Optimum Nutrition - Summer 2022 - PREVIEW

IN THIS ISSUE
08 THE TRUTH ABOUT CRASH DIETS
Hatty Willmoth delves into extreme dieting, from its immediate risks to the long-term effects it can have on metabolism
12 BACK TO WORK
14 ALL ABOUT CHOLINE 16
For those of us heading back to the
office, Catherine Jeans shares tips to
optimise in-person work days
19
Hatty Willmoth looks at steps we
can take to protect ourselves against
environmental toxins
Could choline, an ‘essential’ nutrient,
benefit our brain function — even
before we are born?
HIDDEN TOXINS RESEARCH UPDATE 24
Why supplementing vitamin D and
omega-3 may be more complicated than
picking any product off the shelf
28 YOUNG LIVES
BLOOD SUGAR BASICS 32
Catherine Morgan finds out how
mindful eating may help to slow down
her own little speed eater
35
Judith Orrick explores the sweet and
savoury potential of cardamom and how
to use every bit of these precious pods
41
STORECUPBOARD HERO
IN SEASON
Mackerel is one of Britain’s biggest
seafood exports, and woefully underused
in the UK’s kitchens
50
NUTRITION IN PRACTICE
Paula Werrett on how studying
nutrition took her to a career as head of
undergraduate provision at ION
22
30
Rachel Hampson explains what blood
sugars are, how to stabilise or improve
them, and why we should all care
38
DIFFERENT STROKES
Louise Wates and Hatty Willmoth
discover the power of meditation to help
tackle chronic back pain
44
WORLD CUISINE
Mikkel Karstad, world-renowned chef
and author of Nordic Family Kitchen,
tells us about seasonal Nordic cuisine
INTERVIEW
Sam Feltham talks to Hatty Willmoth
about the Public Health Collaboration’s
aim to save the NHS billions
LOVE YOUR SKIN
As the UK basks in the summer
sunshine, find out how some nutrients
may help to protect your skin
ON YOUR PLATE
MOVE IT
04 COMMENT & NEWS | 26 KIDS’ PAGES | 36 FROM ION | 42 BOOK THERAPY | 47 QUIZ
You don’t have to go low carb to enjoy
these delicious recipes from Budget Keto
Kitchen by Monya Kilian Palmer
40
KITCHEN CHEMISTRY
Tofu: whether you love it or are baffled
by it, here’s how to get the most out of
this plant-based complete protein
48
Having quit dancing lessons as a teen,
Hatty Willmoth goes back to the barre
and discovers the joys of adult ballet
OPTIMUM NUTRITION | SUMMER 2022
3

Feature
THE TRUTH ABOUT CRASH DIETS
Hatty Willmoth explores how extreme dieting can be counterproductive and even dangerous
F
or those who fear their body
will not be ‘acceptable’ in
swimwear in time for the
summer holidays, a short-term, quickfix
‘crash’ diet may seem the solution;
drastically reducing daily calorie intake
in a bid to rapidly shed the pounds.
According to Andrew Jenkinson, a
bariatric surgeon and author of Why
We Eat (Too Much), summer often
compels people to crash diet, as do
upcoming events such as weddings. A
famous recent example of this was Kim
Kardashian posting about turning to
extreme dieting methods in a bid to fit
into a vintage Marilyn Monroe dress at
this year’s Met Gala. 1
IN BRIEF
• Crash diets can lead to deficiencies,
fatigue, increased risk of diseases,
and various other side effects.
• Hunger hormones mean a crash
diet is difficult to maintain.
• Due to the way it affects your
metabolism, quick weight loss can
be counterproductive long term.
• Focus on health, rather than
calories, in order to sustain change.
Regardless of the specifics,
crash dieting is not a good idea
But there can be plenty of other
motives. Those who recently gained
weight — for instance during the
pandemic — may turn to crash dieting
as a swift ‘undo button’. Indeed, private
healthcare provider Bupa observed a
tremendous rise in internet searches
related to crash dieting between January
and December 2021. 2 Searches for ‘easy
ways to get skinny’ doubled; searches
for ‘extreme weight-loss methods’ grew
by 387%; and searches for ‘detox drinks
to lose belly fat’ soared by 800%.
