1 November 2017

GI News - November 2017

GI News

GI News is published by the University of Sydney, School of Life and Environmental Sciences and the Charles Perkins Centre

Publisher:
Professor Jennie Brand-Miller, AM, PhD, FAIFST, FNSA
Editor: Philippa Sandall
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FOOD FOR THOUGHT

THE AMAZING STORY OF BIG CHICKEN
Big Chicken
How did chicken take over the world’s diet? Industrial farming is a big part of it. But secret sauce is 63,000 tons of antibiotics every year. This insight comes from Maryn McKenna in her new book – Big Chicken. Before those innovations, hens were just leftovers from egg production and “a chicken in every pot” was an empty political promise reports ConscienHealth’s Ted Kyle.

When you put antibiotics in a chicken’s food, they grow big and fat. So farmers can make an abundant supply of plump chickens on an industrial scale. Now, Americans eat far more chicken than any other meat. And farms dump millions of pounds of antibiotics into the environment. Most of it goes into chicken manure, which in turn becomes fertilizer for plant crops. The circle of farm life has become a circle of antibiotics. McKenna tells the story of Acronized® chicken from the 1950s. American Cyanamid promoted – and trademarked – its chicken soaked in antibiotics for a longer shelf life: They dipped all the chicken in the US in a bath of antibiotics and sealed it up in packages and thought it would last for a month on the shelf and people could eat it and be fine? Were they crazy? To me that story was really the purest distillation of this uncomplicated belief that science was going to make our lives better.

The problem goes beyond antibiotic resistant superbugs. Dumping all these antibiotics into the environment raises the possibility of contributing to the rise of obesity prevalence. Lee Riley and colleagues explained this theory in a 2013 paper. They estimate that as much as 18 million pounds of antibiotics from animal farming go into the environment. They describe evidence for how antibiotics can move from environment and into the food chain. And thus, they explain the possible link to obesity: “We propose that chronic exposures to low-residue antimicrobial drugs in food could disrupt the equilibrium state of intestinal microbiota and cause dysbiosis that can contribute to changes in body physiology. The obesity epidemic in the United States may be partly driven by the mass exposure of Americans to food containing low-residue antimicrobial agents.”

Ultimately, McKenna sees hope in the story of big chicken and antibiotics. Business, economics, and regulators might have failed. But consumers are succeeding. People are demanding chicken produced without antibiotics. McDonald’s is making a big move in that direction. In turn, it’s exerting a big influence on the rest of the industry.

The move away from antibiotics in chicken can be a case study for beef and pork production. Consumer demand for antibiotic-free meat is growing. Even in China, government is pushing for changes in meat production. It’s a work in progress. 

WHAT’S NEW?

CAN CHICKEN SOUP CURE A COLD? 
Chickens in the garden
Of all the homemade winter cure-alls, chicken soup is the best known and most loved. In fact, the term “chicken soup” has become idiomatic for all things restorative; benefiting every possible problem from the head to the soul. In many different cultures, chicken soup is a traditional treatment for symptoms of the common cold.

Chicken soup is widely known as “Jewish Penicillin”. Some of this may reflect the traditional use of chicken soup as a Sabbath meal and the perceived importance of piety in affecting health outcomes. Nonetheless, it’s a staple among Jewish grandmothers and their snotty grandchildren, worldwide.

Even before the Olympics, Greek grandmothers may also claim they invented Chicken soup for the common cold. Avgolemono (Αυγολέμονο) is a thick egg and lemon (chicken) broth widely administered for the symptoms of cold and flu, or for their prophylaxis on wet winter evenings. Although a quintessentially Greek dish, it is likely that its therapeutic use has its earliest origin in Sephardic tradition. Adding the “all important” lemon may have been the Greek contribution.

Not to be outdone, most Chinese grandmothers are ready and primed to produce chicken soup at the first sign of a sniffle. In traditional Chinese medicine, illness is perceived as a state of imbalance between yin and yang. Yin represents the darker cooling forces, while yang embodies the lighter, warmer forces. In this paradigm, the treatment for cold is obviously yang, and chicken soup is a prime example: restoring the yang forces and balancing the cold of yin.

There have been a few attempts to definitively establish these cold-busting effects in clinical studies. One 1978 study found that sipping hot chicken soup increased the velocity of nasal secretions (runny noses) in healthy volunteers. This could be a good thing for clearing a blocked nose but the study showed it only worked for a few minutes and wasn’t any more effective than hot water.

Beyond the steam, there is no chemical or biological reason for having chicken soup when we are sick with a cold. However, the psychology of chicken soup can’t be overlooked. Chicken soup is a comfort food on a day when we would really like some comfort. With the expectation of efficacy, the succour of being cared for, the taste of home on an otherwise dull day. There’s a good reason for chicken soup for the soul.

Study 

The Longevity List
This is an edited extract from Prof Merlin Thomas’s The Longevity List – Myth Busting the Top Ways to Live a Long and Healthy Life available from www.exislepublishing.com. Thomas is a physician, scientist and author who uses the cutting-edge science and research to help people live better, longer and healthier lives. He has been featured in many of the world’s leading medical journals, and is the author of Understanding Type 2 Diabetes, and Fast Living, Slow Ageing.

BREAST MILK SUGARS FOUND TO FIGHT BACTERIA
Mother and baby
The most prominent infection that affects newborns is called Group B Streptococcus (GBS), which can lead to babies developing sepsis or pneumonia before their immune systems are strong enough to fight off the bug. While GBS can be deadly, most newborns don't get infected. Researchers have now found that although the pathogen can be transmitted to infants through breastfeeding, some mothers produce protective carbohydrates in their milk that could help prevent infection. They also report that the carbohydrates can act as anti-biofilm agents, which is the first example of carbohydrates in human milk having this function. “This is the first example of generalised, antimicrobial activity on the part of the carbohydrates in human milk,” says chemist Steven Townsend. “One of the remarkable properties of these compounds is that they are clearly non-toxic, unlike most antibiotics.”

Curious as to how GBS was infecting these young infants in the first place, researchers about 10 years ago found cases in which the bacteria were transmitted through breast milk, despite milk's known immunologic benefits. But because most babies do not become infected with group B strep, Townsend and others wanted to see if some women's breast milk contained protective compounds that specifically fight that bacteria.

“As carbohydrate chemists, we knew from previous research that milk carbohydrates are protective against other bacteria, so we figured there would be a chance they would be active against group B strep, too,” says Townsend, who is at Vanderbilt University. To test this hypothesis in a pilot study, his lab gathered five samples of breast milk from donors, isolated the complex sugars, also called oligosaccharides, and grew GBS in the presence of the sugars. The women's GBS status was unknown.

“When bacteria want to harm us, they produce this gooey protective substance called a biofilm, which allows them to thwart our defense mechanisms,” Townsend says. “In the initial study, the oligosaccharides from one mother's milk killed nearly the entire colony. Another milk sample was moderately effective, while the remaining three showed diminished activity.”

In the current study, his team members are testing more than a dozen additional milk samples to see if they can replicate their first round of results. So far, two samples have shown activity against both bacteria and biofilms; two just worked against bacteria but not biofilms; and four helped fight biofilm formation but not bacteria. Six were relatively inactive against both. Preliminary data also suggest that some mothers produce milk carbohydrates that make the bacteria more susceptible to common antibiotics, including penicillin and erythromycin. If these results bear out through future studies, these carbohydrates could potentially become a part of an antibacterial treatment for infants or adults. They could also help reduce our dependence on some common antibiotics, Townsend says. “The great thing about these carbohydrates," he adds, "is that if they're safe for babies, they should be safe for everyone.”

Study 
BUILT ENVIRONMENTS AND OBESITY 
Bicycle
Are we building places that harm our health? Yes, unequivocally, yes we are according to distinguished professor Jim Sallis opening a survey of the young science of built environments and obesity at the National Academy of Sciences.

