,” she says. “When I
asked about my chances of conceiving,
he said that judging by the amount of
cysts I had it was ‘slim to no chance of
conceiving without medical assistance’.
But he couldn’t say for definite because
that’s just one symptom.”
She was referred to a hormone
specialist, then to a gynaecologist who
offered her the contraceptive pill or coil.
But in 2018, she started to lose a lot of
weight. “By November my periods had
become regular,” she says. “By April
2020, I had lost about 35kg in total and
also fell pregnant for the first time. My
“The length of time to diagnosis can mean that women suffer for
far longer than they should with their symptoms…We would always
encourage women to speak to their doctor”
8 OPTIMUM NUTRITION | AUTUMN 2021

Feature
daughter is now seven months old.”
Dr Caroline Overton, a spokesperson
for the Royal College of Obstetricians
and Gynaecologists, explains that
because symptoms of PCOS can
come and go, and because there is a
varying scale of symptoms, it can make
it difficult for women like Lovell and
Hawary to receive a diagnosis.
“The length of time to diagnosis can
mean that women suffer for far longer
than they should with their symptoms,”
she says. “We would always encourage
women to speak to their doctor if they
are having symptoms and ask to have
a second opinion or be referred to a
gynaecologist if they feel that they are
not getting answers.”
She adds that whilst there is no cure
for PCOS, there are ways in which
women can manage their symptoms.
“Medical treatments aim to manage
and reduce symptoms which, when
coupled with a healthy lifestyle, can
reduce any long term health risks,” she
says.
“Leading a healthy lifestyle is one of
the main ways to reduce the risks of any
long term health issues associated with
PCOS. This includes eating a balanced
and healthy diet, eating regular meals,
and regular exercise.
“Maintaining a healthy BMI [body
mass index] can help to manage
symptoms of PCOS, and can reduce
the risk of heart problems, high blood
pressure and cancer. Having a healthy
weight can also increase the likelihood
of having regular periods and increase
fertility.”
Insulin resistance
According to research, between 50 to
70% of women with PCOS have insulin
resistance, 3 which is when cells stop
responding to the hormone insulin.
Insulin is a hormone that regulates
blood sugar. When we eat, food is
broken down into sugar (glucose),
which enters the bloodstream and
WHAT IS PCOS?
PCOS is a condition that can affect periods, fertility and aspects of appearance.
According to NHS guidelines, at least two of the following three criteria should
be present in order for a diagnosis to be made: 2
• Excess androgens; a name given to a group of hormones that includes
testosterone, DHEA-S and androstenedione. High levels of these hormones
can result in excessive facial or body hair, oily skin, acne, thinning or hair loss,
weight gain and mood changes.
• Polycystic ovaries; these are egg follicles that haven’t been released upon
ovulation and end up ‘stuck’ on the ovaries.
• Irregular or absent periods; caused by a lack of ovulation.
When it comes to specific nutrients…omega-3 fatty acids, vitamin D,
zinc, vitamin A and adequate protein can support inflammation, skin
and gut health to better manage PCOS symptoms...
signals the pancreas to release insulin.
The insulin then lowers the blood
glucose levels by stimulating uptake into
cells, where it can be stored as glycogen
until it’s needed for energy.
With a lot of glucose in the
bloodstream, however, the pancreas has
to produce more insulin to get it into
the cells. Over time, cells can eventually
stop responding to the insulin,
becoming insulin resistant, which is a
precursor to type 2 diabetes.
When it comes to PCOS, Lovell
explains that excess insulin can impair
ovulation, causing the ovaries to
produce more androgens and resulting
in associated symptoms such as acne
and hair thinning. “High insulin also
reduces sex hormone binding globulin
(SHBG),” she says. SHBG is like a
sponge for excess hormones, so if there
are lower amounts in the body then
there will be more androgen hormones
running free.
According to Lovell, balancing blood
sugar and insulin levels are therefore key
in the management of PCOS. “Avoiding
refined carbohydrates and too much
sugar is helpful,” she says. “An antiinflammatory,
Mediterranean-style
diet with plenty of colourful fruits and
vegetables for fibre, micronutrients and
antioxidants, plus good quality protein
and healthy fats can support PCOS.”
