The Real Food Issue by British Holistic Medical Association

holistic healthcare Volume 16

Issue 3

Autumn 2019

JOURNAL OF

Re-imagining healthcare

• Nourishing a small planet • Eating for individual, public and planetary health

• The real food campaign sustainability food and power • Food, imagination and reality • Is EAT-Lancet wrong? • Eating nose to tail • Eating old-style

• Making health infectious • Measuring food vitality

• A local community food system

• Wildlife-friendly farming • Seeds of survival

• Inspirational community projects

The real food issue

Plus

• Research • Reviews

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holistic healthcare JOURNAL OF

ISSN 1743-9493

Published by

British Holistic Medical Association West Barn, Chewton Keynsham BRISTOL BS31 2SR journal@bhma.org www.bhma.org Reg. Charity No. 289459

Editor-in-chief

David Peters petersd@westminster.ac.uk

Editorial Board

Dr William House (Chair) Professor David Peters Dr Thuli Whitehouse Dr Antonia Wrigley

Production editor

Edwina Rowling edwina.rowling@gmail.com

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Design

www.karenhobden.com

Cover illustration Ben Peters severedhp@hotmail.com

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Volume 16 ● Issue 3 Autumn 2019

Contents Editorial. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Eating for individual, public and planetary health . . . . . . . . . . . . . . 3 Mike Dixon

The Real Food campaign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Antonia Wrigley

For a healthy, sustainable and affordable British diet

Sitopia: the power of thinking through food . . . . . . . . . . . . . . . . . . . . 5 Carolyn Steel

Food: emotion, imagination and reality . . . . . . . . . . . . . . . . . . . . . . . . . 10 Andrew Morrice

EAT-Lancet – is there such a thing as ‘one-size-fits-all’ sustainability? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Robert Verkerk

Nose to tail nutrition and evolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Heather Rosa

Food for health: Putting traditional foods back on the table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Izabella Natrins

Making health infectious: from organic principles to whole health agriculture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Lawrence Woodward OBE

Food quality and its relevance to optimum health . . . . . . . . . . . . . 37 David Thomas

Building a local community food system . . . . . . . . . . . . . . . . . . . . . . . 41 Phillip Sharratt

Wilder labels, better farming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Tim Martin

Seeds of survival . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Fred Groom

Wellington’s inspirational community projects. . . . . . . . . . . . . . . . . 51 Helen Gillingham

‘Let food be thy medicine, and let medicine be thy food’ . . . . . 54 Jessica Frost

Is food the foundation for good health?

Prescribing lifestyle medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Mohanpal Singh Chandan and Asfia Aftab

William House . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Reviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Unless otherwise stated, material is copyright BHMA and reproduction for educational, non-profit purposes is welcomed. However we do ask that you credit the journal. With this exception no part of this publication may be reproduced in any form or by any other means – graphically, electronically, or mechanically, including photocopying, recording, taping or information storage and retrieval systems – without the prior written permission from the British Holistic Medical Association. Every effort is made to ensure the accuracy of material published in the Journal of Holistic Healthcare. However, the publishers will not be liable for any inaccuracies. The views expressed by contributors are not necessarily those of the editor or publisher. 1

Editorial

We need a healthy diet for a small planet

For most of us food just appears as if by magic, like money dispensed at the ATM. It arrives, often embalmed in plastic, whatever the season, so the realities of its planting and harvest are hidden from us. We are spared a hungry winter, but are detached from the natural world and less bothered about what suffered for the sake of our sausage, or the fungicidal mayhem spreading from the fish farm, or the ancient hedgerows torn up as wheat fields spread out, or calves dying so we can drinka pinta milka day. Yet ethics aside, it’s now impossible to think about food without running up against every aspect of our profligate and unsustainable ways of life. In the days before flight-guilt, on an economy flight to somewhere warm, my companion was gazing balefully at her airline lunch-tray. Set before her, anaemic microwaved chicken, reconstituted mash, some wilted hydroponic lettuce, a foil pack of Flora, plastic straws of milk and sugar. ‘It’s real’ she said ‘because it exists… it’s food because you eat it’. This is the problem in a nutshell; that we feel confused about what’s real. In hangar-sized supermarkets we are dazzled by cabinets of tasty looking food-like substances – plant-based only in the sense that they were made in food factories: produced in plants rather than grown on plants. We pop the ready meal into the microwave oblivious to how it got from soil to shelf, shelves that would be empty but for precarious and short-horizon global supply lines. A manufactured food-like product may be technically speaking nourishing: its packaging will tell you about its fat, protein and carb content; its warning flags will alert you to high salt, sugar and unsaturated fat. So far so biochemical, for this is what it usually meant by ‘you are what you eat’: food builds bodies. But nothing goes into the mouth without also going through the imagination, which is why what you eat reveals a lot about who you believe you are. Our dietary habits reinforce these unconscious assumptions, ensnaring us in illusions about our relationship to the natural world, for instance in the way white bread and white sugar used to signal pure and posh, while brown bread was for the poor and the peasantry. Perhaps too it satisfied a wish to detach from human messiness. Then came the wholefood revolution of the 1980s. Initially driven by concerns about fibre and fertilisers, it was accompanied by a widespread preoccupation with ‘naturalness’. Since those heady times, when we only had feelings and opinions to guide our choices, science has given us evidence-based lifestyles, evidence-based diets, even evidence-based contemplative practices. But the sands of expert opinion shift over time: 2

David Peters Editor-in-Chief

dairy fats were demonised for decades, until we learned about the trans fats in the non-dairy spreads we switched to in the 1980s. Now it’s margarine we have to avoid and butter is back on the table. So what is a healthy diet? Eat food; not much, mostly plants said Michael Pollan. Good advice you might think, yet Masai herders lived well on the blood, meat and milk of their cattle and not much else. Until the 1960s most traditional Alaskan Inuit people had a semi-nomadic life hunting and catching fish, marine mammals and birds. But in the 1960s after access to processed foods boosted refined carbohydrate intake by 50% (Fodor et al, 2014), the Alaskans, who were still eating a traditional low-carbohydrate, high-fat/protein diet, had a much lower incidence of atherosclerosis, hypertension and dental caries. The pendulum is swinging away from fat-avoidance towards sugar-fear. In WWII, when sugar was rationed and bread was once again brown, the nation’s health improved, despite wartime stress and austerity. After the battles ended in Europe, something like a war began on the farm as industrial agriculture took to chemical fertilisers and chased ever greater yields. But in time Big Farming damaged the soil structure, stripped out its essential minerals and microbes and poisoned our rivers with runoff. Now the nutrient supplement industry sells us back what’s been taken out, while Big Food sells us fake food that make us ill and Big Pharma sells the NHS its cures. Some say science is giving meat a bad reputation, that we are fundamentally carnivorous, that only processed and smoked meats are a cancer risk. Big Meat would like to convince us of this, and indeed many a small mixed farmer lovingly caring for her land would be in a fix if it weren’t for manure from her cows. Still we have to bear the realities of global overheating in mind, and in a year a cow can release 70 to 120kg of methane, whose climate impact is 23 times greater than the effect of CO2. It takes 1,800 gallons of water to produce one pound of beef, and there’s no counting the ecological cost of clearing Amazonia to grow soy beans for non-pasture-fed beef cattle. It’s no longer a question simply of a diet that’s good for individuals: we need a healthy diet for a small planet. Food is so much more than a mix of nutritional chemicals. In this issue of JHH we look at the power of food to affect soil, soul and society, and shine a light on some inspiration food-based community-building and sustainability projects. Nor have we shied away from the vexed question of food vitality and some radical dietary ideas. Food for thought.

Reference

Fodor JG, Helis E, Yazdekhasti N et al. ‘Fishing’ for the origins of the ‘Eskimos and heart disease’ story: facts or wishful thinking? Can J Cardiol 30:864–8.

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L E AD E R

Eating for individual, public and planetary health Mike Dixon

Chair, College of Medicine

Food is the most important factor in preventing disease. The right diet can also enable and speed recovery when we are ill. Yet diet seems to come bottom of the list when it comes to medical education or providing medical advice in the consultation. Our patients meanwhile – whether at home or in hospital – continue to eat relatively unhealthy diets and are spending a lower proportion of their income on food than ever. Part of the reason for this may be because we medics don’t seem to agree on what is a healthy diet. There are some generally agreed truths such as eat more fruit and vegetables, eat less fatty meat; and the protective effects of a Mediterranean or anti-inflammatory diet are well proven. Some diets have shown to be particularly helpful in areas such as heart disease and prostate cancer. Nevertheless, ‘experts’ and the media continue to confuse the general public with foods that are claimed to be superfoods one day and demons the next. One minute we need to eat less fat, the next it is less sugar. No wonder then if doctors are almost as confused as their patients about what we should be eating. Meat is a case in point. There is little doubt that fatty processed meat is bad for you. Yet we know that a pasturefed Angus steak is much healthier (eg higher omega 3 content) than the cheaper and more widely available meat from cattle grain-fed in barns. What we don’t know is the possible health-positive effects of meat from sheep or cattle grazed in natural pasture, perhaps containing plentiful herbs such as wild thyme and St John’s wort which might make such meat healthier still. Then there are wider issues such as how, without animal manure (and without importing chemicals from abroad), we would fertilise our fields. And when it comes to carbon footprint, let’s not ignore the ability of the pasture plants themselves to sequester carbon; an effect that is reversed by bare ploughed fields. A further element of complexity comes from the discovery of the importance of the trillion bugs that make up our intestinal biome. We know that they matter and that their effects range from bowel problems to obesity and disorders of mood and emotion. We also know that this inner world of gut bacteria prefers a wide range of diet, and that some probiotics and even faecal transplants can restore a healthy microbiome. And though it is still as © Journal of holistic healthcare

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yet a far from an exact science, it is becoming clearer that the individuality of our biomes and genotypes mean there can be no precise one-size-fits-all ‘good diet’. We are currently faced with an institutional and political unwillingness to reverse all the factors that stop us using the evidence available to help us lead more nutritional healthy lives. Healthy foods are, on the whole, more expensive than unhealthy foods. Supermarkets blame their offering unhealthy foods on the customers, who want to buy them. Farmers are encouraged to provide cheap food by the least friendly farming methods and, having bought all this cheap food, we throw away 40% of it. If politicians, food outlets, food producers, farmers and food academics could group together, surely there must be some means of reversing a system that currently ensures that those most in need of a healthy diet are least likely to be able to afford it or be sufficiently motivated to do so. These are some of the issues that will be part of this year’s College of Medicine conference Food on Prescription at the Royal Society of Medicine on 24 October. With social prescription now national policy surely it is time to make access to healthy food part of governmental policy, and a programme to make genuine change instead of just tinkering around the edges. The solution will have to deal with the current silo-thinking and political apathy. We are saddled with a system that competes to make ‘cheap’ food available, and consequently favours commercial interests that encourage farmers and food processors to produce less healthy food. It will also involve a united front among the medical profession – some of whom have too often put their egos and pockets before the common good. The College of Medicine established a Food Forum of all interested parties after our last conference Food: The Future Medicine. This did not succeed in its aims because of those conflicting interests and because it will take more than a few motivated people to unsettle the system: it will require a social movement. The College of Medicine is working with the BHMA to create a movement that will connect farming, food and health and arouse the energy of change required so that we all can live more fulfilled and healthy lives in a system that nourishes us and sustains the health of our planet. 3

C AMPAI G NI NG

THE

REAL

FOOD C A M PA I G N MY FOOD • MY HEALTH • OUR FUTURE

For a healthy, sustainable and affordable British diet Antonia Wrigley

GP; Vice chair BHMA and founder of The Real Food Campaign

While practicing as a GP my passion in nutrition was rekindled a few years ago by coming into contact with a growing number of medical practitioners using low carb diets to reverse diabetes and metabolic syndrome. This led me to further study and a better understanding of the complexity of the relationship between food and health. Through conversations with patients, colleagues and potential collaborators the necessity of focusing on ‘real food’ crystalised and the idea for a campaign took shape. My definition: real food is food that promotes health, both personal and planetary. It is nutrient dense, safe, whole food, which has been raised or grown in ways that regenerate our soils, and restores natural biodiversity.

The birth of the Real Food Campaign The first spark came from Professor David Peters after reading about the collaboration in the US of the Rodale Institute and the Plantrician Project. He wanted to ‘fire up a coalition of parties to promote the life-giving and overlapping areas of sustainable agriculture, lifestyle and diet. And, in addition, to tell a story about the healing power of relationship, with the soil, with one another and with the larger community’. This vision inspired me to plan a small gathering as the first step in a collaborative venture. The Real Food Gathering took place on a very windy weekend at the end of April 2019 and, despite the weather and some technical difficulties, was a huge success. We had 18 speakers and about 30 other participants with different areas of interest and expertise. Together we started a conversation and forged relationships, which are becoming the foundation and inspiration for future campaigning. Read more about the gathering in this blog by one of our collaborators: www.anhinternational.org/news/from-unreal-to-real-food. In the process of planning the gathering, through the many conversations I had and my ongoing exploration of 4

the field of food, farming and health, the inspiration for a campaign slowly developed and a twitter page/feed was started @Food_campaignUK. I see the need for educating both the general public and the medical profession about the importance of real food. From my discussions with patients and other doctors it is clear there is a great deal of confusion about what constitutes a healthy diet; there is also a lot of differing opinion and debate about diet which is likely to be ongoing. However focusing on real food could be an area of agreement and seems intuitively sensible. While the main focus for the Real Food Campaign will be on health we are also concerned about the environment. Happily, on the whole, food which is grown in ways which support nature tend also to be the healthiest. Over the next few months we plan to have more discussions with organisations sharing a similar ethos and aim to collaborate on various agendas including: • getting real food principles into medical education and public health guidelines • improving access to real food in local communities and institutions. There will also be a website which aims to give trustworthy and practical information to the general public and the medical profession which will be supportive of anyone with an interest in producing and sourcing real food. We hope to have blogs and other resources and be a hub for showcasing examples of inspiring local and community projects. We need to start fundraising to support our aims so please donate via our website (which currently redirects to the BHMA site) realfoodcampaign.org.uk. Over time, with the help of local real food ambassadors (sign up online), we hope to build local networks that bring together local producers of real food with consumers, patients and healthcare providers for sustainable community health.

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Sitopia: the power of thinking through food

S U S TAI NABI L I T Y

Carolyn Steel Architect

Food is one of the greatest forces shaping our lives and world, yet its effects can be too big to see. Food shapes our bodies, homes, habits, cities and landscapes, yet since we don’t value it, it does so in ways that threaten our health and planet, from dietrelated disease to climate change. By recognising that we live in a world shaped by food, in ‘Sitopia’ (from Greek sitos, food + topos, place) and by valuing food once again, we can redress these ills in a holistic, practical way.

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In 2008, I published a book called Hungry City: How Food Shapes Our Lives, in which I explored how the feeding of cities through history had shaped civilisations. As a practicing architect and lecturer, I had been looking for ways to expand the discourse about cities to include the everyday lives of those who lived in them. I had the idea of describing a city through food, and invented the word ‘Sitopia’, about which I now write and lecture all over the world.

Talking breakfast What did you eat for breakfast? This seemingly simple question – which most of us can answer without thinking – captures the unique quality of the greatest unseen process shaping our planet. Eating is as natural to us as breathing, so we rarely stop to wonder how the bread, milk, cereals, fruit, bacon or eggs on our plate happened to get there. Yet, when you come to think of it, the fact that most of us in the industrialised world get to eat three meals a day with very little effort on our own parts is something of a miracle; the greatest achievement, one might say, of industrialisation. What is increasingly clear, however, is that the ‘miracle’ has been achieved at a heavy cost: climate change, deforestation, soil erosion, water depletion, pollution, mass extinction, slavery and dietrelated disease are just some of the side-effects of the way we eat. The ‘miracle’, it turns out, is nothing of the sort: rather, it is the result of the systematic externalisation of the true costs of food production and the obscuring of the effort that it really takes to feed us. However great the breakthroughs that have given us industrial food – mechanisation, monocultural production, chemical fertilisers, factory farming, chill-chains, efficiencies of scale, just-in-time logistics – they have all had negative corollaries whose true effects have

Volume 16 Issue 3 Autumn 2019

been systematically ignored. In this way, the illusion of ‘cheap food’ (something that can never exist) came into being, a fantasy upon which modern economies, political systems and urban civilisation itself have come to depend. As EF Schumacher noted at the start of his seminal 1973 book Small is Beautiful, ‘One of the most fateful errors of our age is the belief that the problem of production has been solved’. Living in a Western city, it would be easy to imagine that we’ve solved the problem of how to feed ourselves, yet the very opposite is true: the way we eat is now the greatest threat to us and our planet. How did we get here – and what are we going to do about it? In order to answer such questions, we need to return to the breakfast with which we started. Next time you sit down to eat, take a moment to stare at the food you are about to consume and try to imagine where it came from. Where were the oats in your cereal grown? Did they come from a vast monocultural field, or from a small, mixeduse farm? Were they grown chemically – ie with large doses of artificial fertiliser or pesticides – or organically, in nutritionally rich, living soil? And what of the milk you poured on? Did that come from grass-fed cows grazing in open fields, or animals kept permanently indoors and fed on grain that we ourselves could have eaten? 5

SUSTAINABILITY

Sitopia: the power of thinking through food

Or perhaps you used almond milk, in which case, did it come from the desertified plantations of California? And what of the sweetener you used? Was it honey from local hives, or sugar from vast refineries made from cane grown in the tropics? Do you know if the people who produced it were paid a living wage? As such an exercise soon makes clear, there is nothing simple about food, even an innocent-looking bowl of porridge. Every bite has vast implications for the shaping of landscapes, ecologies, societies, economies, trading patterns, living standards, power structures and cultural attitudes. We live in a world shaped by food: a place I have called sitopia (from the Greek sitos, food + topos, place). Yet by failing to value food – expecting it to be cheap – we have created a bad sitopia: one so bad that it threatens our very future. The morsels of food on our plates are emissaries from other worlds, each bearing signs of the value we place on them. Did the production of the plate of food in front of us make the world better or worse? Eating is an inherently political act, as well as an ecological and ethical one: there is no such thing as amoral food, any more than there is a free lunch. Once we have realised this, eating becomes a very different activity: one that we can no longer do without thinking. This new awareness is one we can harness for good, since most of us choose how we eat. Food, we realise, represents power.

punishment), its one great advantage was the ability to produce a food surplus that could be stored through the year and so used to feed large non-food producing populations. Cities and agriculture co-evolved for this reason, and the world’s first urban settlements – the Sumerian Ur, Uruk, Kish and Nippur, situated on the banks of the Tigris and Euphrates – were effectively citystates: compact urban centres surrounded by dedicated farmland. Although they grew rich by exporting grain, such cities remained small enough to feed themselves, forging an urban blueprint that, for many, remains the ideal.

Food and power

Although hunter-gatherer societies revolved around food, its related tasks were so embedded as to be indistinguishable from the rest of life: one reason why the concept of work is virtually unknown in such communities. Urban-agrarian societies, on the other hand, required new structures and processes to deal with the complexities of farming and the seasonal tasks of sowing, growing, reaping, processing and storing their new staple, grain. Writing and money were two crucial outcomes of this development, as were social hierarchies that distinguished for the first time between feeders and fed, farmers and consumers, rural and urban. Although farming was far harder work than huntergathering (earning it the universal status of divine

The Fertile Crescent, where farming and cities began (drawn by author)

City 1.0: Map of the City of Ur, circa 2000 BCE (drawn by author from a map by Sir Leonard Woolley)

Most pre-industrial settlements followed this basic pattern. Towns and cities were generally small and all roads led to the central market square, which was the heart of all commercial and public life. Most cities were built on rivers, which provided them with fresh water, fish and a handy waste disposal facility. Grain was grown out in the countryside, yet close enough to the city to make the transport of the relatively bulky, low-value food economic, while sheep and cattle, which could walk to market, were often grazed further away. Most households kept pigs, chickens or goats, which could be usefully fed on household scraps. Fruit and vegetables were grown in the city fringes, where they could benefit from ‘night-soil’ (animal and human waste) that was carefully conserved to be used as manure. Most cities, in short, had largely local, circular food economies. The city that bucked the trend was, of course, ancient Rome. The world’s first ‘consumer city’, its vastness – with some million citizens by the first century AD – meant that it had to do things differently. At its height, Rome was importing grain, oil, wine, ham, salt, honey and liquamen (a popular fermented fish sauce) from all over the Mediterranean, North Atlantic and Black Sea. Rome, in short, fed itself via what we would now call ‘food miles’:

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Sitopia: the power of thinking through food

the excess grain to cows, the feedlot system was born, creating a previously unthinkable commodity, cheap meat. Chicago became the meatpacking centre of the world, and when a packer by the name of Gustavus Swift worked out how to get his beef to the East Coast in an edible state (by using refrigerated railcars, the start of the modern chill chain), all the essentials of our current food system were in place. Henceforth, cities would be fed, not by intricate networks of small producers, but by a small number of powerful companies with the scale to take vertical control of the food chain and the logistical capacities to match. Today, the global food system is more consolidated than ever, with a handful of companies such as Nestlé, Walmart and Bayer-Monsanto commanding profits bigger than many national GDPs and just three such corporations controlling 60% of the world’s George Scharf, A Cowkeeper’s Shop in Golden Lane; 1825 watercolour: fresh milk in the pre-industrial city seeds and 70% of its fertilisers and pesticides. As such statistics suggest, the methods a strategy made possible by its command of the sea, over employed by such companies are overwhelmingly industrial, which it was far easier (and about 40 times cheaper) to meaning that crops are grown monoculturally with the transport food than it was overland. With such staples use of chemical fertilisers and pesticides, rather than pouring in from abroad, local farmers were able to organically on mixed farms. Our quest for cheap food has concentrate on producing luxury foods for the city: turned us against nature, with disastrous consequences for everything from fruit and vegetables, poultry and game the natural ecosystems without which we couldn’t exist. to songbirds, pond fish and nut-stuffed dormice. This so-called pastio villatica (villa farming) made farmers a Sitopian economics fortune, yet was ridiculed by Pliny and others, for whom it merely symbolised the capital’s decadence. The way we eat is killing us and our planet – so what can It’s not hard to recognise ourselves in the mirror of we do about it? The most obvious first step would be to ancient Rome. While the city sucked up the nutrition from acknowledge that cheap food doesn’t exist. Food, after distant lands, rich citizens worried about eating too much, all, consists of living things – plants and animals – that we yet as their appetites expanded, the capital increasingly struggled to feed itself, eventually succumbing to collapse as the soils of its North African breadbasket failed. Rome ended up eating itself to death, as we are in danger of doing.

Goodbye geography The nineteenth-century advent of railways transformed the way cities were fed. By making it possible to transport food quickly and cheaply over long distances, railways emancipated cities from geography, allowing them to grow any size, shape or place for the first time. As the metropolitan carpet started to roll out, a matching agricultural one began spreading in the New World, as previously inaccessible territories such as America’s Great West were opened up to grain production. When some US stockmen had the bright idea of feeding

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Ancient food miles: the food supply routes of Ancient Rome (drawn by author)

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Sitopia: the power of thinking through food

food waste, grass and crop residues, much as they were raised in the past. Although organic veganism is the most low-impact way we can eat, we do need animals in our food system if we are to farm organically since, as the British ‘father of compost’ Sir Albert Howard pointed out, they make a vital contribution to the circulation of nutrients and to soil fertility. There are some who say that, in order to save nature, we should intensify agriculture and build vertical farms in cities in order to release as much countryside as possible back to wilderness. First proposed by US epidemiologist Dickson Despommier early in this century, vertical farms already exist in Singapore, New York and London, plying a Ogilby map of London in 1676, shaded to show food markets and supply routes (annoted by author) brisk trade in micro-greens sold to high-end stores and restaurants. Yet, as vertical farmers themselves admit, such farms are not the answer to feeding cities in the future, since, apart from the vast amount of space needed to build them, the cost of growing staples like grain in towers simply doesn’t stack up. Vertical farms may be part of the solution, but they can’t escape the urban paradox which states that, however much we imagine ourselves to be urban, our need for food means that, in a greater sense, we all still dwell in nature and depend on it. Vertical farms are, in essence a luxury item, the pastio villatica of our day. Could lab-made alternatives to meat and dairy be part of the answer? This latest trend from Silicon Valley is already big in the US, Chicago Union Stockyards: the invention of cheap meat with start-ups like Just and Impossible Foods attracting billions in investment from kill in order to live: to treat it as cheap is thus to devalue the likes of Sergei Brin and Bill Gates. Impossible Burgers, life itself. If we were to value food properly again – which which mimic meat juices using a vegetable compound is to say, to internalise its true costs – it would transform called haem (which also exists in animal blood and gives our lives, landscapes and societies. Industrial farming in its current form would immediately become unaffordable, which, in reality, it already is. The true cost of good food – which is to say, food produced in ethical, ecologically friendly ways – isn’t cheap. In societies where food is valued, feeding people is a hugely rewarding way of life. This is a win-win scenario since, if we want to work with nature instead of against it in order to feed ourselves – as, indeed, we must – we will need far more farmers working and looking after the land, not fewer. Contrary to those who insist we can’t feed ourselves organically, the latest research suggests not only that we could, but that we could do so without increasing the amount of farmland needed. In order to do that, however, we would need to eat rather differently – much less meat and dairy and wasting far less – yet such aims are surely not beyond our grasp. We might adopt what the British farmer Growing Underground, London’s subterranean ‘vertical farm’: part of the answer? and journalist Simon Fairlie has called a ‘default livestock’ Credit: Richard Ballard, Growing Underground approach, raising only the animals we could sustain on 8

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Sitopia: the power of thinking through food

haemoglobin its name), are already popular in the US and went on sale in the UK in 2018. Google, meanwhile, is funding a Dutch initiative to grow meat protein in a lab, using bovine foetal serum to replicate muscle tissue to produce so-called cultured beef. Whatever your view of such projects, the question is whether we really want our future food to be made and owned by the likes of Google and Amazon. Control of food, as our ancestors knew, is power. Perhaps the greatest lesson we can learn from our past is that big cities are hard to feed. Plato and Aristotle believed that the polis (Greek city-state) should stay small in order to remain self-sufficient, while Thomas More’s 1516 Utopia, Ebenezer Howard’s 1902 Garden Cities and Patrick Abercrombie’s 1944 London Green Belt all Bohn and Viljoen’s Continuous Productive Urban Landscapes (CPULs): post-fitting the city with countryside. Credit: Bohn and Viljoen Architects. shared the same idea: that cities should be limited in size and surrounded by countryside to satisfy our human needs both for society we live in future. Using the lens of food, we need to and nature. consider what a landscape for human flourishing might In a rapidly urbanising world in which megacities such look like in the mid twenty-first century, by which time life as Tokyo, Delhi and Shanghai have populations upwards will necessarily be ordered as something like a no-growth, of 24 million, such ideas arguably have more relevance steady-state economy. If such a way of life requires that we than ever. Uncontrolled urban growth is predicated on the weave city and country closer together, future cities will false premise that cities are easy to feed. The fact that we have to be planned with farming in mind. Existing ones know this not to be true should urge us to rethink how could be retro-fitted, as André Viljoen and Katrin Bohn have proposed with their concept their Continuous Productive Urban Landscapes (CPULs). As Patrick Geddes once said, we should ‘make the field gain on the street, not merely the street gain on the field’. How we eat means more than simply whether our food tastes nice and makes us healthy: it is critical to the way we shape our lives and those of the other living creatures with whom we share the planet. Food is the great connector: the substance that ties us directly to the world’s living ecosystems, as well as to one another. By thinking more clearly about what and how we eat, and acting accordingly, solutions to our core human needs for sustenance and society will emerge. Because food and feeding are so fundamental, if we can get them right despite the many complexities of our times, humans may yet thrive in an ever more crowded, overheating world. Indeed by valuing food (and interrogating our porridge) we can work together to build a better sitopia.

Reference

Schumacher EF (1973) Small is beautiful. New York, NY: Vintage, p2.