Well into the 20th century, big cities and small towns alike were built for people. Mixed uses meant that neighbourhood businesses served the needs of people who lived nearby. Workplaces and schools often blended into neighbourhoods. People used the streets. By the end of the century, most cities and towns were built for cars. Zoning laws separated homes from businesses. Strip malls and fast food evolved around cars. Pedestrians became second-class citizens at best. Driving to work, to shop, and to school became a big part of daily routines. Public transit faded and frayed.

Did these profound shifts in our environment play a role in the rise of obesity? That was a question rarely studied until the 21st century, said Sallis. Rodrigo Reis, Karen Glanz, and Daniel Rodríguez provided excellent overviews of what we know about this question. Especially in Glanz’s presentation on the food environment, two things were clear.

First, we certainly have good reasons to suspect that we’ve built our world in a way that promotes obesity. But second, the evidence remains thin to pinpoint the critical factors and single out solutions. When tested, assumptions often prove to be false. Considerable money and effort, for example, went toward planting supermarkets in food deserts. But those efforts, by themselves, didn’t move the needle toward better nutrition.

Likewise, efforts to control fast food outlets haven’t yet produced impressive results. Glanz made an important point. These are early days. Maybe the problem is that our methods are weak for studying these questions. Maybe the strategies need refinement. Implementation, intensity, and time are all important factors. Or maybe some of our assumptions are wrong. The time is right for asking what we really know. Which beliefs about the built environment are indeed factual? Which are presumptions? And which of them are simply myths?
—Thanks to Ted Kyle of ConscienHealth for this report.

To read more 
  • For slides and a video recording of the proceedings, click here
  • For perspective on studies of the built environment and health, click here and here
  • For a systematic review of the relationship between local food environments and obesity, click here
  • Photo: Ted Kyle

PERSPECTIVES WITH DR ALAN BARCLAY

DIABETES. IS AN EGG A DAY OK? 
Boiled eggs
The answer is a qualified yes. Here’s why. Eggs are popular. They are delicious and convenient and easy to cook. There’s also a steady stream of scientific research looking at whether we can enjoy them as part of our daily fare, or whether we should limit them. Two recent systematic reviews help explain the evidence and provide an answer for people with type 2 diabetes and those at risk. It’s worth remembering, eggs are a highly nutritious food. One hard-boiled egg is: 

  • A good source of protein and vitamins – B (B12, pantothenic acid, riboflavin, folate), A, E, and is one of the few food sources of vitamin D 
  • A relatively good source of iodine, iron, zinc and phosphorus 
  • Rich in omega-3 fatty acids and cholesterol, and is a source of saturated, poly-unsaturated, and mono-unsaturated fats, with a saturated : unsaturated fat ratio of 0.48 (the ideal ratio is less than or equal to 0.5 so they squeeze in). 
The systematic review that looked at egg consumption on cardiovascular risk factors for people with diabetes included all randomised controlled trials where people consumed either 6–12 eggs per week compared to a control group that consumed no eggs or few eggs (less than 2 eggs a week), for 12 to 20 weeks. In a total of 6 studies, the authors found that consuming 6 to 12 eggs per week had no impact on total cholesterol, LDL (“bad”) cholesterol, triglycerides, fasting blood glucose (sugar), or insulin and that HDL (“good”) cholesterol increased in 4 of the 6 included studies. While these results are encouraging, the study authors noted that “...the studies varied in diet composition aside from the addition of eggs.” Indeed, most of the studies were reduced energy (kilojoules/calories), and had beneficial ratios of saturated : unsaturated fats.

The second review looked at all of the data from observational studies and the risk of developing type 2 diabetes and found that from a total of ten studies (5 in Europe, 4 in the USA and 1 in Asia), consuming 1 egg a day was associated with a 13% higher risk of developing type 2 diabetes. However, they determined that risk was strongly influenced by where you live, with people in the USA consuming 1 egg a day having a 47% increased risk, and people living in Europe and Asia having no increased risk. The authors noted that “...in the US studies, egg intake is often associated with smoking or lower physical activity or higher intake of red meat, whereas this is generally not observed in studies outside the USA.” and that “Food preparation methods (e.g. boiled or fried eggs, whole eggs or only egg whites) or concurrent consumption of other foods that may increase diabetes risk (e.g. home fries, bacon) may also account for a part of the differences, but such information is not available in these studies.”

So yes, it is ok to eat an egg a day if you are at risk of or have type 2 diabetes – provided you enjoy them as part of a healthy balanced diet, rich in other quality proteins (lean poultry, meats and seafoods), minimally refined low GI carbohydrates, and healthy fats (e.g., Canola, olive, peanut, or sesame oil; nuts and seeds). It’s the overall eating pattern that counts. And poach don’t fry.

Declaration of interest. My family loves eggs. We keep chooks and enjoy meals made with their fresh eggs every week.

Studies 
 Dr Alan Barclay  
Alan Barclay, PhD is a consultant dietitian. He worked for Diabetes Australia (NSW) from 1998–2014 . He is author/co-author of more than 30 scientific publications, and author/co-author of  The good Carbs Cookbook (Murdoch Books), Reversing Diabetes (Murdoch Books), The Low GI Diet: Managing Type 2 Diabetes (Hachette Australia) and The Ultimate Guide to Sugars and Sweeteners (The Experiment, New York).

FOOD UN-PLUGGED

PROCESSED VEGAN FOODS 
The vegan diet is exclusively plant-based and excludes meat, fish, eggs, dairy products and honey. People choose to follow a vegan diet typically do so for a combination of reasons: ethical (not killing animals), environmental (a smaller environmental footprint), and health (a plant-only diet is better for you). Fruits, vegetables, legumes, wholegrains, nuts and seeds are nutritious options, no question. But like many food and diet trends, when opportunity knocks, the market answers with a myriad of processed products of varying nutritional quality. This month we take a closer look at the nutritional profile of some good and not-so-good vegan foods.

GOOD 
Quorn sausages – Quorn is the brand name for an interesting meat alternative composed of mycoprotein, which is a kind of stringy fungus (similar to mushrooms) that is compressed into more familiar food products such as “mince” and sausages. Quorn sausages contain more fibre per 50g serve than beef sausages, but unfortunately they don’t contain added Vitamin B12. Vitamin B12 only occurs in animal foods, so adding this essential vitamin to vegan products helps fill this dietary gap.

Chickpea and Sesame Seeds Vegetable Burgers – These contain less than half the protein of a beef burger but are packed with fibre. They are much lower in saturated fat than regular beef burgers.

Soy milk with added calcium – Soy milk is a good source of protein and is fortified with calcium and vitamin D. Note that not all plant milks (e.g. rice, oat, and nut “milks”) are fortified and generally have little protein, vitamins or minerals.

NOT SO GOOD 
Tofutti Cream Cheese – is soy-based and contains less than half the fat of regular cream cheese, but also less than half the protein. There are 13+ ingredients including added sugar, salt, thickening agents, emulsifiers and preservatives. To be fair, regular cream cheese is not a healthy choice either but generally comes with far fewer additives.

Choc Chip Cookies – are gluten-free, egg-free, dairy-free and yeast-free, but they are made with refined flours, chocolate, sugar and salt. Like any cookie (vegan or not) these are high kilojoule/calorie treats best eaten sparingly and in small amounts.

Dairy-Free Chocolate – chocolate without the dairy is still chocolate, just because it is vegan doesn’t give you a free pass to eat it in unlimited amounts.

Unsweetened Coconut Milk – this brand is better than regular coconut milk because it is has half the fat and some calcium added (not all coconut milks have calcium added so check the label). However, it has 16 times less protein than regular milk from regular cows, and has lots of additives.

Protein Snack Bar – this is a highly processed caramel and chocolate bar made according to the label with “real plant-based food ingredients.” There’s a lot of them (we counted around 50). Consider it an occasional treat and opt for an apple or an orange or a handful or nuts for a regular snack food.