When it comes to specific nutrients,
she says that omega-3 fatty acids,
vitamin D, zinc, vitamin A and adequate
protein can support inflammation, skin
and gut health to better manage PCOS
symptoms. “I might also consider
nutrients like magnesium, alpha-lipoic
acid [found in yeast, liver, kidney,
spinach and broccoli] and myo-inositol
[vitamin B8] which can help to regulate
insulin sensitivity,” she adds.
The breakfast club
Women with PCOS and insulin
resistance might also benefit from
enjoying a bigger breakfast, according
to a study from Tel Aviv University,
Israel. 4
Sixty women suffering from PCOS
with a normal BMI were randomly
assigned to one of two calorie
maintenance diets with identical foods
for 12 weeks. One group consumed
more of their calories at breakfast and
reduced their calorie intake through the
rest of the day, whilst the other group
had a smaller breakfast and consumed
the majority of their calories in their
evening meal.
Neither group experienced a change
in BMI, but whilst participants in
the ‘big dinner’ group maintained
consistently high levels of insulin and
testosterone throughout the study,
those in the ‘big breakfast’ group
experienced a 56% decrease in insulin
resistance and a 50% decrease in
testosterone. These reductions led to a
50% rise in ovulation rate by the end of
the study.
Professor Oren Froy, the study’s
lead author, said: “The research
clearly demonstrates that indeed the
amount of calories we consume daily
is very important, but the timing as to
when we consume them is even more
important.”
Gut health
Increasingly, research also highlights
the importance of gut health. According
to Lovell, imbalances in bacteria within
the gut microbiome can contribute to
inflammation and associated metabolic
disorders. The growth of so-called ‘bad’
bacteria can also “impede the proper
excretion of hormones from the body”,
she says, “which can drive PCOS and
make symptoms worse”.
Investigating the impact of gut
bacteria on PCOS, researchers from the
University of California’s San Diego
School of Medicine, USA, found that
women with PCOS had less diverse
populations of gut bacteria compared
to those without the condition and
compared to those with polycystic
ovaries but no other features of PCOS. 5
This lack of diversity in gut bacteria,
the researchers said, was also linked to
elevated testosterone levels, suggesting
that testosterone and other androgen
OPTIMUM NUTRITION | AUTUMN 2021
9

On Your Plate
GRILLED COURGETTES WITH WARM
YOGHURT AND SAFFRON BUTTER
Noor and Yotam say:
“This recipe is inspired by kousa b’laban, a Levantine dish of stuffed baby marrow cooked in yoghurt. In this simplified version,
the yoghurt sauce and grilled courgettes are cooked separately, then served with a quick saffron butter to spoon on top. There’s
a bit of an art to cooking yoghurt without having it curdle; stabilisers such as cornflour and egg yolk tend to do the trick, as does
cooking the yoghurt on a moderate heat, stirring continuously and gently warming through without boiling. The result: a silkysmooth
and tangy sauce, great for these courgettes but also with other grilled veggies, fatty meats or even as a sauce to pasta.”
Prep 10 mins | Cook 30 mins
Ingredients
• 30g unsalted butter
• ¼ tsp saffron threads, roughly
crushed
• 4 small, pale green or regular
courgettes, tops trimmed slightly and
courgettes halved lengthways (600g)
• 2½ tbsp olive oil
• 1 tsp cornflour
• 300g Greek-style yoghurt
• 2 garlic cloves, crushed
• ½ tsp dried mint
• ¾ tsp coriander seeds, toasted and
roughly crushed with a pestle and
mortar
• 1½ tbsp mint leaves
• ½ lemon
• Salt and black pepper
Method
Preheat the oven to a high grill setting.
Put the butter and saffron into a
small saucepan on a medium heat.
When the butter has melted, set aside
to infuse.
Place the courgettes on a parchmentlined
baking tray and toss with 2 tbsp
of oil, ⅓ tsp of salt and a good grind
of pepper. Arrange them cut side up
and grill for 15–20 mins, until nicely
charred and softened.
Towards the last 10 mins of grilling
time, make the sauce. In a large bowl,
whisk together the cornflour and
3 tbsp of water until smooth, then
add the yoghurt, garlic, dried mint,
the remaining ½ tbsp of oil and ½
tsp of salt. Whisk to combine, then
transfer to a large, non-stick sauté
pan on a medium heat. Cook, stirring
continuously, for about 10 mins, or
until thickened slightly and warmed
through. Do not let the sauce boil, or it
will split.
Transfer the warm yoghurt sauce
to a plate with a lip and top with the
courgettes, grilled side up. Spoon over
the saffron butter, then sprinkle with
the coriander seeds and mint leaves.
