Sunday, May 30, 2010
For the last 12 years, I have had my own dietary safety net: nutritional supplements. When I stopped taking them 79 days ago for my Anti-Cancer Challenge (in line with the World Cancer Research Fund’s recommendations, upon which the Challenge is based) I felt like a trapeze artist working without a net, for this is the first time in over ten years that I am supplement-free.
Over the past ten years I have swallowed approximately 50,000 supplements pills. At my peak intake nine years ago, my husband would joke that if you shook me, I’d rattle. For a while, my daily regimen included a high-dose multi-vitamin and mineral supplement, extra vitamin C to boost my immune system, a herbal combo to support my liver, a formulation to stabilize my blood-sugar, probiotics to aid my gut flora, magnesium to help me relax at night and digestive enzymes and hydrochloric acid capsules to assist me in digesting and assimilating my food.
After moving to France from the UK nine years ago I scaled back my supplement intake. When I ran out of my British supplements and couldn’t find easy replacements (in France there aren't entire shops dedicated to the sale of supplements as there are in the US and the UK) I noticed that I felt no worse-off, even after several months of supplement-deprivation. Moreover, as I discovered irresistible fresh, locally-grown food at greengrocers’, farmers’ markets and bistros I quickly lost interest in the encapsulated astronaut fare I had leaned on for years. I was happy to invest the $4-5 a day I was saving on supplements in delicious, fresh and healthy food.
According to the WCRF, some 35% of Britons and 50% of Americans regularly take supplements. In France, that number stands at a modest 20% but it is rising. Many of us see supplements as a sort of top-up health insurance, a safety net for when we don’t get around to eating well. Let’s be honest: isn’t it reassuring to think that if we take multivitamins and minerals, probiotics and omega-3 fatty acids in capsule form, it’s OK to give the real foods that contain these – fruits, vegetables, yogurt, nuts, oily fish – a miss occasionally?
Sporadic dietary transgressions are fine, of course. The problem is, ‘occasionally’ often becomes ‘regularly’ and before we know it, we rely increasingly on supplements to provide our nutrients. For instance, many people who do not eat fish (alas, there are many!) will struggle to obtain enough omega-3's or selenium from their diet.
In terms of cancer prevention – the remit of this blog – supplementation does not appear to deliver great benefits; in fact, in some cases, for instance in smokers taking beta-carotene supplements, they may actually increase risks. That’s why the WCRF concluded in its 2007 Expert Report: “For otherwise healthy people, inadequacy of intake of nutrients is best resolved by nutrient-dense diets and not by supplements.”
“Nutritional supplements contain forms and concentrations of nutrients that don’t occur in nature,” says Dr Rachel Thompson, science programme manager in charge of nutrition at the WCRF, adding that “supplements don’t contain fibre or the many bioactive components found in food and which are important for health.” Indeed, it is increasingly understood that the different vitamins, minerals, proteins, fats and plant chemicals bound up together in natural foods reinforce each other’s actions in synergistic ways that supplements cannot replicate.
To be sure, many nutrients have been found to offer cancer-protection, but these should ideally come from food, not pills. For instance, according to the WCRF the mineral selenium (found in Brazil nuts, whole grains, fish, crustaceans and meat) probably protects against prostate cancer, calcium (from kale, spinach and other green, leafy vegetables, nuts & seeds, canned whole sardines, tofu and dairy products) is thought to act against colon cancer and vitamin E (from plant oils, seeds, nuts & whole grains, berries and green leafy vegetables) may cut prostate-cancer risk.
Granted, swallowing a pill takes a lot less time than preparing a healthy meal. However, healthy, nutritious food is a lot tastier and need not be time-consuming, as my previous post shows. So let’s prioritise real food over laboratory nutrients. For optimal nutrition, the food we eat should be as fresh as possible (ideally, locally grown in rich, healthy soil and eaten as soon as possible after harvesting), highly varied and carefully prepared. Long-distance transportation, long-term storage and overcooking can significantly reduce nutrient levels in foods.