Protein Snack Bar

Chocolate Frozen Dessert – This soy-based frozen dessert is lower in saturated fat than regular ice cream as the fat predominantly comes from vegetable oils (not cream). However, it’s no lower in calories (kilojoules) and the main ingredient is added sugar. Like ice cream, it’s an occasional treat.

The un-plugged truth 

  • A “vegan” label does not guarantee a healthy product. 
  • Highly processed foods vegan foods can be high in calories (kilojoules) saturated fat, salt and added sugars and are likely to have a large environmental footprint. 
  • For the healthiest vegan options stick to minimally processed plant foods, including products fortified with essential vitamins lacking in vegan diets.
Thanks to Rachel Ananin AKA TheSeasonalDietitian.com for her assistance with this article.

Nicole Senior    
Nicole Senior Nicole Senior pulls the plug on hype and marketing spin to provide reliable, practical advice on food for health and enjoyment. She is an Accredited Nutritionist, author, consultant, cook, food enthusiast and mother who strives to make sense of nutrition science and delights in making healthy food delicious.    
Contact: You can follow her on Twitter, Facebook, Pinterest, Instagram or check out her website.

KEEP GOOD CARBS AND CARRY ON

CARROTS 
ROAST CARROT HOMMOUS WITH CARROT TOP and MINT PESTO
Carrots are one of the most popular vegetables in our kitchen and for good reasons says dietitian Nicole Senior. For a start, they are very versatile: they are delicious raw or cooked, and can blend in to most dishes whether it is a stir fry, casserole, grill or salad. It’s really no wonder you’ll find them in most people’s refrigerator. One of my favourite ways to eat this sunshine-y root vegetable is roasted whole with a short length of stem still on (wash thoroughly, then just brush with a little oil and bake). With the water content reduced by the oven, the caramelisation of the natural sugars creates a kind of magic in your mouth and one of the many reasons I shall never be a raw foodist! Which reminds me of another favourite way to enjoy them: with a drizzle of extra virgin olive oil and honey (and a sprinkle of cumin if you like a little spice). I love them in soup too and marvel how well they go with chicken and chickpeas, or in the slow cooker with beef and lentils.

There’s another kind of magic that happens when carrots are cooked long and slow and turn to velvet but still hold their shape: so comforting. But of course, carrots also shine in summer salads and the trick to a super salad is to slice the carrot in long slender strips or ribbons. You can do strips or batons with a sharp knife but you’ll look like a pro if you use a julienne blade on a V-slicer that produces willowy, regular lengths that look gorgeous and perform a texture tango in your mouth. Another very modern idea is to use a spiralizer to make long curly carrot noodles (‘coodles’ anyone?) or vegetable peeler to slice long ribbons. If you do the same with zucchini you can create a two-colour ribbon salad that only needs your favourite chopped herbs and a knockout vinaigrette dressing.

Aside from all this, carrots are really good for you. They even give their name to a family of phytochemicals called carotenoids: carrots are rich in a particular type called beta-carotene that gives them their orange colour. But carrots were purple or dull yellow 5000 years ago in Afghanistan where they are thought to originate, but these ‘heirloom’ varieties are now available again and look simply spectacular on your plate. Being root vegetables, carrots of any colour are high in fibre for digestive health. They also have impressive amounts of vitamin K for healthy bones, vitamin C for immunity and potassium to maintain ideal blood pressure. And if that wasn’t enough, munching on carrots is good for the teeth and gums too because they massage the gums and increase production of saliva which rinses out the mouth and helps to protect against decay.

Raw or cooked, carrots won’t send your blood glucose on a roller coaster ride either. Why? Well, not only are they low GI (39), they have very few carbs. In fact, to get a hefty portion of carbs (38 g) from carrots you’d have to crunch through at least 5 cups or 750g (about 1½lb) raw at a sitting – a pretty awesome achievement even for carrot lovers.

IN THE GI NEWS KITCHEN

CARROT GLUT
This month we are making the most of Sydney’s carrot glut in the kitchen with Kate Hemphill’s roast carrot humous with carrot top pesto, carrot and date wholemeal muffins, some classic carrot soup and salad recipes from Elizabeth David and Jane Grigson and Barbara Solomon’s chicken and barley soup from the Monday Morning Cooking Club.

STICKS, SEEDS, PODS and LEAVES 
Kate Hemphill is a trained chef. She contributed the recipes to Ian Hemphill’s best-selling Spice and Herb Bible. You will find more of her recipes on the Herbies spices website. Or you can follow her on Instagram (@herbieskitchen). Kate uses Herbies spices and blends, but you can substitute with whatever you have in your pantry.

ROAST CARROT HOMMOUS WITH CARROT TOP and MINT PESTO 
Instead of throwing away the tops of lovely fresh carrots, make this versatile pesto with the leafy ends. Makes approx 2 cups of hommous and 1 cup of pesto.

ROAST CARROT HOMMOUS WITH CARROT TOP and MINT PESTO

1 bunch carrots, with tops, washed and cut into 5cm (2in) pieces
1 tbsp olive oil ½ tsp ground cumin
400g (14oz) can chickpeas, drained
2 tbsp tahini
1 small clove garlic
Salt, to taste
2 tbsp lemon juice
75ml (2½fl oz) olive oil

Pesto 
2 cups carrot tops, loosely packed
1 cup flat leaf parsley, loosely packed
3 sprigs mint, leaves picked
1 clove garlic
40g (1½oz) parmesan, grated
30g (1oz) pine nuts
100ml (3½fl oz) olive oil

Preheat the oven to 180C (350F). Toss carrots in olive oil and cumin and roast for 40 minutes until soft and browned. • To make hommous, combine cooked carrots with chickpeas, tahini, garlic, salt and lemon juice in a food processor. Blend while pouring in oil and blitz until smooth. • For the pesto, pulse carrot tops, parsley, mint, garlic, parmesan and pine nuts in a food processor to break down, then add oil while blending. Season to taste.

Per serve (75 g)
740kJ/175 calories; 3.5g protein; 15g fat (includes 2.5g saturated fat; saturated : unsaturated fat ratio 0.2); 5g available carbs (includes 1.5g sugars and 3.5g starches); 3g fibre; 125mg sodium; 185mg potassium; sodium : potassium ratio 0.68

CARROT and CASSIA DATE MUFFINS 
The mashed carrot gives a wonderful moist texture and the dates give a natural sweetness to this tasty, better-for-you, lunchbox treat. Prep: 15 mins • Cook: 30 mins • Makes: 12

CARROT and CASSIA DATE MUFFINS

500g (1lb 2oz) carrots, peeled, boiled until tender, and drained
100ml (3½fl oz) vegetable oil
1 cup semi-skimmed milk
2 eggs, lightly beaten 400g (14oz)
wholemeal self-raising flour
1 tsp ground cassia or cinnamon
75g (2½oz) soft brown sugar
100g (3½oz) pitted dates, chopped

Pre-heat oven to 190°C (375°F). Grease or line a 12-hole large muffin pan or two 12-hole mini muffin pans • Mash or blitz carrots to a smooth puree and combine in a bowl with the oil, milk, and eggs. • Combine the flour, sugar, cassia and dates in large bowl, then add the carrot mixture, stirring until well combined. Spoon the batter into greased or lined muffin pan holes and bake for 20–25 minutes until golden. • Remove from oven and allow muffins to cool on a wire rack. Once cooled, muffins will keep in an airtight container for 3 days.

Per muffin (or 2 mini muffins) 
1105kJ/265 calories; 6g protein; 9.5g fat (includes 1g saturated fat; saturated : unsaturated fat ratio 0.12); 36g available carbs (includes 15g sugars and 21g starches); 6g fibre; 255mg sodium; 330mg potassium; sodium : potassium ratio 0.77

CLASSIC REVIVAL
CLASSIC REVIVAL

We have been seduced to look for new recipes in the latest cookbooks by the hottest chefs with the most gorgeous photographs. Frankly, if you want a simple vegetable soup or salad, turn to the time-tested classics: the books of Elizabeth David and Jane Grigson. The writing is good. The food fabulous.

