ARK VOL.3
The Voice of Healthcare
In this issue TAKING OVER THE WORLD HAVE RUCKSACK, WILL TRAVEL! YOU ARE NOT ALONE... THE DEVIL’S IN THE DOSAGE A THOUSAND DAYS OF LIFE NUTRITION, A BALANCING ACT
Caring for people is at the heart of everything we do POWERED BY
TAKING OVER THE WORLD It’s so easy to take our every day lives for granted. In the 1940’s, American psychologist, Abraham Maslow developed a theory which became known as Maslow’s ‘hierarchy of needs’. As the theory denotes, human physiological needs (air, water and food) are the fundamental requirement for human survival. However, for some people, nutrition is a complex issue that can easily disrupt their very existence. As you’ll read in the pages that follow, Carolyn Wheatley (Chair of PINNT) describes her recent trip to the States and how it had to be strategically planned with the precision of a military operation. Also as part of this issue, I had a very enlightening chat with the UK’s leading expert in nutrition, Professor Alan Jackson who talks about the significance of good nutrition in infancy, as well as the role of diet in managing chronic illness. I’m continually humbled by the many brave people we encounter through our work, the clinicians who strive to offer the very best care and attention, and the patients who, no matter what pain or discomfort they might be in, remain positive and keep fighting. Nutrition has always been of particular interest to me because it evokes such wide-ranging emotions whilst playing a key role within a variety of social, economic, political, environmental and cultural issues. I’m a true believer in each of us being able to make a difference, however small, and with that in mind if we have the luxury of food choices, we should choose wisely so as to positively impact our lives, our families and the planet. Rachel McClelland, Editor.
Passion, belief... and a desire to take over the world.
By Pat Hagan
Tracy Earley, nurse consultant for the Integrated Nutrition and Communication Teams based in Preston, describes what it takes to make a rapid access seven-day a week clinic a success. Tracy Earley sets her sights high. And while world domination might not be her actual goal in life, you clearly get the message that she has the drive to change things for the better. When it comes to establishing a seven-days a week service for patients reliant on artificial feeding, that kind of commitment has helped Tracy and her colleagues break the mould of ‘no weekend’ cover. ‘You have to want to take over the world and have a bit of passion,’ says Tracy, a paediatric nurse by background who spent a decade or so in paediatric intensive care units, spells in Leicester and Nottingham and some US training, before heading to Preston in Lancashire. ‘If you are passionate about what you want to do, then you can normally find a way of getting people on board with you. ‘Believe in what you are doing and why you are doing it.’ It was this mentality which helped Tracy, who won the Nursing Times Nurse of the Year award in 2011, and her team to convince the powers-that-be at the Royal Preston Hospital that extending clinic access made good clinical and financial sense.
She says: ‘Aim high and listen to your patients. ‘You cannot deliver a service based on what looks right on paper because it will never fit your patients’ needs, or the organisation. ‘When you know what patients need, use their stories to go and speak to your exec teams to change the world, because that is what we have done.’ One story in particular stands out. It was a patient who had a PEG (percutaneous endoscopic gastrostomy) tube fitted which fell out over the weekend. He went to A&E at another hospital but staff there were unable to help and the weekday clinic was obviously closed. ‘So the patient called me at home,’ says Tracy. ‘I came in and we sorted his tube out over the weekend. If we hadn’t done this, he would have been in hospital for a few days until we managed to get him transferred over. ‘By then the gastrostomy site would have healed over and he would have had to go through the whole process again. ‘I took this story to our management executives when we were looking at opening seven days a week. ‘It meant they could see the problem from the patient’s perspective.
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If you are passionate about what you want to do, then you can normally find a way of getting people on board with you
‘There was an increased chance of illness because patients were not getting their feed or medicines. ‘And they could see there was a significant impact on the NHS, including a stay in hospital and an expensive procedure that is preformed when it doesn’t necessarily need to be. ‘It was these kinds of stories that really helped make the change.’ So what exactly is the Integrated Nutrition and Communication Team and how does it work? It’s made up of nutrition nurses, speech and language therapists, dieticians and a central venous access team.
‘So getting them into clinic quickly is important and can also be a challenge. ‘This is something we are working on and the increase from a five day clinic to a seven day clinic has helped.’ Difficulties can also arise checking the position of a device to make sure that the patient is safely feeding and safely receiving their medicines. ‘Nasogastric tubes pose a particular problem when it comes to testing of the position by withdrawing gastric aspirate up the tube’, says Tracy. But plans are afoot to improve things.