There are exceptions where supplements are advisable. In people who have marked nutrient deficiencies or heightened nutritional needs, or who have trouble eating, digesting and absorbing food, supplementation is important. People over 50 who have difficulty absorbing vitamin B12 should supplement this. Moreover, women planning to conceive should take folic acid. Vitamin D is recommended for people who are not exposed to sufficient sunlight or those (such as the elderly or people with dark skin) who do not synthesise adequate vitamin D from sunlight. However, do not self-administer supplements; if you think you need extra nutrients or have difficulty digesting and absorbing the nutrients in your food, consult a doctor or nutritionist.
I will report over the next few months on my year without supplements. For now, anyway, I’m feeling fine without my nuritional safety net - indeed, last week I was the only member of my family to escape a spring cold that was doing the rounds.
Picture credit: Five female trapeze artists performing at the circus. Published by Calvert Litho Co., Detroit, Michigan; obtained from the Library of Congress.
Wednesday, May 26, 2010
As soon as I entered the kitchen, my eyes lit on an avocado idling on the counter. It was heavy and firm-yet-yielding -- in other words: perfectly ripe. This sight got my juices flowing and my mind wandering: hmm, what could I do with an avocado that really had to be eaten now? It certainly didn’t go with cheese sandwich, so I’d have to think of something else.
Then I remembered some left-over salmon puree in the refrigerator (canned Pacific salmon mashed with home-made mayonnaise and plain yoghurt, spring onion, parsley and lemon juice). Yes, that would go nicely in the avocado’s hollow.
No sooner had I opened the fridge to retrieve the salmon puree than I spotted a tomato on the vegetable shelf, sitting very still, no doubt hoping I wouldn’t spot it. I did spot it though and out it came. Just as I was about to chop it all up and dump it in a chipped breakfast bowl (part of me still wanted to rush) I remembered four lonesome asparagus spears left over from last night’s dinner and shunted to the back of the fridge. This had to be fate. No more rushing; the time had come for an impromptu feast.
I put away the chipped bowl, took a white china plate out of the cupboard and arranged on it the quartered avocado, a blob of salmon puree, the tomato quarters and asparagus spears, drizzled them with home-made olive-oil dressing (I always keep some in the refrigerator), sprinkled it with dried pepper flakes and a few leaves of parsley. I even found some pine kernels nestling at the bottom of a nearly-empty jar and so while I was arranging my plate, I toasted these lightly in a small, dry pan and scattered them over the plate.
This meal took only seven (yes, 7!) minutes to assemble; that’s my definition of fast food. It was infinitely more nutritious – and delicious! – than the cheese sandwich it replaced. And it helped me 'get out of my head,' sit down on my terrace and savour my meal listening to birdsong, a light breeze on my face -- rather than gobbling it down in-between office tasks.
Yes, there are days when I *do* eat the cheese sandwich, when there are no perfect avocadoes or salmon purees waiting to be discovered. But there are many ways of rustling up basic, delicious and healthy meals in a matter of minutes by keeping healthy supplies in pantries, refrigerators and freezers and not yielding to the temptation of the fast-but-suboptimal snack.
A few things that make healthy impromptu feasts easier:
- A supply of canned fish (especially sardines or mackerel), tomato concentrate, pesto or tapenade in one’s pantry (delicious on toast as a base for sardines or sliced tofu, or to liven up salads or soups).
- A stock of plain yogurt, home-made mayonnaise and salad dressing, goat’s cheese or feta (tastes great crumbled over salads or soups).
- Some longer-lasting items in the vegetable drawer (e.g. tomatoes, cucumbers, washed lettuce in a zip-lock bag, some parsley – washed, dried and kept fresh in an airproof container, carrots, vacuum-packed beets).
- Herbs and spices, nuts and seeds ring in the changes and liven up any dish.
- Left-overs! I generally cook a little more than we need for dinner so that I can eat the rest the next day, either cold or briefly reheated in a small saucepan.
Friday, May 21, 2010
Three generations – my three children, their parents and visiting grandparents – sat down for a shared meal of chili con carne* that my 13-year-old son had prepared. Before we began to eat, each gave thanks for something they felt grateful for: the fine weather, the delicious meal, a good day at school. When it came to the chef’s turn, my son said: “I am thankful that we are all together, and for this nice atmosphere.” Amen to that!