POTAGE CRECY 
Elizabeth David’s classic carrot soup from French Provincial Cooking. Why Crecy? It’s reputed to have the best carrots in France and as David says, “It’s important to have very good quality carrots”.

375g (¾lb) carrots, 1 large potato, 1 shallot or half a small onion, 30g (1oz) butter, 600ml (1 pint) veal, chicken or vegetable stock, or water if no stock is available, seasoning, parsley and chervil if possible.

Scrape the carrots, shred them on a coarse grater, put them together with the chopped shallot and the peeled and diced potato in a thick pan with the melted butter. Season with salt, pepper, a scrap of sugar. Cover the pan, and leave over a very low flame for about 15 minutes, until the carrots have almost melted to a purée. Pour over the stock, and simmer another 15 minutes. Sieve (blend), return the purée to the pan, see that the seasoning is correct, add a little chopped parsley and some leaves of chervil. Enough for three.

CARROT SALAD 
From Jane Grigson’s Vegetable Book, the go-to book for the definitive guide on the selection and cooking vegetable. Still.

Grated raw carrots, dressed with an olive oil and lemon juice vinaigrette and plenty of chopped herbs – either fennel or tarragon, or chives and parsley mixed. Chill well and drain off any surplus liquid before serving.

CARROT SALAD WITH RAISINS
As above, but instead of herbs use seedless raisins and split (slivered) almonds. The flavour is improved if you toast the almonds.

MONDAY MORNING COOKING CLUB
Monday Morning Cooking Club started back in 2006 when six Jewish women who live in Sydney came together on a Monday morning to share recipes and talk about food. What they started as an idea to raise money for charity, grew into a project to document their community’s somewhat obsessive relationship with food, and has become a series of beautifully photographed books.

CHICKEN AND BARLEY SOUP
Barbara Solomon’s totally, totally delicious soup from the Monday Morning Cooking Club (their first book) may not cure a cold but it sure nourishes body and soul. Use leftover roast chicken, or pick up half a chicken from the takeaway and shred the flesh, discarding the skin and bones. Makes 8 servings.

2 tbsp olive oil
2 onions, chopped
2 carrots, peeled and chopped
2 stalks celery, sliced
2 garlic cloves, crushed
400g (14oz) can diced or crushed tomatoes
8 cups chicken stock (home-made is best, but a bouillon cube is fine)
1 cup pearl barley
2 cups shredded chicken meat (no skin)
2 tbsp chopped parsley

ROAST CARROT HOMMOUS WITH CARROT TOP and MINT PESTO

Heat the olive oil in a large saucepan and cook the onions, carrots and celery until soft. Add the garlic to the pan and cook for a further 2 minutes, then add the tomatoes and stock and bring to the boil. • Add the barley and reduce the heat to a simmer, then cook for about 50 minutes (no lid) or until the barley is tender. Add the chicken and parsley, and stir to heat through. Season well and serve.

Per serving (based on making 8 servings) 
Energy: 885kJ/210cals; Protein 12g; Fat 8.5g (includes 1.6g saturated fat; saturated : unsaturated fat ratio 0. 23); Available carbohydrate 20g; Fibre 4.5g

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1 October 2017

GI News - October 2017

GI News

GI News is published by the University of Sydney, School of Life and Environmental Sciences and the Charles Perkins Centre

Publisher:
Professor Jennie Brand-Miller, AM, PhD, FAIFST, FNSA
Editor: Philippa Sandall
Scientific Editor/Managing Editor: Alan Barclay, PhD
Contact GI News: glycemic.index@gmail.com

Sydney University Glycemic Index Research Service
Manager: Fiona Atkinson, PhD
Contact: sugirs.manager@sydney.edu.au

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FOOD FOR THOUGHT

DON’T CONFUSE CORRELATION WITH CAUSATION 
In an entertaining and informative piece in The Conversation, Jon Borwein and Michael Rose look at the dangers of making a link between unrelated results. “Here’s an historical tidbit you may not be aware of,” they write. “Between the years 1860 and 1940, as the number of Methodist ministers living in New England increased, so too did the amount of Cuban rum imported into Boston – and they both increased in an extremely similar way. Thus, Methodist ministers must have bought up lots of rum in that time period! Actually no, that’s a silly conclusion to draw. What’s really going on is that both quantities – Methodist ministers and Cuban rum – were driven upwards by other factors, such as population growth. In reaching that incorrect conclusion, we’ve made the far-too-common mistake of confusing correlation with causation.”

Rum

As we are reporting on a number of large prospective studies and their correlations (otherwise known as associations) in this issue of GI News, we thought we would kick off with an extract from a post by Prof Arya Sharma (Even Correlations Based on Billions of Data Points Do Not Prove Causation, Obesity Notes, August 23, 2017) reminding us of the very serious limitations of such studies.

Even Correlations Based on Billions of Data Points Do Not Prove Causation 
Readers may have already heard about a recent study by Tim Althoff and colleagues from Stanford University, published in Nature, that analyses physical activity data collected from smart phones consisting of 68 million days of physical activity for 717,527 people, in 111 countries (only 46 of which were included in the study). As one may expect, not only do activity levels vary widely across countries but also substantially within countries (which in general terms, the authors refer to as “activity inequality”). It turns out that activity inequality and not actual levels of activity predict obesity rates (based on BMI).

The authors discuss [in their paper] various limitation of their study but fail to mention the biggest limitation of all, the simple fact that correlations, no matter how strong or how large the data set, simply cannot prove causality.

Thus, while the data does prove the point that you can do all sorts of interesting analyses when you have large data sets, it simply does not prove that activity levels (or activity inequality for that matter) actually has much to do with obesity at all. Indeed, one could think of a number of confounders that would otherwise differentiate countries with high activity inequality that happen to have high obesity rates from countries that have low activity inequality and low obesity rates (let’s not even mention reverse causality).

Thus, as nice as the figures presented in the paper may be, it is really hard to follow the authors’ conclusion that, ‘Our findings can help us to understand the prevalence, spread, and effects of inactivity and obesity within and across countries and subpopulations and to design communities, policies, and interventions that promote greater physical activity.’

This is not to say that designing communities, policies, and interventions would not be of substantial health benefits – given all of the known benefits of physical activity. Unfortunately, whether or not, these policies would do anything to prevent or reverse obesity is another matter altogether and remains as unclear after this study as before. 

 Dr Sharma 
Dr Sharma is Professor of Medicine and Chair in Obesity Research and Management at the University of Alberta, Edmonton, Canada. He is also the Clinical Co-Chair of the Alberta Health Services Obesity Program. He has authored and co-authored more than 350 scientific articles and has lectured widely on the etiology and management of obesity and related cardiovascular disorders and is regularly featured as a medical expert in national and international TV and print media and maintains a widely read obesity blog at www.drsharma.ca.

WHAT’S NEW?

PROTEIN AND THE PROSPECT OF DIABETES 
There have been a couple of prospective studies or what we are now going to call “Methodist ministers and Cuban rum” studies recently on protein intake and risk of type 2 diabetes.

Nuts - plant protein

  • The findings of the University of Eastern Finland study in the British Journal of Nutrition suggest the source of dietary protein may play a role in the risk of developing type 2 diabetes. The researchers found that replacing animal protein with plant protein was associated with a lower risk of type 2 diabetes. 
  • The findings of a prospective study and meta-analysis of the Melbourne Collaborative Cohort published in the American Journal of Clinical Nutrition showed that higher intakes of total and animal protein were both associated with increased risks of type 2 diabetes, whereas higher plant protein intake tended to be associated with lower risk of type 2 diabetes. 
What the researchers have found are actually correlations not “findings” in the sense of answers or causation. Certainly, diets high in plant protein such as wholesome whole foods like beans, chickpeas and lentils seem to be protective of a number of chronic diseases including type 2 diabetes. They are also generally low GI. Diets rich in animal protein don’t seem to convey the same advantage and numerous prospective studies over the years show this. Perhaps the saturated fat in meat has something to do with it. Saturated fat does contribute to insulin resistance making the poor old pancreas work harder pumping out more insulin. It’s also worth remembering that the Insulin Index of Foods published in the American Journal of Clinical Nutrition showed that any type of meat (beef, chicken, and pork) produced substantial insulin secretion.