Ebenzer Howard’s Garden City: an unrealised utopia

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Food: emotion, imagination and reality FO O D AND I MAG I NAT I O N

Andrew Morrice GP, psychotherapist, educator

There is a real urgency to solve the extinction and climate disasters that we have collectively created, and food production is a massive part of the problem and solution. There is nevertheless a division of well-meaning opinion on what exactly we should do, with at least two quite different dietary approaches proposed to tackle the rising tide of chronic disease and the climate emergency. Rational objectivity requires calmness, good quality information, and a willingness to consider many perspectives. If ‘a human being is an animal that believes the stories it tells about itself ’, surely our task is to work out what is the truest story. 10

I became interested in diet and health and what was then called ‘alternative medicine’ while still at school and went on to study medicine. I have been a member of the BHMA for 32 years and co-led the London Medical Students Group from 1988–1991. I work mainly in general practice, and I was a member of the clinical team at Bristol Homeopathic Hospital for eight years and taught at Bristol University on the Whole Person Care course for 15 years. I am a registered human givens (HG) therapist, and teach regularly for HG College. In 2018 I set up JoinedUpHealth to develop and deliver education for GPs (and perhaps the public) about how the HG model applies not just to mental but overall health. In terms of diet and health I have experienced a number of approaches including classic whole-food vegetarianism, blood-type, Atkins, lowcarbohydrate, raw diet, and veganism. Things have settled down completely since moving to a blue-zone diet about eight years ago. www.joineduphealth.net

Why are we in this situation? The answer lies in the way our embodied minds work, which is of course not in the reasonable, rational way imagined by lawyers, logicians and (when we know we are right) ourselves. What is going on is far more interesting, far less ‘cognitive’ and a great deal more emotional. Rational objectivity is a state we can hope to achieve, and it requires special conditions, of which the key component is calm. Calm, good quality information, and a willingness to consider many perspectives. This, and other similarly helpful tools for understanding our human world, came for me primarily through my long reflection on the human givens (HG) approach (Griffin and Tyrrell, 2003). The HG model starts with the observation that human beings are organisms, and like any other organism we survive and thrive by deploying a set of innate resources to meet our innate needs in the environment. It goes on to describe health as arising from a situation in which needs can be met in balance, through properly developed and deployed resources within an environment that will

support this process. Though developed originally to describe mental and emotional health, this simple biological idea works well for health overall: the key to creating and restoring health is work out how to meet our needs in balance. Crucially this means we must distinguish clearly between our needs and desires, a surprisingly difficult task particularly in the area of food and nutrition.

Our emotional guidance system One resource, which we share with the other vertebrates, is vital to understanding many of our difficulties: the ‘emotional guidance system’. What do we mean by this? Animals typically operate through movement and behaviour, an approach that requires large-scale information processing equipment – brains and nervous systems – to integrate information and guide action aimed at meeting needs such as nutrition, safety and reproduction. The fundamental questions for a moving organism are to move or rest and, if moving whether towards or away. Fear and disgust prepare us to move away, anger and desire to move towards –

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Food: emotion, imagination and reality

though in quite different ways. Emotions guide the actions of the entire organism and one of the fundamental tasks of this system is to find food. It has transpired that these emotional (or more correctly, affective) states are built into the fundamentals of brain function, into everything it perceives and predicts, though we only tend to notice them as a feeling or emotion when the intensity is strong enough. Back in the 1990s the concept of emotional hijack was popularised, but this idea – that strong emotional arousal hijacks cognitive processes – has been replaced by a more nuanced model (LeDoux and Brown, 2017) in which affect and emotion are continuously focusing our attention and framing our perceptions (Feldman Barrett, 2017). The totality of sensory information available through eyes, ears, nose, skin, joints, muscles, tongue and internal organs would if processed raw require what Douglas Adams memorably described as ‘a brain the size of a planet’. Instead our brain is constantly jumping to conclusions – usually with remarkable accuracy – by creating a simulation of the world from a series of summaries of past experience learnt from infancy onward. What we experience, what we see, hear, touch and smell is a set of constructions, a simulation which our brain has created on the basis of prediction. This is the basis of many well-known phenomena, includng th fct that yu can rd the rst of ths sentnce wth sme of th lttrs missng. It is a very efficient way of dealing with all the data to hand, and is balanced by an ongoing ‘error checking’ process.

The mirage-making brain Crucially this whole process is influenced by affect; and generally the more intense the affective-emotional state we are in, the less interested our brain becomes in checking out whether what we perceive is true. Lisa Feldman Barrett expresses this memorably by comparing the highly emotionally aroused brain to ‘like a bad scientist’ who is unable to acknowledge data that contradicts their theory. This suggests that confirmation bias is in fact a manifestation of the way we perceive the world. It also warns us that passionately held views are likely to be held even in the presence of information that clearly contradicts them. Furthermore, human beings have taken this ‘miragemaking’ capacity of the brain to extraordinary lengths. The human brain, perhaps uniquely, is not just dealing with real-time information coming from the outside world and from our biological interior, but also with dreams, visions, memories and anticipations, fantasies, inventions, symbols, and stories. Our brains can create not only a current reality but can create images and hear sounds of things past, things future, things as yet undreamt of. We run simulations of that argument we had last week, or watch an internal movie of ourselves performing well in an interview, or dream up a new recipe. Not only this, we have created language to symbolise ideas, objects and actions. So when we read a book we may hear the voices described, when we listen to someone speak we may see

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what they talk about, and these sights and sounds are (almost) as real to our brains as reality itself. And all of these are, in important respects, as real to the brain as anything else. Our mind might much more usefully be described as a ‘reality simulator’, or as our ‘imagination’. And the basic stuff of emotions – affect – is woven right into the fabric of this amazing human resource. One lovely way of summing all this up is, ‘A human being is an animal that believes the stories it tells about itself ’ (Rowlands, 2010).

But why is any of this pertinent to food? The finding and consuming of food is of central importance to any animal, so the role of affect in our perception of nourishment is extraordinarily ancient and well-developed. There are few areas of life as emotive as food. We are fed by those we love and who love us when we are at our most small and vulnerable. The simple act of eating in company – with family or friends – is profoundly bonding, creating trust and love. Because eating is such a strong stimulator of our relaxation and connection responses we can learn to associate comfort with anything from a tub of ice-cream to a steak. Refugees and exiles always dream of the food of their homeland, the taste of a loved recipe from childhood is, as Nigel Slater noted in his book Toast (2003), a powerful gateway to a world of memory and feeling. Regardless of the environmental or health costs of a particular food eaten in childhood, each of us will perceive it through a powerful and very personal lens of emotion and feeling. This is one of the ways in which food becomes identity. This is the hidden payload in the often repeated and seldom examined phrase ‘we are what we eat’. Indeed. The French are (apparently) ‘frogs’, the English ‘les ros-bifs’, the Dutch ‘kaaskoppen’ (cheese-heads), and the Germans ‘krauts’. In this way we can understand that anyone who has not grown up eating a diet that will optimally preserve their health and wellbeing may encounter a profound sense of threat to their identity when a suggestion is made that they might change their eating patterns. There are people who would rather die than change what they eat: and history is full of examples of people who have chosen death rather than give up a core aspect of identity. And not just because of identity: the social aspects of shared food are enormously powerful, as anyone who has changed their diet from the prevailing pattern in their family and social network knows to their cost. Anyone who has decided not to eat meat, for example, may find themselves as pressured and mocked as a teetotaller in the company of drinkers.

Pleasure and addiction The human givens model has a neat way of understanding addiction – when our emotional needs are not met in balance we can easily form an addiction to any activity that 11

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can generate a feeling of pleasure. Obviously this happens most readily when there is an element of pharmacological action as with tobacco, caffeine, alcohol and opiates. And the food industry understands all too well that there is a simple recipe for creating addicting foods: fat, salt and sugar. The foods most problematic in terms of addicting behaviour consistently have these features, or at least two in combination. The fat-and-salt combination in bacon or cheese is as hard to deal with as more regularly demonised sugary foods such as breakfast cereals and sodas (Schulte et al, 2015), which is a concern as bacon is in the same carcinogen category as asbestos and plutonium (IARC, 2018). And if you are now undergoing a strong emotional reaction – do look up the references! What is interesting is that although there is a clear sugar–salt–fat predisposition to addicting foods, which are associated with all the brain changes seen with classic addictions (Wiss et al, 2018), there is also evidence that individual conditioning is important – anything pleasant can be addicting (Burger and Stice, 2012). This is all very relevant because the language of resistance around dietary improvement is at times identical to that around tackling addiction. For example: ‘you’ve got to live’, or ‘life wouldn’t be worth living’ or ‘it’s my only pleasure in life’.

Safety also plays a part We all have an innate need to stay as safe as possible (while meeting our other needs), and a perceived threat to safety puts us in a highly focused emotional state. Decades of marketing specific foods on the basis that they contain specific essential nutrients has created a situation where people fear doing without foods that are simply not essential, in order to obtain nutrients that are found in an enormous variety of foods. A good example is the marketing of milk as containing vitamin D which began in the 1920s and soon shifted to calcium. Milk is not an essential food for any adult mammal. Perhaps you now are feeling cross, and perhaps tempted to put this article aside? Bear with it. It may be worthwhile. If I mention spinach and iron (another early example), does that help? Notice how powerful these reactions can be. Seafood is another good example here. Nowadays we are advised to eat oily fish regularly. One wonders how many of those giving this advice notice or care that the oceans are now dying toxic waste dumps with dwindling populations of oily fish concentrating ever larger quantities of persistent organic pollutants and heavy metals, or that wild fresh-water fish also contain the long chain omega-3 fatty acids (William et al, 2017) we believe we need to get from seafood, but which most of us (but not all) can, along with our microbiomes (Wall et al, 2009), produce for ourselves (Domenichiello et al, 2015) from abundantly available alpha-linolenic acid, or obtain direct from algae (Sarter et al, 2015). No. We tumble straight from magical ingredient to over-specific terminology into a collaboration in the destruction of marine ecosystems.

Returning to safety and fear, these show up again in the issue of familiarity. It is an essential protective instinct for small children to be disgusted by unfamiliar and strong-tasting foods, and they learn by imitation (and now also through advertising) what is safe, desirable and palatable. This distrust of the unfamiliar remains, albeit in somewhat diminished form into adulthood. At the Food Gathering we heard a wonderful story about an old lady who refused to try the ‘organic’ potatoes until they were offered as a free sample. She had distrusted these strange new-fangled and doubtless hallucinogenic objects, until she ate them and found that ‘they were real potatoes, like the ones you used to get’.

Black and white thinking Just as the animal fundamentally needs to distinguish what to approach and what to avoid, in the area of food we have a profound tendency to divide foods into ‘good’ and ‘bad’, ‘healthy’ and ‘unhealthy’. And often all that is needed to flick a food from one category to another (a process usually accompanied by fear or desire) is a word, an ingredient, a nutrient or an idea. This is the whole magic of food labelling and marketing. Yet in reality foods are varied in their quality, content and provenance in very many ways, some are better in many or all ways than others. It is more helpful to think of better and worse, than good and bad, in colour, rather than plain black and white. Yet day by day we are faced with a series of effectively binary choices – to eat or not to eat specific foods – and we are easily swayed by ‘low-fat’ ‘protein’ ‘natural’ or ‘vegan’ to makes choices that could easily have been improved on. The use of self-declared standards in this area is of concern. We may support the idea of pasture-feeding livestock, but there is no currently binding definition of this, and a ‘pasture-fed’ designation that is on the wrong side of the threshold required to either confer proven overall health, and overall climate benefit is simply greenlighting a product that could be construed as harmful.

The power of language We are so accustomed to our trick of substituting sounds for objects, processes, perceived qualities and abstract concepts that we forget how powerful and potentially misleading our language can be. ‘Milk’ is a noun that can be used to describe both a skimmed homogenised carton and the liquid of yesteryear which could be found on our doorsteps, consisting of several layers: milk, cream, air, foil, and bluetit. ‘Bread’ can describe a pizza base and a wholemeal spelt loaf. Which means that terms like ‘bread’ and ‘milk’ can hide as much as they reveal. But at least milk and bread – variable as they are – are as tangible as tables and carburettors. Our difficulty becomes more obvious with abstract terms like ‘natural’, ‘goodness’, ‘healthy’ and – paradoxically – ‘real’. These terms can be useful, but only when we can agree on what

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Food: emotion, imagination and reality

they mean. Politicians love such words because they can be used to manipulate us. ‘The people of Britain want change’ – yes, but different people want different things to change. ‘Change’ is an example of a nominalisation – a word that denotes an abstraction, action or quality, but which is used like a noun. It is an essential task of language to summarise sometimes complex concepts, but our problems start when we are left filling in the blank ourselves: in the politician’s audience we are all obliged on hearing the word ‘change’ to imagine our own idea of desirable change. ‘Sustainable’ is another example, because one person’s sustainable is another person’s environmentally damaging. We all have a slightly different idea about what ‘real food’ might be. It is a useful way of starting a discussion, but we need to move beyond this concept to something we can see or touch, test or otherwise agree on.

Us-and-them thinking Language is often used to create categories, which however arbitrary, can acquire an apparent solidity (through the same fundamental process as the examples above) causing many difficulties. It is not unusual for people to describe themselves as vegetarian or vegan or paleo or low-carb. The tragedy is that these are all arbitrary artificial concepts, which are then used as the basis of ‘us and them’ thinking, promoting conflict, sometimes between people who actually agree on a great deal more than they disagree on. But a moment’s thought can often release us from these traps. After all, how often does a person need to eat meat to be an omnivore? And if you have porridge for breakfast are you a vegetarian? It is pointless if vegans assume that nothing about their diet can harm the environment or that no animals died or suffered in the process of producing their food. Similarly it is quite daft to think that anyone now can eat a paleolithic diet without being a traditional hunter-gatherer in one of the few remaining wild places on our planet.

Collective self-deception Both are examples of linguistic spell-casting, forms of collective self-deception. Another place in which this is particularly problematic is in the description of foods as macronutrients. The habit of discussing food primarily in terms of protein, carbohydrate and fat is quite novel, and really only took off in the 1970s. There are two huge problems with this approach. The first is that the overwhelming majority of food is made of living things, and living things are built of cells, and cells are made of lipids, water, carbohydrates, proteins, nucleic acids, and myriad other compounds. Unless the food has been refined into a pure compound – like white sugar, corn oil, or whey powder – it is usually unhelpful to label it primarily as one or other macronutrient. The second, related problem concerns research (above and beyond the well-known issues with industry funding, which is widespread in

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nutrition research). There is no agreed definition of high or low carbohydrate, fat or protein diets. Yet these terms are routinely used. It is hard to think of another area of science where such a lack of clarity would be tolerated for an instant, let alone decades. For example it is not uncommon for the ‘low fat’ group in a diet study to be eating 30% calories from fat (Shai et al, 2008). Since most of us don’t read the actual scientific papers (often they are behind a paywall), we (or the journalist writing about the study) who believe the abstract and the title are misled. This misapprehension about macronutrients has also provided ample material for storytellers, and human beings do love to believe the stories they tell.

What are we to believe? A recent story goes like this: on the basis of cherry-picked data in Ancel Keys’ Seven Countries Study, the scientific community went on a 50-year publicly-funded wild goose chase blaming saturated fat for heart disease, and gave the public the misleading advice in the 1970s that what was needed was a shift to a low-fat diet. This low-fat diet advice led to the avoidance of dietary fats and an upswing in the consumption of sugary and starchy foods leading the current obesity epidemic (Taubes, 2009). A great story, and debatable at every point (Guyanet, 2017; Astrup et al, 2000; Pett et al, 2017) the most striking evidence being from the US government data that shows that Americans overall didn’t ever eat a low-fat diet during this period, they just kept right on eating more and more of everything (USDA, online). Perhaps you’ve also heard another: that from the turn of the millennium the meat and dairy industry funded studies that appear to have been designed to neutralise the scientific consensus on dietary fat. Examples include that you can eat beef and lower your cholesterol, by halving the overall saturated fat in the ‘beef ’ diet (Roussell et al, 2012); not controlling for known confounders (Guo et al, 2017); apparently comparing high fat and high carb diets, while actually carefully matching fatty acid intakes (Thorning et al, 2015). They were able to rely on our modern press and commentariat to over-interpret the studies and overlook the fine print. I like this story too but I know enough now to hold it lightly. The truth is going to be in one way more complicated (Forouhi et al, 2018), and less of a stark contrast to the past (Sacks Frank et al, 2017). The truth is much easier to apprehend when we talk about foods, rather than macronutrients, and if we give due emphasis to studies that can robustly show causation and that focus on meaningful outcomes. We can ask ourselves, could this situation have arisen without the particularly problematic interaction between human imagination and emotion when it comes to food?

What are we to do? ‘Let us not talk falsely now: the hour is getting late’, sang Bob Dylan in All Along the Watchtower. 13

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The hour is indeed getting late and, regardless of our intentions, to avoid ‘talking falsely’ we need calm attentiveness and the ability to hear clearly what other people are saying. We do well to notice that most informed proponents of different dietary approaches agree on many elements of healthy diet and most thoughtful food producers can find ample common ground. We need therefore, to open ourselves to information that might disprove our ideas, and be prepared to be wrong at times. We need to urgently agree guiding principles that are maximally consistent with the reliable information we have to hand, not just our favourite data. We urgently need robust terminology and concepts to describe the actions we need to take. Our planet will remorselessly respond, not to what we imagine we are doing, but to what we actually do. Even our bodies can only do so much: clinical experience suggests there must be a limit to the food-placebo effect. We are with a few enlightened exceptions, emotional creatures, living largely in our imaginations, believing the stories we tell about ourselves, using words that we take for reality. Given all this, surely our task is to work out what is the truest story. Perhaps we can start by noticing the basic dietary pattern that the longest lived and healthiest populations around the world eat (Buettner, 2012) is neither low-carb, nor vegan, nor paleo, and is probably consistent with all the aims and objectives of those who met at the Real Food Gathering in April. And it might just see us through.

Blue zones

With their strikingly high concentrations of individuals who live to be over 100-years-old, blue zones include the following regions: Ikaria, Greece; Okinawa, Japan; the province of Ogliastra in Sardinia, Italy; the community of Seventh-Day Adventists in Loma Linda, California; and Costa Rica’s Nicoya Peninsula. Although food choices vary from region to region, blue zone diets are primarily plantbased, with as much as 95% of daily food intake coming from vegetables, fruits, grains, and legumes. People in blue zones typically avoid meat and dairy, as well as sugary foods and beverages. They also steer clear of processed foods. A wholesome diet isn’t the only factor thought to lead to longevity for those living in blue zones, however. Such individuals also have high levels of physical activity, low stress levels, robust social connections, and a strong sense of purpose. www.verywellhealth.com/blue-zone-diet-foods-4159314

based milkshake. The American Journal of Clinical Nutrition, 95(4) 810–17. Domenichiello AF, Kitson AP, Bazinet RP (2015) Is docosahexaenoic acid synthesis from -linolenic acid sufficient to supply the adult brain? Progress in Lipid Research, 59, 54–66. Feldman BL (2017) How emotions are made: The secret life of the brain. Stuttgart: Pan Macmillan. Forouhi NG, Krauss RM, Taubes G, Willett W (2018) Dietary fat and cardiometabolic health: evidence, controversies, and consensus for guidance. BMJ 361, k2139. Griffin J, Tyrrell I (2003) Human givens: A new approach to emotional health and clear thinking. Chalvington: Human Givens. Guo J, Astrup A, Lovegrove JA, Gijsbers L, Givens DI, Soedamah-Muthu SS (2017) Milk and dairy consumption and risk of cardiovascular diseases and all-cause mortality: dose–response meta-analysis of prospective cohort studies. Eur J Epidemiol 32, 269–287. Guyenet S (2017) Did the US dietary guidelines cause the obesity epidemic? [Online]. Available at: www.stephanguyenet.com/did-the-usdietary-guidelines-cause-the-obesity-epidemic (accessed 24 July 2019]. IARC (2018) Red meat and processed meat. IARC monographs on the evaluaton of carcinogenic risks to humans, volume 14. Geneva: WHO Press. LeDoux JE, Brown R (2017) A higher-order theory of emotional consciousness’. Proceedings of the National Academy of Sciences, 114(10) E2016–25. Pett KD, Willett WC, Vartiainen E, Katz DL (2017) The Seven Countries Study. Eur Heart J 38, 3119–3121. Roussell MA, Hill AM, Gaugler TL et al (2012) Beef in an optimal lean diet study: effects on lipids, lipoproteins, and apolipoproteins. Am J Clin Nutr 95, 9–16. Rowlands M (2010) The philosopher and the wolf: Lessons from the wild on love, death, and happiness. New York, NY: Pegasus Books. Sacks FM, Lichtenstein AH, Wu J HY, et al (2017) Dietary fats and cardiovascular disease: a presidential advisory from the American Heart Association. Circulation 136, e1–e23. Sarter B, Kelsey KS, Schwartz TA, Harris WS (2015) Blood docosahexaenoic acid and eicosapentaenoic acid in vegans: Associations with age and gender and effects of an algal-derived omega-3 fatty acid supplement. Clinical Nutrition 34, 212–218. Schulte EM, Avena NM, Gearhardt AN (2015) Which foods may be addictive? The roles of processing, fat content, and glycaemic load. PLOS ONE, 10(2) e0117959. Shai I, Schwarzfuchs D, Henkin Y et al (2008) Dietary Intervention Randomized Controlled Trial (DIRECT) Group, 2008. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 359, 229–241. Slater N (2003) Toast. London: Fourth Estate. Taubes G (2009) The diet delusion. London: Vermilion. Thorning TK, Raziani F, Bendsen NT et al (2015) Diets with high-fat cheese, high-fat meat, or carbohydrate on cardiovascular risk markers in overweight postmenopausal women: a randomized crossover trial. Am J Clin Nutr 102, 573–581.

References

United States Department of Agriculture (2019) Food availability (per capita) data system. Available at: www.ers.usda.gov/data-products/foodavailability-per-capita-data-system (accessed 24 July 2019).

Astrup A, Grunwald GK, Melanson EL, Saris WH, Hill JO (2000) The role of low-fat diets in body weight control: a meta-analysis of ad libitum dietary intervention studies. Int Jour Obes Relat. Metab Disord 24, 1545–1552.

Wall R, Ross RP, Shanahan F (2009) Metabolic activity of the enteric microbiota influences the fatty acid composition of murine and porcine liver and adipose tissues. Am J Clin Nutr 89, 1393–1401.

Buettner D (2012) The blue zones. 2nd Edition: 9 lessons for living longer from the people who’ve lived the longest. New York, NY: National Geographic. Burger KS, Stice E (2012) Frequent ice cream consumption is associated with reduced striatal response to receipt of an ice cream–

Wiss DA, Avena N, Rada P (2018) Sugar Addiction: From Evolution to Revolution’. Frontiers in Psychiatry, 9. Williams MCW, Murphy EW, McCarty HB et al (2017) Variation in the essential fatty acids EPA and DHA in fillets of fish from the Great Lakes region. Journal of Great Lakes Research 43, 150–160.

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EAT-Lancet – is there such a thing as ‘onesize-fits-all’ sustainability? E AT-L ANCE T

Robert Verkerk

Founder, executive and scientific director, Alliance for Natural Health International

The EAT-Lancet Commission was formed with the recognition that food systems have the potential to nurture both human health and the environment, yet are currently negatively impacting both. This paper is a critique of the EAT-Lancet report, published in January 2019, which proposes a global 50% cut in consumption of red meat and sugar, and a doubling of consumption of nuts, fruits, vegetables and legumes. The critique emphasises the weaknesses of any one-sizefits-all approach based on evaluation of published literature, its clash with traditional eating cultures and production systems, and, ultimately, its potential to fail to deliver on its promises. © Journal of holistic healthcare

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It was an honour to present on this subject at the inaugural Real Food Gathering in April 2019, in a marquee on an organic farm in the wilds of the Glastonbury Valley in Somerset, in the midst of howling gales gifted by Storm Hannah. Over the last four decades, as both an academic and a campaigner, I have explored sustainability as applied to the environment, food production systems and human health. I have worked in diverse settings in Europe, sub-Saharan Africa, Central Asia, South-East Asia, Australia and the US. Insights from this work make me deeply concerned about the centralised, integrated approach proposed by EAT-Lancet that has the potential to benefit the world’s largest agrifood businesses more than either the natural environment or human health.

Introduction January 2019 saw the publication of a Lancet Commission study that attempted to provide a global solution for dietary and planetary sustainability (Willett et al, 2019). The 47-page, 357-reference article, Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems, was a product of more than two years of deliberation by a Lancet Commission led by Harvard’s Professor Walter Willett and Stockholm Resilience Centre’s Professor Johan Rockström. They were supported by 17 scientific experts and 20 co-authors. The work was carried out in conjunction with the Norway-based EAT Forum (2019a), a non-governmental organisation ‘dedicated to transforming our global food system through sound science, impatient disruption and novel partnerships’ (EAT Forum, 2019b). The EAT-Lancet Commission proposes a global transformation of food systems that set boundaries, limits and estimates for foods humans should eat and what foods should be cultivated in order to nurture both human health and the environment.

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The proposal is deemed fit for the expected 10 billion population expected by 2050. The EAT-Lancet report sought to provide an integrated framework, a series of scientific targets, and a battery of soft and hard levers that should be used by policymakers, the food industry, agricultural producers and the global public to help catalyse a transition toward sustainable food consumption and production patterns. While the report was widely acclaimed by the world’s media, criticisms have subsequently emerged, including by the Sustainable Food Trust (2019), through my own critique (Verkerk, 2019), and by a subsequent decision by the World Health Organization to withdraw its support (Torjesen, 2019). While there are many aspects of the EAT-Lancet report that are widely agreed, the primary purpose of this paper is to focus on areas of uncertainty, weakness, controversy or disagreement. Ultimately, the goal is to encourage debate so that rational, proportionate, individualised and location-specific ways forward can be established for both producers and consumers in different parts of the world. 15

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The planetary health diet and human health implications The EAT-Lancet Commission proposes a universallyapplicable daily reference diet, referred to by the EAT Forum as the ‘planetary health diet’, that includes target intakes as well as ranges for eight distinct food groups (Table 1, opposite). Among the reference diet’s most notable features are: • Average proposed daily intakes for adults are given for eight food groups (incorrectly referred to as ‘macronutrients’) along with wider intake ranges to take into account social and cultural differences and diversity. • Zero to relatively small amounts of meat are proposed (an average of 43g of beef, lamb, pork and poultry, comprising 3.7% of daily energy). This contrasts with present levels of meat consumption in the US of 128g a day (Daniel, 2011). • The reference diet proposes a greater energy ‘allowance’ for sugar (120 kcal) than for beef, lamb, pork, chicken, other poultry, and eggs combined (111kcal energy). • The proposed ‘added sugars’ allowance is the equivalent to more than seven teaspoons of added sugar every day (about 5% of daily energy intake). • The reference diet proposes limited intakes of starchy vegetables, contrary to most current government guidelines. • Very limited intake of saturated fats (added animal fats limited to 5g a day, equivalent to 1.4% of daily energy) are advised. • The report proposes that palm oil, currently the second most commonly consumed dietary fat worldwide, should be limited to a maximum of just 6.8g a day (2.4% of daily energy). • The proposed substitution of plant oils for animal fats will probably lead to n-6 to n-3 polyunsaturated fatty acid (PUFA) ratio that is strongly n-6 dominant given the lack of stipulated n-3 sources and the high n-6 content of unsaturated plant oils. • The reference diet proposes a surprisingly low average ratio of vegetables to fruit (fresh weight) of 3:2, although a maximum of 6:1 is possible if the maximum intake of vegetables and the minimum of fruit shown in the ranges is consumed. • It recommends a 32% contribution of daily energy from whole grains (34% from all starchy carbohydrates). • It proposes only 8% of the daily energy contribution from all vegetables and fruit. • The report proposes the addition of an average of 250ml a day of whole milk or derivative equivalents of dairy products (equivalent to about 25–40g of cheese), although it also allows for zero intake for those who are dairy intolerant.

While the EAT-Lancet report proposes significant reductions in consumption of red meat, sugars and highly refined carbohydrates, the proposed high intakes of n-6 relative to n-3 PUFAs, grains and starchy carbohydrates are not substantially dissimilar from current eating patterns in industrialised countries such as the UK (NDNS, 2018). Furthermore, the presentation of the reference diet by the EAT Forum (EAT Forum, 2019c) is misleading. In its diagrammatic representation (Figure 1A), fruit and vegetables are denoted by fresh weight, and in the same figure, the remaining seven food groups are shown by energy contribution, the mixing of units in the same figure being misleading. Figures 1B and 1C represent the EAT-Lancet reference diet by fresh weight and energy contribution, respectively. These latter diagrams show that the reference diet is relatively close to current government guidelines, that are described by Harcombe (2017) as being designed more for food industry wealth than for public health. As shown by the latest data on adult consumption patterns (NDNS, 2018), compliance with the guidelines has also improved significantly since 2012 (Harland et al, 2012), yet obesity, type 2 diabetes and related conditions have continued to soar. Taken together, it is unlikely that the escalating rates of non-communicable diseases, particularly in relation to heart disease, obesity and type 2 diabetes, could be reversed with the proposed dietary pattern which could hardly be described as ‘anti-inflammatory’ (Biobaku et al, 2019). Furthermore, the reference diet is based on 2,500 kcal (10,460 kJ) daily intakes, which does not take into account caloric restriction which has been linked to reduced incidence of preventable chronic diseases (Lee and Longo, 2016). The EAT-Lancet report also avoids any consideration of food frequency or intermittent fasting, the ‘how’ we eat having been shown to be at least as important as ‘what’ we eat (Miller et al, 2018; Templeman et al, 2019). Furthermore, with carbohydrate intakes, maintained at around 35% of total energy intake, the EAT-Lancet reference diet ignores extensive clinical evidence and emerging published evidence for the benefits of carbohydraterestricted diets, especially among overweight, obese, type 2 diabetic or prediabetic individuals (Zafar et al, 2019). However, many of these assumptions are based on the average values proposed, and not the ranges. It is therefore important to evaluate the potential health implications of different interpretations of the reference diet, based on the flexibility offered by the ranges. It also worth pointing out that widespread public adoption of dietary patterns at the limits of these ranges may alter quite dramatically the relevance of the EAT-Lancet Commission’s findings as well as its recommendations. Examples include widespread consumption of the minimum amount (200g per capita) of all types of vegetables per day, or maximum consumption of animal protein sources (211g per capita daily from beef, lamb, pork, chicken and other poultry, eggs and fish).