Squeeze over the lemon half and serve
right away.
Make it your own
• No saffron? Use a pinch of turmeric
instead.
18 OPTIMUM NUTRITION | AUTUMN 2021

DO YOU
HAVE
AN APPETITE
FOR
NUTRITION?
Take our quiz to test your nutrition knowledge
a
b
c
a
b
c
a
b
c
a
b
c
a
b
c
1. WHICH IS HIGHER IN VITAMIN C?
A red pepper, raw
An orange
A kiwifruit
2. WHAT GIVES CARROTS AND SWEET
POTATOES THEIR ORANGE COLOUR?
Lycopene
Beta-carotene
Tartrazine
3. WHICH FOOD DOES NOT COUNT
TOWARDS YOUR FIVE-A-DAY
Sweet potato
Potato
Baked beans
4. WHAT DOES THE BODY PRODUCE
USING BETA-CAROTENE?
Vitamin A
Vitamin B
Cholesterol
5. WHAT IS A PREBIOTIC?
Food for your gut bacteria
Something your doctor prescribes
A supplement containing beneficial
microbes
a
b
c
a
b
c
a
b
c
a
b
c
a
b
c
a
b
c
6. WHICH SPICE IS ASSOCIATED
WITH BENEFITS FOR BLOOD SUGAR
REGULATION
Turmeric
Cinnamon
Nutmeg
7. WHICH VITAMIN AIDS IRON
ABSORPTION?
Vitamin C
Vitamin D
Vitamin A
8. WHICH IS CONSIDERED AN OILY
FISH AND A GOOD SOURCE OF
OMEGA-3 FATS?
Cod
Haddock
Mackerel
9. FERMENTED FOODS SUCH AS
SAUERKRAUT, KIMCHI AND KEFIR
ARE COMMONLY EATEN FOR THEIR:
Gut health benefits
Heart health benefits
Eye health benefits
10. WHICH OF THE FOLLOWING IS NOT
A TYPE OF SUGAR?
Maltodextrin
Barley malt syrup
Locust bean gum
11. WHICH SPICE IN CURRY
IS CONSIDERED TO BE ANTI-
INFLAMMATORY?
Turmeric
Coriander
Cumin
a
b
c
a
b
c
a
b
c
a
b
c
12. APPROXIMATELY HOW MANY
GRAMS OF SUGAR ARE IN ONE
TEASPOON?
7
4
2
13. WHICH VEGETABLE IS A GOOD
SOURCE OF CALCIUM?
Kale
Radishes
Carrots
14. WHAT IS THE RECOMMENDED
INTAKE OF FIBRE FOR ADULTS?
80g
10g
30g
15. WHICH HAS THE HIGHEST SUGAR
CONTENT?
Mango
Pear
Grapefruit
HOW DID YOU SCORE?
1-5: GOOD EFFORT!
You might be interested in our free,
bite-size video series Food as Fuel,
designed to cut through the myths and
false information about nutrition.
Sign up at ion.ac.uk/food
6-9: IMPRESSIVE!
Have you considered subscribing to
Optimum Nutrition? You’ll be able to keep
up to date with the latest in health and
nutrition with a new issue delivered to
you every quarter.
Subscribe at ion.ac.uk/mag
9+: YOU CLEARLY KNOW YOUR
STUFF!
Why not take things a step further
and study nutritional therapy with the
Institute for Optimum Nutrition?
Find out more at ion.ac.uk/nt
ANSWERS: 1. a / 2. b / 3. b / 4. a / 5. a / 6. b / 7. a /
8. c / 9. a / 10. c / 11. a / 12. b / 13. a / 14. c / 15. a
OPTIMUM NUTRITION | AUTUMN 2021
19

Interview
IT ALL
STARTS
WITH
ONE...
Community chef Sanjay Prosenjit Kumar tells Alice Ball how his culinary travels fuelled his
passion for slow food, and how he’s working to eradicate food poverty one person at a time
30 OPTIMUM NUTRITION | AUTUMN 2021

Interview
S
ardines weren’t born in
“ Cornwall, they came to
Cornwall. I wasn’t born in
Cornwall, I went there. Cooking
brought me here and gave me a
passport. It is my role to give something
back to cooking by teaching people to
eat better.”