What next? Prospective studies like these are useful for developing hypotheses that can then be put to the test with randomised controlled trials.

The studies 

SUGAR’S SWOON IS GOING GLOBAL 
A new industry analysis by Rabobank suggests sugar’s swoon appears to be passing a tipping point reports ConscienHealth’s Ted Kyle. Food marketers are bowing to consumer pressure and driving sugar out of products, even in developing markets. For more than a decade now, the reputation of sugar as the primary culprit behind obesity trends has been growing. U.S. consumption of added sugars and sugar sweetened beverages peaked at the turn of the millennium. But the market for sugar continued to grow in developing markets. That refuge for marketing sugary foods is fading away.

Sugar

The Rabobank report describes a cycle of consumer preferences. At its heart, this is a story of steadily rising global obesity rates, finger pointing, and the repercussions of consumers cycling through a love/hate relationship with the three macronutrients – carbohydrate, fat, and protein – and, in the process, demonizing certain foods. Currently, protein is on the rise (certainly in North America and Europe), as sugar, sugar-containing products, and other highly refined carbohydrates are increasingly cast as the main villain in the unremitting rise in obesity and metabolic syndrome rates. A “clean label” with a short ingredient list is the imperative that food companies are chasing. Added sugar will drop out. Artificial sweeteners are scary, so they aren’t coming back, either.

Now that global food makers are bowing to the storm of pressure that started with public health advocates, what are those advocates saying? Tom Farley, Philadelphia’s health commissioner, says it will take many years before any of this has an impact on public health. He says: “Sugar is a problem, but sugar is not the only problem.” In responding to doubts about the impact of Mexico’s sugar sweetened beverage tax, Barry Popkin and colleagues recently wrote: “The obesity epidemic will take decades to slow down, stop, and finally reverse itself, but other benefits might be seen sooner.” In other words, don’t hold your breath for health miracles from declining trends in sugar consumption.

To read more 
Ted Kyle is a healthcare professional experienced in collaborating with leading health and obesity experts for sound policy and innovation to address health needs and the obesity epidemic in North America. Through ConscienHealth, he works to advance changes in policy and public opinion that will allow new approaches to be developed and put into use.

NEW GI VALUES 18 EMIRATI FOODS

Azmina Govindji

“I welcome this unique set of data, which provide local populations with a practical and more effective way of controlling their blood glucose levels,” says award-winning Registered Dietitian Azmina Govindji (a media spokesperson for the British Dietetic Association and NHS Choices who was Chief Dietitian to Diabetes UK for 8 years).

“Eating well is about enjoyment, nutritional balance, and also cultural appropriateness. There is a growing incidence of diabetes in UAE and up until now, we’ve only had nutritional and GI information on Western-style foods.

Accurate analysis of the glycaemic impact of locally available produce, as well as dishes cooked using traditional methods, can help people with diabetes make more informed choices about local cuisine. This new research will fill an important gap, enabling healthcare professionals to have a more effective means of providing tailored dietary advice.

The data shows, for example, that foods like khameer bread and beef harees perform well on the GI scale, whereas regag bread and beef thareed are best saved for special occasions.”

GI values of 18 Emirati foods

Test method: For each test food, at least fifteen healthy participants consumed 25 or 50g available carbohydrate portions of a reference food (glucose), which was tested three times, and a test food after an overnight fast, was tested once, on separate occasions. Capillary blood samples were obtained by finger-prick and blood glucose was measured using clinical chemistry analyser. A fasting blood sample was obtained at baseline and before consumption of test foods. Additional blood samples were obtained at 15, 30, 45, 60, 90 and 120 min after the consumption of each test food. The GI value of each test food was calculated as the percentage of the incremental area under the blood glucose curve (IAUC) for the test food of each participant divided by the average IAUC for the reference food of the same participant.

Study 

PERSPECTIVES WITH DR ALAN BARCLAY

PURE BUT NOT SO SIMPLE 
Most nutrition experts have been recommending that we enjoy traditional healthy eating patterns like the Mediterranean and Okinawan diets for many years now, rather than focusing on single nutrients, ingredients or food groups. After all, we eat foods, not nutrients, and the one-nutrient-at-a-time approach is fraught with unintended consequences as nutrition scientists such as Dr David Katz have enumerated very clearly on numerous occasions. However, the old fat versus carbohydrate debate still seems to attract media attention and the recent publication of the results of the PURE (Prospective Urban Rural Epidemiology) study are another example of hype over serious dietary substance.

High fat meal

The PURE study followed over 135,000 people living in 18 countries (three high-income (Canada, Sweden, and United Arab Emirates), 11 middle-income (Argentina, Brazil, Chile, China, Colombia, Iran, Malaysia, occupied Palestinian territory, Poland, South Africa, and Turkey) and four low-income countries (Bangladesh, India, Pakistan, and Zimbabwe) for over 7 years and found that death rates were highest in those who reported having the highest carbohydrate intakes, and conversely were lower in those with higher fat intakes. “Global dietary guidelines should be reconsidered in light of these findings,” they proclaim.

While the PURE study may sound impressive, like all observational studies, it can only show associations (like the Methodist minister and Cuban rum story). It also has a number of significant limitations, including the fact that the associations were only observed in the extreme levels of consumption (43% and 78% of energy from carbohydrates and 11% and 38% of energy from fats), and that diabetes diagnosis was self-reported (so we don’t know how many people really had diabetes). Many people in the low-income countries may have had diabetes but didn’t know it. This would significantly confound the results. However, one of the most significant limitations is how they estimated people’s food and nutrient intakes.

At the very beginning of the study (seven years in the past), a food frequency questionnaire was used to assess people’s food intakes. That was the only time people were asked what they ate. Food frequency questionnaires ask you to recall all the foods and drinks you consumed over the previous 12 months – a difficult task for most of us at the best of times (what did you eat last week?). These questionnaires also have to be carefully designed to reflect the food preferences of the people being studied – it’s not wise to use a questionnaire designed for one country in a different country, as food preferences and the food supply are usually very different. And finally, food frequency questionnaires need to be validated to see how well they measure actual food and nutrient intakes. There are many different ways of doing this. Overall, it’s highly unlikely that the protein, fat and carbohydrate estimates used in the PURE study are very accurate, which of course has profound implications for the results and their interpretation.

Finally, the study looked at the different kinds of fat (saturated, mono and polyunsaturated) but for some reason was not able to look at carbohydrate quality – not even examining the effect of dietary fibre, let alone refined carbohydrates (both starches and sugars), glycemic index or load. Like fats, all carbohydrates are of course not the same, and it is not very useful to lump them all together.

Despite all these significant limitations, and taking the study’s results at face value, we must consider how relevant they are in comparison to what the average person is eating today. In Australia, for example, our most recent national nutrition survey determined that the average adult consumed 43.5% of energy from total carbohydrate and 30.9% from fat. The nutrient reference values that underpin Australia’s dietary guidelines recommend that Australians consume 45-65% of energy from carbohydrates from carbohydrates and 20-35% of energy from fats. These ranges are very similar to what are recommended in the PURE study – our dietary guidelines therefore do not need updating based on this. We are already eating the minimum amount of carbohydrate and close to the upper end of the recommended range for fat. We therefore need to be eating better quality (minimally refined, high fibre, low GI) carbohydrates, not less, and similarly we need to be eating more poly and mono-unsaturated fat, not more saturated fat.