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EAT-Lancet – is there such a thing as ‘one-size-fits-all’ sustainability? Table 1. EAT-Lancet reference diet/planetary health diet by food group and recommended daily intake (grams fresh weight

and by energy [kcal])

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EAT-Lancet – is there such a thing as ‘one-size-fits-all’ sustainability? Figure 1. Three different representations of the

recommended daily intake of different food groups as proposed in the EAT-Lancet reference (planetary health diet), based on a daily energy intake of 2,500 kcal (10,460 kJ)

EAT-Lancet reference dietary composition represented by fresh weight only

EAT-Lancet reference dietary composition represented by energy contribution only

EAT Forum representation that conflates fresh weight and energy contribution values for different food groups in the same pie chart

Exploring the flexibility of the planetary health diet We conducted a detailed scenario analysis in which the nutrient composition of three types of ‘flexitarian’1 and vegan diets for which specific foods were selected in amounts compliant with the reference diet were compared (Verkerk, 2019). Nutrient contents were determined from data in the USDA National Nutrient Database for Standard Reference (https://ndb.nal.usda.gov). The three types were characterised as ‘basic’ (assuming typical interpretations, using average amounts), ‘lower carb’ (common and popular among those with metabolic issues and seeking weight reduction) and ‘higher protein, physically active’ (given that the average protein stipulation in the reference diet is inadequate and has not been optimised for physically active individuals (Slater and Phillips, 2011; Stellingwerff et al, 2011). The following conclusions could be drawn from the scenario analysis: • Protein intakes ranged from a minimum of 8.7% of total energy for the ‘higher protein, physically active’ vegan diet to 11.3% of total energy for the ‘lower carb’ ‘flexitarian’ diet. • The protein intakes for all three vegan scenarios (based on a 70kg adult) were below the consensus levels set for adult humans established by an international expert group in 2007 (Joint WHO/FAO/UNU Expert Consultation 2007).

• Despite including the minimum amounts proposed in the reference diet, the protein intake in one of the vegan scenarios (‘lower carb’) was below the level considered adequate even by the EAT-Lancet authors. • The amino acid profiles in the vegan scenarios may be incomplete for some individuals, particularly those who are immunologically challenged, with a higher arginine requirement (Daly et al, 1990). • Total energy intake from carbohydrates could be varied by different dietary compositions from 33% (‘flexitarian’ ‘higher protein, physically active’) to 52% of total energy (vegan, ‘basic’). • The contribution of daily energy from whole grains could be varied from 20% (flexitarian ‘higher protein, physically active’) to 35% (flexitarian, ‘basic’), the latter, not the former, being close to the EAT-Lancet target of 32%.

1 As used here, a ‘flexitarian’ diet focuses on healthy plant proteins and other whole, minimally processed plant-based foods with the inclusion of low to moderate amounts of animal-derived products.

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• Given the relatively large intakes of plant foods, dietary fibre intakes in all scenarios readily met the 30g per day target (range: 35–53g) set in the landmark study by (Reynolds et al, 2019). • The vegan diets are likely to be deficient in a wide range of micronutrients, including vitamin A (retinol) (Kristensen et al, 2015), haem iron (Miller, 2013), vitamin B12 (Gilsing et al, 2010) and long-chain omega3 fatty acids (notably eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) (Burdge et al, 2017). • High levels of phytic acid may prevent adequate absorption of zinc, copper and iron (Lim et al, 2013). • Replacing animal-based foods with vegan ones may illicit adverse reactions in sensitive individuals, owing to increased intakes of gluten (Schnedl et al, 2018), antinutritional factors such as lectins (Miyake et al, 2007), phytate (Schlemmer et al, 2009), goitrogens (Felker et al, 2016) and oxalates (Prezioso et al, 2015). • The EAT-Lancet recommendations do not adequately take into account adaptations of specific sub-populations to particular diets and the potential impacts on the microbiome, especially of the gut (Gupta et al, 2017) that can be associated with dietary transformation. • The Lancet-Commission authors continue to maintain an anti-saturated fat stance, contradicting the recent changes in the scientific consensus on the subject (Fattore and Massa, 2018; Zhu et al, 2019). The authors also do not adequately address the evidence for the proinflammatory nature of diets in which a high dietary n-6: n-3 polyunsaturated fatty acid (PUFA) ratio contribute to metabolic diseases (Torres-Castillo et al, 2018). • The EAT-Lancet authors make a strong case for increased use of oilseed rape (canola) because of its provision of essential fatty acid alpha-linolenic acid (ALA). Twenty-five per cent of the world’s oilseed rape is genetically modified, the vast majority of this being grown in Canada, the US and Australia (Belter, 2016), with a consequent increase in herbicide-resistant weeds (Fernando et al, 2016). • The data that the EAT-Lancet Commission has relied on to draw its conclusions are based on long-term studies involving mortality (not morbidities or comorbidities), many of which are based on consumption patterns that precede the era of widely available globalised, ultraprocessed foods. Additionally, there are major, ongoing dietary transitions associated with increasingly urbanised populations, such as the consumption of increasing amounts of food outside of the home, which generally has been shown to be detrimental to health compared with food preparation in the home (Nago et al, 2014). Accordingly, the findings may not be relevant to consumption patterns required to reduce morbidities and mortalities in the current or future eras.

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Greening agriculture? The EAT-Lancet’s environmental protection and agricultural sustainability goals are laudable. They include climate change mitigation, conversion of agricultural systems from net carbon emitters to net carbon sinks, water conservation, improved nutrient recycling, and enhancement of biodiversity. All of this, says the EATLancet Commission, is to be achieved through great strides in efficiency in the use of fertilisers and land – with no additional land use over that presently used for agriculture. Despite growing awareness about the health of plantbased diets and adverse impacts of factory farming of animals over the last decade or more, there has been no slowing in demand for livestock products, a trend that is strongly linked to growing affluence. The World Health Organization (WHO) projects that annual meat production will increase to 376 million tonnes by 2030, a 72% increase from 1999 (WHO, 2019). The proposal to halve meat consumption globally met with an expected negative reaction from the meat industry. However, the EAT-Lancet authors – as is often the case with desk-based research projects reliant on macro data – have failed to take into account the profound differences that livestock production systems can have depending on whether they operate as part of industrial farming or agroecological systems.

Marginal lands

Parts of the USA, Russia and Australia, for example, have relatively large amounts of marginal land that is suitable for grazing, but not for arable or horticultural production. In fact, the concept of ‘marginal land’, in which land is considered marginal for agriculture, but vital for grazing, is integral to any large-scale, holistic, sustainable agroecosystems model (Shahid and Shankiti, 2013). Dry land, much of it viewed as marginal, represents 45% of the world’s land area and the role of livestock to aid the ‘upcycling’ of such land is viewed as increasingly important for the future of food, people and planet. Ironically, as the Global Dry Land Alliance (GDLA) member countries are only too well aware, the trend towards salinisation and desertification of dry lands is actually reducing available arable land, and increasing land suitable for grazing and restoration for mixed uses.

Maintaining ideology, avoiding reality The EAT-Lancet report avoids some of the most thorny questions around intensification of agriculture production systems, including the centralisation of agricultural resources (eg seeds, fertilisers), increased use of genetically modified (GM) crops and associated pesticides (eg glyphosate), and the impacts of pesticides on non-target organisms including pollinators and humans. These were among the issues considered as crucially significant in the five-year, seminal findings of the International Assessment 19

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of Agricultural Knowledge, Science and Technology for Development (IAASTD, 2009) which, based on five years of research by 400 scientists from 60 countries, favoured transition towards decentralised, locally-adapted, agroecological models. There remains considerable confusion over the extent of agriculture’s contribution to greenhouse gas emissions, the EAT-Lancet report authors relying on Vermeulen et al’s (2012) estimate of ‘up to 30%’ contribution to greenhouse gas emissions. By contrast, the US Environmental Protection Agency (EPA, 2018) estimates the contribution at just 9% of the total amount, with 28% linked to transportation, 22% to industry and 28% to electricity generation. The contribution from livestock is estimated at just 4.2%, comprising 2.2% from beef, 1.4% dairy, 0.5% swine and 0.1% from poultry. By contrast, New Zealand, with just 4.6 million human population and more than twice that many cattle, is estimated to produce 46% of its greenhouse gases from agriculture, with electricity production contributing nearly the same amount, at 42% (NZ Ministry for the Environment, 2014). So while per capita greenhouse gas emissions are a stunning 16 times over the global sustainable rate of 1 ton of CO2-equivalent per person, New Zealand, by virtue of its small population, is well outside the top 20 greenhouse gas emitting countries. In order to reaffirm the need for prioritisation, New Zealand’s emissions represent just 1.7% those of China and 3.4% those of the US.

Global versus local Given that a central tenet of EAT-Lancet is to reduce global consumption of red meat by over 50% ostensibly to reduce greenhouse gas emissions, we calculated, using FAO data, the relative impact of animal protein intake per country, taking into account per capita animal protein intake and population sizes (Verkerk, 2019). This analysis showed that just three countries (China, the US and India) contributed to 67% of the global impact, assuming equivalence of impact per gram of animal protein consumed. This emphasises the need to focus on regional and local solutions, as opposed to global ones that inevitably encourage further globalisation and centralisation of resources, a trend being widely considered as counter to environmental, cultural and social diversity and sustainability (der Ploeg, 2012).

Concluding remarks Views about the most sustainable nutritional and agricultural practices are increasingly being informed by desk-based researchers and policymakers with strong belief systems and ideologies, but who have little practical experience either of nutrition or sustainable agriculture in diverse ecotypes. Data on which views are based is often derived from meta-analyses or systematic reviews, whose original data 20

may be many decades old and so no longer relevant to current or future scenarios. During the analysis and interpretation of results, association is often incorrectly taken to imply causation. When the results are published, media channels that support the ideologies spin the findings further – and the public does its best to pick up the pieces and integrate them with its own knowledge, experience and belief systems. The EAT-Lancet project is, in our opinion, a case in point. The much-publicised research paper by Poore and Nemecek (2018), which has been used as a justification to vilify animal-based foods, is another. With an ideology in place, it is very easy to look past the full range of factors that require consideration if truly sustainable approaches are to be found. That might include, for example, the consideration of biodiversity loss (eg small mammals, birds, soil organisms) attributable to soil degradation, herbicide, fertiliser and pesticide use, as well as the destruction of hedgerows and borders, all in the name of expanding large-scale arable monocultures intended for human consumption. Another major issue with the big picture, globalised approach that occurs when scientists and policy makers get together in the manner of this Lancet Commission, is that they work with averages. In doing so, the subtleties, vagaries, mysteries and wonders of outliers are omitted from their analyses. Their lack of practical experience of such examples – whether it is the resolution of autoimmune conditions through the removal of certain types of plant food from the diet, or the restoration of marginal grasslands through the re-introduction of livestock – means they remain invisible. Once an ideology takes hold – as is the case with concepts such as peak livestock and the perceived need to globally transition from animal to plant-sourced proteins (Harwatt, 2018) – momentum can gather quickly. If policy measures including taxes on foods deemed unhealthy or bad for the environment are imposed, the process of transition is likely to accelerate. In this case, it is essential that the approach – and the evidence that underpins it – is sound. In many cases, contrary to the bold assertions made by the EAT-Lancet authors, the data are far from certain. The EAT-Lancet report, in effect, vilifies meat consumption. However, even accepting the arguments made, meat eating is not the problem per se – it is excessively cheap meat that is the problem, where the cost of the meat does not adequately take into account the true cost of its production in environmental terms. This includes how different types of animal production systems act as sources or sinks for greenhouse gases, or whether their net carbon footprints and the ecosystem services offered, including that related to the forage crops or feed that helped create the animals, have been adequately factored in. If agro-ecological systems were to be valued for their reduced impacts on climate change, their contribution to biodiversity and reduced pollution, and in which livestock

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were accepted as a necessary part of these systems, a degree of meat-eating, probably significantly over the levels contemplated in the planetary health diet, would probably be tolerable. But such approaches are completely counter to the kind of industrialised animal production methods that have become de rigeur through much of the world. The westernisation, simplification and globalisation of diets is a massive issue for both people and planet. This process, that has swept across the world ever more rapidly over the last three or so decades, is being driven as much by industry and government, as it is by consumer demand. As emphasised by research on the five blue zone regions of the world, long, healthy lives are not associated with technological advancement either of food production or healthcare systems (Buettner and Skemp, 2016). The corollary is also true. Obesity, type 2 diabetes and the primary health burdens of the 21st century, are all associated with technological advancement. Traditional diets and agricultural practices are being forgotten at an astonishing rate as adoption of technology and urbanisation gathers pace in the so-called developing nations. For the sake of people and planet, a major international effort is urgently required to compare the net harms and benefits of different strategies relating to food production systems and consumption patterns in different regions and countries. This should include comparisons between high-input, industrial-scale farming systems for plants and animals, against low-input, sustainable systems, based on agro-ecological, nutrient-cycling principles. As suggested by Christine King (2008), these agro-ecological systems are about reconnecting people and food, and people with people – as well as helping to create community and health resilience. Fundamental to the viability and stability of these systems is their adaptation to local environments and cultures, and their resilience in the face of climatic, social and political instability. Such considerations are of key importance given the deficiencies of the EAT-Lancet report and the rise of the corporatocracy (Vanbergen, 2016). Equally, full account needs to be taken of the social, environmental, economic and cultural impacts of current trend tendency for control of agricultural, food production and healthcare resources into the hands of a small number of transnational corporations (George, 2015; Hendrikson et al, 2017).

References

Belter A (2016) Long-term monitoring of field trial sites with genetically modified oilseed rape (Brassica napus L) in Saxony-Anhalt, Germany. Fifteen years persistence to date but no spatial dispersion. Genes (Basel), 7(1) pii: E3. Biobaku F, Ghanim H, Batra M et al (2019) Macronutrient mediated inflammation and oxidative stress: relevance to insulin resistance, obesity and atherogenesis. J Clin Endocrinol Metab, pii: jc.2018–01833. Buettner D, Skemp S (2016) Blue zones: lessons from the world’s longest lived. Am J Lifestyle Med, 10(5) 318–321. Burdge GC, Tan SY, Henry CJ (2017) Long-chain n-3 PUFA in vegetarian women: a metabolic perspective. J Nutr Sci: e58. Daly JM, Reynolds J, Sigal RK et al (1990) Effect of dietary protein and amino acids on immune function. Crit Care Med, 18(2 Suppl) S86–93.

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Daniel CR, Cross AJ, Koebnick C et al (2011) Trends in meat consumption in the USA. Public Health Nutr, 14(4) 575–83. EAT Forum (2019a) EAT Forum website. www.eatforum.org (accessed 5 August 2019). EAT Forum (2019b) EAT Forum – who we are. Available at: https://eatforum.org/about/who-we-are (accessed 5 August 2019). EAT Forum (2019c) Healthy diets from sustainable food systems. Summary report. Available at: https://eatforum.org/content/uploads/ 2019/01/EAT-Lancet_Commission_Summary_Report.pdf (accessed 5 August 2019). EPA (2018) Sources of greenhouse gas emissions. Available at: https://www.epa.gov/ghgemissions/sources-greenhouse-gas-emissions. (accessed 5 August 2019). Fattore E, Massa E (2018) Dietary fats and cardiovascular health: a summary of the scientific evidence and current debate. Int J Food Sci Nutr, 69(8) 916–927. Felker P, Bunch R, Leung AM (2016) Concentrations of thiocyanate and goitrin in human plasma, their precursor concentrations in brassica vegetables, and associated potential risk for hypothyroidism. Nutr Rev, 74(4) 248–58. Fernando N, Manalil S, Florentine SK et al (2016) Glyphosate resistance of C3 and C4 weeds under rising atmospheric CO2. Front Plant Sci, 7, 910. George S (2017) Shadow sovereigns: How global corporations are seizing power. London: John Wiley & Sons. Gilsing AM, Crowe FL, Lloyd-Wright Z et al (2010) Serum concentrations of vitamin B12 and folate in British male omnivores, vegetarians and vegans: results from a cross-sectional analysis of the EPIC-Oxford cohort study. Eur J Clin Nutr, 64(9) 933–9. Gupta VK, Paul S, Dutta C (2017) Geography, ethnicity or subsistencespecific variations in human microbiome composition and diversity. Front Microbiol, 8, 1162. Harcombe Z (2017) Designed by the food industry for wealth, not health: the ‘Eatwell Guide’. Br J Sports Med, 51(24) 1730–1731. Harland J, Buttriss J, Gibson S (2012) Achieving eatwell plate recommendations: Is this a route to improving both sustainability and healthy eating? Nutr Bull, 37, 324–343. Harwatt H (2019) Including animal to plant protein shifts in climate change mitigation policy: a proposed three-step strategy. Climate Policy, 19(5) 533–541. Hendrickson MK, Howard PH, Constance DH (2017) Power, food and agriculture: implications for farmers, consumers and communities. EconStor Preprints 171171. Kiel, Germany: Leibniz Information Centre for Economics. IAASTD (2009) Agriculture at a crossroads. International Assessment of Agricultural Knowledge, Science and Technology for Development, Sub-Saharan Africa (SSA) Report. Available at: www.fao.org/fileadmin/ templates/est/Investment/Agriculture_at_a_Crossroads_Global_Report_ IAASTD.pdf (accessed 5 August 2019). Joint WHO/FAO/UNU Expert Consultation (2007) Protein and amino acid requirements in human nutrition. World Health Organ Tech Rep Ser, (935) 1–265. King CA (2008) Community resilience and contemporary agri ecological systems: reconnecting people and food, and people with people. Sys Res Behav Sci, 25(1) 111–124. Kristensen NB, Madsen ML, Hansen TH et al (2015) Intake of macro- and micronutrients in Danish vegans. Nutr J, 14, 115. Lee C, Longo V (2016) Dietary restriction with and without caloric restriction for healthy aging. F1000Res, 5. pii: F1000 Faculty Rev–117. Lim KH, Riddell LJ, Nowson CA et al (2013) Iron and zinc nutrition in the economically-developed world: a review. Nutrients, 5(8) 3184–211. Miller JL (2013) Iron deficiency anemia: a common and curable disease. Cold Spring Harb Perspect Med, 3(7) pii: a011866. Miller VJ, Villamena FA, Volek JS (2018) Nutritional ketosis and mitohormesis: potential implications for mitochondrial function and human health. J Nutr Metab, 11, 2018:5157645. Miyake K, Tanaka T, McNeil PL (2007) Lectin-based food poisoning: a new mechanism of protein toxicity. PLoS One, 2(8) e687.

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Nago ES, Lachat CK, Dossa RA et al (2014) Association of out-of-home eating with anthropometric changes: a systematic review of prospective studies. Crit Rev Food Sci Nutr, 54(9) 1103–16. NDNS (2018) National Diet and Nutrition Survey – results from years 7 and 8 (combined) of the rolling programme (2014/2015 to 2015/2016). Available at: https://assets.publishing.service.gov.uk/government/ uploads/system/uploads/attachment_data/file/699241/NDNS_results_ye ars_7_and_8.pdf (accessed 5 August 2019). NZ Ministry for the Environment (2014) New Zealand’s greenhouse gas inventory 1990–2012 and net position snapshot April 2014. INFO 709. Available at: www.mfe.govt.nz/publications/climate-change/ new-zealands-greenhouse-gas-inventory-1990–2012-and-net-position (accessed 5 August 2019). der Ploeg JD (2012) The new peasantries: struggles for autonomy and sustainability in an era of empire and globalisation. London: Routledge. Poore J, Nemecek T (2018) Reducing food’s environmental impacts through producers and consumers. Science, 360(6392) 987–992. Prezioso D, Strazzullo P, Lotti T et al (CLU Working Group) (2015) Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group. Arch Ital Urol Androl, 87(2) 105–20. Public Health England (2018) Guidance: Eatwell Guide. Available at: www.gov.uk/government/publications/the-eatwell-guide (accessed 5 August 2019). Reynolds A, Mann J, Cummings J et al (2019) Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet, 393(10170) 434–445. Schlemmer U, Frølich W, Prieto RM, et al (2009) Phytate in foods and significance for humans: food sources, intake, processing, bioavailability, protective role and analysis. Mol Nutr Food Res, 53 Suppl 2, S330–75. Schnedl WJ, Lackner S, Enko D et al (2018) Non-celiac gluten sensitivity: people without celiac disease avoiding gluten – is it due to histamine intolerance? Inflamm Res, 67(4) 279–284. Shahid SA, Al-Shankiti A (2013) Sustainable food production in marginal lands – Case of GDLA member countries. Int Soil Water Conserv Res, 1(1) 24–38.

Sustainable Food Trust (2019) ‘EAT-Lancet report’s recommendations are at odds with sustainable food production’ (17 January 2019). Available at: https://sustainablefoodtrust.org/articles/eat-lancet-reportsrecommendations-are-at-odds-with-sustainable-food-production (accessed 5 August 2019). Templeman I, Gonzalez JT, Thompson D et al (2019) The role of intermittent fasting and meal timing in weight management and metabolic health. Proc Nutr Soc, Apr 26, 1–12 [ahead of print]. Torjesen I (2019) WHO pulls support from initiative promoting global move to plant- based foods. BMJ 2019, 365, l1700. Torres-Castillo N, Silva-Gómez JA, Campos-Perez W et al (2018) High dietary -6: -3 PUFA ratio is positively associated with excessive adiposity and waist circumference. Obes Facts, 11(4) 344–353. Vanbergen G (2016) The rise of the corporatocracy. The European Financial Review. Available at: www.europeanfinancialreview.com/ the-rise-of-the-corporatocracy (accessed 5 August 2019). Verkerk R (2019) Has the EAT-Lancet Commission found a ‘win-win’ for people, food and planet? Available at: www.anhinternational.org/news /anh-intl-special-report-analysis-of-the-eat-lancet-report (accessed 5 August 2019). Vermeulen SJ, Campbell BM, Ingram JSI (2012) Climate change and food. Annual Review of Environment and Resources, 37, 195–222. WHO (2019) Global and regional food consumption patterns and trends. Available at: www.who.int/nutrition/topics/3_foodconsumption/ en/index4.html (accessed 5 August 2019). Willett W, Rockström J, Loken B et al (2019) Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet 393(10170) 447–492. Zafar MI, Mills KE, Zheng J et al (2019) Low-glycemic index diets as an intervention for diabetes: a systematic review and meta-analysis. Am J Clin Nutr, Aug 2, pii: nqz149. Zhu Y, Bo Y, Liu Y (2019) Dietary total fat, fatty acids intake, and risk of cardiovascular disease: a dose-response meta-analysis of cohort studies. Lipids Health Dis, 18(1) 91.

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Nose to tail nutrition and evolution

D O WE NE E D ME AT ?

Heather Rosa

Dean, Institute for Optimum Nutrition

This article is an abridged version of a presentation given by the author at the BHMA’s April 2019 Real Food Gathering, a two-day debate on the nature of ‘real food’ and just what we mean by a health-enhancing human diet. The scientific evidence is only partially helpful, for instance the benefits and hazards of meat in our diet is particularly conflicted, though according to paleontologists, our earliest ancestors were meat-eaters, who would have eaten all the edible parts of the animals, including fish and shell fish as well as insects and spiders.

1 Babies born premature or with poor in utero nutrition succumb to western diseases 10 years earlier than the general population according to Barker (1997)

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Food was the key to my recovery from illness and my inspiration for studying nutritional therapy. It has since kept at bay Barker’s baby trajectory1 and helped me survive 30 years in academia. Having surmounted the usual zeal to find the perfect diet I now have sleepless nights pondering complexity! I’m endlessly fascinated by the web-like interconnections between health, dis-ease, food, beliefs, movement, evolution, genes, microbiota, individuality, community, environment, politics... As Dean of the Institute for Optimum Nutrition my goal is to educate nutrition scholar-practitioners, instilling critical thinking, evidence informed and collaborative practice. I’m half Italian, grow organically, forage, and eat chicken feet!

Introduction What do we mean when we speak of ‘real food’? The simplest of food is complex. We eat combinations of food – more complexity. We are complex and the environment in which we eat and live is complex. The impact on health of what and when we eat is influenced by individuality, belief, community, environment, access, politics etc. We no longer eat to survive. The diversity of food eaten in the UK has diminished. Now place all this complexity and lack of diversity over a lifespan of continual change and challenge. This complexity often appears insurmountable, for there are so many confounders on the food journey from soil/sea to self. Research underpinning current public advice sits on shaky foundations, poor methodology, and bias, both personal and commercial. For the public this leads to confusing messages and reversals… welcome back to butter! Where nutritional considerations collide with concerns about environmental sustainability, ill-advised future diets (EAT-Lancet, 2019) may be proposed. Research methods including randomised controlled trials are inadequate in the face of such complexity, but new research paradigms and methodologies are emerging – genome, epigenome,

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microbiome and exposome research. However we cannot wait, we need a consensus on a definition for ‘real food’ that takes into account at least genetic adaptations, human physiology and biochemistry and health status. There are no simple messages in nutrition, however an ideal food/diet should both sustain reproduction and health throughout the lifespan and be regenerative for the environment. We can apply principles of holism, food diversity and evolutionary theory, and take into consideration current advances in genomics, epigenomics and our understanding of the microbiome, while remaining open to challenging these frameworks as we discover more through new research and experience.

Food is medicine – nutrigenomics and the microbiome What is ‘real food’? One answer is that ‘food is information that tells your entire biology what to do and when to do it, but junk food is like malware on your computer: scrambled information that leads to a major hardware crash’ (Frank Lipman, 2019) The substances in food change the environment in the gut. Food speaks to our gut microbiome which in turn 23

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speaks to the whole body. Food influences the expression of genes. Microbes, for example, train the immune system via conversations with Regulatory T cells (Treg cells) which by restraining inappropriate immune responses in the healthy gut have a central role in the maintenance of intestinal homeostasis (Spector, 2016). Not eating reduces microbial diversity however, yet short-term fasting can be beneficial as long as non-fast days contains a diversity of nutrients dense foods. Nutrient-dense foods contain vitamins, minerals, complex carbohydrates, lean protein, and healthy fats. Examples of nutrient-dense foods include fruits and vegetables, whole grains, low-fat or fat-free milk products, seafood, lean meats, eggs, peas, beans and nuts.

We now understand that it is not just vitamins and minerals conversing with our genes and microbes. There are myriad other substances in food that also communicate, such as phytochemicals (think rainbow), nucleotides (found in organ meat), short chain fatty acids (eg butter, coconut), fibre, hormones, bacteria and bacterial fragments (fermented foods), fungi, viruses and as yet unknown beneficial factors as well as xenobiotics introduced in the growing, processing and preserving of food. The context in which food is eaten, lifestyle and environment, are also important. So, we could add to our ‘real food’ definition foods that speak beneficially to both our microbiome and to our genes. There is still much to learn about these interactions. However, generally research shows a rich diversity of whole, nutrient dense (important if a person is intermittent fasting), minimally proceeded food, low in xenobiotics keeps these conversations healthy (Spector, 2015).

Evolution: an ancestral approach Diet, and the use of fire for cooking, has been cited as a driving force in human evolution (Cornelio et al, 2016). Associated physical changes included increased brain size, a reduction in gut length and blunter teeth. For our preagricultural, hominin ancestors’ nose to tail consumption of fish, seafood, animal foods and insects became the dominant sources of energy, protein, long chain fatty acids, iodine, vitamin B12, taurine, haem iron and zinc. Brain development occurred alongside an abundance of essential fatty acids (EFAs) from aquatic, and animal fatty tissues (brain, bone marrow etc). Humans are inefficient in the conversation of plant rich 18-carbon fatty acids (seeds, nuts) into the 20- and 22-carbon polyunsaturated fatty acids (EPA and DHA) essential for cell membrane function and brain tissue. This conversion is further hampered by high n-3 and sugar intakes, type 2 diabetes and subclinical deficiencies in B6 and zinc co-factors in the conversation pathway.

What are humans adapted to eat? Necessitated by migration, biological adaptations over time have expanded dietary patterns for some populations: eg milk (lactase) and grain (amylase). However, there are no known non-animal food civilisations perhaps because such a diet would provide inadequate energy return for survival. It has been argued that divergence from our evolutionary dietary pattern involving high meat intake (fat and protein) to a more grain and processed foodbased diet, forms the basis of lifestyle-related chronic diseases (Mann, 2018). We can’t go back in time and eat the foods our ancestors ate, nor know fully the extent of their dietary intake and patterns of eating. However, we evolved with certain nutrient needs. Could we define a ‘real food’ diet as one that meets intra-individual requirements for physiological, psychological and anatomical needs across the lifespan, without the need to supplement (eg B12) or fortify the food? Quality, as well as diversity and quantity, is another important factor to consider in defining ‘real food’. Quality of food is impacted at multiple points along the journey from soil/sea to self. For example what we feed animals becomes us: something worth remembering when advocating nose to tail eating. Soil nutrient content and whether to supplement micronutrients is another significant topic.