‘Once a patient is discharged from us, they are looked after in the community by a different set of nurses and dieticians. ‘I want the same staff to work in and out of hospital, so the patients don’t have any kind of difference in the approach.’ This is a crucial issue, she believes, because patients can become very expert at their own care very quickly. So they are inclined to notice the difference if anyone does things ever so slightly differently. ‘So I want our nurses to be able to go in and out of the community and hospital to ease the passage for patients. ‘It would give them confidence in their care, no matter where they are having that care delivered.’
They work together with the patients, avoiding where possible artificial feeding.
‘We are working on a technology with NGPod Global Ltd that will revolutionise the way we look after patients with nasogastric tubes,’ says Tracy.
But when patients do need to be artificially fed, the team ensures they get the best device and the best fit for them and provides a port of call for when things go wrong.
‘It’s really exciting. It will provide a quick and reliable response on whether it is safe for patients to feed or not, which is better for them and will keep them in better health.’
She adds: ‘We have to ensure that what we are doing is right for them.
Seven days a week provision means patients can be seen by an expert group of nurses who can help replace their feeding device, without having to be admitted into hospital.
But restricted opening is not the only thing that needs to change, she believes.
‘We try really hard to work within their lifestyles.
Another area that needs tackling urgently is the divide between hospital and community services.
‘It’s important to put the right device in for the patient because if you get it right they are happy and will stay out of hospital a lot longer.
But there are still challenges. ‘My idea of quickly doesn’t necessarily match other people’s ideas,’ Tracy says. ‘If you have a patient whose feeding device has fallen out, this is time critical.
Tracy says: ‘At the moment these operate separately. ‘I would like to see them integrate better, as it will provide a more seamless transition for patients
This issue of patient choice is clearly one that is high on Tracy’s agenda. And the reason is simple. A happy, well-cared for patient is less likely to end up in hospital.
‘We try to have good relationships with our patients in order to get the best fit for them.’
HAVE RUCKSACK, WILL TRAVEL! Carolyn Wheatley, from the charity PINNT (supporting people at home on parenteral and enteral nutrition), charts the ups and downs of long-haul travel when you depend on home artificial feeding. By Carolyn Wheatley
I felt so organised - yet so unprepared - for my journey to New York. Organised in terms of meticulous planning; flight, connecting flight, hotels, medical supplies (fluids and ancillaries), communicating with my homecare company and nutrition team, medical letters, excess baggage arrangements - the list was endless. But unprepared in terms of packing personal luggage. Come on, a girl needs good coordination and a selection of shoes. You have to be prepared for all eventualities! Why New York? Well, I was fortunate to be attending a patient conference in Saratoga Springs, New York state. I am not a first time attendee. This is actually my third trip to the ‘Big Apple’ and I am in fact a seasoned conference traveller in the USA. It’s where I saw my first ambulatory parenteral infusion pump many years ago. I had ‘pump envy’, or should I say ‘freedom and lifestyle choice envy’. It’s a long story but thanks to visiting this same conference many years ago I, along with a dear friend Dawn, returned to the UK and started to campaign for freedom and lifestyle choices by encouraging the introduction of ambulatory pumps into the UK. But as I settled into my seat prior to take off the usual discussion took place with the airhostess about not being able to keep my rucksack with me during take-off. After explaining that I was connected to it (on long
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flights I always keep hydrated by infusing saline) she agreed it was okay to keep it with me. Presumably because she realised I couldn’t be safely stowed in the overhead locker along with the rucksack! Of course, I had made pre-flight arrangements. But as many people in my position will know, these aren’t always filtered down to the crew. I’m fed via a central venous catheter every night with a three litre bag of parenteral nutrition. I may be gutless and in need of artificial nutrition but I do try and make the most of the investment so many people have made in me in terms of giving me back my life. That said, taking your own ‘food’ on holiday isn’t everyone’s idea of fun. But for me it’s essential. I’m not a fussy eater, simply unable to eat sufficient to sustain my life. I’m not complaining – no menus to drool over, no calorie counting; that’s been done for me, a twelve hour infusion of parenteral nutrition every night keeps me going. The menu, if you like, is pre-set.
for eight days is no mean feat. Lots of excess baggage and lots of bag counting to ensure all are present and correct, especially when catching a connecting flight. It’s anything but relaxing. There are lots of ‘what ifs’, the main one being what if something gets lost or broken in transit. That’s why it’s so important to have a ‘what if’ list and be prepared for problems. There are factors you can control but there are many that are also unforeseeable. The crucial thing is to have a back-up plan for how the disappearance of this very special baggage could be resolved in a timely and appropriate fashion. Oh and did I mention I was travelling with a colleague who has enteral tube feeding? So in essence it was potentially double trouble if something went wrong.