This is all very academic. We eat foods not nutrients. Most people don’t know what percent of energy they get from protein, fat or carbohydrate. Patterns of eating are much more useful, which is what most modern dietary guidelines focus on: recommending that we eat mostly “good carbs” like fruits, vegetables, legumes, wholegrains, milk and yoghurt and save refined carbohydrates like sugar-sweetened beverages, confectionery, savoury starchy snacks (e.g., chips, crisps), etc for special occasions. Keep it relevant. Keep it simple.

Study 


 Dr Alan Barclay  
Alan Barclay, PhD is a consultant dietitian. He worked for Diabetes Australia (NSW) from 1998–2014 . He is author/co-author of more than 30 scientific publications, and author/co-author of  The good Carbs Cookbook (Murdoch Books), Reversing Diabetes (Murdoch Books), The Low GI Diet: Managing Type 2 Diabetes (Hachette Australia) and The Ultimate Guide to Sugars and Sweeteners (The Experiment, New York).

FOOD UN-PLUGGED

GLUTEN-FREE
In August, the Medical Journal of Australia published an article questioning the existence of non-coeliac gluten or wheat sensitivity. The article was hot media fodder, with most stories including a medical expert suggesting that most people avoiding gluten without being diagnosed with celiac disease didn’t need to do so. The article also concluded that gluten-free diets carry risks, are socially restricting and are costlier. We were glad to see this article published and pleased to see this issue being raised because we’ve being saying something similar for years.

While a gluten free diet is the only treatment for people with coeliac disease, there are many that claim going gluten-free is the magic bullet to weight loss and optimum health for everyone. While there is no good evidence to back this up and a growing number of studies now suggesting it might have adverse effects in the long run, the marketing horse has already bolted and gluten-free foods are a large and growing category. We thought we’d take a closer look at them.

Gluten is a stretchy protein found in grains such as wheat, rye, oats, barley and triticale. This protein gives bread the ability to rise and form a light airy loaf. Gluten-free food alternatives are often made with starches and additives rather than wholegrain flours. It is perhaps no surprise that one review found that gluten-free diets are often lower in fibre and higher in saturated fat. This review also noted that gluten-free diets tend to have a higher glycemic index (GI). This is not helpful for overall metabolic health and may leave you feeling hungrier sooner.

We compared the nutritional value of a muesli bar, mixed grain bread, and a flaked breakfast cereal compared with their gluten-free variants.

 Gluten Free Foods Comparison

Because the serve sizes aren’t the same, it’s hard to make direct comparisons about kilojoules/calories, but there’s not a lot in it. Two significant differences stand out. When it comes to protein, regular trumps gluten free by a significant margin. The same goes for dietary fibre (something most of us need a lot more of).

The down sides of gluten-free
Another factor to consider is the glycemic index (GI) of food. While the glycemic index of the bread we refer to above has not been tested, another similar gluten-free multigrain bread on the market was found to have a high GI (79). Many regular wholegrain breads have a low-medium GI, including this one with a low GI (53). Low GI foods give you more stable blood glucose levels following your meal.

Gluten-free diets tend to be low on grains that are an important source of B vitamins. For example, folate is essential prior to and during pregnancy to help reduce the risk of neural tube defects, and folate is also important for heart health.

Studies have shown that eating wholegrains regularly protects against type 2 diabetes and coronary heart disease. Avoiding gluten unnecessarily in the pursuit of good health may have the opposite effect.

The un-plugged truth 

  • The gluten-free diet is essential for people with celiac disease, but unlikely to be of benefit for the rest of us. 
  • A gluten-free diet should only be undertaken after a confirmed diagnosis and best managed with the help of a qualified dietitian. 
  • Gluten-free foods can be less healthy: lower in protein and fibre, and higher GI.
Thanks to Rachel Ananin AKA TheSeasonalDietitian.com for her assistance with this article.

Nicole Senior    
Nicole Senior Nicole Senior pulls the plug on hype and marketing spin to provide reliable, practical advice on food for health and enjoyment. She is an Accredited Nutritionist, author, consultant, cook, food enthusiast and mother who strives to make sense of nutrition science and delights in making healthy food delicious.  
Contact: You can follow her on Twitter, Facebook, Pinterest, Instagram or check out her website.

KEEP GOOD CARBS AND CARRY ON

CAPSICUMS (SWEET PEPPERS) 
Speedy underestimates the rate at which the Old World embraced the New’s zesty chilli. Try these hot peppers (pimiento) said Columbus proudly introducing them in 1493 – after all pepper (pimento or black pepper) was what he was looking for (well, he possibly said something like that). Within two hundred years they were widely cultivated throughout Europe, Asia and Africa as the tongue-tingling spice we know today. At the same time a mild, sweet variety of capsicum was also evolving. And what a veg. Red, orange, yellow, green, purple: capsicum’s crisp, juicy flesh sets the taste bar high. It’s no wonder they have made themselves at home in kitchens around the world sliced or diced into salads, or stuffed, stir fried, roasted, and often peeled which is not as hard to do as it sounds. Just hold them over a gas flame with metal tongs or place under a very hot grill or on a lightly oiled tray in a hot oven until the skin is charred then drop into a plastic bag and seal. When cool, the skin will slip off easily. If you don’t have time to do this, you can buy them ready prepared from your favourite deli counter. There are numerous good brands of jarred “fire-roasted” peeled strips in olive oil.
CAPSICUMS

What to look for Red, orange and yellow capsicums are not only sweeter than regular green ones, but they keep their colour better when cooked. Select well shaped, firm and glossy capsicums with bright, taut skins and their stems fresh and green. Watch out for soft spots, wrinkled skin or blemishes (that means they are starting to dry out). Select capsicums that are firm and glossy with a uniform colour. Avoid any with dull or wrinkled skin, spots or blemishes. Store unwashed capsicums in a plastic bag in the fridge so they keep their crunch and sweetness. If you have picked up a plastic wrapped tray for a bargain price, unwrap them when you get home as they need to breathe a bit.

What’s in them? A medium raw capsicum (about 90 g or 3 oz) has about 80 kilojoules (19 calories), 1.5g protein, 0g fat, 3g carbs (sugars), 1g fibre, 2mg sodium, 135mg potassium and a low GI (estimated) as they have no starch. They are one of the best sources of vitamin C around.

Some like it hot The hot comes from capsaicin, which is found in its highest concentration in the chilli’s seeds and fleshy “placenta” material that is joined to the seeds says Spice and Herb Bible guru Ian Hemphill. It blows your mind because it releases endorphins which create a sense of wellbeing and stimulation. In spite of the inordinate preoccupation with heat in chillies, the tremendous flavour contribution made by dried chillies should not be overlooked says Ian. And there’s more. Research in recent years has provided some evidence that capsaicin can raise your metabolic rate. A meal containing freshly chopped chilli may also help reduce insulin levels. What’s not to like?
The Good Carbs Cookbook
Extract from The Good Carbs Cookbook published by Murdoch Books and available online and in good bookstores.

IN THE GI NEWS KITCHEN

SPICE IS NICE 

This month Kate Hemphill showcases three spice blends – sambar curry powder, paella spice mix and Creole seasoning – from the Herbies range that transform simple, relatively inexpensive family meals – a burger, a one-pot stew and stuffed peppers – into something you could serve for a more special occasion.

STICKS, SEEDS, PODS and LEAVES
Kate Hemphill is a trained chef. She contributed the recipes to Ian Hemphill’s best-selling Spice and Herb Bible. You will find more of her recipes on the Herbies spices website. Or you can follow her on Instagram (@herbieskitchen). Kate uses Herbies spices and blends, but you can substitute with whatever you have in your pantry.