Expanding the diversity of ‘real foods’ in the diet Dietary diversity and quality

Today we eat fewer than 20 separate food items a day, from just four main ingredients wheat, corn, soya or meat, mostly processed, and with high glycaemic potential to elevate blood sugar. The fossil records and observations of modern hunter-gather tribes, suggest a broader diet could contain over 150 foods a week, mostly animal with plants playing an important supplementary role (the Hadza of Tanzania have access to around 600 plants and animal species [mostly birds] [Spector, 2017] and insects). These foods came whole, not as juices and certainly not fractionated (eg high-glucose corn syrup) or highlyprocessed. Foods were seasonal, local and fresh, eaten raw and cooked (meat and starchy tubers). Preparation methods (increasing in diversity and complexity over time) included cutting, chopping, soaking, cooking and preserving (air, sun or with naturally occurring materials and later fermenting). It is not only ultra-processed food that we need to beware of in defining what real ‘real food’ is or isn’t. We also need to understand that many of the fruits and vegetable we eat today bear little resemblance to those eaten by our ancestors. Selective breeding has increased their sweetness and reduced numbers of seeds, phytonutrients and fibre content making these foods relatively easy to consume in large amounts. © Journal of holistic healthcare

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DO WE NEED MEAT?

Nose to tail nutrition and evolution

Seed content and size of a wild and cultivated banana

Tim Spector who lived three days with the Hadza reported: ‘My next snacks were wild berries on many of the trees surrounding the camp – the commonest were small Kongorobi berries. These refreshing and slightly sweet berries have 20 times the fibre and polyphenols compared with cultivated berries – powerful fuel for my gut microbiome.

The low glycaemic index of ancient/wild/bush carbohydrate foods places a relatively low demand for insulin secretion potentially protecting from a genetic predisposition to insulin resistance and the consequences for developing chronic diseases (Brand-Miller and Holt, 1998). So can modern plant varieties be classed as ‘real food’? Would the public be prepared to eat wild/bush varieties?

Insectivory

Analysis of fossilised faeces suggests our early ancestors routinely consumed a wide diversity of insect species — ants, beetle larvae, lice, ticks, mites, and spiders well before we early hominids began to hunt or farm. When the Hadza eat honey they also eat fat and protein from larvae, pupa and insect parts (Marlowe et al, 2014)

Hadza eating honey-plus (National Geographic, 2017)

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It is estimated that as much as 80% of the world’s current population eats insects intentionally. Whether wild and collected or farmed, this extends to over 1,555 species of insects and spiders. However 100% of humans eat them unintentionally according to Srivasta et al (2009). Do you like chocolate? Chocolate averages 60 to 90 or more insect fragments per 100 grams. The food colouring cochineal is made from the eggs of pregnant beetles. Honey is the by-product of insect activity. For those of you who like smoothies, up to 60 per cent of frozen berries can be mouldy, with an average of four or more larvae, or ten or more whole insects, per 500 grams. I like to forage so I’m lucky I’m getting more! Can any plant-based diet be truly vegan? Humans eat two classes of invertebrates: mollusca (shellfish), and arthropoda (insects, crustaceans, scorpions, spiders etc) (McGrew, 2014). Somewhere back in time insects became the enemy, probably when farming invested in livestock (Gordon, 2013). Prawns are generally eaten without a second thought, although this was not always the case. Witchetty grubs can be thought of as land prawns, but our distaste for them is an issue, since insects are nutrient dense, and proportional to their macronutrient composition, they could serve as equivalents not only of wild meat, but of a range of other foods including some shellfish, nuts, pulses, vegetables and potentially fruits (McGrew, 2014). As a solution for food and feed security, they contain 60% protein per 100g. Compared with producing meat, where 100 gallons of water creates 6g of cow protein, or 18g of chicken protein, the same amount of water can turn into 238g of cricket protein (FAO.org). Utilising insect powders, pastes, liquids and oils may be a way to surmount barriers to diversifying our diets with insects, a rational argument – but without a sustained change in attitudes and habits, we will need many more creative solutions. Insect farming is a massive industry in the far east. European production is small, producing niche costly products (Dossey et al, 2016). Environmentally there are questions about the cost of energy needed to maintain growing temperatures. Grain and high-quality meat are used as feed. In the UK EU laws regulating animal feed don’t allow the use of food waste to be used as animal feed. In short there is no such thing as a free lunch! Quality is an issue. As with salmon when insects are farmed and fed a cereal-based diet their n-6/n-3 ratio increases significantly and are not considered supportive of human health (Oonincx, 2019). Current consumption of n-6 is already considered excessive and potentially detrimental creating a pro-inflammatory state in the body. The optimal ratio may vary with the severity of a disease resulting from the genetic predisposition (Simopoulos, 2008). A more desirable n-6/n-3 ratio can be obtained by enriching standard insect diets with 1%–2% of flaxseed oil or chia seed oil (Oonincx et al, 2019.) Fat is in the form of ALA and not EPA. DHA is not retained in insects. Human conversion of ALA to EPA is inefficient and reduced further in type 2 diabetes. 25

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Table 1: Nutritional value of various insects Insect

Giant Water Beetle

Protein (g)

Fat (g)

Carbohydrate

Calcium (mg)

Iron (mg)

13.9

3.5

2.9

47.8

5.7

Red Ant

Silk Worm Pupae Dung Beetle Cricket

Grasshopper Grasshopper June Beetle Caterpillar Caterpillar Termite Weevil

Beef (Lean Ground) Fish (Broiled Cod)

Iowa State University (2000)

19.8

8.3

2.1

9.6

5.6

2.3

41.7

20.6

6.1

3.9

35.2

17.2 12.9

14.3

13.4

28.2 9.7

14.2 6.7

27.4

28.5

4.3 5.5

3.3

1.4

N/A

N/A N/A

N/A

5.1

2.2

2.9

N/A

N/A N/A

N/A

Insects provide natural nutrient dense, minimally processed food sources for humans but is this ‘real food’ if the insects are not fed their natural diet? While insects can provide lower energy and resource intense sources of protein, fish and shellfish remain the better sources of EPD and DHA in the human diet.

Conclusion It is not just the quantity but the quality of food we consume that confers health. Humans can tolerate a wide diversity of foods, but it appears we have not evolved to thrive on a diet high in ultra-processed foods, sugar and damaged seed oils nor are we likely to. Avoiding these foods is an easier message. More problematic is what we advise on foods that are perceived as healthy yet may, through hybridisation, breeding and other insults on the journey from soil/sea to self, have a low nutrient density and less fibre, are higher in sugar and whose essential fatty acid profile is skewed. Eating nose to tail is to be applauded for providing increased nutrient density and the benefits of non-nutritive health-giving compounds. While including insects in the diet could improve available nutrient density, it might not provide the touted solution to future world food supply unless insect farming practices embrace sustainable and regenerative principles. The frameworks briefly explored here provide reasonable starting points for defining ‘real food’. Still, individuality (eg of the genome and microbiome) and food’s biological and cultural complexity will mean that no simple universal nutrition message is possible, and especially so for those with chronic ill health. Nevertheless, any diet that encourages eating a diversity of nutrient-dense wholefoods both animal and plant, minimally processed to enhance nutrient availability, has to be the basis for any real food project to begin with. 26

43.5

30.9

75.8

27.5

22.6

13.6 1.8

7.7

9.5

5.0 3.0

6.0

N/A

35.5

N/A

13.1

N/A

1.9

35.5 3.5

1.0

References Barker D (1997) Maternal nutrition, fetal nutrition, and disease in later life. Nutrition 13(9) 807–813. Bland JS (2014) The disease delusion: conquering the causes of chronic illness for a healthier, longer and happier life. New York, NY: HarperCollins. Brand-Miller JC, Holt SHA (1998) Australian Aboriginal plant foods: A consideration of their nutritional composition and health implications. Nutrition Research Reviews 11(1) 5–23. Buck Louis GM, Sundaram R (2012) Exposome: Time for transformative research. Stat Med, 31(22) 2569–75. Cornélio AM, de Bittencourt-Navarrete RE,3 de Bittencourt Brum R, Queiroz CM, Costa MR (2016) Human brain expansion during evolution is independent of fire control and cooking. Front Neurosci, 10: 167.

Dossey AT (2016) Modern insect-based food industry: current status, insect processing technology, and recommendations moving forward. In: Dossey AT, Morales-Ramos J, Guadalupe Rojas M (eds) (2016) Insects as sustainable food ingredients: production, processing and food applications. London: Academic Press. Gordon DG (2013) The eat-a-bug cookbook. Revised: 40 ways to cook crickets, grasshoppers, ants, water bugs, spiders, centipedes, and their kin. Available at: http://davidgeorgegordon.com (accessed 21 August 2019). Iowa State University (2000) Available at: www.ent.iastate.edu/misc/ insectnutrition.html (accessed 21 August 2019). Lipman F (2019) Twitter: @DrFrankLipman, 0:15 am, 31 July 31. https://twitter.com/DrFrankLipman/status/1156342500048740355?s=03) Mann NJ (2018) Meat in the human diet: an anthropological perspective. Available at: www.thefreelibrary.com/Meat+in+the+human+diet%3a +an+anthropological+perspective.-a0169311689 (accessed 21 August 2019). Marlowe FW, Berbesque JC, Wood B, Crittenden A, Porter C, Mabulla A (2014) Honey, Hadza, hunter-gatherers, and human evolution. Journal of Human Evolution, 71, 119–128. Oonincx DGAB, Laurent S, Veenenbos ME, van Loon JJA (2019) Dietary enrichment of edible insects with omega 3 fatty acids [online]. Insect Science. Available at: https://hal.archives-ouvertes.fr/hal-02173580/ document (accessed 24 August 2019). O’Malley R, McGrew B (2014) The other faunivory: the significance of insects & insect resources for nonhuman primates, modern humans, & extinct hominins. Journal of Human Evolution, 71, 119–128. Simopoulos AP (2008) The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Experimental Biology and Medicine 233(6) 674–88. Spector T (2017) I spent three days as a hunter-gatherer to see if it would improve my gut health. Meldical X press. Available at: https:// medicalxpress.com/news/2017-06-spent-days-hunter-gatherer-guthealth.html (accessed 21 August 2019). Spector T (2015) The diet myth: the real science behind what we eat. London: Orion Books. Srivasta SK, Babu N, Pandey H (2009) Traditional insect bioprospecting – as human food and medicine. Indian Journal of Traditional Knowledge, 8(4), 485–494. Stull V, Patz J (2019) Research and policy priorities for edible insects. [Online] Sustainability Science. Available at: https://link.springer.com/ article/10.1007/s11625-019-00709-5 (accessed 24 August 2019). © Journal of holistic healthcare

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Volume 16 Issue 3 Autumn 2019

Food for health:

E AT I NG O L D -S T Y L E

Putting traditional foods back on the table Izabella Natrins

Nutrition and lifestyle health coach; nutritional chef

Diet controversies are ongoing across a spectrum that stretches from the strictly vegan to eating patterns low in carbs and high in flesh; controversies made all the more complex by environmental concerns. However, few doubt that cheap manufactured ‘food-like’ substances, with little or no nutritional value, are sabotaging health and quality of life. ‘Deep nutrition’ kept our ancestors free from the chronic diseases that plague today’s world: the meat, eggs, butter, milk and cheese of grass-fed animals; bones and broths; organic fruit and vegetables, seafood and fermented foods. The author makes suggestions for how to source real food affordably. © Journal of holistic healthcare

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Food-and-lifestyle-as-medicine is my passion. I write, educate and teach on regaining traditional food wisdom, engaging with sound science and learning the forgotten skills that restore energy, vitality and true health. As a former health research psychologist, my training at the organic Ballymaloe Cookery School in Ireland introduced me to traditional farming, food production and preparation methods, from soil to plate. After creating IzabellaNatrins.com to promote holistic wellbeing, I trained as a nutrition and lifestyle health coach with the Institute of Health Sciences (Dublin). I became a Public Health Collaboration Ambassador and joined the Real Food Campaign UK to play a part in joining up thinking across all parts of farming, food and medicine for better health.

‘Dis-moi ce que tu manges, je te dirai ce que tu es’ Tell me what you eat, and I will tell you what you are… Anthelème Brillat-Savarin, 1826

A race to the bottom This article is based on the presentation I gave at the 2019 Real Food Gathering, where I had been asked to provide an overview of foods once common in the traditional western diet. The content, which reflects my experience as a nutrition and lifestyle health coach and chef, is based on the extensive research I carried out in order to write my book Once Upon a Cook – Food Wisdom, Better Living: Reclaim your kitchen. In the book I examine each category of the traditional foods highlighted in this article in detail over the course of 14 chapters, two appendices and citing over 500 references. As a nutrition and lifestyle health expert, coach and a nutritional chef, I care deeply that the traditional, timehonoured foods, the powerful medicine that kept generations before us fit and free of chronic disease, are no longer

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on our tables. In the UK, perhaps largely because of our increased consumption of ultra-processed foods, we are now leading a global race to the bottom of international league tables for health and disease. This article expresses my belief that the crisis in healthcare won’t be solved by money, but only by going back to real, nutrient-dense food.

Granny’s larder If we are to halt the present nutritional race to the bottom, the timehonoured, traditional foods our grandparents (and theirs) enjoyed must find their way back on to our dining tables. For instance the sorts of bone broth ‘grannies’ in diverse cultures around the world have been making for generations. The basis of a Polish granny’s great chicken soup ‘rosol z kury’ would have been a slow-cooked chicken broth. If she was Jewish she would have served up ‘goldene yoich’. Her Italian counterpart cooked ‘fedelini in brodo’ and in Romania ‘ciorba de pui’. In Mexico they spice theirs up in ‘zopa di fideros’, while Peruvians enjoy a ‘caldo

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de gallina’. Traditional Chinese medicine has long prized healing ‘congee’ – a well cooked rice-based porridge – which could be made with a chicken feet stock. In India various versions of ‘kitchari’ (a well-cooked broth of rice, mung beans, vegetables and spices often on a meat/ bone-based stock) have been prescribed to countless generations for restoring a weak digestion. All over the world, foods like these are part and parcel of timehonoured healing traditions.

Eggs – the humble egg – organic, genuinely freerange or pasture-fed – is an all-round superfood with proteins, fats, vitamins A, B, D, E and K and other key micronutrients. Our grandparents’ encouragement to ‘Go to work on an egg!’ was sound advice. Seafood – although oily fish like salmon have been very much in vogue, the deep nutrition in the humble sardine, white fish and seafood such as mussels, crab and oysters that granny enjoyed are once again coming into their own.

more than in pasteurised – and in vitamin C which is not present at all in pasteurised dairy products. Bone broths – straight out of granny’s kitchen come bone broths and stocks. Chicken and beef bone broths and stocks from pasture-fed animals are a nutritional powerhouse. Incredibly healing for the digestive tract, broths aid liver detoxification and support the immune system and heart health. Among many other nutrients, bone broths contain a magical ingredient: gelatin… Gelatin – is not just for jelly! Gelatin is a good source of protein, containing important amino acids not found in lean muscle meat. It supports skin, hair and nail growth; is good for joints and can help joint recovery; can help tighten loose skin and improve digestion since it naturally binds to water; and helps food move more easily though the digestive tract. Gelatin is the ultimate ‘beauty’ food, as it’s not only rumoured to help improve cellulite but is a great source of dietary collagen. (Forget collagen creams and make broth instead!) Bone-in and ‘slow-cook’ cuts from grass-fed animals – back in the day, lean meat was cast aside in favour of what we now call ‘cheap’ cuts. But very lean meat is tough on our digestion and lacks important nutrients like gelatin. Granny’s slow-cooked casseroles and braises make use of old-fashioned cheaper cuts on the bone, with rich connective tissue that melds down its precious gelatin into the gravy, greatly helping digestion. Organ meats – chicken liver pâté with bacon, pâté de campagne, pork and herb terrine, meatloaf, steak and kidney casserole – all delicious, nutritious organ foods. All liver is beneficial, especially liver from pasture-fed animals; good for all vitamins and packed with minerals. Beef liver, although strong in taste, is particularly nutritious. Thankfully, ‘nose-to-tail’ eating trends are encouraging more of us to enjoy these organ meats. Cultured and fermented foods – every civilisation throughout history has understood the power of cultured dairy: home-made yoghurts, labneh, raw-milk kefir, cultured butter and fermented vegetables such as kimchi, sauerkraut, carrots. These foods are incredibly efficient chelators (detoxifiers) and contain more nutrients than before fermentation. Grains – organically-grown wheat, spelt, oats, barley, cornmeal, rice and grain-based products like flour and

Dairy – dairy and its products have been prized throughout history and were widely used as a medicine before industrialised, pasteurised dairy products came along. We are witnessing a renaissance of organic, nonhomogenised milk; grass-fed, free-range milk; full-fat raw milk from certified producers; full-fat and raw cheeses, supporting our gut health and immune system function. Raw dairy is rich in fat-soluble vitamins A, K and E – 50% 28

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Food for health: Putting traditional foods back on the table

cereals, can play a part in a varied, nutrient-dense diet. But they are problematic for our digestive systems. Grains and their products are complex carbohydrates which release their energy slowly, but they need to be well broken down into simpler sugars in our digestive tract before they can enter the blood stream. Granny’s grains were prepared by traditional, time-honoured methods – like soaking, sprouting or fermentation, for better digestion and to avoid potential mineral deficiencies. Colourful roots, shoots, tubers and squashes – these starchy carbs ultimately get broken down to glucose in the digestive system to deliver energy efficiently to our cells. Although starchy carbs have become demonised lately, for many of us these undervalued, below-theground vegetables – carrots, beetroot, parsnips, swedes, celeriac, squashes and potatoes – are much easier to digest (and therefore can meet our energy needs) than the fibrous and very difficult to digest leafy greens that we obsessively whizz into those healthy green smoothies every morning.

Leafy green and sulphur-rich vegetables – we eat first with our eyes, so green vegetables are an appealing addition to any meal. Organically-grown kale, spinach, broccoli, cabbage, cauliflower, brussels sprouts and sulphur-rich onions and garlic all graced granny’s larder. They supply much-needed fibre in our diet, but they can be a problem for many of us if eaten to excess, and granny knew that they need to be cooked well – and served with butter or olive oil – to support digestion and nutrient absorption. Fruit – evolutionarily, we’re hard-wired for sweet foods. For our ancestors, colourful, ripe fruit was an indicator for, and important source of, vitamins. Although modern fruit has been hybridised to be sweeter than the sharper fruits our ancestors enjoyed, it still plays an important part in a traditional, nutrient-dense diet. Granny knew that eating whole fruit rich in fibre slows down the absorption of the fruit sugars. A word about carbohydrates – grains and their products, starchy and green vegetables and fruits are all carbohydrates and ultimately are all…sugars. There’s no denying that as a food group, carbohydrates have become controversial… and whether we even need to eat carbs at all is currently at the centre of a huge nutritional debate.

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Despite the current backlash, these dietary carbohydrates provide our bodies with energy to use and to store for fuelling our cells. They provide structure, feed beneficial gut bacteria and bulk out our stools, as well as supporting our immune, digestive and cardiovascular systems. But excess consumption of highly refined and processed carbohydrates has skewed a proper dietary balance of other macronutrients – proteins and fats, for example spawning ‘carb-phobia’ (fast replacing fatphobia) and demonising them as the new dietary demon on the block. All carbohydrates break down into sugars and there is no doubt that the developed world now consumes horrifying amounts of excess and highly refined isolated, added and synthetic sugars all hidden in ultra-processed foods. But natural, simple sugars in the form of honey, maple syrup, molasses, and fresh, ripe fruits had an honest place in granny’s larder, supporting a wellbalanced, metabolically-positive diet. Fat – is our healthy friend, but for decades, fat-phobia has ruled the day. Thankfully, both forgotten and emerging science is now proving what granny always knew: saturated fats like coconut oil and animal fats like butter and cream (grass-fed, raw if possible) or beef tallow (from pastured and grass-fed and finished animals), are all high in fat-soluble vitamins A, D and E. Mainly monounsaturated fats like lard (from pastured pigs), avocado oil and extra virgin olive oil are highly beneficial too. These healthful fats need to be back on the table. Salt – is most definitely the victim of misplaced blame and takes the rap for a variety of serious health conditions. However, salt plays a complex role in the body and we need it to keep our metabolism high and manage our body’s stress response – anything that chronically stresses our system will lead to a health issue. But not all salt is created equal. We need to understand the difference between healthful, unrefined salts like Maldon or Cornish sea salt or Himalayan salt and the free-flowing, refined, industrial-grade salt that appears on our tables and in processed foods. It’s worth remembering that Mother Nature has given us a taste for salt and every chef worth their salt knows that what separates good food from great food is salt!

Not in granny’s larder Granny would have shuddered at the prospect of ultraprocessed and convenience foods, full of excessive and carefully hidden amounts of sugar, far more than we would ever use in our own kitchen. Although we tend to think that ‘added’ sugar is only found in desserts, cakes, biscuits and other sweet treats, it’s widely found in savoury processed foods, such as bread, pasta and pasta sauce. To make matters worse, many foods promoted as ‘natural’ or ‘healthy’ are laden with these added sugars. The food industry uses a dizzying array of names to conceal the frightening amounts of added sugar contained in these super-sweet foods. 29

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Neither would granny have given any shelf space to the cheap, highly processed, damaged and rancid polyunsaturated fats such as ‘vegetable’, sunflower, soya and rapeseed oils which are found everywhere in today’s processed, junk and fast foods… and in our kitchens. Studies are clearly showing us these oils are detrimental to our health and should be banished from our kitchens and from our plates.

Real food – affordably With over 80% of food retail in the UK controlled by four supermarket chains, we’ve been seduced with convenience, open-all-hours-one-stop-shopping, bewildering choice, bargain-buys, and… a parking space. Along the line, we’ve been brainwashed into believing that real food is an expensive luxury.

Shifting mindsets toward real food shopping When I speak to groups and get people to stop to think about the nature and quality (or lack of it) of the food they’re putting into their supermarket shopping trollies and their bodies, one comment comes up again and again: ‘Where can I shop, if not at the supermarket?’ People are genuinely surprised to learn that a wide variety of very accessible and affordable options are available… all it takes is a mindset shift, a little planning time and a consultation with Google.

How to shop for affordable real food Visit the high street

Town centre parking is always a problem, but traditional butchers, fishmongers and greengrocers on the high street know where their produce comes from and are more likely to offer fresher, locally sourced produce. They’ll also carry a much wider range of traditional cuts (much cheaper and more nutrient-dense) than those found at the supermarket and they offer advice on how to prepare and cook their products. Buying local also supports the local economy, not anonymous corporate profits.

Visit a local farm shop, pick-your-own operator, or farmers’ market Buying direct from the producer has all the benefits of high street shopping and is easily the best and most economical way to eat seasonally and source fresh, local products. While farmers’ markets can be expensive (think overhead costs of stall rents, transport, staff and opportunity costs), farm shops tend to offer better value for money and pick-your-own schemes are a seasonal, fun, money-saver. Again, buying local supports the local economy.

Support a CSA scheme

Newer on the UK scene, Community Supported Agriculture (CSA) emerged to repair the local food links damaged by the anonymity of intensive large-scale farming and supermarket dominance, to promote sustainable food production and encourage reconnection with real food. For an upfront contribution, members receive a share of the food produced by the CSA: most commonly vegetables, but also poultry, bread, fruit, pork, lamb, beef and dairy produce. It’s a win-win model: a CSA farmer has cashflow for long-term planning and members get fresh, nutritious and affordable products, support their local economy and have opportunities to get involved at practical, environmental and often social level.

Order a meat box or bulk-buy direct for full traceability

Most high-quality farmers do their own butchery and can offer a wide range of traditional, inexpensive cuts like blade and skirt and offer discounts for bulk purchases, half-a-carcass deals and free delivery with a minimum spend. Check out the Pasture for Life website for producers with mail order delivery schemes. An increasing number of farms now deliver 100% grass-fed and organic meat nationwide (my personal go-to is Fordhall Organic Farm, a community land initiative with a commitment to education, youth projects and care farming). Another well supported favourite is Green Pasture Farms, a collective of traditional family farms with 100% grass-fed beef and lamb, and Eversfield Organic Farm, which supply meat from farms that are certified by the Pasture Fed Livestock Association and the Soil Association, or Organic Farmers and Growers.

Buy truly free range and organic poultry

Truly free-range (and organic) poultry is beyond delicious. Springfield Poultry offers national delivery for both free range and organic naturally reared, succulent birds a million miles away from anything you’ll find in a supermarket – at any price – and a whole bird will go much, much further than you think. And you’ll have the carcass left for nutritious stock. 30

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Order a fish box, or bulk buy online for sustainable sourcing If you don’t have a local wet-fishmonger and aren’t prepared to travel (I regularly travel 12 miles each way to mine) then sourcing sustainable fish online, direct from a fleet or retail fishmonger, is definitely the way to go. My tried and tested suppliers are all in Cornwall: Fish For Thought, The Cornish Fishmonger, Stevenson’s Fish, Trelawny’s Fish and Deli, and W. Harvey & Sons (for handpicked shellfish). All offer variety, great value and the less ‘fashionable’ but never-the-less delicious species like whiting, pollack and megrim sole and deliver spankingfresh fish nationally. Visit their websites to be educated and inspired.

a private house, where members can pick up their order. Splitting items, like a case of organic processed tomatoes or baked beans, can mean substantial savings. Sustain: the alliance for better food and farming, has a variety of resources and toolkits to help a buying group get started.

Search online for natural and organic products

Goodness Direct is an online retail shop selling natural, free-from, organic and Fairtrade food products, frozen, chilled and bulk whole foods, natural toiletries and ecofriendly household products. Substantial savings can be made on products and delivery charges by bulk ordering.

Shop one-stop-online with national box schemes

Riverford (now in employee-ownership) and Abel & Cole are the longest established and biggest box delivery schemes in the country, both offering a wide range of organic vegetables, fruit, eggs, dairy, bread and meats and other products like recipe boxes with measured ingredients. There are also many local schemes with fewer food miles and supporting the local economy.

Grow your own and/or barter with neighbours

Finally, nothing is better for health or community than the satisfaction of harvesting, preparing and eating (and sharing) your own organically grown produce. Be it veg, fruit, or eggs, home-grown produce from one’s own or a neighbour’s garden, or from a local allotment-holder will not get fresher, tastier, or more nutritious.

Use BigBarn Fifth-generation farmer Anthony Davison developed this online portal connecting farmers with customers, after discovering his onions were being sold in a supermarket for eight times their wholesale price. Anthony’s mission is to reconnect people with local food and the Big Barn portal offers over 7,500 shopping outlets, information, education and even recipes and cooking videos.

Open Food Network UK

The Open Food Network (OFN) UK is an online website bringing shoppers and food producers together. It’s made up of a community of independent producers, retailers and distributors, dedicated to building a stronger, fairer food system in the UK. Customers can shop by UK postcode for the freshest, seasonal produce at affordable prices and can define a preferred delivery service (drop-off or pick-up). Shoppers may have to order a week in advance and wait until their order is harvested/produced.

Join (or start) a local buying group

Getting together with family, friends and neighbours to start a buying group and bulk-buy store-cupboard staples (like coffee, grains, rice, beans) brings substantial savings on wholesale prices. Collective orders placed with wholefood suppliers, such as Suma, are dispatched to the wholesaler, which then delivers to a drop-off point such as © Journal of holistic healthcare

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Is real food affordable? This granny says yes. Try one of Izabella’s delicious recipes for yourself at IzabellaNatrins.com

Further reading

Doulliard J. Proving ancient wisdom with modern science: natural health & ayurveda. http://lifespa.com (accessed 29.07.2019). Fallon S (2000) Ancient dietary wisdom for tomorrow’s children. Weston A. Price Foundation. www.westonaprice.org/health-topics/ traditional-diets/ancient-dietary-wisdom-for-tomorrows-children (accessed 29.07.2019). Fallon S, Enig M (2009) Nourishing traditions – the cookbook that challenges politically correct nutrition & the diet dictocrats. New Trends Publishing. Jaminet P, Jaminet S-C (2013) The perfect health diet. Scribner. http://perfecthealthdiet.com (accessed 29.07.2019). Natrins I (2019) Once upon a cook – food wisdom, better living: reclaim your kitchen. Take back your health. Better Living Press. Price Pottenger Nutritional Foundation. https://price-pottenger.org (accessed 29.07.2019). Price Weston A (1997) Nutrition and physical degeneration. Keats Pub Inc. Professor Tim Spector. http://britishgut.org (accessed 29.07.2019). Shanahan C (2017) Why your genes need traditional foods. St Martin’s Press. Weston A. Price Foundation www.westonaprice.org (accessed 29.07.2019).