In my last post, I sang the praises of the Mediterranean diet – its healthy vegetables and fruits, fish, herbs, garlic and olive oil. However, the health benefits of Mediterranean-style eating go far beyond mere molecules: taking time to prepare and savor good food in the company of people we love also has immeasurable benefits.
Indeed, possibly the most life-affirming aspect of the Mediterranean food culture is the central role of conviviality: the pleasure of sharing food with others, of celebrating communal culinary traditions and life at large. Without it, the Mediterranean diet would be just another health-food prescription; conviviality, at its heart, makes it a lifestyle.
The word ‘convivial’ derives from Latin, where it means quite simply ‘the act of living together.’ We are drawn to conviviality by our need for safety, companionship and comfort. But in today's hyper-efficient, fast-paced world, we often sacrifice that which made us human – our fundamental need for food – and the communality that was born of this need. Instead, we rush from one task to the next and eating becomes just another chore to be slotted into our busy schedules.
Over the long term, this modern way of eating cannot provide us with the biological or emotional sustenance we need to thrive. For a truly anti-cancer way of life, let's rediscover the joys of eating calmly, at a table, using cutlery and plates, ideally in the company of people we are fond of.
Shared, leisurely meals are about much more than fuelling our bodies, they are “uniquely human institutions where our species developed language and this thing we call culture,” Michael Pollan argues in an impassioned plea for a return to more traditional eating habits (In Defence of Food, Penguin Books 2008). “The shared meal elevates eating from a mechanical process of fuelling our body to a ritual of family and community, from mere animal biology to an act of culture.”
In recommending the Mediterranean diet, I want to move beyond the ‘food-as-medicine’ paradigm, where our diet is seen merely as an amalgamation of molecules that support bodily functions (a mechanistic view popular in Anglo-Saxon countries). Instead, I espouse the more holistic ethos prevalent in Mediterranean cultures where food is also a source of spiritual nourishment, of pleasure, comfort and vitality – a celebration of life in the fullest sense.
Although modern eating patterns have been making inroads into Mediterranean countries, many retain a rich and joyful food culture. Indeed, French bistros at lunchtime throng with office workers enjoying a leisurely meal and engaged in lively conversations not pertaining to work. On Sundays, three-generation families gather around many a restaurant table for two to three hours’ eating, relaxing and laughter. These groups often include babies and toddlers who learn from an early age that eating with others is an occasion for joy and communality.
Sociologists have compared habits of conviviality in Mediterranean and Anglo-Saxon countries and their results make fascinating reading. In an international survey of people’s attitudes to food and eating, respondents were asked to describe what, to them, constituted a ‘healthy diet’ (Fischler C, Masson E. Manger – Français, Européens et Américains face à l’alimentation. Odile Jacob (Paris), 2008).
Whereas primary health-concerns for the Americans and Britons surveyed touched on scientific concepts such as 'proteins,’ ‘carbohydrates’ and ‘fat,’ Italian and French respondents overwhelmingly focused on the notion of pleasure.
There was also a great divergence in respondents’ attitudes to conviviality: when asked what constitutes a healthy diet, French and French-speaking Swiss participants spoke spontaneously of ‘family meals’ or ‘eating with friends.’ In the French-speaking focus group, the word ‘family’ came up 39 times, ‘friends’ 51 times, ‘convivial’ 72 times and ‘sharing’ 38 times.
This is in striking contrast with the Anglophone groups, where ‘family’ was mentioned eight times, ‘friends’ four times and ‘sharing’ only three times. Lastly, while Anglophones and Germans valued ‘conviviality’ on special occasions, the French, in particular, said they treasured conviviality as an ordinary, day-to-day event.
In addition to their attachment to conviviality, the French and Italian respondents were also found to adhere most closely to strict rules about meal times (three times a day, at fixed times), portion sizes (modest), table manners (no phones, no TV), in-between-meals snacking (forbidden), second helpings (frowned-upon), dietary variety (essential), eating environments (tables, real dishes and cutlery, not cars, sidewalks or desks).