It’s a bit of a nuisance at times and I have to admit it would be so easy to skip a night. Yet the consequences wouldn’t upset anyone but me. Why would I risk making myself ill for the sake of a ten minute set up process? Home parenteral nutrition equals life for me and that’s motivation enough on those nights when I could easily cut corners.
We finally arrived at the conference hotel and with little rest it was straight into the conference the next day. First on the list was a workshop by the Oley Foundation Ambassadors, a USA organisation that represents those needing home intravenous and tube feeding. As the UK Ambassador it’s a great opportunity to be updated with Oley business, then brainstorm with fellow ambassadors on how to fulfil our roles. As I am based in the UK my role is different but it’s wonderful when I can help someone when they worry about travelling to the UK. There are always laughs along the way as we all network to support patients.
The first part of my trip this time was to a small town outside New York to represent PINNT at a conference. And if I’m honest, I was feeling rather proud. Travelling with HPN
The next two days were a mixture of plenary sessions and workshops. Again, great to find out what’s new, different or how to showcase UK processes and procedures. Mingling with
For those asking ‘Can I go on holiday?’ it might be better to start with where and when?
fellow home artificial nutrition people always raises the question of travel, given that we’ve come all the way from the UK. We met a friend there from Czech Republic who had travelled with her parenteral nutrition too so we were all quizzed as to how we did it. It’s always a healthy debate and highlights the differences in cold chain transportation, multi-chamber bags and stability data for packaging, along with appropriate storage when in a hotel or holiday accommodation. I should be able to accept the problems we face when storing supplies on the move. But I can’t. Most of the HPN patients I meet are happy to use ice from the ice machines at the hotel to keep their PN cold. I still can’t get my head round that because, here in the UK, we are taught very differently.
After a fabulously interactive educational conference we had time to stop off in New York City itself. Leaving the tranquil surroundings of Saratoga Springs and arriving in Times Square was part two of our educational trip. Similar routine; lots of baggage which was slightly depleted due to usage but still more than your average traveller, sorting out fridges and working out how much and when to fit in essential feeds! But there was no time to worry as we set out into the evening to absorb the electrifying atmosphere. Bright lights and crowded pavements. Enticing restaurants and bars at every turn, not so attractive when you are limited to what you can take in orally. Still, absorbing the atmosphere was good enough for us. Being in town on 4th July was also a great buzz with a splendid firework display. Leaving aside all the excitement there is a serious side to travelling with artificial nutrition. I’ve often wondered whether, when a traveller dependent on artificial feeding asks for medical consent to travel, does the person in charge understands the consequence of their response? I firmly believe anyone electing to travel with artificial nutrition needs to assume responsibility for their decision. For all those asking ‘Can I go on holiday?’ it might be better to start with where and when? It’s not just about being fit to fly. It’s
also about being responsible for the preparation and planning. PINNT often receive calls from people who say they didn’t appreciate all that was involved in travelling. I advocate choice; choice in being able to make decisions about your own life, or that of your child’s. But it needs to be an informed decision. PINNT produce Holiday Guidelines and Talking Points Information sheets that certainly aid the process of travel. Reflecting on my trip to New York, I am always grateful that I managed to enjoy another wonderful experience. I’m not sure about you but while away I always say ‘where next?’ Well, for me, where next is Australia. That will be another great adventure, so the meticulous planning has already started. The airline isn’t being as accommodating as I’d like in terms of excess baggage and that’s an obstacle to overcome. And as this trip involves a wider team of people on both sides of the world, communication is key. But as long as I have the ability to travel and I can obtain appropriate travel insurance I will keep asking that question - ‘where next?’
YOU ARE NOT ALONE… My name is Rosemary Martin. I am 70 years old and have been on Home Parenteral Nutrition (HPN) for over 33 years. By Rosemary Martin
43 years ago I became ill. My symptoms were sickness, diarrhoea, cramps, aching joints, dry skin, hair loss and always feeling cold. I was anaemic, generally depressed and could not lead a ‘normal’ life. The fear of having a personal accident meant that social activities and holidays were out of the question, so I soon became a prisoner in my own home. I was put on various drugs and treated for Irritable Bowel Syndrome (IBS). Eventually after a second opinion at a different hospital, Crohn’s disease was diagnosed. There followed frequent admissions to hospital for nutritional disturbances requiring Iron infusions, until it was decided I would have an irreversible ileostomy. After this, things looked up for a while. Then the Crohn’s flared up again. At my request, I was transferred to Hope Hospital, now known as Salford Royal, to be treated by an eminent surgeon in a special unit called the Intestinal Failure Unit. A laparoscopy was performed first and an abscess drained. At only 5 stone, I was put on HPN to build me up for further surgery. Following surgery, I was left with only 20 inches of small bowel - which was not enough to sustain me and that is why I was put on HPN. I’ve been on it for 7 nights a week for over 33 years now. I know that without the treatment and the care from the doctors and nurses on the unit, I would not be here. I have tried to lead as near ‘normal’ life as I can. I have been determined to rule my own life and not let the condition or treatment rule it. My family and I have been on many holidays both in the UK and abroad. I have continued to visit the gym, swim, cycle, walk, do my gardening and help to bring up two grandchildren. Most importantly I also returned to work.