Making health infectious: from organic principles to whole health agriculture O R G ANI C G ROWI NG

Lawrence Woodward OBE

The health of individuals and communities cannot be separated from the health of ecosystems. Health is the wholeness and integrity of living systems, not simply the absence of illness, but the maintenance of physical, mental, social and ecological wellbeing. Immunity, resilience and regeneration are key characteristics of health. The organic farmer sees the farm as a living organism whose ‘living soil’ can transmit health through the food chain to plants, animals and humans, and through careful, organic husbandry seeks over time to enhance this vitality.

The question, ‘How do we feed ourselves when oil and other finite resources run out?’ led in 1975 to my farming organically. It was still pressing when I co-founded and began to direct the UK’s leading organic research and development centre in 1980. But over the 30 plus years in that role I became obsessed by health questions; what makes a ‘healthy’ farm? What qualities does it have? How are these passed on in its food and environment to people and animals? These are the unanswered questions of my professional life.

Creating and managing positive health Generally in the conventional medical world, it seems health is seen in terms of absence of disease rather than as a positive state. There is an alternative view though, notably promulgated by the Peckham Experiment and its Pioneer Health Centre (Scott Williamson and Pearse, 1980) that there is such a thing as positive health and that this is a dynamic process with its own pattern of behaviour, and which can be as infectious in its way as disease. This example of holistic thinking leads to the idea that the health of soil, plant, animal, man and planet is one and indivisible. This provides a conceptual basis for organic food and farming. However, few farmers – organic or conventional – farm for health. Knowledge and understanding about how to manage a farm for health is limited. Nor do they know how it can be made to be infectious and how it can be transmitted. Yet we can experience some farms or crops or animals where ‘health smacks you in the face’. But why that is or why others don’t is largely unknown.

What is known is that organic agriculture is the only farming system consciously built on a concept of health (IFOAM, 2005). Whatever their merits, approaches such as agro-ecology, ‘agricology’, precision farming, low-input farming, regenerative farming, pasture-fed farming or any of the other buzzword farming approaches, are not conceptually or systemically build around health in the way organic farming is – and certainly none of them have been going for as long. There are clear differences, between organic and other farming systems in a range of ‘beneficial parameters’ of food quality (FiBL and ORC, 2015). But apart from pesticide residues these differences are not as great as organic protagonists claim. Moreover they are statistically and visibly variable. It is clear that soil, farm type, season and major management differences in such things as rotations, cultivations, variety selection, manure and other input management, stocking rates etc are significant factors in this variability. What is unknown is how, why and if these factors affect the process of positive health and its transmission.

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Making health infectious: from organic principles to whole health agriculture

Organic farming is based on a concept of health The genesis of organic agriculture is arguably to be found in three schools of thought, which originated in the first three decades of the twentieth century: the biodynamic or anthroposophical school of Rudolf Steiner; the organicbiological school of Muller and Rusch; and the organic school of Howard and Balfour. Also important is the work of Schuphan and Voisin who promulgated the idea of the ‘biological value’ of soil, plant and food in the early 1960s (Woodward, 2002) Though there are some highly significant differences between them (for example the anthroposophical perception of ‘ethereal and astral forces’ is unique to the biodynamic school), there is an essential core of agreement on three aspects: • the concept of the farm as a living organism, tending towards a closed system in respect to nutrient flows but responsive and adapted to its own environment • the concept of soil fertility through a ‘living soil’ which has the capacity to influence and transmit health through the food chain to plants, animals and humans, and that this can be enhanced over time • the notion that these linkages constitute a whole system within which there is a dynamic yet to be understood.

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Health is the wholeness and integrity of living systems. It is not simply the absence of illness

These core agreements underpin the principles of organic agriculture as health, ecology, care and fairness, as set out by the International Federation of Organic Agriculture Movements (IFOAM, 2005). Although they are all linked together it is the first two which are most relevant to this discussion. The organic principle of health declares that ‘the health of individuals and communities cannot be separated from the health of ecosystems: healthy soils produce healthy crops that foster the health of animals and people. Health is the wholeness and integrity of living systems. It is not simply the absence of illness, but the maintenance of physical, mental, social and ecological wellbeing. Immunity, resilience and regeneration are key characteristics of health. ‘The role of organic agriculture, whether in farming, processing, distribution, or consumption, is to sustain and enhance the health of ecosystems and organisms – from the smallest in the soil to human beings. In particular, organic agriculture is intended to produce high quality, nutritious food that contributes to preventive healthcare and wellbeing. In view of this, it should avoid the use of fertilisers, pesticides, animal drugs and food additives that may have adverse health effects.’ © Journal of holistic healthcare

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The organic principle of ecology ‘roots organic agriculture within living ecological systems’. It states that production is to be based on ecological processes, and recycling. Nourishment and wellbeing are achieved through the ecology of the particular environment. For example, in the case of crops this is the living soil; for animals it is the farm ecosystem; for fish and marine organisms, the aquatic environment. Organic farming, pastoral and wild harvest systems should fit with the cycles and ecological balances in nature. These cycles are universal but their operation is site-specific, so organic management must be adapted to local conditions, local ecology, local culture and scale. Inputs should be reduced by reuse, recycling and efficient management of materials and energy to maintain and improve environmental quality and conserve resources. ‘Organic agriculture should attain ecological balance through the design of farming systems, establishment of habitats and maintenance of genetic and agricultural diversity.’ In 1981 the United States Department of Agriculture (USDA) produced a definition of organic agriculture which is arguably more accessible to farmers (Woodward, 2002): ‘Organic farming is a production system which avoids or largely excludes the use of synthetically compounded fertilisers, pesticides, growth regulators and livestock feed additives. To the maximum extent feasible, organic systems rely on crop rotations, crop residues, animal manures, legumes, green manures, off-farm organic wastes, and aspects of biological pest control to maintain soil productivity and tilth, to supply plant nutrients and to control insects, weeds and other pests. The concept of the soil as a living system...that develops...the activities of beneficial organisms… is central to this definition.’ Here we can see what organic farmers do not do, what positive things they do instead and the context in which they work; ie the living soil. Here is the key to understanding what organic farm management looks like – or should look like – wherever it is. It concentrates primarily on adjustments within the farm and farming system, in particular rotations and appropriate manure management and cultivations, to achieve an acceptable level of output. External inputs are generally adjuncts or supplements to this management of internal features. Wherever it is found in the world, the common basis of organic agriculture is practical, clear and coherent enough for all but the dullest or most obstructive to understand.

The health of soil, plant, animal, man (and the planet) is one and indivisible ‘Health can be as infectious as disease, growing and spreading under the right conditions.’ Establishing that organic farming is built on a concept of health with management practices based on ecological systems is important but it does not go far enough in 33

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Making health infectious: from organic principles to whole health agriculture

Core concepts of ‘the living soil’ Eve Balfour’s thinking revolved around four notions, which she discussed in varying depths in her book. These were: • A biologically active, living soil is an essential prerequisite for soil fertility and the role of soil micro-organisms (especially fungi) is particularly important – as had been highlighted in MC Rayner’s earlier research on mycorrhizae. • This natural soil fertility is maintained and enhanced by the return and addition of organic material in the form of compost – Sir Albert Howard was the leading proponent of this ‘compost-farming’. • The third concept came from the nutritional studies of Sir Robert McCarrison, who found that the diets of the healthiest peoples he studied were ‘for the most part, fresh from its source, little altered by preparation and complete; and in the case of those based on agriculture, the natural cycle – (wastes to soil to plants to animals/man) is complete’.

• Fourth, that all living things are whole entities with their own integrity but they function in ‘mutuality of action’ with all the other entities in their environment, so that while they are independent, only a functional relationship between them can sustain the health of the whole. This holistic perspective was primarily provided by George Scott Williamson and Innes Pearse. Lady Eve was more of a ‘doer’ than a ‘thinker’ and she quickly began to focus on what could be done practically to improve health. She came up with five propositions: 1 The primary factor in health (or lack of it) is nutrition. 2 Fresh unprocessed natural whole foods (such as wholewheat bread, and raw vegetables and salads) have a greater nutritive value than the same foods when stale, or from which vital parts have been removed by processing, or which have been destroyed by faulty preparation. 3 Fresh foods are more health-promoting than preserved foods (dried, canned, or bottled). 4 The nutritive value of food is vitally affected by the way in which it is grown. 5 An essential link in the nutrition cycle is provided by the activities of soil fungi, and for this and other reasons the biological aspects of soil fertility are more important than the chemical.

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The diets of the healthiest peoples he studied were for the most part, fresh from its source, little altered by preparation and complete

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explaining the perceived holistic nature of health, farming and food. For this, a consideration of the ideas of Lady Eve Balfour is needed (Woodward, 2006). In her seminal book The Living Soil, first published in October 1943, Eve Balfour argued that the health of the soil is the same as the health of the plants that grow in it, of the animals that eat those plants, and the health of the humans that eat both. Eve Balfour (1898–1990) co-founded The Soil Association in 1946 following publication of what became the founding text of organic agriculture, The Living Soil. At an earlier stage of her work, she thought of soil, plant, animals and man as separate entities that were somehow linked together. Her concern – and that of a number of leading mainstream scientific thinkers – was to find ‘the missing link’; the crucial component that made this vital link. However, influenced by the doctors Scott Williamson and Innes Pearce of the Pioneer Health Centre and the Peckham Experiment, she came to the conclusion that they are not separate and linked but are one and indivisible.

She felt that the first two of these propositions ‘have been pretty conclusively proved’, but that although the evidence to support the other three was strong, they had not been proven and ‘it has become a matter of the utmost national urgency to submit them, without delay, to a final and conclusive test’. It was this process that most intrigued sympathisers from the scientific establishment such as Viscount Bledisloe, a Parliamentary Secretary to the Ministry of Agriculture and Chairman of the Lawes Agricultural Trust, which ran Rothamsted, the country’s leading agricultural research station. Bledisloe readily accepted McCarrison’s argument that ‘immunity from degenerative human disease followed the ingestion of a fresh, well-balanced diet of unprocessed natural foods’. He also accepted Howard’s work on compost and how it engendered resistance to disease in otherwise susceptible crops. Yet, does this mean that there is a ‘consequential relation between humus and human health’? Bledisloe believed that ‘viewed from a strictly scientific standpoint, there is, it would appear, a small but important “missing link” in the chain of contact’ and he welcomed the idea of a ‘perhaps epoch-making © Journal of holistic healthcare

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Making health infectious: from organic principles to whole health agriculture

experiment’ which would investigate the possibility of such a link (Woodward, 2006).

Transmitting health and making health infectious The process by which health can be transmitted is the weakest element, although arguably the most important, of the whole Living Soil argument. It was not adequately defined nor even described in any of the early editions of the book. Its existence is alluded to through an association of the words ‘vitality’, ‘living’ and ‘quality’. At various points Lady Eve uses the terms ‘soil fertility’ and ‘soil vitality’ interchangeably. She then makes a theoretical link with the quality of food and health by what is, in essence, a linguistic or textual association.

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Land … is not merely soil: it is a fountain of energy flowing through a circuit of soils, plants and animals

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In the 1976 edition published in the United States as The Living Soil and the Haughley Experiment, she makes a rather more precise effort to describe the process and picks up on the Scott Williamson and Innes Pearse idea that: ‘health is not a state but a dynamic process… .The early pioneers believed that its course is identical with the flow of the nutrition cycle, and that to promote it one must, therefore, keep open all the living channels of this flow, though no one yet knows what they all are, or even the true nature of the flow itself. That land is a great storehouse for it, however, seems clear. What then is land? Let me give the late Aldo Leopold’s definition: “Land…is not merely soil: it is a fountain of energy flowing through a circuit of soils, plants and animals. Food chains are the living channels which conduct energy upward: death and decay return it to the soil”. Soil fertility he defined as “‘the capacity of soil to receive, store and transmit energy”’. Lady Eve then continued: ‘The concept that the nutrition cycle is not merely a transfer of nutrient materials from one form of life to another, but also a circuit of energy, though even now not universally accepted, is no longer considered revolutionary, and under the name of ecology has become an acceptable subject for research’. There is a touch of revisionism here about the thinking of the early pioneers and many would think that she is stretching the definition of ecology and it is a moot point as to whether this gets any nearer to describing what the ‘consequential relationship’ between soil and health might be. Depending on taste, one might see Leopold’s imagery as poetic and powerful, or as fanciful and obscure, but certainly it adds nothing from a scientific perspective and only serves to reinforce the lack of evidence. © Journal of holistic healthcare

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However Lady Eve was determined to find that evidence and to understand the ‘functional relationships’ of organic entities – ‘man, animal, plant along with…the living inhabitants of the soil’, because she had concluded that between these entities there is no ‘missing link’, there is a ‘mutuality of action’. Drawing on the work of Scott Williamson and Innes Pearse at the Pioneer Health Centre in Peckham she hypothesised that ‘all disease might be a symptom of unbalance between a living organism and its total environment, and that the key to health would not be found through the fragmentary approach of seeking the cause of specific diseases, but in studying living function between organisms and their environment as a dynamic whole’.” She therefore resolved to establish the Haughley Experiment to be ‘a type of comparative research different from any existing agricultural research’. And the inclusion of a more or less closed system – fundamentally at odds with Howard’s Law of Return – ensured that it was (Woodward, 2006)

The Haughley experiment Work on the Haughley experiment got under way in 1947 and from the beginning was beset by management difficulties, methodological problems and lack of funding. It was a stop and start, debilitating experience but in establishing three comparative working ‘farmlet’ systems on one sizeable area of land with the same soil type, it was innovative and groundbreaking. Three systems were established: a linear input/output system using only synthetic agri-chemicals (called the stockless section) ; a mixed cropping and livestock system recycling nutrients from within the system supplemented by bought in feed and fertilisation (called the mixed section); and a closed system with livestock and cropping with no outside inputs (misleadingly called the organic section). For the most part data collected from the experiment was not analysed (and of course analytical methods of the time would be considered inadequate today) and in most cases (but not all) the published results were not peer reviewed. However there are some notable findings: • plant growth patterns between the sections were significantly different • nitrogen levels in cereals and aphid numbers were significantly higher on the stockless section • humus levels in the organic (closed) system over time were significantly higher than the mixed system despite no fertiliser or external organic manure input and both were significantly higher than those in the stockless section • milk yields were comparable between the closed and mixed sections despite significantly lower feed intake

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Making health infectious: from organic principles to whole health agriculture

• there was significantly greater longevity and fertility of cows in closed section. The differences between the stockless and the mixed and closed sections are not surprising. However, the differences between the mixed and closed sections are and are at odds with the conventional scientific knowledge of the time and, for the most part, of today also. The major limitations of the Haughley experiment in terms of resources, management and methodology mean that we can draw no conclusions as to whether these differences tell us anything about Innes Pearse’s hypothesis that there is a ‘mutuality of actions’ of whole organisms or the transmission mechanism of health whereby ‘each taking what it needs and rejecting what it has had no use for, thereby sustaining the needs of others (within their mutual inhabitation of the ecosphere). As a shift occurs through the action of one, so all shift within the functional organisation of the whole’. But more than this: ‘What each utilises in building up its own substance and carrying out its proper function, it stamps with its own specificity – its own “individuality”, or uniqueness. In the traffic of exchange there are then to be sought different types of contribution within the whole. There is that which is of specific pattern; and that, too, which is “anonymous” and in use common to all. Heat for example, generated in any transaction passes “unlabelled” in its going, while there is that which having passed through the living organism, when ejected into the traffic stream, is imprinted with its specific identity, and leaving there its imprint on the scene for us to find – if we care to look!’ (Woodward, 2006).

Research evidence since Haughley Since the The Haughley experiment ended a reasonable amount of research has been completed by a wide range of institutions from different countries revealing a clear trend that organic produce (in appropriate crops) contains more desirable components (vitamins, dry matter, protein, phytochemicals (including antioxidants and phenols) and fewer undesirable substances (pesticide residues, nitrates, sodium and some heavy metals) than conventional

produce. In livestock trials, animals fed on organically grown feed generally show greater fertility and longevity, higher healthy fatty acids and a better omega 3 to omega 6 ratio than those on conventionally produced feed (FiBL and ORC, 2015). Most of this work has been carried out using mainstream methods and statistical analysis. However, some so-called ‘novel or complementary methods’ of analysis have been used in some of the trials. Picture-developing methods, bio-crystallisation, fluoresence-stimulation spectroscopy and forced-storage tests have been used to measure factors that are not revealed by chemical analysis. As most of these methods have now been validated under the International Organisation for Standardisation (ISO) we can have confidence in their findings. The factors revealed have been called vitality and structural energy. Clear differences have been shown between organic and conventional systems; between fertilisation regimes; between plant and seed varieties; and between growing conditions. It is postulated that these differences might be important for health. Further work is needed on these approaches but they might provide the evidence of a positive health dynamic and help identify how we can farm to optimise health.

Towards whole health agriculture We cannot be definitive on how to farm for health nor how to make health infectious. We do not know what the important transmission factors are or how the ‘mutuality of actions’ work – whether through micro-organisms, bacteria, energy, vitality, self-organisation or something else. However we do know some things that are likely to be important and which farmers should pay attention to. These revolve around managing the soil and above- and below-ground livestock through biological system management and not through inputs whether these are synthetic or organic. Whole health agriculture as an organisation is undertaking case studies of farmers to understand what works and what doesn’t, how and why. We welcome farmers and growers who wish to join us in the vital exploration. www.wholehealthag.org

References

Fibl (Research Institute for Organic Agriculture Switzerland) and ORC (Organic Research Centre) (2015) Sustainability and quality of organic food. [Online]. Available at: https://shop.fibl.org/chen/mwdownloads/ download/link/id/335 (accessed 25 August 2019). IFOAM (2005) Principles of organic agriculture. [Online]. Available at: www.ifoam.bio/sites/default/files/poa_english_web.pdf (accessed 25 August 2019). Williamson G Scott, Pearse IH (1980); Science, synthesis and sanity. Edinburgh: Scottish Academic Press. Woodward (2006) Introduction to The Living Soil in: Balfour E, The Living Soil. Soil Association Organic Classics. Bristol: Soil Association. Woodward (2002) Science and research in organic farming. Available at: http://orgprints.org/3835 (accessed 22 August 2019).

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Food quality and its relevance to optimum health David Thomas

Founder Member, Register of Nutritional Therapists

Most food science focuses on the chemical content of what we eat. Only a few decades ago, little was known about the presence and importance of trace elements. The author presents evidence that these minerals though present in tiny amounts are less available in our foods than they were 50 years ago. If, as some suspect ‘food vitality’ is also declining, do we need to revisit the notion of ‘vital force’, now viewed as an emergent biophysical informational ‘quality’. The article touches on ways of visualising food-vitality.

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It seems I’ve been banging on about the dangers to general health of mineral deficiencies in foods for over 25 years and at long last the significance of the micronutrient content of foods has begun to find traction. Now, in addition to the physical composition of foods, I have become more aware of less quantitative, more qualitative aspects of foods. I feel there’s need to conduct future research work into their significance – and maybe this can ultimately lead to a more inclusive less reductionist scientific paradigm than is currently in vogue.

In the mid 1990s I wrote a report that reflected a mantra evident at that time within the naturopathic fraternity – that the foods we eat today are not as nutritious as they once were. Its implications for the general health of the UK population were of course negative. The report was eventually picked up by a wider audience and this resulted in its being expanded and published in 2002 in the journal, Nutrition and Health (Thomas, 2003) The report used as a historical comparison food analysis data first published by the Medical Control Agency in 1940 (McCance and Widdowson, 1940) with subsequent publications under similar reputable government agencies through to 1991 (McCance & Widdowson, 1991). The first publication was initiated because, in the 1930s, it was hypothesised that the rising incidence of diabetes was in some way connected to diet. At that time there was no quantitative data relating to the chemical composition of foods. The current awareness of micronutrient content of foods is of course far more substantial. We are now aware that foods contain carbohydrates, minerals, trace elements, essential fatty acids, vitamins, amino

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acids, phytonutrients, probiotic material, and the list constantly being added to as we find out more about the essential roles of certain food components to health and wellbeing: the microbiome being the latest to come into the spotlight Historically, food compositions were categorised into far fewer subdivisions. The Chemical Composition of Foods, published in 1940, identified fats, proteins, available carbohydrate (as glucose) and minerals as the main subdivisions. Of those minerals, the only trace mineral (other than Iron) was copper – which was found to be essential in 1928. Consequently, my report could only record the mineral content of those foods analysed – sodium, potassium, phosphorous, calcium, magnesium, iron, copper and sulphur. Since that time many other trace minerals have been named as essential – these include zinc, cobalt, manganese, molybdenum, boron, iodine, selenium and chromium. Table 1 summarises the results of my subsequent study (Thomas, 2007) which demonstrated that over a 62year period across 72 different foods the mean average copper content in those foods was reduced by 62%. 37

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Food quality and its relevance to optimum health

Table 1: Historical essential mineral depletion changes in five categories of food products

Sodium

1940 to 1991

1940 to 2002

-49%

-29%

-24%

-9%

-47%

Vegetables (n = 28)

Fruit (n = 17)

Potassium

-16%

-19%

Magnesium

-24%

-16%

Phosphorous

Meat (n = 14) -9%

-19%

-15%

-26%

-50%

-53%

-21%

Calcium

-46%

-16%

-29%

Copper

-76%

-20%

-55%

Iron

-27%

-24%

To put the significance of these findings into perspective, let’s consider the european nutrient reference values (NRV) for magnesium (375mg), zinc (10mg) and chromium (40µg), which many nutritionists consider to be the minimums below which deficiency diseases begin to manifest. How much is this actually per day? Given that a level teaspoon represents 5mg, 1/13th of a level teaspoon would represent the magnesium quota; 1/500th is the requirement for zinc; while approximately a 1/125,000th of a teaspoon is all that is required for chromium. In relationship to the amount of food we eat each day, these are minuscule amounts: yet deficiencies do indeed occur. Consequently, micronutrient content can be considered one fundamental signifier of a food’s nutritional quality. Deficiencies of micronutrient content in food has been linked in part to declining soil quality. The UK Environment Agency recently published a report (Environment Agency, 2019) on poor soil quality in the UK, which although it doesn’t directly link to reduction in nutrients within our food, can be used to draw conclusions between the two. There is a growing awareness of the significance of soil health to the health and welfare of not just commercial crops but of the neighbouring ecosystem. Jim Porterfield, an independent researcher in the US, has alerted me to how the low mineral content of vegetables and grains can be positively improved by following guidelines given in the publication Ideal Soil (Astera, 2014). With these facts in mind the reader can make their own judgement as to the relevance of my findings – but I contend that the loss of minerals in our food – directly or in association with other factors for which these levels are a surrogate marker – will have a fundamental bearing on the prevalence of chronic disease. Similar studies have also been published (Davis, 2004; Davis, 2009; Bergner, 1997). Since 2000, as the incidence worldwide of chronic non-communicable disease conditions has increased, the evidence supporting the importance of micronutrient content of foods in relationship to health and wellbeing has grown.

Cheeses (n = 9)

-8%

-15% -91%

Dairy (n = 4)

Weighted Average (n = 72

-7%

-15%

-1%

-19%

-83%

-37%

34%

-34% 1%

-29%

-97%

-62%

Is there more to the quality of foods than their micronutrient content?

This thought was inspired by the 1940 publication The Chemical Composition of Foods (McCance and Widdowson, 1940), which implied that there is more to foods than their chemistry. This is in contrast to a subsequent edition (McCance and Widdowson, 1991) which implied that chemistry is all we need consider when assessing food quality. However, the current debates about food quality must include the food production methods of organic and bio-dynamic farming, methods that certainly guarantee that no toxic chemical residues of pesticides, insecticides, fungicides, etc so often used in conventional farming practices. will be present. This emphasis on ‘absence of ’ detracts from the positive qualities that result from excellent husbandry and stewardship of the land by farmers committed to these methods. These aspects, humanly and humanely important though they are, do not according to accepted ways of measuring nutritional quality add any value. Were this ‘vitality’ or ‘vibrancy’ quality to be scientifically demonstrable, organic and bio-dynamic practices would gain a very valuable unique selling point, but more than this, the awareness of ‘vitality’ and food quality would have important consequences for individual, communal and planetary health. The scientific model bequeathed to us in the 1600s has at its centre a dualism that separates qualities from quantities, and a reductionism that assumes we can understand the whole by measuring the parts. However, in striving to grasp at ever smaller components, have we as a society lost sight of the whole? I was reminded of the fable of Sir Isaac Newton who, sitting under a tree, when the apple fell on his head suddenly understood the law of gravity. Has science, in its endeavours to discover ever more about the material world (and despites the many ‘gifts’ that research has provided) been less curious than it ought to have been about how the apple got up there? Consequently, suspecting this worldview was incomplete, I started to look at what else could give some indications of food quality. And indeed I found plenty of © Journal of holistic healthcare

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indicative research which, although currently considered too subjective and qualitative, nevertheless could suggest methods for researchers interested in ‘measuring’ the ‘vitality’ of foods; and not only through subjective attributes of sight, taste, aroma, touch – the senses we instinctively use to judge what to eat and what to avoid. The true scope of food quality suddenly weaves an intricate web of components, some physical (its farming, storing, shipping, processing and manufacturing practices), some mental and emotional (that shape individual choice), some cultural (that influence preparation, and whom we can and cannot eat with) and possibly even the spiritual (expressing appreciation and gratitude through the saying of Grace and giving thanks for the food that nourishes us and the web of life). All these dimensions have their own validity, but within today’s scientific paradigm only one, its chemical composition, is readily accepted as credible. Though we all recognise the quality of aliveness (after all, a person who has just died physically has all we have, except ‘life’) this isn’t something to be quantified, ie weighed and measured. And that’s the difficulty. Yet maybe this paradox could be the motivation for establishing some scientifically viable parameters that represent food’s living qualities.

Picturing nutritional forces within foods Biophotonics is a branch of quantum biology dealing with interactions between photons and living tissues, from which very low levels of biophoton emission have been widely reported. Extensive research by Dr Fritz-Albert Popp has explored the function of biophotons as taking part in an information system signalling within and between cells. Some who have speculated that this system facilitates physical healing hypothesise that levels of biophoton emission may correlate with the vitality of biological tissues. If this were shown to be the case it would provide us with a much needed quantitive measure of food quality (www.biontologyarizona.com/dr-fritzalbert-popp). An earlier attempt to reveal the nutritional forces present within foods was Ehrenfried Pfeiffer’s sensitive crystallisation method, which was developed on the basis of indications by © Journal of holistic healthcare

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The beautiful crystallisation image above (of biodynamic wine) has been created using the sensitive crystallisation method developed by Pfeiffer

Rudolf Steiner, who was concerned about a decline in food’s nutritional properties. Steiner believed a loss of vitality was a direct consequence of introducing mineral fertilisers into agricultural practice. Pfeiffer – who developed the bio-dynamic farming method – found a 10% solution of copper chloride when it crystalised showed patterns that correlated with the ‘quality of the food substance used’. The problem associated with this method though, is the amount of training required to interpret the complex crystalisation patterns and form a judgement on the quality of the product. Sensitive crystalisation has been further developed by the Bio-Dynamic Association, which in 2016 held a conference on the theme Vitality and Quality as Seen Through Picture Forming Methods (Lia, 2016). A more

Walter Danzer’s photos: left: extract from an organic apple; right: non-organic extract

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Food quality and its relevance to optimum health

recent pictorial development has been achieved by Walter Danzer. He has investigated more than 50 foods, both organic and non-organic, in his own specially designed laboratory and published a book of his results (Danzer, 2016). In it, the author says: ‘I have discovered that organic foods possess an amazingly beautiful life-energy or order force (life design principle), whereas the life-energy of non-organic foods is generally weakened, disrupted or destroyed. Since I find this important I wanted to share it with you, so that you can make informed decisions’. These investigations point to the possibility of an emergent informational quality in living tissues, and therefore that the food we eat is more than just its material molecules. The hypothesis is that in the process of organising itself into life a new property emerges, of a subtle but literally vital and necessary informational content which contributes to the physical material chemical body’s ability to self-organise. Danzer’s work implies that we need food that can nourish this vital information body through its abundance of order force (life design principle), which represent in a sense the informational memories and experiences of the food’s growth. If this is so then there is a significant value to the way our food is grown and prepared. A parallel research area, which seems to support Danzer’s hypothesis involves empathic food testing whose aim is to evaluate scientifically the emotional and physical impacts of food, and how the ‘emotional properties’ of food products influence our well-being and performance (www.wirksensorik.de/en).

Conclusion The gut prevents products of digestion and other ‘foreign’ substances from leaking into the circulation. When the system fails to do so and foreign proteins get into the body fluids undigested they can have toxic effects in the short and longer term. Ought medicine therefore be more curious about how the more subtle food qualities previously alluded to are absorbed and assimilated, and how they affect health and wellbeing? I’m reminded of the scenario where a group of blind people attempt to describe an elephant. With each holding and describing a part, all are correct in their own way, but none ‘see’ the whole elephant. In terms of food quality the big picture is huge and its study, even leaving aside biological and 40

Extract from a grain of rice, magnified x 400; left: organic; right: non-organic.

chemical content, would entail a nested hierarchy of disciplines that include geology, climate science, soil studies, agricultural history and anthropology, the logistics and economics of storage, transport, processing and manufacturing. Each layer will have had an effect on the chemical composition and the informational ‘life’ force qualities of the emerging food product, and the cultural background and individual circumstances in which these foods are prepared and ultimately eaten.