STUFFED CAPSICUMS LOUISIANA STYLE 
The Louisiana-style seasoning works amazingly with this healthy and flavoursome dish, giving the rice, beans and corn a huge lift. For meat lovers, serve alongside beef, lamb or chicken grilled with a sprinkle of the seasoning. Prep time: 10 mins • Cook time: 1 hour • Makes: 6

STUFFED CAPSICUMS LOUISIANA STYLE

1½ cups low or lower GI brown rice (such as Doongara or brown basmati)
6 capsicums, top cut off and seeds removed
1 red onion, finely chopped
2 cloves garlic, finely chopped
2 tbsp Creole seasoning
2 ripe red tomatoes, peeled and diced
½ cup corn kernels
400ml (14oz) can black beans, rinsed and drained

Pre-heat oven to 170C (340F). • Rinse rice and cook until tender, drain. • Meanwhile, sweat onions in a little olive oil until soft, then add garlic and spices. Stir for one minute, then add tomatoes, cooked rice, corn and black beans. Combine well and taste for seasoning. • Firmly stuff the capsicums with rice mixture, place lids on top, and bake for 40 minutes, or until capsicum is tender when pierced.

Per serve 
1445kJ/345 calories; 14g protein; 2.5g fat (includes 0.5g saturated fat; saturated : unsaturated fat ratio 0.25); 60g available carbs (includes 14g sugars and 46g starches); 13g fibre; 455mg sodium; 967mg potassium; sodium : potassium ratio 0.47

INDIAN LAMB BURGER 
These burgers make great picnic or party food cooked bite-size and served with raita. You can use any of Herbie’s many Indian spice blends in these burgers, depending on your mood. The mild sambar powder used here is perfect for younger children. Prep time: 15 mins • Cook time: 10 mins • Serves: 6

INDIAN LAMB BURGER

500g (1lb 2oz) lean lamb mince
1½ tbsp sambar powder
½ tsp salt
1 egg
1 tbsp grated brown onion
1 tsp grated fresh ginger
1 garlic clove, crushed
1 cup Greek yoghurt
1 small cucumber, diced
8 mint leaves, finely chopped

To serve
Turkish bread or burger buns
½ cup mango chutney
2 cups mixed salad leaves
fresh onion and mint for garnish, optional

For burgers, pulse all ingredients in a food processor, or mix well in a large bowl with your hands. Shape into 6 burgers and refrigerate until ready to cook (up to 24 hours). • Combine the yoghurt, cucumber and mint to make the raita and season to taste. • Heat a grill or barbecue and cook burgers for 5–6 minutes per side. Allow to rest for 2 minutes before assembling burger. • Lightly toast bread or bun, if desired, and top with raita, chutney, salad leaves, burger and garnish fresh onion rings and mint leaves.

Per serve (with Turkish bread) 
1200kJ/290 calories; 23g protein; 9g fat (includes 4g saturated fat; saturated : unsaturated fat ratio 0.8); 28g available carbs (includes 18g sugars and 10g starches); 3.5g fibre; 450mg sodium; 580mg potassium; sodium : potassium ratio 0.78

SPANISH CHORIZO and BEAN STEW
One pot stews are perfect for cooler days, and this dish benefits from a long, slow cook. This is a great dish to prepare ahead and it reheats well after storing in the fridge or freezing. Tip: check how hot your chorizo is, you may like to add some chilli powder if it is mild. Prep time: 10 mins • Cook time: 2 hours • Serves: 8

SPANISH CHORIZO and BEAN STEW

1 tbsp olive oil
2 red onions, finely chopped
4 cloves garlic, crushed
2 red bell peppers (or red capsicum) cut into 2cm pieces
¼ cup sherry vinegar
2 tbsp paella spice mix
2 x 400ml (14oz) cans crushed tomatoes
2 x 400ml (14oz) cans cannellini beans, drained
4 small semi-dried chorizo sausages (cooking chorizo), approx 400g (14oz), cut into ¾in (2cm) thick slices
flat leaf parsley

Preheat oven to 120C (300F). • Sweat onions in olive oil in an ovenproof dish on the stove top over low heat. Add garlic and capsicum once onions are soft. Pour in sherry vinegar and stir until evaporated, then add spice mix, tomatoes, beans and 1½ cups water. • In a large frying pan over high heat, briefly brown chorizo then add to stew. • Bring stew to a simmer, stirring, then place in the oven with a lid. Cook for 1½–2 hours until chorizo is meltingly tender. Check for seasoning and serve with parsley.

Per serve
1400kJ/335 calories; 20g protein; 15.5g fat (includes 5g saturated fat; saturated : unsaturated fat ratio 0.48); 22g available carbs (includes 11g sugars and 11g starches); 12g fibre; 790mg sodium; 840mg potassium; sodium : potassium ratio 0.94

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1 September 2017

GI News - September 2017

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FOOD FOR THOUGHT

ALTERNATE DAY FASTING IS NO BETTER THAN ANY OTHER FAD DIET
In his Obesity Notes blog, Dr Arya Sharma recently reviewed a year-long randomised controlled study by John Trepanowski and colleagues that showed alternate day fasting is evidently no better in producing superior adherence, weight loss, weight maintenance, or cardio-protection compared to good old daily calorie/kilojoule restriction (which also produces modest long-term results at best).

“It seems that every year someone else comes up with a diet that can supposedly conquer obesity and all other health problems of civilization. In almost every case, the diet is based on some “new” insight into how our bodies function, or how our ancestors (read – hunters gatherers – never mind that they only lived to be 35) ate, or how modern foods are killing us (never mind that the average person has never lived longer than ever before), or how (insert remote population here) lives today with no chronic disease. Throw in some scientific terms like “ketogenic”, “gluten”, “anti-oxidant”, “fructose”, or “insulin”, add some level of restriction and unusual foods, and (most importantly) get celebrity endorsement and “testimonials” and you have a best-seller (and a successful speaking career) ready to go.

Hunter gatherers
Source

The problem is that, no matter what the “scientific” (sounding) theories suggest, there is little evidence that the enthusiastic promises of any of these hold up under the cold light of scientific study. Therefore, I am not the least surprised that the same holds true for the much hyped “alternative-day fasting diet”, which supposedly is best for us, because it mimics how our pre-historic ancestors apparently made it to the ripe age of 35 without obesity and heart attacks.

The alternate day fasting group in the year-long randomised controlled study published in JAMA Internal Medicine had significantly more dropouts than both the daily calorie restriction and control group (38% vs. 29% and 26% respectively). Mean weight loss was virtually identical between both intervention groups (around 6kg).

Purists of course will instantly criticize that the study did not actually test alternative-day fasting, as more people dropped out and most of the participants who stayed in that group actually ate more than prescribed on fast days, and less than prescribed on feast days – but that is exactly the point of this kind of study – to test whether the proposed diet works in “real life”, because no one in “real life” can ever be expected to be perfectly compliant with any diet. In fact, again, as this study shows, the more “restrictive” the diet (and, yes, starving yourself every other day is “restrictive”), the greater the dropout rate.

Unfortunately, what counts in real life is not what people should be doing, but what people actually do. The question really is not whether or not alternate-day fasting is better for someone trying to lose weight but rather, whether or not “recommending” someone follows an alternate-day fasting plan (and them trying to follow it the best they can) is better for them. The clear answer from this study is “no”. So why are all diets the same (in that virtually all of them provide a rather modest degree of long-term weight loss)?

My guess is that no diet (or behaviour for that matter) has the capability of fundamentally changing the body’s biology that acts to protect and restore body fat in the long-term. Irrespective of whether a diet leads to weight loss in the short term and irrespective of how it does so (or how slow or fast), ultimately no diet manages to “reset” the body-weight set point to a lower level, that would biologically “stabilize” weight loss in the long-term. Thus, the amount of long-term weight loss that can be achieved by dieting is always in the same (rather modest) ballpark and it is often only a matter of time before the biology wins out and we put all the weight back on.

Clearly, I am not holding my breath for the next diet that comes along that promises to be better than everything we’ve had before. My advice to patients is: do what works for you, but do not expect miracles – just find the diet you can happily live on and stick to it.”