Others may even crash diet regularly,
following cycles of yo-yo dieting;
gaining weight in winter and losing it
for summer. Regardless of the specifics,
8 OPTIMUM NUTRITION | SUMMER 2022

Feature
crash dieting is not a good idea.
Immediate risks
Registered nutritional therapy
practitioner Julia Young says there are
risks associated with rapid weight loss.
“The first thing that normally
happens when we’re losing weight is we
lose a lot of water,” she says. “But there
is a danger that we lose muscle as well.”
There is even a risk of losing muscle
tissue from vital organs. Then there is
the risk of rapidly releasing toxins.
“We store toxins in our fat cells,” says
Young. “So if we’re losing weight very
quickly, then we’re going to release
those toxins in our body.”
Toxins are a hotly-contested topic,
but some believe they can push out
nutrients, increase the risk of cancers
and other diseases, and put extra
burden on the liver. (See p19 to learn
more about environmental toxins.)
Crash dieters may also become
deficient in vitamins and/or minerals.
“If you’re cutting out food groups and
vitamins and minerals that you would
get from eating a balanced diet,” says
Young, “that will be an issue.” For
example, a diet lacking in vitamins C
and D may weaken a dieter’s immune
system so they keep getting sick. Other
deficiencies can cause thinning hair, low
mood, irritability and dizziness. Long
term, it could lead to conditions such as
hair loss or brittle bones.
A crash dieter who is not getting
enough energy is likely to feel
persistently tired and fatigued. There is
also a risk of low blood sugar and blood
pressure, which can in turn lead to
light-headedness, nausea, blurred vision,
IMAGINE YOU’VE GONE ON A CRASH DIET
Your leptin (a fullness hormone released by fat tissue) levels have decreased as you’ve
lost weight, but your ghrelin (the hunger hormone) levels have gone up, so you’re
feeling very hungry.
Your metabolism has become more efficient; with a slower resting heart rate and
lower blood pressure, you feel colder, weaker and sleepier. Young calls this “starvation
mode”, as your body does “everything it can to conserve energy”.
It’s also becoming increasingly difficult to resist all the food you have banned
yourself from eating, and eventually you are likely to crack. At this point, low fullness
hormone levels (peptide-YY (PYY) and glucagon-like peptide-1 (GLP-1)) mean you
can eat a great deal before feeling the need to stop.
You may give up on your diet completely; perhaps you’ve been to the wedding,
or summer’s over, or you’ve just had enough. Now, with a much lower BMR and
adjusted hormone levels, your body is primed to gain weight quickly.
And this cannot be easily resolved. Jenkinson says: “Those hormones can be
affected for up to a year after a diet has finished. So you can feel less full and more
hungry even a year after you stopped dieting.”
“It’s like a man walking past an oasis in the desert when he hasn’t
drunk water for three days”
confusion and fainting.
Extreme patterns of eating can even
be precursors to full-blown eating
disorders such as anorexia, 3 which
has the highest mortality rate of any
psychiatric condition. 4 The strain that
drastic weight loss puts on the body
can also, in the long term, increase the
risk of brain damage, diabetes, altered
immune function, liver and/or kidney
failure, heart attack and stroke. 5
Gaining it all back again
Rapid weight loss is also rarely
sustainable. “You quite often see
people promoting losing a stone in
a couple of weeks or something, and
it’s very attractive,” says Young. “But
more often than not, people regain the
weight because if you return to the way
you’re eating, you’re going to put that
weight back on.”
Even on moderate diets, weight
loss is difficult to maintain. One 2020
study concluded from the weight loss
trajectories of nearly 22,000 patients
that any positive effects of moderate
dieting had largely disappeared after a
year.6 Meanwhile, an older Californian
study simply declared all dieting to
be ineffective because the majority of
participants eventually regained more
weight than they initially lost.7
Yet Jenkinson notes that there is
some evidence to suggest “the faster
you lose weight, the faster you regain
it”, implying drastic weight loss is
extremely difficult to sustain.