References

Astera M (2014) Soilminerals.com (accessed 25 August 2019). Bergner P (1997) The healing power of minerals. Roseville, CA: Prima Publishing. Davis D (2009) Declining fruit and vegetable nutrient composition: What Is the evidence? HortScience 44(1). Davis D (2004) Changes in USDA Food Composition Data for 43 Garden Crops, 1950 to 1999. Journal of the American College of Nutr, 23(6). Environment Agency (2019) The state of the environment: soil. Available at: www.gov.uk/government/publications/state-of-theenvironment/summary-state-of-the-environment-soil (accessed 25 August 2019). Lia B (2016) Vitality and quality as seen through picture forming methods. Available at: hwww.biodynamics.com/research/vitality-andquality-seen-through-picture-forming-methods (accessed 25 August 2019). McCance and Widdowson (1991) The composition of foods, 5th edition. London: Royal Society of Chemistry/Ministry of Agriculture Fisheries and Food. McCance and Widdowson (1940) The chemical composition of foods, 1st edition, special report series no 235. London: Medical Research Council. Thomas DE (2007) The mineral depletion of foods available to us as a nation over the period 1940 to 2002, Nutrition and Health, 19, 21–55. Thomas DE (2003) A study of the mineral depletion of foods available to us as a nation over the period 1940 to 1991. Nutrition and Health, 17, 85–115.

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Building a local community food system Phillip Sharratt

Chief Executive, Somerset Local Food Limited

The globalised food chain is moving food production further away from the communities it serves, at the same time creating widespread health problems and contributing to ruination of the natural environment through soil degradation, change of land use and loss of habitat. It’s becoming clear that food production will demand innovation if we are to stem what appears to be an unstoppable and increasingly detrimental decline in the quality of what we grow and eat. A Somerset-based social enterprise project is showing the value of bringing together community engagement, with sustainable growing, and access to good food. © Journal of holistic healthcare

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With 30 years’ experience of working as a business and management consultant, I arrived in Somerset in 2005 to deliver a project that supported small businesses to become more successful. Since then I have delivered numerous economic and community development projects with a strong social purpose, including tackling poverty by helping people to set up their own business, working with construction businesses across the south west to adopt environmental technologies, and introducing computer coding into primary schools to help give children new skills and possibly support them to achieve their future potential. I joined Somerset Local Food two years ago and have led the transition of the business from a commercial model to a community-owned not-for profit Community Benefit Society.

The big challenge The global food sector accounts for between 14% and 30% of global greenhouse gas emissions (Vermeulen et al, 20912) with around 50% of those emissions attributable to transportation, refrigeration, packaging and waste on a scale not previously experienced. Over-production and commoditisation of an abundance of processed food is making food a less valued, cheap and disposable commodity, And the well documented visual quality requirements for fresh produce is forcing farmers to dispose of unattractive yet perfectly edible food. These requirements have reduced consumer choice to an homogenised range of fresh produce grown for appearance and yield, and caused a loss of ancient heritage varieties whose unexplored genetic properties may well prove crucial to withstanding the impact of climate change.

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‘Food is the most important thing to our health and to our life, yet we degrade it and don’t value it properly. At the end of

the day, farmers will only produce to what the consumer wants. It’s about everybody taking responsibility, taking more interest in their food and where it’s produced.’ (Walrond, 2019)

‘Good food’ is a term coined by the Bristol Food Policy Council to describe the broader value of real food. ‘As well as being tasty, safe, healthy and affordable, the food we eat should be good for nature, good for workers, good for local businesses and good for animal welfare.’ And yet even this definition misses the true power of good food to bring people together, to build community, and reconnect people with nature and each other, and thereby mitigate the health and wellbeing challenges we all face in an increasingly fast, disjointed and isolating society.

Somerset Local Food We launched as an online food retailer in 2002 in the early days of slow dialup internet. An existing network of farmers markets in Somerset brought 41

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Food variety tree

together the market gardeners, family-owned farms and small-scale food producers which didn’t have outlets through supermarkets or large retail chains. By broadening their consumer base – selling produce online and delivering orders across a much larger area that included the cities of Bristol and Bath – small local growers stood a better chance of achieving traditional business development targets of increased turnover and job creation. Initially Somerset Local Food was a roaring success, and achieved it’s purpose of ‘supporting small-scale food producers’. Then, as supermarkets started retailing online, sales volumes went into a decline, and growers tried to compete on price by reducing their own margins. Inevitably the next 10 years saw waning numbers of

Community cohesion Health and wellbeing

Rural heritage and art

Local food system Natural environment Community resilience Somerset Local Food social impact model

market gardeners and small-scale family-owned farms, and a large turnover of local micro-food producers. The initial organisation had failed because it treated food as a commodity: a tool for creating financial wealth and jobs. So another approach was needed, one that recognised the broader social impact for ‘good food’ to boost community engagement and increase social capital. An understanding of these vital added values would remind potential consumers that in reality there can only be one price for food, a price that reflects the true cost to society and the environment. Buying ‘cheap food’ in fact creates a debt that our children and grandchildren will have to pay for an overburdened health system, soil degradation, declining biodiversity, continued destruction of natural habitat, and our inability to curb the impacts of climate change on food systems. In addition, all these factors will have an enormous impact on rural communities. Two years ago Somerset Local Food received significant social investment to transform into a not-for-profit social enterprise. With new branding and website and a committed purpose it is now thriving and once again growing communities through food, and supporting local smallscale, community food growers, farmers and producers who are passionate about healthy food, and about protecting and enhancing the natural environment. We are helping build networks among those food producers to share knowledge and experiences, and encourage them to collaborate to develop plans for extending access to good food for local communities using limited growing space. The Community Farm at Chew Valley in Somerset is an example of an engaged community grower. It was started by a group of volunteers in April 2011. Initial start-up funds came from 419 people investing in a community share offer, creating a group of consumers with shared values for good food, for the environment, and to belong to a community of like-minded people. Today, the farm grows market garden-scale organic vegetables and fruit on a 14-acre rented site that supplies an organic veg box service and wholesale delivery hub supplying Somerset Local Food and other wholesale customers.

Expanding to be more inclusive of the local community the farm now welcomes people to ‘get on our land’ for learning, work, recreation and wellbeing. The staff team has grown to around 15 full-time equivalent people with an annual turnover approaching £1 million. The site, which at the start had nothing but one cold water tap, now has four polytunnels, a warehouse and cold store for the packing operation, a yurt and roundhouse for classrooms, and a learning area where children and wellbeing groups turn their hand to growing. There are accessible composting toilets, mature apple trees, owl boxes, and a pond.

The operation delivers around 500 veg boxes each week in Bristol, Bath and the Chew Valley. A small farm shop runs in Bath, and a weekly fresh produce stall at Southmead Hospital in Bristol serves NHS staff and visitors. The farm also supplies some wholesale

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Volunteers at the community farm

consumers. By working directly with other producers, both at home and abroad, the farm pays a fair price for produce that goes directly to the grower. The Get on Our Land programme welcomes weekday volunteers all year round and on 15 community farmer Saturdays each year. In growing season, schools bring 60 children each week for a learning day run by partner organisation Earthwise. Diverse groups come for learning, team days and wildlife activities. Partnerships with Bristol Drugs Project, Bath Wellbeing College, and Ecowild enable wellbeing courses, and therapeutic and rehabilitation activities. More than 1,200 people spend at least a day on the farm each year and numbers are continuing to grow.

In addition to the impact of a 14-acre site converted to organic farming, and routes to market for many more organic acres, the major impact is on people; box consumers say they love the produce, eat far more fruit and veg because it is always there, and are healthier as a result. Volunteers and visitors say that for them the farm is a lifeline, a meaningful project that they love being part of. It gives them outdoor activity, friendship, purpose, joy, structure, new skills, confidence, routes to employment, connections in the local community, learning about farming and wildlife, and leads to lasting change in healthy eating. In short they describe it as ‘rehab in a mad world’.

Somerset Local Food Limited also supports therapeutic and social growing projects through the sale of its surplus produce.

Root Connections collect a polytunnel from Charles Dowding, the Somerset-based leading authority on no-dig gardening © Journal of holistic healthcare

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Seed of Hope CIC (SoH) was started in 2014 over a pint of cider in the local pub. Jayne Alcock, the grounds and gardens supervisor of the Walled Gardens of Cannington, and Kris Scotting realised they both had interest and experience of using horticulture as a tool to bring people together in a therapeutic environment. Jayne had previously worked as a mental health social worker before moving into horticulture, and Kris had trained as a mental health nurse, and worked in health and social care for over 30 years, several of these years in therapeutic horticulture projects. They approached Bridgewater and Taunton College for permission to start a weekly group at the Walled Gardens of Cannington for people with mental health issues, and the initial SoH project was born. Subsequently groups in Watchet and Glastonbury have started and a pilot gardening project launched with a local housing association to help tenants who can’t cope with their gardens. The vision of Seed of Hope CIC is to grow mental health recovery throughout the south west of England using therapeutic horticulture. Like the Big Issue, they believe that people with mental health needs need a hand up rather than a handout, and are challenging society’s assumptions about the abilities of people with mental health problems.

SoH has supplied fresh herbs and wild flower seeds and we are looking forward to a regular supply of mushrooms grown at their Glastonbury site.

Root Connections CIC links homelessness and community through inter-agency involvement. It operates a successful outreach service for rough sleepers, offering a safe place where people can seek help and advice, and assistance to start their journey of recovery. The ethos is one of hope, finding meaning and strength together, giving support and by showing ways towards a more sustainable future.

The Root Connections plot is based on a beautiful Duchy farm in Somerset, occupied by farmer Rob Addicott and wife Suzanne, who both have a heart for community and people on the fringes of society. The garden sits alongside the Dairy House, a six-bed hostel offering residential accommodation to the homeless, rough sleepers and isolated individuals with (sometimes complex) mental health issues and needs. Initially the garden was a patch of land Rob offered to the residents but a volunteer quickly saw the benefits of residents working together outdoors, with the local community getting involved as well, which resulted in improved health, sleep and general wellbeing. The Dairy House residents are encouraged to volunteer in the garden as often as they feel they’re able to, where we offer structured activities, encourage soft horticultural learning and support with social re-integration by working alongside our team of volunteers. We also have volunteer land days two mornings each week, where people from the local community join us and work alongside the Dairy House residents and volunteers, and each Friday we come together for a shared lunch of fresh, local produce. The garden is now sufficiently productive that the produce can be sold through a network of local churches, farmers markets, other community events and online through Somerset Local Food.

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Seeds of Hope erecting a garden shed at their Watchet site

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We are now eagerly anticipating the roll-out of social prescribing so we can engage with GPs and primary care agencies

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Our community of consumers identify and recommend new suppliers and suggest which growers and producers they would like to meet through visits to farms. These gatherings for enjoying local produce always generate conversation and new friendships. There is also a growing recognition among community food producers that they are not competing with each other; that through collaboration we can grow the market for good food and improve its nutritional value, while building stronger, more resilient and coherent communities passionate about good food and their natural environment. Together we can offer a broader choice including heritage varieties of fresh produce, more traditional cuts of meat no longer offered by supermarkets, and we are seeing a growing appreciation of local foods, such as the amazing choice of cheeses and dairy produce.

projects. A pilot distribution network will be aiming to move seasonal produce gluts between local distribution hubs, and enable improved crop planning across the entire subregion, with Bristol to the north and all of Devon to the south. Bristol is a former Green Capital and currently a Sustainable Food City. Its well-established and productive community food system, led by Feed Bristol, incorporates not only a network of community farms and small-scale producers, but also independent food retailers, catering and hospitality businesses. To the south in Devon there are many established community farms, producers and retailers, so it makes sense to link all these local food systems and so increase efficiencies through collaboration and create a bigger social impact through knowledge-transfer and by sharing assets and produce. We are now eagerly anticipating the roll-out of social prescribing so we can engage with GPs and primary care agencies for mutual benefit. By bringing good food to many more people we can improve local health and wellbeing, while building social capital and at the same time protecting and enhancing our local natural environment. By working together like this to join up the dots, the Good Food Network’s impacts could be felt far beyond the south west of England.

References

Vermeulen SJ, Campbell BM, Ingram J (2012) Climate change and food systems. Annual Review of Environment and Resources, 37, 195–222. Walrond R (2019) Positive News [online]. Available at: www.positivenews/environment/agriculture/farming-in-somerset-in-anera-of-climate-change (accessed 23 August 2019).

The Good Food Network Through the Good Food Network – lately established with the support of Resonance, a social impact investment company – we are already beginning to deliver 44

Somerset Local Food team

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Wilder labels, better farming

WI L D L I FE

Tim Martin

My whole life has been shaped by wildlife. As a child I was a keen naturalist and wildlife photographer, and this led to a zoology degree and over 20 wonderful years as a director then executive producer in the BBC Natural History Unit. But against a backdrop of rapidly declining biodiversity I felt that just filming wildlife wasn’t enough – I wanted to get more directly involved in the fight to protect and restore nature. And that’s meant immersing myself in the world of farming.

Founder, Farm Wilder

Intensive farming is failing us all, through loss of biodiversity, falling nutritional quality of food, depletion of soil and high greenhouse gas emissions. Farm Wilder is a social enterprise promoting a new way of labelling food that for the first time gives consumers the choice to support farmers who are leading the way to a better future, through regenerative and wildlife friendly farming.

Last year I was delighted to finally see a Marsh Fritillary, a very rare and stunningly beautiful butterfly. Once widespread, it is one of our fastest declining species, and for me it’s become symbolic of the biodiversity we have lost as farming has intensified. I was in the middle of a damp Dartmoor meadow, known as a Rhos pasture, and looking out past the orchids, buttercups and forget-me-nots I could see dozens of these exquisite little orange and black checkered creatures flitting from flower to flower, energised by the strong June sunshine. I’d come for the butterflies, but my senses were being bombarded with natural wonders in the way that normally only happens in a rainforest. A cuckoo called higher up the valley,

soaring buzzards mewed, and from the hedgerows came the constant bubbling song of willow warblers and blackcaps. As I crossed the meadow I inhaled scores of scents – wild mint, the coconut aroma of warm gorse flowers and the herby compost of marsh soil. It was a poignant reminder of just how bursting with life our countryside can be. Sadly, very little of our farmland is like this now. We might survey the patchwork of fields full of crops and livestock and remark on how green and beautiful it looks – but up close most of it is a green desert. Birdsong and the buzz of insects has given way to eerily quiet monocultures of rye grass, wheat, barley, oats and oil-seed rape. A whole generation has grown

The Marsh Fritillary butterfly – an endangered species which Farm Wilder farmers are working to protect

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up deprived of the joy of experiencing a The cuckoo – one of Britain’s fastest declining birds. healthy vibrant countryside. I’ve watched Dartmoor is one of its strongholds. this impoverishing of our land unfold in slow motion over several decades. As a BBC wildlife film-maker I’ve been fortunate to visit some of the world’s great wildlife hot spots, but I’ve also been aware of the sad irony that wildlife has been rapidly dying out in my own back yard. It’s been abundantly clear that the root of the problem is intensive farming. Over 70% of Britain is farmed, so most of our wildlife relies on farmland for its survival. The widespread use of chemicals, along with the loss of flower meadows, hedges, ponds and scrub has been catastrophic. Once common creatures like hedgehogs, turtle doves and tree sparrows have declined by 95%, and Britain by government and EU policy, and by us consumers is now one of the least biodiverse countries in the world. wanting to buy the cheapest food we can. The good news The situation had become so desperate that I decided to is that many farmers desperately want to change course, find out for myself what was going so wrong, and what I they just need our support in doing so. could do to help put it right. What I found out was shocking – Britain’s whole farming system is utterly broken. It isn’t just failing wildlife, it’s failing human health through the declining nutrient There are plenty of conventional quality and chemical residues in intensively produced farms that are very wildlife friendly food; it’s failing farmers, many of whom struggle to make ends meet; it’s threatening our homes by increasing thanks to special measures to flooding; it’s poisoning waterways through the runoff of toxic chemicals; and it’s gambling with all our futures protect habitat through high emissions of greenhouse gases, and because of the way soil is being mistreated. Not only has the carbon content of soil declined, but the soil itself is being So how do we help farmers to farm more sustainably? depleted at an alarming rate – farmers are effectively The problem is that as consumers we have very little mining it rather than nurturing and replenishing it, with power to influence how our food is being produced. the result that some of our best land could be unfarmable There’s so little information on the labels that when we in a few decades. Most of our farming is about as shop we can’t separate food that’s been farmed in a sustainable as a coal-fired power station. But it’s wrong to wildlife friendly and sustainable way, from intensively blame farmers for this – they’ve been led down this route produced food from green desert. The only widely available labelling option is organic, but does that mean rare wildlife is being supported? Sadly not – organic farms may have more worms and bugs, and more of the most common wildlife, but there’s no guarantee of anything with more specialized needs like a Marsh Fritillary or a Cuckoo. At least I thought that organic would guarantee better soil, but even that’s not always the case. Organic farms have to plough to control weeds, and ploughing is bad for soil health: a poorly managed organic farm can actually end up with less carbon stored in the soil than a well-run conventional min-till or no-till farm that uses a small amount of herbicide so they don’t have to plough. To add to the confusion, there are plenty of conventional farms that are very wildlife Filming Lost Land of the Jaguar friendly, thanks to special measures to

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Wilder labels, better farming

Farm Wilder labels highlight the wildlife that our farmers are looking after

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Marsh Fritillary sheltering in grass tussock, Dartmoor

massively reduced or eliminated, animal health and wellbeing is improved, and biodiversity boosted. It’s more profitable for farmers, even before we pay farmers the Farm Wilder premium of an extra 45p per kilogram. Just as important is that this system produces extremely tasty and healthy meat from native breeds that thrive on relatively poor upland pastures: beef connoisseurs say you can actually taste the herbs from the flower-rich meadows, and research points to an improved nutrient density compared to grain-fed meat, including up to five times more omega3s, and twice as much conjugated linoleic acid (CLA).

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The greater mass and length of roots adds organic matter and carbon to the soil, building soil rather than depleting it

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protect habitat, while some organic farms can be surprisingly devoid of life. It was clear that we needed much better labelling to support wildlife-friendly regenerative farming, and to educate consumers about why it’s so badly needed. So I left my job at the BBC and set out to try and create it. In January I launched a social enterprise, Farm Wilder CIC, together with journalist and Farming and Wildlife Advisory Group (FWAG) farm and policy advisor Luke Dale-Harris. We select food exclusively from groups of farms who are farming regeneratively, and who look after rare wildlife. We’ve started with beef and lamb, because many of our most endangered species need sensitively grazed meadows to survive, although in the longer term we are also looking into cheese, beer and cereals. We’ve named the meat after the Dartmoor wildlife that’s being nurtured by our farmers: Cuckoo Beef, Cuckoo Lamb and Fritillary Butterfly Beef. Beautifully illustrated and informative labels tell the story of the wonderful work these farmers are doing, and the meat is now on sale in several butchers in Bristol and Totnes, and online across England and Wales from ethical retailer www.fresh-range.com. Currently we are funded by grants, donations and a lot of goodwill, but over the next couple of years, as our sales volume grows, we will be increasingly self-sufficient through a small levy on the meat sold. By buying our meat, consumers are helping farmers do two things – conserve rare wildlife and farm in a more holistic and regenerative manner. We work with charities including Butterfly Conservation, RSPB, FWAG and Devon Wildlife Trust to provide advice on managing habitat for Marsh Fritillaries and Cuckoos. And we partner with the Pasture for Life certification scheme, encouraging and training farmers to transition to their more regenerative 100% pasture-fed system, where artificial inputs are

The most critical aspect of this pasturefed system is that it radically improves soil health – and there are few things more important to human health than the future of our soil. Shallow rooted rye-grass is replaced by a mix of over a dozen grasses, herbs and legumes, all of which have a different role to play. Some fix nitrogen from the air (instead of applying expensive fossil fuel-derived fertilisers), while others bring up different minerals from deep underground. The greater mass and length of roots adds organic matter and carbon to the soil, building soil rather than depleting it, and sequestering carbon which helps to combat climate change. This healthier soil is more permeable, so that water soaks in and is retained, rather than running off into rivers taking the soil with it. It’s a beautiful system, making farms much more resilient 47

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try to inject some reality into an often confused debate about the rights and wrongs of meat-eating. It’s all too easy to label all meat eating as bad – but that’s nonsense. Just as electricity can be from sustainable or unsustainable sources, so can meat. Our message is simple – eat less meat, but when you do buy our high quality Farm Wilder meat that helps protect endangered wildlife as well as restoring soil and regenerating the countryside. The past 18 months have been an extraordinary voyage of discovery for a former TV producer who knew little about farming – but I don’t think there’s ever been a more exciting or important time to be Wildlife-friendly Rhos pasture, Dartmoor

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Farming … has the potential to provide solutions, if only we can fully embrace farming that regenerates the soil, sequesters carbon, and restores lost biodiversity

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in the face of floods and droughts, and it has the built-in benefit that the greater variety of flowers and grasses provides food for many more insects than ryegrass can ever sustain. It’s an interesting time to be promoting meat, as more and more people turn vegan, but that makes Farm Wilder’s educational work all the more important, as we Tim with his daughter

Ryegrass monoculture

involved in British agriculture. Farming holds a special role in the future of humanity, far beyond just providing food. It is both a major cause of the greatest problems of our time, collapsing biodiversity and mushrooming greenhouse gasses; but it also has the potential to provide solutions, if only we can fully embrace farming that regenerates the soil, sequesters carbon, and restores lost biodiversity. The scale of this challenge can be daunting, but I’m more optimistic than ever that we will make this change, and I’m pleased that in its own small way Farm Wilder’s innovative labelling scheme is already starting to contribute towards this transformation.

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Seeds of survival Fred Groom

I have a background in ecology, horticulture and human ecology, and have been working with seed in various capacities for five years. For a long time it has been my dream to start a small organic seed company, and in 2018 the time seemed right; Vital Seeds was born. Vital Seeds produces and sells organic vegetable, herb, and flower seeds of openpollinated varieties to home gardeners and small-scale growers. A core part of our mission is to re-skill people in the art and craft of seed saving. My growing journey has taken me from urban rooftops through Spanish deserts to the lush green hills of Devon, where I and Vital Seeds now reside.

Co-founder, Vital Seeds

Vital Seeds co-founders Fred Groom and Ronja Schlumberger offer a sustainable and local alternative to most seeds that are planted in the UK, many of which are grown thousands of miles away in countries with a dryer climate and cheaper labour. They are based at Westford farm, on the north edge of Dartmoor. Here in their converted barn, they process seed and test its germination quality in a specialist ‘germination oven’. It is here that they test their seed twice a year to check it is still top quality. Part of Vital Seed’s mission is to re-skill gardeners and growers in how to save their own seed, and to revive this ancient and fascinating craft.

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S E E D S AV I NG

Nine out of ten mouthfuls of food start with a seed, and that is not going to change any time soon. These small and unassuming objects hold within them the key to our survival as a species. They are essentially little packets of information, containing instructions on how to produce sugar, starch, protein and many other lifegiving molecules from soil, sunlight and water. They also contain the instructions on how to create almost identical replicas of themselves ensuring that this information can be disseminated year after year. The work they perform is no less than alchemy. It is a disturbing fact that in the last 100 years, more than 90% of the diversity within food crops has been lost. This is in large part as a result of the industrialisation of global food production, and the dangerous shift in control of the global seed supply from gardeners, growers, and small regional seed companies, to large multinational chemical giants, who now control more than two-thirds of the world’s seed. The shift from naturally breeding, open-pollinated varieties to high-tech F1 hybrids means that even if gardeners and growers wished to save their own seed, they cannot, because any seed produced by F1 plants will be genetically unstable. You can save the seed of an F1 hybrid, but you won’t get the same plant when you try to grow it next year. So gardeners who use F1 hybrid plant varieties must buy new seed every year.

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In the UK the majority of organic food is actually grown using nonorganic seed, as the supply of organic seed is so poor. On top of that nearly all of the vegetable seed (organic and non-organic) planted on UK farms is produced in other countries, with dryer climates and cheaper labour. So most of the ‘local’ food we endeavour to eat actually comes from seed produced on the other side of the world. In response to this situation, we started Vital Seeds, a small independent seed company based in Devon, producing and selling organic vegetable, herb and flower seeds. Our vision – lofty as it may sound – is to create a world where all farming is ecological and all crop varieties are perfectly suited to their environments. We want to breed new crop varieties

Peas

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varieties, and people wanting to grow the varieties must go back to the company every year to buy more seed. Another result of hybrids producing bad seed is that they are unable to adapt to changing conditions, making them essentially an evolutionary dead end.

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We need excellent seeds of welladapted and resilient varieties to give us the best chance of moving towards a future we want our children to live in

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Carrot root selection

and improve existing ones. All our varieties are openpollinated, so you can save seed from them year after year. What do we mean by ‘open-pollinated’ I hear you ask? Open-pollination is the natural way that plants breed, whereby they exist in populations and each generation is similar to the last. There is genetic diversity within the populations which means that they can evolve and adapt to changing climatic conditions. Conversely, F1 hybrid varieties of crops do not have this genetic diversity; all the individuals of a given variety are essentially genetically identical; not quite clones of each other but almost. Not only do they have very limited genetic diversity, but the seeds which they produce will not produce plants similar to their parents, due to a genetic phenomenon called segregation which there is not the space here to go into. As it is not possible to save good seed from hybrids, it means that seed companies have total ownership of

Some say we are approaching an eco-crisis; I personally think that it is already in full swing. If we are going to come out the other side of it with any hope of producing nourishing food from freely accessible plants, then we must start to take seeds more seriously. We need excellent seeds of well-adapted and resilient varieties to give us the best chance of moving towards a future we want our children to live in. To make this happen it is imperative that individuals and communities are re-skilled in the art and craft of saving seeds. This humble activity would once have been one of the most important elements of our seasonal land-based existence. Without good seed to plant in the spring, the harvest – and therefore our health – would have suffered greatly. This is still as true today as it has ever been. There are gene banks and some seed companies who are stewarding varieties which may be of use in the future. However, it would be no less than foolish to depend on a few ‘Noah’s Arks’ to save the day. The real ark is in every grower and gardener who saves seed year after year and swaps seeds with their neighbours and friends, and teaches them to save their own seed. This is the option for true resilience. In this scenario not only are we keeping valuable varieties alive and evolving, but we are also enabling the flow of genetic and cultural material between communities in a truly organic form. As well as producing and selling top-quality seed, part of our mission at Vital Seeds is to educate gardeners and growers in seed-saving skills, through workshops and online content. We are passionate (borderline obsessive) about seeds and want to share this with others. Seeds really are little miracles waiting to happen. What can you do today?

Kale seed drying

• Learn to save seed – start with self-pollinating, annual crops as they are easy (eg French beans, peas, lettuce, tomatoes) • Join the Heritage Seed Library (few £s a month) – their raison d’etre is to keep alive old varieties which might otherwise go extinct • Support small regional organic seed companies (like Vital Seeds). © Journal of holistic healthcare

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Wellington’s inspirational community projects T R ANS I T I O N TOWN

Helen Gillingham Transition Town Wellington (TTW)

People have an affinity with the natural world, and many studies have shown that when we get in touch with nature, we are happier and healthier for it. But many of us living in cities, surrounded by concrete and steel, have become so disconnected, our heads too full of our jobs or relationships to allow space for anything else.

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The miracles of nature never cease to amaze me. I was taught to treat the body as a whole by my homeopath from an early age, which led me to pursue a career in holistic massage and skincare. Permaculture seemed to perfectly suit my holistic approach to life, and I have been involved with the transition town movement for about 10 years. Being part of of TTW’s Sustainable Food Group has brought me a lot of joy, so I hope readers will be inspired to join their own local group to take positive steps towards a greener, kinder, and healthier future.