Thus, ‘Mediterranean’ anti-cancer eating, as I see it, isn’t just about eating healthy food. It’s also about consciously developing a health-promoting attitude to food which nourishes body and soul.
Call me a hopeless romantic, but to me, healthy nutrition is about eating natural food grown nearby under open skies, moistened by rain, ripened by the sun and brimming with essential nutrients, simply prepared and enjoyed in a relaxed mood, ideally in the joyful company of fellow-humans. This celebration of the senses and the grateful, guilt-free acceptance of pleasure is one of the best things we can do for our health.
*If you think that ‘chilli con carne’ has no cancer-prevention virtues, let me assure you that my son’s stew contained only 60 grams (cooked) of grass-fed beef per person, supplemented with copious amounts of red kidney beans, five red and yellow peppers, two large onions, 6 cloves of garlic, four large tomatoes, tomato concentrate, generous amounts of cumin, coriander and paprika powder, a pinch of red pepper flakes, raw cocoa powder and a lavish scattering of fresh cilantro. Alongside it we ate steamed quinoa, a tasty, low-glycemic alternative to rice, low-salt tortilla chips (a small bag between 7 people, which yielded 8 chips each. Boy, did the children savour those!), and cubed fresh avocado to scatter over the stew. Bursting with flavour and nutrients, the dish contained little meat, yet it satisfied even the most rabid meat-eater in my family.
Every month I publish two Mediterranean-diet-inspired recipes on my website (click 'my recipes' tab on left menu). They are tasty, simple and affordable -- why not give them a try?
Tuesday, May 18, 2010
The traditional Mediterranean diet has garnered much academic and media attention in recent years, but it's no fad diet - in fact, it's been around for millennia. It is rich in protective plant foods, healthy fats and fish and eschews the refined carbohydrates, industrial fats and large quantities of red and processed meat that characterize the typical Western diet.
Over and above merely biochemical considerations, the Mediterranean diet embodies freshness, diversity, simplicity, conviviality and joie de vivre. As a nutritionist, I believe that healthy food should be enjoyable; if it feels like a chore, we won't persist eating that way for long. As a hedonist, the Mediterranean diet pushes all my pleasure buttons - and not just mine, as the huge popularity of Italian and French cuisines around the world illustrates.
In addition, the region has given birth to a rich food culture that celebrates conviviality, diversity and freshness - all of which boost the healthiness of the food we eat. (Incidentally, when I refer to the ‘traditional' Mediterranean diet, I mean a style of eating that prevailed until the 1950's, after which western eating patterns began making inroads into the Mediterranean way of eating - with regrettable consequences, as we shall see in a separate post.)
In relation to cancer, it is unclear whether the Mediterranean diet actually prevents the formation of tumors, or whether its protective role lies in hindering micro-tumors from developing into full-blown, life-threatening cancer. Whatever the mechanism, scientists estimate that up to 25% of colorectal cancers, 15% of breast cancers and 10% of prostate, pancreas, and endometrial cancers could be prevented if the populations of highly developed Western countries did nothing more than adopt a Mediterranean diet.
The more closely people adhere to the Mediterranean diet, the greater its anti-cancer effect. According to a study conducted in Greece, strict adherence to two elements of the Mediterranean diet - for example, a high consumption of vegetables and a low intake of meat - causes a 12% reduction in the incidence of all cancers. The study shows that the more elements of the Mediterranean diet are incorporated, the greater the protection; thus, simply adhering to four elements of the Mediterranean diet - for instance, by adding a high intake of fruits and legumes to the two measures described above - may reduce cancer incidence by up to 24%.
When combined with other healthy life-style habits, the Mediterranean style of eating can confer even greater protection. A large-scale European study found that people eating a Mediterranean diet who hadn't smoked for 15 years or longer, had regular physical activity and drank a moderate amount of alcohol, were 65% more likely to outlive their peers who had none of these healthy habits, and were 60% less likely to die of cancer.
You might be wondering how to adopt a Mediterranean diet without moving to Greece or Italy (albeit perhaps a tempting thought...). The good news is: you can eat this way wherever you live! Based on ingredients that are easily available everywhere, simple to prepare and delicious, Mediterranean-style eating can be transported to any part of the globe and adapted to local conditions.