Basal metabolic rates
Difficulty maintaining weight loss
is largely due to hormonal changes.
Weight is determined by the
hypothalamus, the part of the brain
that keeps us in a state of homoeostasis
(stability), and which maintains our
‘weight set point’ — the ‘ideal weight’
determined by the brain. It does this by
releasing different amounts of hunger
and satiety (fullness) hormones,
and by altering our basal metabolic
rate (BMR). This is the amount of
energy it takes to run a human — to
beat a heart, inflate and contract a
couple of lungs, maintain a constant
internal temperature, and so on — and
makes up about 70% of the energy
we normally use. The hypothalamus
adjusts our BMR in response to
available and needed energy, so when
we eat less, we burn less energy.
In other words, when we lose
weight, our metabolism becomes more
efficient.
Hunger hormones
Hormones powerfully control how
hungry a person feels. Ghrelin,
secreted by the stomach and known as
the ‘hunger hormone’, could bend even
the strongest of wills.
Jenkinson explains what happens
during a crash diet: “That ghrelin level
will go very, very high and you’ll have
this voracious hunger and food-seeking
behaviour. Hormones guide your body,
tell it what to do. It’s very hard to resist
those instructions. So, when ghrelin
is sky high, it is almost impossible to
walk past a Starbucks. It’s like a man
walking past an oasis in the desert
when he hasn’t drunk water for three
days.”
Furthermore, he explains, fullness or
OPTIMUM NUTRITION | SUMMER 2022
9

Interview
KEEP CALM AND
EAT REAL FOOD
Public Health Collaboration (PHC) founder and director Sam Feltham talks to Hatty Willmoth
about his hopes to save the NHS billions by helping diabetics live real food lifestyles
S
am Feltham wants to change
the state of the nation’s health.
A former personal trainer,
snowboarding instructor, and YouTuber,
he is also the founder and director of
the Public Health Collaboration (PHC),
a registered charity that, according to
its website, is ‘dedicated to improving
public health and saving the NHS
money at the same time through better
lifestyle information’.
It’s no small project, either.
Supported by a scientific advisory
committee and patrons, PHC offers
a range of resources to the public and
doctors, including recipe leaflets, a ‘real
food GP map’, and links to external
sources of support. It even has a
cookbook called Real Food Rocks.
PHC is all about getting that
information to the public, says Feltham.
Its ambassadors programme currently
has “just shy of 300 volunteers” and is
open to applications from healthcare
professionals and interested members of
the public alike.
“They’re all in contact with local GP
practices to give them better lifestyle
information to hand out to their
patients, so our reach is getting there,
although we’ve got a long way to go.”
There is also PHC’s Lifestyle
Club, a “service that is starting to get
commissioned through the NHS to
help people better manage their type 2
and pre-diabetes, and even put it into
remission”.
Fighting diabetes with real food
At the heart of all this activity lies the
concept of ‘real food’ with a low-carb
slant. Notably, one of the members of
16 OPTIMUM NUTRITION | SUMMER 2022

Interview
“that was really the idea —
that we could simultaneously
help people get healthy and
save the NHS money”
PHC’s scientific advisory committee
is Dr David Unwin, a GP who has
previously spoken to Optimum Nutrition
about putting type 2 diabetes into
remission through a low-carb diet.
“David’s example is just incredible,”
says Feltham. “It started off just under
£30,000 a year that he was saving,
and now it’s up to £50,000. If we
extrapolated that across the 9,500 GP
practices across the country, that would
be a saving of half a billion pounds a
year for the NHS — and that’s just on
drugs for diabetes; it doesn’t cover the
preventative costs of people going on to
have surgery, which is where the main
costs of type 2 diabetes comes from.”
He adds that of the £10 billion a year
that type 2 diabetes costs the NHS, £2
billion is spent on drugs, and £8 billion
is spent on surgeries. “If we can prevent
people from going on to have surgery,
then you have massive savings as a
result.”