The transition town movement Rob Hopkins, the permaculturalist and addiction counsellor who founded the first transition town group in Totnes in 2005, pointed out that our society is addicted to fossil fuels – and will do almost anything to avoid facing the fact that we need to change. Some deny that there is a problem; others adopt survivalist strategies and build a bunker, or pin their hopes on outlandish technical solutions – perhaps we can move to another planet? The real answer is much closer to home: to work together as a community to transition away from fossil fuels – and fast. For if we carry on consuming the earth’s resources at the current rate, as well as warming the climate and damaging the environment, shortages and price rises are likely to cause war and conflict. But if we use the remaining resources wisely to build infrastructure such as solar farms, hydro dams and wind farms, we could have a future that’s not just viable but actually more desirable, within closer-knit and mutually supportive communities. The transition strapline is: ‘If we wait for the governments, it’ll be too little, too late; if we act as individuals it’ll be too little; but if we act as communities, it might be just enough, just in time.’ If we were to show, as I believe we are now starting to, that the ‘electorate’

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really care about the environment, climate change, and the destruction of habitat, politicians will have to respond. Hearing about too many of the world’s problems, on our ever increasingly depressing and negative news, can leave us feeling powerless. This feeling can lead to a sense of hopelessness. The problems are so vast and complex, it feels like nothing we can do will make the slightest difference. But this is what the transition movement is all about. Whatever local community group you choose to join, or create, you can be part of the solution. We all have the ability to influence and change the small patch of earth we call home. The transition movement aims to reskill people with the arts we are losing – learning from our elders how to sew, bottle food, mend our bikes – the kind of life we led before our throwaway and consumerist society started to wreak havoc on our climate and environment. This could build connections in our community and help us become a more cohesive society. If we can take the best from modern life – the technology that makes life easy – and combine that with some of the skills and values from the past, the Earth and us humans would be happier for it. Repair cafés – closely allied to the transition movement – are a wonderful way forward, as we saw in practice when we started our own in Wellington earlier this year. 51

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Growing our own One of the first regular events we set up in Transition Town Wellington were talks on how to grow organic vegetables. This was a chance for both experienced and novice gardeners to get together and share knowledge. Unlike the town’s regular gardening club, which invited ‘experts’ to give talks on their special area with the audience sitting and listening, we decided to run the meetings more as a knowledge-sharing platform, where novices and more experienced gardeners could learn from each other. The notes are available from our website ttw.org.uk. They have been revised and added to over the years, to provide a valuable resource for us in the future – and for others too. Growing plants to eat is a complete joy. I would like to encourage anyone reading this who doesn’t already grow to give it a go. It will help you discover a fundamental connection to the earth, and this connection will grow stronger over time, even if you live in a city, and will have a positive impact on your mental health. Until relatively recently, in evolutionary terms we, like all other animals on our planet, spent our lives in pursuit of food. Becoming more self-reliant and reconnecting with this primal drive will give you more confidence and satisfaction. As well as encouraging people to grow their own fruit and vegetables, TTW also wanted to encourage home cooking. The emergence of convenience food, fridges and freezers in the 1960s, drew many people away from cooking from scratch. Then, as the busyness of our lives increased and more women started to work full-time in the 1970s, cooking skills took a back seat. Chef-led programmes may encourage a few to have complicated food and cooking as a hobby, but as a group, we want to reskill normal people with basic cooking skills. We organised chutney-, soup- and bread-making afternoons, where we would get together in a church kitchen and make a variety of recipes from mainly home grown produce.

Low carbon farming Looking at the bigger world picture, 26% of the world’s carbon emissions come from food production (www.bbc.com/news/science-environment-46459714) so growing food locally is a good place to start when it comes to reducing our carbon footprint. At the start of the Dig for Victory campaign in the Second World War, Britain only produced around a third of its food. There was a massive government drive to increase yield, until in the early 1980s we had the ridiculous situation of phenomena like ‘grain mountains’, although we did produce 82% of our food. But now we have slipped back to 61% self-sufficiency (www.countryfile.com/news/can-the-uk-feed-itself-afterbrexit/). But if we are going to rely less on fossil fuels and minimise the destruction of our natural environment, we need to move away from a highly mechanised and artificially fertilised agriculture. We can influence how agriculture works by campaigning for government policy 52

change, and as individuals aim to increase the amount of organically produced food we buy, and reduce our intake of meat products. In time, more farmers will change their practices to meet consumer demand. Meanwhile, as a community, we can help our urban landscape provide food, and wildlife to thrive there. We can choose what we grow in our own gardens, but we can influence what gets planted in our communal spaces. Wellington local council has been co-operating with transition town efforts for planting and maintaining unused public spaces for the overall good of the town. TTW has been planting fruit trees, bushes, and herbs, around the town for five years now. We are working towards a vision that there could be food to forage near everyone’s home, to provide an opportunity for everyone, through gardening, to connect to the earth, and to their neighbours, even if they have no garden nor time to commit to their own allotment.

Community orchards and woodland We started by helping to expand and develop a community orchard on a new housing estate, on a spare bit of green space that had to be preserved due to the presence of a pond with greater crested newts and 10 veteran apple trees. This sizeable orchard has the most productive community trees in town. We have added 29 more apple trees and four plums and pears to the original heritage orchard, plus a range of soft fruit bushes and hazels. In 2013, we planted a new orchard on an old church site. This is now known as Trinity Orchard, and contains 14 apple trees, a plum and a pear tree. In 2015, we planted some fruit bushes and rhubarb on council land by the Wellington Bowling Club. In 2016, we got a grant from the council to plant suitable fruit trees and bushes in a damp field dubbed a ‘community woodland’, and morello cherries along the shady edge of a rugby pitch. As the projects have grown, awareness of our activities has spread, and residents have started to ask if we can plant up small patches near their houses. By December 2018, we had planted plum, apple, cherry and pear trees near a local primary school, which in time will provide fruit for the children to pick on their way home from school. These sites are shown on our foraging map drawn using the artistic skills of volunteers, and reproduced with sponsorship from local businesses; again using the resource of our community. Our foraging map got us noticed and together with our other projects led us to win a Green Heart Hero award in March 2019, as an ‘inspirational community project’.

Gaining momentum The Free Community Food Map (https://ttw.org.uk/freecommunity-food-map) has helped raise awareness of what we are doing as a group, as families are using the foraging sites more and more. It’s lovely to see young children

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TRANSITION TOWN

Wellington’s inspirational community projects

discovering picking fresh food for the first time, as well as spending time with their families. New people are learning when different fruits become ripe, not from someone telling them, but from practical experience. As the most bountiful harvest so far in the town are the apples at the original community orchard, we have been running apple-juicing days for around five years now. As more people join the group, we may run an elderflower cordial event, or jam-making sessions, and share more recipes to use the foraged fruit by one of the many social media platforms. This year we are embarking on our biggest project yet – a new community garden of around an acre next to a railway line. This site was brought to our attention at the same time as the community woodland, in 2016. The energy and enthusiasm of local volunteers has transformed the idea into something much greater than our original vision, with wildlife and nature now as its main focus. The picture below shows the plan for the site. The council’s ecologists are using our developing sites as case studies for the Pollinator Action Plan, adopted by Somerset County Council in 2018, to help provide insectfriendly habitats which are in desperately short supply. Hopefully in the future, this once bramble-covered field will be not just a bountiful resource for foraging, but also a haven for wildlife and a place for people to come together and enjoy picnics in a beautiful semi-wild garden. The future is really bright for Transition Town Wellington. People seem to be waking up to the urgency of the situation – especially climate change and species loss – and realising more than ever that we all play a part in the global picture. Perhaps the success of our most recent projects is an indicator that more people are searching for something they can do to make a change. It feels like we are involved in the right movement at the right time.

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Coming together for change I would really encourage anyone reading this to join a project or start one. What is it that bugs you, that you’d like to change? If we can do it in Wellington, then you can. You don’t need to be an expert, or have any particular qualifications. All it needs is the willingness to spare some time, some patience to deal with different people, and energy and enthusiasm to have a go. It doesn’t need to be perfect, and you don’t need to know everything – society just needs someone to volunteer, especially if no one else is doing it already. It might be a bit of hard work, but that is totally outweighed by the great feeling you get of being part of the solution. Member Andrea says: ‘I was feeling a bit low one day with my job on the computer, wondering if my life was worth anything, but the following day, using a mattock to dig up bramble roots to create a footpath at Longacre, I felt my life had purpose and meaning, because I was helping the community’. Maybe you can join us in planting fruit trees and bushes in your town, or creating a community veg patch, or a wildflower meadow, joining many other similar projects in the country, until all of Britain’s urban spaces are greener and more beautiful, providing hope for our future and our food security.

‘Let food be thy medicine, and let medicine be thy food’: S T U D E NT E S S AY

Is food the foundation for good health?

Jessica Frost

Final year student, Birmingham Medical School

The title for the 13th annual BHMA student essay competition was Is food the foundation for good health? Our winner, Jessica Frost, impressed the judges particularly with her references to two topical issues – junk/ processed/ultraprocessed foods and the Eat-Lancet report on sustainability. They were also impressed by the fact that she took it beyond diet to food’s role in lifestyle medicine. The essay is particularly relevant as the Real Food Campaign is launched (see page 4) focusing on food that promotes health, both personal and planetary.

Throughout university, I have become increasingly passionate about lifestyle medicine, plant-based nutrition and fitness, with an insatiable love of dance, martial arts, running and weightlifting. I am eager to educate others about the monumentally positive impact even small changes in lifestyle can have on both mental and physical health and, as a trainee doctor, feel it is my duty to practise what I preach. I also believe it is imperative that patients are made to feel engaged and empowered by their healthcare providers, hence why I aspire to pursue a career in general practice, where I can provide others with evidence-based lifestyle advice and further develop my interests in this exciting, up-and-coming field.

Food has played a fundamental role within healthcare for centuries, and its use in both preventative and therapeutic medicine has been documented in medical texts dating as far back as the Hippocratic epoch. The quote attributed to Hippocrates himself, ‘let food be thy medicine, and let medicine be thy food’, further reiterates how nutrition and dietetics have been viewed persistently as key to the optimisation of health since ancient times. Health is a dynamic state, described by The World Health Organization as one ‘of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity’ (WHO, 2006). This definition provides the individual facets through which this essay will explore the age-old link between diet and wellness, to ultimately decide whether food today still provides the foundation for good health, or whether such a narrative oversimplifies what is actually a hugely composite healthcare issue.

The foods people consume ultimately define a population’s health, with dietary risk factors one of the biggest contributors to the global burden of disease and responsible for one in five deaths worldwide (GBD 2017 Diet Collaborators. 2017; Afshin et al, 2019). Although the health benefits reaped by following a plantbased, Mediterranean diet have long been documented, the obesogenic Western diet has precipitated an impressive peak in chronic disease rates and poses a similarly dire threat to the planet (Sofi et al, 2014). Research published by the BMJ reiterates these dangers: consumption of more than four servings of ultraprocessed foods per day was associated with a 62% higher all-cause mortality rate than consumers of less than two portions per day, plus significantly higher rates of cardiovascular and cerebrovascular disease (Rico-Campà et al, 2019). Thus, although diet is irrefutably intertwined with physical health, a comprehensive change in

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STUDENT ESSAY

‘Let food be thy medicine, and let medicine be thy food’: Is food the foundation for good health?

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low-GI, plant-based diet, centred around wholegrains, fruit and vegetables, results in long-lasting improvements in the mood and energy-levels of patients with mental ill-health (Rao et al, 2008; Lassale et al, 2019).

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No single food can cause or cure disease; the key is in moderation, balance, and viewing lifestyle medicine as a collective

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culture and mentality is required before this relationship becomes symbiotic, including a shift away from the patient as a passive participant to an active advocate for their own healthcare. However, statistics are discouraging and compliance to health-promoting national dietary guidelines remains poor: for instance, although fibre is essential for reducing incidence of and mortality from non -communicable diseases such as diverticular disease, ischaemic heart disease, stroke, type 2 diabetes and colon cancer, only 9% of people in the UK currently achieve recommended levels of the macronutrient per day (Reynolds et al, 2019). A recent study by the GBD 2017 Diet Collaborators (2017), which evaluates dietary factors and noncommunicable diseases in 195 countries, further quantifies the terrifying implications of modern food patterns on human health. It declares 11 million deaths in 2017 were due to poor diet: 10 million as a result of cardiovascular disease, the remainder from cancer deaths and type 2 diabetes. Food has thus become undeniably important within preventative medicine. The EAT-Lancet Commission argue that it is, in fact, ‘the single strongest lever to optimise human health and environmental sustainability on Earth’ (EAT-Lancet Commission, 2019). In contrast to pharmacotherapy alone, a balanced, whole-foods diet wields the power to not only prevent and treat, but also reverse, myriad chronic illnesses including diabetes and high blood pressure. Even simple changes, such as reducing saturated fat, cholesterol and salt intake, and increasing dietary fibre, can have a huge impact on overall health and wellbeing, as well as the prevention of obesityrelated disease (WHO, 2003). The emergence of the Planetary Health Diet earlier this year, a global initiative which proposes a plant-based diet as a sustainable means of feeding a population of 10 billion, is a powerful move in the right direction and promises huge health and environmental benefits. By pushing food to the healthcare frontline, its potential as a tool to prevent disease and simultaneously maintain both human and environmental wellbeing can be properly utilised. The influence of food on health, however, extends much further than our physical state. Research is emerging that highlights the negative corollaries of consuming nutrient-poor, energy dense foods on brain health. Diet, among other lifestyle components, has been repeatedly underlined as contributing to the genesis of mental illness, yet largely ignored in therapeutic approaches. Just as cardio-metabolic diseases depend heavily on diet for primary and secondary prevention, the same may be true for psychiatric disorders. Unsurprisingly, the most common deficiencies occurring in patients with mental disorders are of precursors to neurotransmitters, including B vitamins, omega-3-fatty acids and amino acids (Rao et al, 2008). Furthermore, diets low in carbohydrates have been shown to precipitate depression in susceptible individuals, given that the production of serotonin and tryptophan are triggered by carbohydrate consumption (Ghoch et al, 2016). Evidence thus suggests a high-carbohydrate,

Other studies assessing the impact of diet as an adjunct to pharmacological and psychological treatment of depression echo the suggestion that dietary changes may be an efficacious means of managing the condition and associated with positive mental health outcomes (Parletta et al, 2019; Jacka et al, 2017; Psaltopoulou et al, 2013; Sanchez-Villegas and Martinez-Gonzalez, 2013). The close correlation evident between the extent of dietary change and the extent of improvement in depressive symptoms reiterates the need for further studies to assess nutrition’s potential in the prevention and treatment of mental disorders, especially given the rising rates of mental illness in the UK and the stigma which continues to surround antidepressant use. Furthermore, depression incurs the greatest societal costs in Europe at present, and is a leading cause of disability worldwide (Lassale et al, 2019). Thus, it is essential that we begin to accept nutritional medicine as ‘a mainstream element of psychiatric practice’ (Sarris et al, 2015) as it constitutes such an accessible, affordable, efficacious and side-effect free treatment strategy for the general population. However, despite the unequivocal benefits of food on our health, its limitations must also be considered. As Hippocrates once said, ‘in food excellent medicine can be found, in food bad medicine can be found; good and bad are relative’. Like all aspects of clinical practice, if utilised poorly, food can be equally as damaging as it can be remedial. Carb-restriction, juice ‘cleanses’, ‘detoxes’, ketogenic and alkaline diets, spuriously promising quickfixes and dramatic weight loss, are the result of society’s simultaneous demonisation and moralisation of food. No single food can cause or cure disease; the key is in moderation, balance, and viewing lifestyle medicine as a collective. However, the obscured view of food as medicine – which unabashedly over-emphasises the health-properties of certain food types – and disregard for the wider panorama of lifestyle medicine – has perpetuated the UK’s damaging diet culture. This elusive pursuit of the ‘thin ideal’ has not only resulted in macro-and-micronutrient deficient dietary patterns, especially among young people, but has also contributed to the growing anorexia crisis and recent surge in hospital admissions for disordered eating (Marsh, 2019). Hence, an effort must be made to distinguish between food and medicine, and to appreciate them as separate yet synergistic entities, as 55

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‘Let food be thy medicine, and let medicine be thy food’: Is food the foundation for good health?

opposed to relying on food as medicine, or as an alternative to it. Hippocrates also declared that ‘eating alone will not keep a man well’, reiterating that while a balanced diet irrefutably forms the scaffolding of good health, it is not the only player in a comprehensive lifestyle approach to good health (Berryman, 2012). Exercise is another key modifiable risk factor for chronic diseases such as ischaemic heart disease, stroke and diabetes, and one which has been proven to wield a similar efficacy to pharmacotherapy (Naci and Loannidis 2013). With its ability to reduce the risk of dementia, shrink mortality of depressive disorders, as well as overall risk for the condition, and lower risk of several cancer types, especially colon and breast, it offers a seemingly simple solution to the UK’s growing disease burden (Larson et al, 2006; Murri et al, 2018; Rezende et al, 2018). However, despite government recommendations currently suggesting that the most beneficial ‘dose’ is 150 minutes of moderate intensity physical activity, current figures suggest that 34% of men and 42% of women do not meet these targets (NHS Digital, 2017). This lack of physical activity is thought to result in at least one in ten premature deaths in the UK, with a direct economic corollary of more than £1 billion (Lee et al, 2012). Furthermore, we cannot omit stress reduction, good sleep hygiene, minimisation of alcohol consumption and tobacco avoidance from the health equation, as only when all of these factors are considered together can diet be utilised as part of an efficacious method to maximise physical, mental and social wellbeing. Ultimately, while food in isolation is not a panacea for achieving health and longevity, together with exercise it forms the foundation for good health and constitutes one of our greatest weapons against the global epidemic of preventable chronic disease. Given that most doctors are more comfortable prescribing pharmaceutics than a healthy lifestyle, undergraduate medical training in evidence-based nutrition and lifestyle interventions deserves much more attention than it currently receives. Lifestyle medicine and ‘fitness prescriptions’ have the potential to slash our burden of chronic disease and ballooning NHS costs, hence why it is paramount that patients are made to feel engaged and empowered by their healthcare providers. A balanced diet may not be as prescriptive as a pill, or as easy to dispense, with doses and formulations for every eventuality, but it is arguably the most powerful, accessible and affordable driver of global wellbeing we currently have at our disposal. We therefore need to use it.

References

Afshin A, Sur PJ, Fay KA et al (2019) Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 393: 1958. Berryman J (2012) Motion and rest: Galen on exercise and health. The Lancet, 380: 210–211. GBD 2017 Diet Collaborators (2019) Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 393:1958–1972.

Ghoch M, Calugi S, Grave R (2016) The effects of low-carbohydrate diets on psychosocial outcomes in obesity/overweight: a systematic review of randomised, controlled studies. Nutrients, 8:402. Jacka F, O’Neil A, Opie R, Itsiopoulos C et al (2017) A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Medicine, 15: 23. Larson E, Wang L, Bowen J, McCormick W et al (2006) Exercise is associated with a reduced risk for incident dementia among persons 65 years of age and older. Annals of Internal Medicine, 144: 73–81. Lassale C, Batty GD, Baghdadli A, Jacka F et al (2019) Healthy dietary indices and risk of depressive outcomes: a systematic review and metaanalysis of observational studies. Molecular Psychiatry, 24(7):9 65–986. Lee I, Shiroma E, Lobelo F, Puska P, Blair S (2012) Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. The Lancet, 380: 219–29. Marsh S (2019) Hospital admissions for eating disorders surge to the highest in eight years. The Guardian. [online] Available at: www.theguardian.com/society/2019/feb/15/hospital-admissions-foreating-disorders-surge-to-highest-in-eight-years (accessed 24 May 2019). Murri M, Ekkekakis P, Magagnoli M, Zampogna D et al (2018) Physical exercise in major depression: reducing the mortality gap while improving clinical outcomes. Front Psychiatry, 9:762. Naci H, Loannidis J (2013) Comparative effectiveness of exercise and drug interventions on mortality outcomes: meta epidemiological study. BMJ, 347: 5577. NHS Digital (2017) Health Survey for England 2016: Physical Activity in Adults. [Online]. Available at: http://healthsurvey.hscic.gov.uk/media/ 63730/HSE16-Adult-phy-act.pdf (accessed 24 May 2019). Parletta N, Zarnowiecki D, Cho J, Wilson A, Bogomolova S et al (2019) A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: a randomized controlled trial (HELFIMED). Nutritional Neuroscience, 22: 474–487. Psaltopoulou T, Sergentanis T, Panagiotakos D, Sergentanis I et al (2013) Mediterranean diet, stroke, cognitive impairment, and depression: a meta-analysis. Annals of Neurology, 74: 580–91. Rao TS, Asha MR, Ramesh BN, Rao KS (2008) Understanding nutrition, depression and mental illnesses. Indian Journal Psychiatry, 50: 77–82. Reynolds A, Mann J, Cummings J et al (2019) Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. The Lancet, 393:434–445. Rezende L, Sá T, Markozannes G, Rey-López J, Lee I et al (2018) Physical activity and cancer: an umbrella review of the literature including 22 major anatomical sites and 770,000 cancer cases. British Journal of Sports Medicine, 52: 826–833. Rico-Campà A, Martínez-González M, Alvarez-Alvarez I, Medonça R, Fuente-Arrillaga C, Gomez-Donoso C et al (2019) Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study. BMJ, 365: 1949. Sanchez-Villegas A, Martinez-Gonzalez M (2013) Diet, a new target to prevent depression? BMC Medicine, 11:3. Sarris J, Logan A, Akbaraly T, Amminger G et al (2015) Nutritional medicine as mainstream in psychiatry. Lancet Psychiatry, 2: 271–274. Sofi F, Macchi C, Abbate R, Gensini GF, Casini A (2014) Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutrition, 17:2769–82. The EAT-Lancet Commission (2019) Summary Report of the EATLancet Commission: Healthy Diets From Sustainable Food Systems. [Online] Available at: https://eatforum.org/content/uploads/2019/04/ EAT-Lancet_Commission_Summary_Report.pdf (accessed: 24 May 2019). WHO (2006) Constitution of the World Health Organization. [Onlinet] 2006. Available at: www.who.int/governance/eb/who_constitution_en.pdf (accessed 23 April 2019). WHO Technical Report Series (2003) Diet, nutrition and the prevention of chronic disease: report of a Joint WHO/FAO Expert Consultation. Geneva: WHO.

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PRESCRIBING L IF ESTYL E MEDICINE Mohanpal Singh Chandan GP

Take two frontline GPs in Birmingham and bring them together at an NHS Leadership for Change Improvement course and what do you get?

You get them both attending the RCGP approved Prescribing Lifestyle Medicine course, and then embedding its principles in innovative ways in clinical care and possibly leading to a change in the NHS which may revolutionise how medicine is practiced in the UK. It really is that cataclysmic.

Out went the biomedical model, paternalistic medicine, downstream sticky plasters for metaphorical gaping wounds… And in came ‘root cause’ medicine, whole person medicine, personalised medicine as well as group medicine and lifestyle solutions for lifestyle problems. System-based thinking rather than organ-based. Prevention rather than shortsighted symptom-driven decisions with offending, questionable evidence

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and motive represented by Big Pharma.

In came the Farmacy, fiveminute workouts, amber glasses and 345 Breathing, digital detox and natural living and environments in healthy communities. No more auto pilot for the patient or for us. We stopped.

We took note.

We took a deep breath and we created a 1:1 lifestyle clinic called Healthy Lives, practicebased small group lifestyle lessons and large community based group health events, affectionately termed the Smartcare Be Happy Hub (offering lifestyle medicine and social prescribing to 80,000 patients in the West Midlands).

True 4 Pillar plans/IFM Lifestyle aficionados fervently flocked to these newly drawn frontlines. Not just GPs, but consultants: Rheumatologists, Gastroenterologists,

Volume 16 Issue 3 Autumn 2019

Asfia Aftab GP

Endocrinologists, Nutrition Therapists, osteopaths, health coaches, chefs, artists, horticulturists, tai chi, meditation and mindfulness instructors, social workers, psychologists, social prescribers, pharmacists, nurses, physios, physicians associates, dieticians, charity societies, volunteers medical students, GP trainees and even teenage work experience students… learning together, peer-peer support, presenting together, eating nutritious food together with patients… and so much more.

Eminent guests (including the founders of the PLM Jeremy Hawkey, Rangan Chatterjee, Mike Ash, CCG officials, Health Education England, and founder of the international Functional Medicine forum, James Maskell, were all genuinely in awe of what has been achieved in such a short space of time and all inspired by one book and one course. Support came from big and small organisations, local and national: Action for Happiness, Permission to Smile, British Lung Foundation, MIND…

From small acorns...

The 1:1 Healthy Lives clinic showed that even 12 months Patients revelled in finally feeling after a single lifestyle medicine as if their problems were really appointment, patients attended being addressed in a truly holistic, their own GP surgery 30% less progressive and mindful way. often. From this it appears that when a person is empowered HCP felt free of the stifling to create health rather than ‘pill for every ill’ tinnitus-like manage disease, skills develop whisperings. And finally felt they that are sustainable and do not were making a real difference… decay with time. Prescribing finding their passion for their costs went down by 7% across vocation, working alongside each the 220 patients seen in the other, watching relationships and clinic and this was sustained for confidence grow, stories being a whole year. For people with shared by the figurative tribal type 2 diabetes who attended campfires, sourdough being the clinic, there was an average brought in for newly formed of 7 points reduction in HbA1c, friends as learnings developed, of and 14 patients brought their connections and gut brain axes. HbA1c reading into the nondiabetic range. A health costs The clinics and the hubs analysis showed that for every brimmed with gleeful £1 spent on the service, £3 was positivity but what did the saved for the NHS.

figures show…

The group sessions impacted greatly on wellbeing scores in all areas as well as physical scores. Every patient attending type 2 diabetes group sessions has reduced their HbA1c readings. There was a 74% drop in GP appointments. Weight, BP, cholesterol all went down. Pain scores went down. Prescription costs went down.

The only humming we hear now is of the deep inhalations and even longer exhalations we take, as we learn to breathe again while we truly take care of patients as we had dreamed we would.

Welcome to a new dawn. The future looks bright. The future looks holistic. We urge you to pick up the baton and encourage what nature intended. To eat sleep, relax and move in a better environment for you.

Meets the professionalism, expertise and commitment requirements to the highest possible standards of general practice.

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Volume 16 Issue 3 Autumn 2019

Food for thought and the power of a story

William House

Retired GP; Chair of the BHMA

Food hardly featured at all in the medical curriculum when I trained in medicine. That was in the late 1960s. I hope it’s better now, but have we recognised the true breadth of food’s importance to us humans? Here is a story about the perhaps unexpected healing power of food. Jenny (not her real name) was diagnosed three years ago with follicular (non-Hodgkin) lymphoma. She is a determined woman, a force to be reckoned with! But the disease was growing fast with widespread enlarged lymph nodes, swollen stomach and legs, weakness and tiredness. The haematologist told her they can help to control the condition, but not cure it. For her, this was a red rag to a bull, but she could see she needed help and agreed to chemotherapy. The proposed treatment was planned in a cycle of four doses by intravenous infusion at monthly intervals. During the weeks following the first dose it was obvious to Jenny that the disease was melting away and when she returned the next month for a check prior to the second dose she was very well and the disease was clearly retreating, but further treatment was delayed because of a low white cell count. At the next month’s check-up, there were no traces of the disease and the white cell count remained slightly low. The rest of the treatment cycle was cancelled. This happened between December and February 2016–2017. Today (September 2019) she remains very well and free from disease without having any further medical treatment. This is extremely unusual. So where is the connection with food here? Jenny and I recently reminisced about her illness and some © Journal of holistic healthcare

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very interesting things emerged. Firstly, about her consultations with the haematology team she said: ‘I didn’t want to take on any information beyond what I had to accept: that is what was seen down the microscope. I rejected medical dogma about curability – I viewed it as an unhelpful story – and I made up my own story and I’m sticking to it through thick and thin! … I just knew I had to build a protective ring around my immune system.’ Jenny’s ‘own story’ was inspired by a visit to a Reiki practitioner before her chemo started. He said the body’s frontline defences are very important and ‘we call them “Mum”, and mum goes around sweeping up messes’. ‘Of course!’, Jenny thought, ‘mum has slipped up and I must help her, then she may be able to cope on her own. This became her empowering story, which ultimately expressed itself mainly in the planning and preparation of meals – surely a crucial role for a ‘mum’! She was (and still is) very excited about this. Healthy, nourishing food along with some other healthy lifestyle changes would become the ‘protective ring’ around her immune system. She began reading widely especially about diet and health. One particular recipe book, good good food by ex-medic Sarah Raven, focuses on food and health in a very practical way. This became Jenny’s key reference work. She showed it to me. I counted 43 bookmarks in it! So what is going on here? It is certainly a striking story. The impact of a single dose of chemotherapy was truly remarkable and we are all immensely grateful for that. But the

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medical specialists’ preoccupation with the disease and its technical treatment at the expense of engagement with the wider human self-healing potential of the patient is surely a missed opportunity. For Jenny, it is not so much the details of her new diet that became so important in her recovery, but rather the inspiration and positive empowerment that has come with it. The creation of an inspiring story leading to positive action has been her route towards that empowerment and healing. She believes that the medical profession too often misunderstands what helps patients most: they focus on the disease at the expense of the patient. Interestingly, Jenny told me that at one of her subsequent hospital check-ups the haematologist admitted, when pressed, that they had seen a few long-term ‘remissions’ of follicular lymphoma. But he was reluctant to speak of these ‘remissions’ as cures, as if it was inconceivable that the will and empowerment of the patient could possibly complete the job that the medical treatment left not quite finished. Of course, we are in the territory of holistic medicine, or rather, the lack of it. We are looking for what David Reilly calls ‘creative consulting’ seeking to liberate ‘the healing response’ (Reilly, 2001, 2002). It is a great credit to Jenny’s imagination and strength of character, and also to the Reiki practitioner’s inspiring story, that they were able to enhance the haematologists’ remarkable medicine. Surely this should be a lesson for the future. Reilly D (2002) The Healing Shift Enquiry. Video. Available at: www.davidreilly.net/HealingShift/ About.html (accessed 3 September 2019). Reilly D (2001) Creative consulting: why aim for it? BMJ, 323. Available at: www.bmj.com/content/323/ Suppl_S4/0110364 (accessed 3 September 2019).