Sanjay Prosenjit Kumar would
compare himself to a sardine. Just like
the small fish, which migrate from
the Mediterranean up to the coast of
Cornwall, the Indian-born chef has
travelled far and wide throughout his
career; from the royal kitchens of Saudi
Arabia to training under Raymond Blanc
in Oxford.
Now based in Hertfordshire, Kumar
has spent the past decade working as a
food activist, using a skills based approach
to tackle food poverty. In 2012, whilst
living in Truro, he founded the aptly
named School of Cornish Sardines, a
mobile cookery school that teaches people
to eat well on a shoestring.
The enterprise came about after
Kumar was asked to perform a cookery
demonstration for a local school as part of
Falmouth Oyster Festival.
“I went into the kitchen and there
was a big deep fat fryer waiting to fry
sausages,” he says. “That was when my
jaw dropped. [We’re doing] all of these
demonstrations for people who can afford
oysters. What are we doing for these
children who are the consumers of the
future?”
Inspired to tackle the problem directly,
he enrolled onto a social enterprise
course.
“In Cornwall there is this dichotomy
where there’s lots of fresh produce,
but there is so much food poverty,” he
explains. “My idea was using cooking as
the tool to educate and upskill people.”
He quickly realised, however, that food
poverty can take many forms.
“I was asked to do a barbecue in
Newquay for people with learning
difficulties,” he explains. “I gave this corn
on a cob to a guy who had a physical
disability and he dropped it. That’s when
I realised that all these classes and all this
cooking is only for people who have the
time, money and ability.”
In response, he set up a weekly club
where those with learning difficulties
could come together over food. “Some
would come just for the sound of a packet
crunching or a fish frying in a pan,” he
says. “But we’d sit and eat together. That
is my vision of being a cook.”
But like a sardine, he’s been on quite
the adventure to get here. “For a while in
the ocean you drift,” he says, “Then you
drag yourself with the current and you
swim a little bit. Then destiny takes you
some place.”
Humble beginnings
Born in Kolkata, India, Kumar has fond
memories of his grandmother’s kitchen,
where food would be cooked over a coal
and wood fire burner stove. “We would
huddle around and fresh chapattis or rice
and daal would be made and distributed
according to your age,” he recalls. “You’d
sit on the floor and you’d eat out of these
copper plates.”
Yet becoming a chef, he says, was a
“complete accident”. Whilst most of his
classmates went on to become doctors
or engineers, he opted for a course in
hotel management. “I was always a bit
different from the pack,” he says. “Not
looking for anything mainstream.”
Having been given the opportunity
to work in hotel kitchens, he quickly
discovered that becoming a chef could
open up “a world of opportunities”.
“You could be getting salmon and
caviar from Norway, and be eating white
asparagus from India.”
In 2000, Kumar was working in
the Taj Exotica in Goa whilst the
ambassador of Saudi Arabia was visiting.
“In Cornwall there is this dichotomy where there’s lots of fresh
produce, but there is so much food poverty...My idea was using
cooking as a tool to educate and upskill people...”
“It was a day when I was in the kitchen
and the head chef was off,” he says. “I
went to ask him how his [dish] was and
he said he loved it. Then he said, ‘would
you like to go and cook for the king?’”
Within a few months, Kumar had a
passport and was on a flight to Saudi
Arabia to cook in the royal kitchens.
“It was opulence to the bar of
something you never see. During
Ramadan, we cooked camels in pans and
stuffed them with lambs and chicken.”
Working with colleagues from the
Philippines, Sudan and Pakistan, it was
his first glimpse into how food could
unite people.
“Beyond all artificially created
differences, human beings connect with
food,” he says. “We would sit around a
table on a floor and literally break bread.
That’s the beauty of food; it unites the
world and it unites people.”
He also became aware of food
shortages and excess. “The problem
and the solution are the same,” he says.
“You’ve got to channel that to someone
else’s benefit. If there is less food, you
have to share. If there is more food, you
definitely have to share.”
After two years he returned to the
Intercontinental in Mumbai, before
coming to England in 2003 with just
£200 in his pocket. From Chelmsford
onto Oxford, where he trained under
Raymond Blanc (“I didn’t know who
he was”), then on to Manchester
and Tunbridge Wells before settling
in Cornwall, where he gained an
appreciation for fresh, local produce.
“You could actually connect with the
producer and understand where food
Image: Zagzig © 123RF.com
OPTIMUM NUTRITION | AUTUMN 2021
31