And he believes that such savings
are a realistic possibility for the NHS.
Unwin, he says, helped 50% of his type
2 diabetic patients into remission, and
90% of those with pre-diabetes into
remission.
When he founded the PHC, did he
expect similar success to Unwin’s?
“Yeah, that possibility was there and
that was really the idea — that we could
simultaneously help people get healthy
and save the NHS money,” he says.
“I’m absolutely hopeful for it, because
it’s coming to a point now where it is
so obvious that [support on low carb,
real food eating] is at least one of the
options that people should be offered.”
From web design to snowboarding
Whilst the ambition seems huge,
Feltham says he has always been
interested in health. As a teenager, he
worked weekends at a sports centre. “I
did everything from children’s party
coordinator to cleaning the showers.”
He remembers getting “a good view
of physical activity” — and of vending
machines full of sweets and crisps.
After university he went into website
design, but got bored and went to New
Zealand where he was a snowboarding
instructor for four years. He then
became a personal trainer, growing
a fitness bootcamp business to 10
locations across the UK, and developing
a YouTube channel and podcast.
Like many of the nutritionallycurious,
Feltham wasn’t beyond
experimenting on himself either. As
a personal trainer, he was already
compelled to promote real food diets; so
for his YouTube channel, he conducted
what he calls “overfeeding selfexperiments”,
using himself as a diet
guinea pig to demonstrate that “not all
calories are created equal”.
Sam the guinea pig
Feltham’s one-man studies involved
putting himself on three different diets
and eating twice as much as usual over
three weeks for each one, with a threemonth
washout period in between.
“The first diet was low carb, real
food,” he says, “and I was eating just
shy of 6,000 calories a day…Over
the three weeks, after taking away
any physical activity that I was doing,
protein thermogenic effects [the extra
energy that protein takes to be digested]
and loss of any fibre, I ended up in a
47,000-calorie net surplus. According
to the calorie formula, I should have put
on 6.1kg, but I actually only gained one
and a quarter, and I lost 3cm from my
waist as well. It was a really interesting
experiment just on its own.”
He then followed this up with what he
calls a “low-fat, fake food” diet. Again
eating just shy of 6,000 calories a day,
he reached an identical 47,000-calorie
net surplus, but this time gained 7.1kg
of weight and 9.3cm around his waist.
The third diet was very low fat, real
food and vegan. “I’d have porridge with
water for breakfast, and then potatoes
and beans for lunch, and then rice and
water chestnuts — stuff like this —
and fruit in between for snacks.” He
only managed a net surplus of 39,000
calories this time, because of the fibre
he was eating, but nevertheless gained
7.8cm around his waist. “To put it
in perspective,” he says, “the daily
recommendation for fibre is 30g, and
I was eating 175g a day. My wife was
rather unhappy with that — it wasn’t
pretty!”
He adds: “The idea is that even if
you have similar net calorie surpluses,
you can end up with different results,
because your body does completely
different things with the food that you’re
eating.” Then, with a grin: “That caused
a bit of a storm at the time.”
Setting up the PHC
Yet despite the traction gained by his
experiments, Feltham wasn’t satisfied.
“We were helping hundreds of people
every month with their health,” he says.
“But one thing became clear after five
years of doing that: we were going to
constantly be in an uphill battle unless
the root causes were actually fixed.
“And so I fell into this philosophical
quandary where I was thinking, do I
carry on with the fitness bootcamp
business or do I create a charity that can
really try to tackle this issue, and try to
fix it?”
He pitched his idea for the PHC
to the people who now make up its
scientific advisory committee. “They
said, ‘great idea, but where’s the money
going to come from?’.” However,
an online crowdfunding campaign,
launched in February 2016, doubled its
target within a month.
In March 2016, Sam closed down
his fitness business to focus all his
attentions on the PHC. “And we’ve
been going from strength to strength
ever since.”