Research summaries Thanks to James Hawkins http://goodmedicine.org.uk/goodknowledge

We need to talk about meat

So what is a healthy amount of red or processed meat? It’s looking increasingly like the answer, for both the planet and the individual, is very little. Saying this is one thing. Getting the world to a place where we have the ability to balance the desire to eat whatever we want with our need to preserve the ecosystem we rely on to sustain ourselves is quite another. The conversation has to start soon. Editorial, The Lancet (2018) 392(10161). DOI:https://doi.org/10.1016/S0140-6736(18)32971-4

Plant-based diets tied to 23% lower diabetes risk

One of the main risk factors for type 2 diabetes is diet. Many studies have suggested that plant-based diets significantly reduce diabetes risk. A recent review and meta-analysis of nine large studies showed that a predominantly plant-based diet of any kind is associated with reduced diabetes risk. ‘Predominantly plant-based’ could mean either a diet of healthful plant foods, or less healthful ones such as potatoes and sugars. Both diets could include some animal products. Participants who adhered more strictly to plant-based diets had a 23% lower risk of type 2 diabetes than those who adhered less strictly. Reduction of risk was even stronger in those who adhered to strictly plant-based diets featuring a large amount of fruit, vegetables, legumes, whole grains, and nuts. The team noted that healthful plant-based foods can improve insulin sensitivity and blood pressure, reduce weight gain and low-grade inflammation, both of which contribute to a person’s risk of diabetes. Some of the authors have disclosed potential conflicts of interest: one co-author received individual research support from the California Walnut Commission, and honoraria from two dietary supplement companies.

Qian F et al (2019). Association between plant-based dietary patterns and risk of type 2 Diabetes. JAMA Intern Med. www.ncbi.nlm.nih.gov/pubmed/31329220

So how much meat is it safe to eat?

Not much it seems. Members of the Seventh-day Adventist Church tend towards a plant-based diet rich in whole foods and low in most animal products, alcohol, and caffeinated drinks. However, some followers eat some low-fat dairy products, eggs, and low amounts of certain ‘clean’ meats or fish. A study involving more than 72,000 Seventh-day Adventist men and women recruited between 2002 and 2007 aimed to find out whether those who did eat red and processed meat had shorter lives. In fact processed meat alone was not significantly associated with greater risk of mortality, but there was a greater all-cause and cardiovascular disease mortality in those with a bigger intake of

red and processed meat. These findings suggest moderately higher risks of all-cause and cardiovascular disease mortality associated with red and processed meat in a low meat intake population.

Alshahrani S et al (2019) Red and processed meat and mortality in a low meat intake population. Nutrients, 11(3): 622. DOI:10.3390/nu11030622

Ultra-processed foods and cancer risk?

Are people who eat a lot of ultra-processed food more likely to get breast, prostate, and colorectal cancer? In a population-based European study 104,980 participants aged at least 18 completed a series of 24-hour dietary e-records, that categorised 3,300 different food items and their degree of processing (by the NOVA food classification). In this large prospective study, a 10% increase in the proportion of ultra-processed foods in the diet was associated with a significant increase of greater than 10% in risks of overall and breast cancer. Further studies are needed to better understand the relative effect of the various dimensions of processing (nutritional composition, food additives, contact materials, and neo-formed contaminants) in these associations. Fiiolet T et al (2018) Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort. BMJ, 360. DOI: https://doi.org/10.1136/bmj.k322.

How much cancer is diet-related?

Diet is an important risk factor for cancer that is amenable to intervention. An American study estimated the annual number and proportion of new cancer cases attributable to sub-optimal intakes of seven dietary factors among US adults aged 20 years or older, and by population sub-groups. An estimated 80,110 new cancer cases were attributable to sub-optimal diet, accounting for just over 5% of all new cancer cases in 2015. Of these most, 67,488 (= about 4% of US total) were attributable to direct associations and 12,589 (= 0.82% of US total), to obesitymediated associations. Colorectal cancer had the highest number and proportion of directly diet-related cases (52,225). Low consumption of wholegrains and dairy products, and a high intake of processed meats contributed to the highest burden. Men, middle-aged (45–64 years) and racial/ethnic minorities (non-Hispanic blacks, Hispanics, and others) had the highest proportion of diet-associated cancer burden than other age, gender, and race/ethnicity groups. More than 80,000 new cancer cases were estimated to be associated with sub-optimal diet among US adults in 2015, with middle-aged men and racial/ ethnic minorities experiencing the largest proportion of dietassociated cancer burden in the United States. Zhang FF et al (2019) Preventable Cancer Burden Associated With Poor Diet in the United States. JNCI Cancer Spectr. 3(2):pkz034. doi: 10.1093/jncics/pkz034. © Journal of holistic healthcare

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Reviews The Uninhabitable Earth: A Story of the Future

David Wallace-Wells Allen Lane, 2019 ISBN 978-0241355213

I am approaching my 75th birthday. As I look back, I see my life has been overshadowed by the gathering ecological catastrophe. I have a childhood memory, strangely both clear and hazy, that was an intimation of things to come. As a small boy in the 1950s I am sitting at the kitchen table turning the pages of a weekly magazine – possibly Life or Picture Post. I come to a double-page spread featuring a dramatic black and white photo of a filthy smokestack, illustrating an article predicting a future environmental crisis. I ask my mother about it, and her reply brushes my concerns aside as if forbidding even the thought behind the question, ‘You don’t want to think about that, dear’. But clearly the notion that life on Earth was precarious lodged in my mind. Throughout my adult life this early intimation was reinforced: I was just 18 in 1962 when Rachel Carson’s Silent Spring was published; I recall having the weird image of a mother bird crushing her eggs as she sat to incubate them because the shells were so thin. This was followed in 1968 by Buckminster Fuller’s challenging proposal that we live on ‘Spaceship Earth’; in 1972 by the Club of Rome’s Limits to Growth report pointing to overshoot and collapse; in the 1990s by Al Gore’s movie An Inconvenient Truth; in the new century by the series of increasingly alarming reports from the Intergovernmental Panel on Climate Change (IPCC); and now daily reports of rapidly melting icecaps, record temperatures, violent storms, the bleaching of coral reefs, chemical and plastic pollution, all indicating that ecological catastrophe is on us faster even than the pessimists thought. As professor at the University of Bath, I taught and researched ‘sustainable business practice’ – a phrase the now seems rather archaic. I remember conversations with colleagues back in the 1990s, agreeing, ‘We have another 10 years to address this, then it will be too late’. Yet here we are now, over halfway through the second decade of the new millennium, when little has really changed. Is it still nearly too late, as the latest IPPC report argues; or has the moment, if indeed it existed, actually slipped from our collective grasp? And is it alarmist to talk about the possibility of ecological and social collapse? Or is that a taboo that needs breaking? All these issues are raised by David Wallace-Wells’ The Uninhabitable Earth. In 2017 Wallace-Wells published an article in New York Magazine ‘peering beyond scientific reticence’ to argue that the climate catastrophe is ‘I promise you, worse than you think.’ It was a punchy piece that attracted considerable criticism for being alarmist and for selecting evidence to suit his argument. When I read it myself, having watched humanity fail to respond © Journal of holistic healthcare

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to the gathering crisis for so many years, I thought his major theme was uncontrovertibly true. The book is a development of that article. It is a shocking book, shocking in several ways. First, in its appearance. From the moment my review copy arrived in the post, I tried to keep it out of view. The stark cover – the title set in plain black letters on a light cover, with a small dead bee underneath – is a brilliant piece of typographical design. But it is not the kind of image you want to have at your bedside – I found myself constantly putting the book out of sight on a high shelf. It was as if I myself was hiding from confronting the issue. The second way in which this book is shocking is the most important: its content. For the book details the many ways in which climate change is impacting life on Earth far faster and more profoundly than public discourse accepts. It has become the all-encompassing stage on which life in conducted – and will continue to be so into the distant future. We brought this upon ourselves. Humankind impacted the Earth system since hunting with spears cause the extinction of megafauna way back in prehistory, as Elizabeth Kolbert brilliantly details in The Sixth Extinction. But most of the damage to climate stability has taken place since the Second World War in what has been called the ‘great acceleration’, the exponential growth of resource use and pollution, mainly in developed Western economies. Indeed, Wallace-Wells tells us that a full half of the carbon dioxide exhaled into the atmosphere by burning fossil fuels has taken place in the last three decades – since Al Gore, then US Senator, published his book Earth in Balance: ‘we have now engineered as much ruin knowingly as we ever managed in ignorance… we wouldn’t, or couldn’t, or anyway didn’t look squarely in the face of the science’. The first main section of the book details the ‘Elements of Chaos’, the many ways in which climate change will have an apocalyptic impact of life on Earth. It must, at the very least, mean the end of the way of life that we in the developed West take for granted, let alone the impact on the global south and other creatures: heat death, hunger, drowning, wildfire, unbreathable air, plagues, economic collapse and conflict. Each chapter is packed with statistics gleaned through research articles and interviews that makes horrifying reading. To pick just one example: as Arctic ice melts and reflective albedo is lost, additional warmth is absorbed by the dark sea; this results in as much additional heating as 25 years of global carbon emissions. Parts of Earth will become too hot for human survival; sea will rise of up to two metres by 2100, inundating coastal cities and changing coastlines; crops will fail – cereal crops in particular don’t do well in higher temperatures; storms will be increasingly violent and damaging; and on and on. We have to move fast in reducing carbon emissions, not to stop, but just to limit the warming that is already in the climate system. This book doesn’t definitely claim, despite its title, that Earth will become uninhabitable within current lifetimes; that depends on the choices we make and fail to make. But ‘the fact that we

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have brought that nightmare eventuality into play at all is perhaps the overwhelming cultural and historical fact of the modern era’. What we face is ‘the end of normal’, the end of the environmental conditions that enabled the human animal to evolve and develop its range of cultures and civilisations. The impact of climate change is more extensive and faster than certainly conventional science imagined. The IPCC report that global society has just twelve years to take effective action is alarming enough, but it is important to note that the IPCC is necessarily conservative, only admitting new research that has passed the threshold of unarguability. For example, the last report did not account for the kind of feedback effects of loss of albedo, or the potential release of methane from thawing permafrost. And in the past two years since that report, the Earth has had record-breaking temperatures, and new evidence that ancient ice is melting far faster than expected in both Arctic and Antarctic. This leads to the third way in which I find this book shocking: it is shocking that we find it shocking. There is an apocryphal story of the leading professor of climate science who asks all prospective PhD students to name the major theoretical advances in climate science since the 1970s. The correct answer is, of course, that there have not been any: there are new empirical findings and new methods of assessment, but the theory has been confirmed time and again; indeed, scientists first predicted the impact of greenhouse gases in the nineteenth century. But the scientific community has generally been reticent about setting out the threats clearly; and despite the best efforts of many activists, we have not found the language, the stories, the rhetorical forms to encompass the threats. We continue to discuss climate change within the conventions of today’s world, rather than in terms of a world ‘deformed and defaced beyond recognition’. We pick up on one issue for a while – plastic pollution is the current favourite – but fail to understand the systemic implications, the ‘cascade effects’ as Wallace-Wells calls them. Maybe the current wave of schoolchildren’s strikes and movements like Extinction Rebellion will contribute to the emergence of a new narrative: there certainly does seems to be some fledgling new urgency in public discourse, although not from government circles. I also find the book shocking in that it is entirely anthropocentric. The author makes clear he has never been an ‘environmentalist’ or a ‘nature person’. He writes ‘I may be alone on the environmental left in feeling that the world could lose much of what we think of as ‘nature’ as far as I cared, so long as we could go on living as we have in the world left behind. The problem is we can’t’. Apart from his failure of empathy for other creatures, he appears to have no clue that humans are part of a web of life, totally dependent on a flourishing ecology for our survival. The book has been generally welcomed in the mainstream media, described as ‘lively’, as ‘relentless, angry journalism of the highest order’. But I found it not really very well written; assembled rather than composed. Here I agree with John Gibbons in the Irish Times, who sees Wallace-Wells as a ‘skilled essayist’, but finds the book doesn’t advance his original arguments, feels rushed, and needing better editing to free the narrative from a tangle of statistics and extraneous details. I often found myself stumbling on long sentences full of subclauses, having to go over them a second or third time to grasp his meaning. The first major section of the book, detailing

the elements of chaos, has a certain dynamism to it, driven by the information he lays out. The later part of the book, ‘The Climate Kaleidoscope’, explores significant themes – Storytelling, Capitalism, Technology and others – in short and rather insubstantial chapters. Wallace-Wells draws on major and minor contemporary commentators but all too briefly and superficially. There is no unifying perspective or narrative through this second part. Overall, I found the book a struggle to read. This book is important because it contributes to breaking the taboo against discussing the seriousness of our predicament: to repeat, it is ‘worse, much worse, than most of us think’. It is a contribution to the emerging debate about the profound existential threat posed by climate change and by our collective failure to make anything like an adequate response; a debate we must learn to have. For to accept this does not mean we must lapse into fatalism; as Jan Zwicky writes in Learning to Die, the first requirement of a moral human is to ‘look the truth of our situation in the eye’. And beyond that, there remains much we can do for ourselves and for the community of life on Earth – adopting the kind of New Green Deal proposed by the Greens in the Europe and the radical Democrats in the US would be a good start. Above all we need imagination and courage to dream new futures. I suspect this is a book that will be more bought and discussed than actually read. I would certain recommend reading the original article in the New York Magazine before buying it. I would also consider other books and media sources that make the same argument: Elizabeth Kolbert’s The Sixth Extinction is well researched and much better written; Naomi Klein a much stronger polemicist; academic and Green Party campaigner Rupert Read sets out the climate catastrophe in his talk on YouTube; management professor Jem Bendell covers similar ground in his paper on Deep Adaption; there is a very clear essay Facing Extinction by Catherine Ingram, an Australian writer and Buddhist teacher. I must give the last word to David Wallace-Wells, who ends his book asserting: ‘climate change… calls the world, as one, to action. At least I hope it does.’ Peter Reason is a writer and sailor whose work links the tradition of nature writing with the ecological crisis of our times

Root to Stem

Alex Laird Penguin Life, 2019 ISBN: 978-0241371213

Growing up in the Kent countryside and on the banks of Loch Lomond in Scotland, medical herbalist Alex Laird was in tune with the natural world from the start. She spent her childhood and teens surrounded by hills, rivers and beaches but it wasn't until age 12 that she had an epiphany and started to appreciate nature’s power. ‘Standing on the Loch bank one day before school I was suddenly overwhelmed by the great beauty of my surroundings,’ says Alex whose life’s work has been to get us to reconnect © Journal of holistic healthcare

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with nature. ‘ I was knocked out by this great feeling of calm and knew it was an important moment but didn't know why,’ she adds. But time would tell. Moving on to study philosophy and politics at Bristol University followed by a decade in television, Alex found herself becoming increasingly fascinated by health, alternative economics, sustainability and green issues and decided to train as an aromatherapist. This led her to working with HIV patients at Turning Point as well as in clinics at the Chelsea and Westminster Hospital in London. Then came a second epiphany. ‘While recovering from ME I picked up a copy of The Essential Book of Herbal Medicine by Simon Mills and realised what that moment on the loch banks all those years ago was trying to tell me – that plants and herbs have amazing healing powers. It became my mission to find out more.’ ‘I trained as a medical herbalist and started practising at the Breast Cancer Haven in Fulham and at Whipps Cross Hospital in Leytonstone, but wanted to share the knowledge I had gained over the years. And her new book Roots to Stem does just that. These beautifully illustrated pages set out the benefits of consuming whole foods in their natural state, which means eating the skin, pith, and seeds of vegetables and fruit. Why? Because as Alex explains this is where the plant’s defence chemicals are found, which we and other animals can use as medicine. Roots to Stem goes on to show us the foods and herbs that are the best to eat and grow for optimum health, season by season. There are also simple, delicious recipes and easy-to-make herbal remedies to try. With details on how to use a slew of plants and herbs for common ailments ranging from allergies to infections, there is also a wealth of invaluable information on how to boost immunity. There are some surprises along the way too, such as how, in spring, nettles, sorrel and cleavers can help to cleanse your system, how, in summer, eating raw foods will help to beat the heat, while, in autumn, mushrooms are key to beating infections thanks to their antiviral and antibacterial properties. Meanwhile, in winter, red berries, purple potatoes and rosehips are an essential weapon in the fight against colds and flu. And that’s not all. Throughout the book you will learn how living and eating in sync with natural rhythms can make a real difference to your health and that of the planet. As Alex explains, ‘ We are all part of one unique and complex ecosystem’. So following a root-to-stem approach to living is not only good for us but good for the planet too, because we are all interdependent. This is a must-read for anyone wanting to eat with the seasons and learn more about the intriguing links between nature and ourselves. Don’t miss it. Jane Garton, health writer and Chelsea Physic Garden guide

Grass-fed nation: getting back the food we deserve Graham Harvey Icon Books, 2016 ISBN 978-1785780769

Why do we have such a seemingly illogical food system? This is the question at the heart of Graham Harvey’s recently published book, Grass-Fed Nation, a manifesto for grazing livestock and the extensive benefits of mixed farming.

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Peppered with case studies, the book convincingly asserts how mixed farms are essential for improving soil fertility, increasing yield and reducing pests. How do mixed farms strengthen local communities and rural economies by providing jobs and using a diverse range of local services? And how do they improve the long-term health of the planet by converting arable land back to pasture, thus improving the soil’s ability to store carbon? Harvey, renowned food and farming journalist and agricultural advisor for The Archers, is a long-standing champion of grazing animals and mixed farming. This latest book is a damning criticism of the rise of industrial arable agriculture and a detailed perspective on the positive human health and environmental impact of a return to grass-based farming systems. When the water in his local river turned murky brown following heavy rainfall, Harvey knew something was wrong. Like the canary down the mine, he cautions that, ‘Milky brown waters are a warning we ignore at our peril’. What it signified was a fundamental problem in our farm systems causing soil to become eroded and washed away. The decline of pasture and the rise of intensive arable cropping has mined the nutrients from the soil and left bare earth exposed and vulnerable to weather. But the impact of this is not solely environmental, it carries equally worrying implications for our health. Harvey claims we need to join the dots, offering the river as a perfect example. ‘What happens to our rivers – and more precisely, what happens to the land they flow through – is connected with the level of disease in society.’ Integrated thinking combining food, farming, health and the environment has been in short supply for many years. But recently there appears to be a shift, away from thinking in siloes, and towards a more systemic approach. This informs one of the strongest messages in Harvey’s book, that the way we farm impacts our diet and our health, and vice versa – our diet and concerns about health affect the way we farm. Meat consumption is one of the clearest examples of this. Despite evidence to the contrary, which is intelligently explored throughout the book, the myth that saturated fat is bad has been perpetuated by dieticians and manufacturers of low-fat foods. This has contributed to a decline in pasture and encouraged the shift to ever more intensive crop production as the demand for plant-based foods and vegetable-based oils has increased. Harvey also points out how our diets have changed dramatically throughout human existence. We shifted from a hunter-gatherer lifestyle to reliance on starchy, sugary refined foods within a relatively short period of time. So it’s little wonder that society is now suffering from multiple dietaryrelated diseases, such as heart disease and type 2 diabetes. This, he claims, is directly related to the shift to industrial agriculture. Grass-fed meat is a nutrient-dense food containing far higher levels of beneficial fatty acids. Milk too is much healthier

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when produced in a grass-fed system. Far from being a cause of disease and obesity, Grass-Fed Nation contends that meat and dairy produced from pasture-reared animals should form a key part of healthy diets. But industrial agriculture has not only waged war on our health, it has also waged war on our environment. Monoculture cropping reliant on chemicals poses an ‘existential threat’ to our countryside, according to Harvey. With subsidies that encouraged farmers to plough up pasture and sow wheat instead, the UK has seen the staggering loss of 97% of its wildflower meadows since the 1940s. An evocative description about the destruction of one particular meadow in Wiltshire, portrays it ‘As an act of sheer vandalism’ continuing, ‘it was like taking half a dozen of Turner’s masterpieces out of the National Gallery and torching them on the pavement of Trafalgar Square.’ Intensive arable cropping has led to the decline of half of plant species, one third of insect species and four fifths of bird species. Harvey details the astounding number of chemicals that go into a typical growing season for a wheat crop, including four different weed killers, an insecticide, five plant-growth hormones and no fewer than twelve disease-killing fungicide chemicals. Traces of these chemicals not only end up in our soils and rivers, but also in the food on our plates. There are, as Harvey points out, those who argue that intensive crop production is necessary to feed a growing world population. But this is far from the case. A major study in 2008 found that industrial crop growing would not be capable of feeding the global population and was unfit for purpose. With smallholder farmers still producing 70% of the world’s food, a change of direction is evidently needed to ensure sustainable, small-scale farming is given protection and support. According to Harvey, the way to enable this is through a return to mixed farm systems in which pasture and grazing livestock form a central part. He also explores the role that mob stocking might play, a system inspired by Allan Savory in which the natural pattern of grazing animals is emulated by intensively grazing pasture in a rotation. This prevents pasture being overgrazed and damaged through re-grazing too quickly and adds an even spread of manure and the trampling that’s needed to improve soil and plant growth. Grass-Fed Nation is far more than a book about grass. Encompassing everything from human health to the future of our planet, Harvey shows just how important it is to get our farming systems right. Megan Perry, Sustainable Food Trust Communications and Policy Officer

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FOOD C A M PA I G N MY FOOD • MY HEALTH • OUR FUTURE Join us now @Food_campaignUK www.realfoodcampaign.org.uk

Real food for pregnancy: The science and wisdom of optimal prenatal nutrition Lily Nichols Lily Nichols, 2018 ISBN 978-0986295041

In Real Food for Pregnancy, Lily Nichols explores the confusing and often contradictory topic of prenatal nutrition. Taking an evidence-based approach, Nichols concludes that many conventional recommendations for eating during pregnancy do not correspond to what research suggests is best for optimal prenatal nutrition. Nichols then brings the research down to an approachable level, making concrete and manageable suggestions for modifying your diet during pregnancy. My reaction: I love reading books that gather and work through the research, and Nichols certainly does that in this book. She also nicely includes highlighted statements and summary sections, so if you are more interested in her conclusions than how she gets there, you can get a nice handle on the material in a short amount of time. I especially enjoyed Chapter 4 where Nichols works through recommendations on lunch meat, alcohol and more. I also appreciated the balanced approach she takes when she notes that first-trimester nausea may make a diet overhaul unrealistic, but that it is something you can work toward as you feel able. And, she also shares that eating ‘real food’ doesn’t have to be all or nothing. As with so much in pregnancy and parenting, having the information you need to make the best choices for your family – even if those choices include small-scale changes in prenatal nutrition rather than following her advice to the letter – is what truly matters. Some quotes of note: ‘Part of listening to your body is recognizing when your food choices don't leave you feeling well and making a mindful choice to opt for a more nutritionally balanced option the next time you eat.Your body deserves nourishing foods and you deserve to enjoy your food. There is a place for these two things to coexist.’

‘Calorie and macronutrient needs vary widely and therefore there’s not a single meal plan that will work for all women.’

‘When you ignore your hunger cues, you tend to ignore your fullness cues as well.’

My takeaway: Real Food for Pregnancy gives you all the research with practical ways to apply it to your eating during pregnancy. While some nutrition books can load you with pressure, this one incorporates mindfulness and emphasises that we are all different, making plenty of room for you to take what you need from the book without feeling completely overwhelmed. I’d recommend this book to anyone looking to troubleshoot their pregnancy nutrition or make changes preconception. Johanna Tomlinson, postpartum doula This review first appeared on www.nestedmama.com

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holistic healthcare JOURNAL OF

Re-imagining healthcare

About the BHMA

In the heady days of 1983 while the Greenham Common Women’s Camp was being born, a group of doctors formed the British Holistic Medical Association (BHMA). They too were full of idealism. They wanted to halt the relentless slide of mainstream healthcare towards industrialised monoculture. They wanted medicine to understand the world in all its fuzzy complexity, and to embrace health and healing; healing that involves body, mind and spirit. They wanted to free medicine from the grip of old institutions, from over-reliance on drugs and to explore the potential of other therapies. They wanted practitioners to care for themselves, understanding that practitioners who cannot care for their own bodies and feelings will be so much less able to care for others. The motto, ‘Physician heal thyself’ is a rallying call for the healing of individuals and communities; a reminder to all humankind that we cannot rely on those in power to solve all our problems. And this motto is even more relevant now than it was in 1983. Since then, the BHMA has worked to promote holism in medicine, evolving to embrace new challenges, particularly the over-arching issue of sustainability of vital NHS human and social capital, as well as ecological and economic systems, and to understand how they are intertwined. The BHMA now stands for five linked and overlapping dimensions of holistic healthcare:

Whole person medicine

Whole person healthcare seeks to understand the complex influences – from the genome to the ozone layer – that build up or break down the body–mind: what promotes vitality adaptation and repair, what undermines them? Practitioners are interested not just in the biochemistry and pathology of disease but in the lived body, emotions and beliefs, experiences and relationships, the impact of the family, community and the physical environment. As well as treating illness and disease, whole person medicine aims to create resilience and wellbeing. Its practitioners strive to work compassionately while recognising that they too have limitations and vulnerabilities of their own.

Self-care

All practitioners need to be aware that the medical and nursing professions are at higher risk of poor mental health and burnout. Difficult and demanding work, sometimes in toxic organisations, can foster defensive cynicism, ‘presenteeism’ or burnout. Healthcare workers have to understand the origins of health, and must learn to attend to their wellbeing. Certain core skills can help us, yet our resilience will often depend greatly on support from family and colleagues, and on the culture of the organisations in which we work.

Humane care

Compassion must become a core value for healthcare and be affirmed and fully supported as an essential marker of good practice through policy, training and good management. We have a historical duty to pay special attention to deprived and excluded groups, especially those who are poor, mentally ill, disabled and elderly. Planning compassionate healthcare organisations calls for social and economic creativity. More literally, the wider use of the arts and artistic therapies can help create more humane healing spaces and may elevate the clinical encounter so that the art of healthcare can take its place alongside appropriately applied medical science.

Integrating complementary therapies

Because holistic healthcare is patient-centred and concerned about patient choice, it must be open to the possibility that forms of treatment other than conventional medicine might benefit a patient. It is not unscientific to consider that certain complementary therapies might be integrated into mainstream practice. There is already some evidence to support its use in the care and management of relapsing long-term illness and chronic disease where pharmaceutics have relatively little to offer. A collaborative approach based on mutual respect informed by critical openness and honest evaluation of outcomes should encourage more widespread co-operation between ‘orthodox’ and complementary clinicians.

Sustainability

Climate change is the biggest threat to the health of human and the other-than-human species on planet Earth. The science is clear enough: what builds health and wellbeing is better diet, more exercise, less loneliness, more access to green spaces, breathing clean air and drinking uncontaminated water. If the seeds of mental ill-health are often planted in an over-stressed childhood, this is less likely in supportive communities where life feels meaningful. Wars are bad for people, and disastrous for the biosphere. In so many ways what is good for the planet is good for people too. Medical science now has very effective ways of rescuing people from end-stage disease. But if healthcare is to become sustainable it must begin to do more than just repair bodies and minds damaged by an unsustainable culture. Holistic healthcare practitioners can help people lead healthier lives, and take the lead in developing more sustainable communities, creating more appropriate models of healthcare, and living more sustainable ways of life. If the earth is to sustain us, inaction is not a choice.

Journal of Holistic Healthcare

“The Journal of Holistic Healthcare… a great resource for the integration-minded, and what a bargain!” Dr Michael Dixon

Want to contribute to the journal? Find our guidelines at: http://bhma.org/wp-content/uploads/2016/07/JHH-Essentialauthor-information.pdf

Standard BHMA membership of £30 a year gives unlimited access to online journal. Print copy subscription +£20

Editorial Board Dr William House (Chair) Professor David Peters Dr Thuli Whitehouse Dr Antonia Wrigley

In collaboration with The College of Medicine www.collegeofmedicine.org.uk

Join the BHMA to get the journal and other benefits

The Journal of Holistic Healthcare is free to all BHMA members. For just £30 a year members get unlimited access online, regular email newsletters, discounts on events and access to a closed Facebook group (optional). The concessionary rate (students/unemployed/receiving state benefits or state pension) is £15. If you prefer to have a printed copy of the journal which is published three time a year, membership is just £50 a year. Finished with your journal? Please donate it to your local GP surgery, community centre, library etc so others can read about holistic healthcare and the importance of looking after the whole person, not just their immediate symptoms.

PROMOTING HOLISTIC PRACTICE IN UK HEALTHC ARE