Read more:

Dr Sharma 
Dr Sharma is Professor of Medicine and Chair in Obesity Research and Management at the University of Alberta, Edmonton, Canada. He is also the Clinical Co-Chair of the Alberta Health Services Obesity Program. He has authored and co-authored more than 350 scientific articles and has lectured widely on the etiology and management of obesity and related cardiovascular disorders and is regularly featured as a medical expert in national and international TV and print media and maintains a widely read obesity blog at www.drsharma.ca.

WHAT’S NEW?

FUDGING CONCLUSIONS ABOUT CHILDHOOD OBESITY PREVENTION 
“We have a pretty good idea of how to curb childhood obesity.” Such convictions run deep. And because of those convictions, prevention is a frontline strategy for dealing with childhood obesity. So, it’s especially dispiriting when we see the scientific literature stained by a paper that fudges conclusions about childhood obesity prevention into “some evidence of effectiveness” reports ConscienHealth’s Ted Kyle.

children playing at school

In the Australian and New Zealand Journal of Public Health, Mary Malakellis and colleagues published a report on a large obesity prevention program called “It’s Your Move”. Deep in the bowels of their paper, you will find that the sum of all their data showed no effect. But, the authors did not stop there. They picked apart the data to look for subgroups with an effect. They found it in two of the schools they studied. So, their abstract failed to mention finding no effectiveness in the overall results. And their conclusion claimed “some evidence of effectiveness.”

Ted Kyle asked biostatistics expert, Professor David Allison, about this study. Despite the claims of effectiveness in the paper’s abstract says Allison, the body of the paper clearly describes the findings as null. The authors state “Models to Compare the Intervention and Comparison Groups (i.e. All Three Intervention Schools Combined Compared to All Three Comparison Schools Combined) … showed No Statistically Significant Interaction Effect on Weight, Height, BMI, BMI-z and Proportion of Overweight/obesity.” The contrary statements in the abstract are an inappropriate use of spin as defined by Boutron et al. They lead to distortion of the scientific record and propagation of myths and presumptions which are all too common in the obesity domain. Authors and journals should hold themselves to higher standards of accurate reporting.

Null findings offer golden opportunities for learning. You do a study and the data tells you, you were wrong. That intervention – perhaps a wonderful prevention program – didn’t work the way you thought it would. Maybe the study was flawed. Or maybe the intervention just doesn’t work. Perhaps we need a new approach. But if you ignore that null finding, you’re kidding yourself. You might deceive others. And you get in the way of progress. 

FASTING BLOOD GLUCOSE AND INSULIN NEW BIOMARKERS FOR WEIGHT LOSS Fasting blood glucose and/or fasting insulin can be used to select the optimal diet and to predict weight loss, particularly for people with prediabetes or diabetes say researchers from the Department of Nutrition, Exercise and Sports at the University of Copenhagen reporting the findings from a weight loss biomarker study published in the American Journal of Clinical Nutrition (AJCN). The findings suggest that for most people with prediabetes, a diet rich with vegetables fruits and wholegrains should be recommended for weight loss and could potentially improve diabetes markers. For people with type 2 diabetes, the analysis found that a diet rich in healthy fats from plant sources would be effective for achieving weight loss. These diets could also be effective independent of caloric restriction.

“Recognizing fasting plasma glucose as a key biomarker enables a new interpretation of the data from many previous studies, which could potentially lead to a breakthrough in personalized nutrition,” said Prof Arne Astrup. “The beauty of this concept is its simplicity. While we are looking into other biomarkers, it is quite amazing how much more we can do for our patients just by using those two simple biomarkers. We will continue to participate in and support research to explore additional biomarkers such as gut microbiota and genomics approaches, which may offer more insights and help to more effectively customize the right diet for specific individuals.” 

PERSPECTIVES WITH DR ALAN BARCLAY

KETONES 
No. Not a music group. But ketones are creating a lot of noise. They are a kind of fuel our liver produces from fatty acids (from what we eat or body fat stores), when glucose is severely restricted. Dietary regimens that stimulate the production of ketones are known as “ketogenic diets”. What are their health effects?

Randomised controlled trials give us some clues. Ketogenic diets typically require people to limit their total carbohydrate intake to less than 10% of energy (less than 50g a day for an adult), and recommend fat provides around 80% of energy. This means severe restriction of: 

  • most fruits 
  • starchy vegetables (carrots, corn, peas, pumpkin, potatoes, etc) 
  • cereal-based foods (bread, breakfast cereals, pasta, rice, etc) 
  • legumes (beans, chickpeas, lentils, etc) 
  • milk and yoghurt. 
For a typical adult, 10% of energy, or 50g of carbohydrate a day, is equal to 2 slices of bread plus 1 piece of fruit. Instead of carb-containing foods, people on a ketogenic diet mostly eat: 
  • meat, seafood, poultry 
  • eggs 
  • cheese 
  • butter and cream 
  • fats and oils 
  • low-carb vegetables (greens, onions, peppers, etc) 
  • low-carb fruits (berries). 
As it’s difficult to get all of the essential nutrients eating this way, people on a ketogenic diet need supplements.

Fatty meats  
Epilepsy A ketogenic diet has been trialled in children with chronic epilepsy. Children are typically given a diet that provides 80% of daily energy from fat, and the remainder from protein and carbohydrate (typically, 10% from each). A recent Cochrane review determined that after following a ketogenic diet for 3 months, seizure rates may decrease by up to 85% in some (but not all) children. But all studies included in the review also reported adverse effects – vomiting, constipation and diarrhoea plus other adverse effects. A recent study determined that while medically effective “The study did not find any improvements in quality of life”. So, while a ketogenic diet may help some children with epilepsy, it’s no panacea. However, if you have a child with severe, frequent seizures, you may wish to try a ketogenic diet under very careful medical and dietetic supervision.

Cancer therapy Certain kinds of cancer cells prefer to use glucose as a fuel. Therefore, in theory, reducing blood glucose levels may help in the management of certain kinds of cancer by starving them of fuel. A recent systematic review examined all the available evidence in people (not rats). No randomised controlled trials were identified, but 15 other lower-quality clinical studies, case-control and cohort studies incorporating 330 people were available. The authors concluded “In contrast, to the considerable attention from researchers, physicians and the media for its potential role in cancer treatments, evidence on benefits [of ketogenic diets] regarding tumor development and progression as well as reduction in side effects of cancer therapy is missing.” The bottom line – despite the hype, much more research is needed.

Ketogenic diets for weight loss While not new, ketogenic diets are at present one of the most popular weight loss diets around the world. Fortunately, over the past 2 decades, there have been a significant number of randomised controlled trials comparing (high-fat) ketogenic diets to low fat diets, and a systematic review and meta-analysis was published recently. It identified thirteen studies incorporating 1415 people and determined that over 1–2 years (medium-term), people consuming the ketogenic diet lost more body weight, and their blood pressure and fats improved compared to people consuming a low fat diet. The authors concluded “... in the long term and when compared with conventional therapy, the differences appear to be of little clinical significance, although statistically significant.”

So while the ketogenic diet may be an alternative to other diets under certain circumstances it is not necessarily superior in the long-term; we must as usual keep in mind the simple fact that one size does not fit all. Because food plays such a pivotal role in our family and social lives, ketogenic diets can be disruptive and long-term adherence and enjoyment of food (one of life’s pleasures) are frequently issues. And there are side effects, especially in the beginning until the body adjusts, including constipation, headache and fatigue.

You can listen to Alan discuss ketogenic diets on Health Professional Radio, here.

 Dr Alan Barclay  

Alan Barclay, PhD is a consultant dietitian. He worked for Diabetes Australia (NSW) from 1998–2014 . He is author/co-author of more than 30 scientific publications, and author/co-author of  The good Carbs Cookbook (Murdoch Books), Reversing Diabetes (Murdoch Books), The Low GI Diet: Managing Type 2 Diabetes (Hachette Australia) and The Ultimate Guide to Sugars and Sweeteners (The Experiment, New York).