Low-carb diets
Primarily, the PHC promotes lowcarbohydrate
eating. “The evidence
shows that there are some really good
starting points in terms of real food
lifestyles,” says Sam, “and a low-carb
diet in the context of weight loss and
type 2 diabetes is the best place to start,
according to randomised control trial
evidence.
“But we do absolutely advocate for
whichever real food lifestyle works for
you. If your blood work is showing
improvement, and you’re able to
maintain personal good health, then
whatever real food lifestyle works for
you is the one that works for you.”
Public policy or personal choice?
Other PHC projects include
Collaboration for Kids, which aims to
improve children’s food environment
and information to reverse the incline
of childhood obesity, and Real Food
Runners, an informal running club for
people following real food lifestyles.
But although PHC promotes lifestyle
changes for the individual, it mainly
targets doctors and wants to influence
government policy.
So I ask Sam whose responsibility
“I fell into this philosophical quandry where I was thinking, do
I carry on with the fitness bootcamp business or do I create a
charity that can really try to tackle this issue, and try to fix it?”
OPTIMUM NUTRITION | SUMMER 2022
17

On Your Plate
BIG ON TASTE, LOW ON CARBS
Budget Keto Kitchen is the third book from Monya Kilian Palmer, a trained chef and professional
recipe developer. Since moving to the UK from South Africa in 2012, Palmer has worked for
Heston Blumenthal’s Fat Duck Group as well as Le Cordon Bleu International. Her 2020 debut
best-seller, Keto Kitchen, was followed by Lazy Keto Kitchen in 2021. We’ve picked three recipes,
packed with flavour and great ingredients!
Budget Keto Kitchen by
Monya Kilian Palmer is
published by Kyle Books.
Photography by Maja
Smend and Sam Folan
CREAMY BAKED FISH
WITH BABY ONIONS & THYME
Monya says: “This is a simply scrumptious fish dinner where a garlic and thyme-infused cream bakes down to create a glorious
flavour. The baby onions add just a hint of sweetness, and if you find yourself with half a bag of baby onions left over after making
this dish, why not use them to make pickled onions. That’s what I do!”
Serves 4
Prep time 10 mins
Cook time 40 mins
Ingredients
• 150g baby onions or round shallots,
halved through the root (see tip for
easy peeling)
• 1 tsp olive oil
• 1 tsp unsalted butter
• 3 garlic cloves, finely chopped
• 3-4 fresh thyme sprigs, leaves picked,
plus extra to garnish
• 250ml double cream
• 4 white skinless fish fillets
(approximately 120g each)
• Salt flakes and salt
• Ground white pepper and freshlyground
black pepper
Method
Preheat the oven to 200C/180C fan/
gas 6 and grease a small roasting dish (it
should be the right size to allow all 4 fish
fillets to sit snugly together when we add
them later).
Place the onions in the prepared
roasting dish and drizzle over the olive oil,
then toss to coat. Roast for 15 mins.
Meanwhile, melt the butter in a
saucepan over a medium heat. Add
the garlic and cook for 1–2 mins until
softened. Add the thyme leaves and cream
and bring to a simmer for 3-4 mins,
allowing the cream to reduce a little. This
will give you maximum infusion of flavour
from the garlic and thyme. Season with
salt and ground white pepper.
Once the onions are done, remove
them from the oven and tip them into the
pan of simmering cream. You will use the
roasting dish again, so set it aside for now.
Remove the fish fillets from their
packaging and lightly season all sides
with salt and ground white pepper. Lay
them in the roasting dish, then pour
the creamy onion mixture over the top,
nestling the onions in between the fish.
Bake for 23–24 mins.
Season with salt flakes and freshlyground
black pepper, and serve with
more picked thyme leaves scattered over
the top.
Serving suggestion
Flake the fish in the pan after baking
and serve over creamy cauliflower rice
or courgetti.
Tip
Peeling baby onions or shallots can be
frustrating. Place them in a bowl. Pour
boiling water over them, then leave
them to sit for 15-20 mins. This makes
them much easier to peel.
32 OPTIMUM NUTRITION | SUMMER 2022