During the Anti-Cancer Challenge, I have decided to adopt a traditional Mediterranean Diet following these principles:
The Mediterranean Diet: My Top-10 Tips
- High intake of vegetables and fruits
- High intake of olive oil, moderate intake of saturated animal fats
- High intake of legumes
- High intake of whole grains
- Frequent use of aromatic herbs and spices
- Moderate-to-high intake of fish
- Moderate consumption of dairy products, mostly as cheese and yoghurt
- Low consumption of meat and meat products, especially red meat
- Moderate red wine consumption with meals
- Enjoyment: taking time to prepare meals and sharing food and drink with others in a convivial atmosphere
Wednesday, May 5, 2010
“We are pleased to advise Conner throughout her Challenge,” says Dr Rachel Thompson, science programme manager in charge of nutrition at the WCRF. “A third of the most common cancers could be prevented by eating healthily, being physically active and maintaining a healthy weight. Unfortunately many people are not aware this. This is why we are pleased that Conner has launched the Anti-Cancer Challenge. We hope her initiative can help raise public awareness about the links between diet and cancer and show how our recommendations can be incorporated into everyday life.”
Regular readers of my blog will have noticed that I frequently refer to the WCRF for information and recommendations. That’s because I consider this organization to set the gold standard for cancer prevention.
WCRF International, founded in 1982, is a not-for-profit umbrella association unifying a global network of cancer charities dedicated to funding research and education programmes into the link between food, nutrition, physical activity, weight maintenance and cancer risk. The national charities under WCRF International’s umbrella are based in the US (American Institute for Cancer Research), the UK (World Cancer Research Fund UK), the Netherlands (Wereld Kanker Onderzoek Fonds), Hong Kong (World Cancer Research Fund Hong Kong) and France (Fonds Mondial de Recherche contre le Cancer).
The WCRF is best known for its landmark Expert Report “Food, Nutrition, Physical Activity, and the Prevention of Cancer: a global perspective” (WCRF/AICR 2007), preceded by “Food, Nutrition and the Prevention of Cancer: a global perspective” in 1997. The 2007 report is the most comprehensive investigation published to date on the links between food, nutrition, physical activity and cancer prevention and is based on the in-depth analysis of over 7,000 scientific studies published on cancer prevention over the last 50 years. A panel of 21 renowned scientists reviewed the research evidence and drew conclusions that led to the WCRF’s recommendations for cancer prevention, which in turn underlie my own Anti-Cancer Challenge exercise and diet plans.
In February 2009 the WCRF/AICR published “Policy and Action for Cancer Prevention,” a companion publication to the 2007 Expert Report that provides advice and guidance for key groups, such as governments and employers, on what can be done to influence and change people’s lifestyle choices, as they relate to their risk of cancer. All three reports are rather voluminous but quite accessible to lay readers with an interest in health and public policy.
Somewhat less visibly, the WCRF also funds research into cancer prevention; to date, the WCRF global network has funded over £64 million (some $97 million) of research. To see the studies the WCRF has helped fund, click here.
For people seeking hands-on practical advice, the WCRF network supplies a wealth of information free of charge on its websites. The content varies from one country’s website to another, but all the material is equally useful so do consult them all regularly. On the UK website, for instance, you can find an informative blog, tasty recipes and useful information booklets. The US website also offers a frequently-updated blog and research updates you can subscribe to, and more recipes. It may take more than one rainy afternoon to digest all the information available!
For those who do not have any rainy afternoons to spare, I aim to condense some of that information, supplemented with material of my own, on this blog by posting practical advice on healthy eating and exercise. For my Anti-Cancer Challenge, I have put together diet, fitness and sleep guidelines that I plan to follow for a year; to join me in the Challenge, simply click to download these guidelines, print them out, stick them on your refrigerator and off you go!
Do share your thoughts, ideas, suggestions or general feedback with the rest of us – if we all chip in, this blog can become a valuable resource helping people around the world keep themselves and their loved ones healthy.