Over the years I have been only too willing to help other patients by talking to them. They have had various worries, the most frequent ones are understandable. They worry about what they are putting the family through; they find many activities are no longer appealing to them, so the family don’t continue to enjoy them either. As a patient, you need family and friends the most to support you emotionally, particularly to help with the transition from hospital life to home life again. After a long stay in hospital, people can become institutionalised because the safety that they felt from the doctors and nurses is suddenly taken away. They can feel isolated and alone and many patients want to know what is ahead of them, some don’t. Some want to take one day at a time and take what comes. Others want to try and plan their future.
find similar problems to your own and how they are dealt with. In addition, there are some really interesting articles and current research in there too. There is no blueprint for coping with life at the best of times, even with good health on your side. But you need people to understand that you are still reliable, responsible, hardworking, caring individuals and that you are capable of giving and receiving love.
Young people worry about forming relationships, dating and being able to have a family. Are they going to be able to cope with looking after a family, especially if they become ill and have to be admitted to hospital? Are they ever going to meet a partner? Might they grow old on their own? They fear friendships will collapse because sometimes they can’t or don’t want to go out to dinner or partake in certain social activities. If they do have a family, are they going to pass on any illnesses, are they hereditary? My advice is, remember that you are not alone with your problems and you need to talk and share them. One way is to join PINNT, a support group for Patients on Intravenous and Nasogastric Nutritional Therapy. This group was formed over 25 years ago and a magazine is sent to you three to four times a year, where you will
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THE DEVIL’S IN THE DOSAGE Nutrition expert and personal training consultant, Simon Hall, has ten years’ experience in the health and fitness sector, specialising in health and body transformation via a unique multi-disciplinary approach. Prior to setting up global consultancy, Body Composition, Simon travelled the world researching and working with some of the most influential leaders in the industry. By Rachel McClelland IT’S ALL ABOUT THE GUT… To what extent do you think nutrition has an impact on disease prevention? Hugely - we work with people all over the world who have had issues with thyroid health, diabetes, IBD etc. It’s amazing really to look at disease in fine detail as it can always be linked back to a deficiency. Recently I have been looking into the gut and microbiology’s effect on human health, and there is a pretty strong correlation between problems with the gut and disease. To what degree do you think food affects mental health? Ok so this is a fun one… Nutrition has a large impact on our emotional, hormonal, mental states, the way we feel and I guess you can say the way we view ourselves. It’s amazing to hear about people who start to eat right that the first things they feel is mental clarity and improved energy. With deeper mental issues, I believe it’s very important to look further down the rabbit hole. There is a huge correlation between the gut and mental health. What are you views on current trends like gluten free foods? Gluten free produce certainly has a place for people with certain intolerances. However, given the current trend for gluten free products, e.g. gluten free cakes and gluten free brownies it’s important to remember that they’re not necessarily healthy. What do you think the greatest challenges are for global nutrition? In my opinion the biggest challenge is in the education of nutrition. Speaking to people around the world, you realise that they don’t know what the right foods are, what it is that they should be eating and the impact of a bad diet. If we were able to
address the issue from a younger age, we could have a really positive impact throughout the world. What advice do you give to people when working with them on their diet? Humans are habitual, so you have to look at their current habits and start rebuilding. If you approach things habitually with say a different focus each week, such as; getting your optimal water intake, changing your breakfast, eating more vegetables – then slowly but steadily you can start building a healthier lifestyle. What does the average person need when it comes to diet? It’s all about balance and eating nutritionally dense foods, but you have to be able to go out and enjoy yourself and not become a social recluse! There has been a lot in the press recently about sugary foods, what’s your take? We are always looking for something to blame. A good tip with anything is to remember that the devil is in the dosage; we can demonise fat, we can demonise sugar. It’s when we eat too much that the issues occur. Is there actually any nutritional value in fast food? Fast food pretty much has all the nourishment, enzymes etc. taken out of it and it gets filled with preservatives. Have you ever seen the pictures on the internet of the fast food burgers that have been left on people desks for years and they still look the same two years on from the day they were bought?
Is it worth buying organic food? It’s all about preference and financially what can be afforded. Organic food is definitely worth considering. There is a great article called the ‘Dirty Dozen’ about the 12 foods that are most treated with pesticides. Organic food arguably has more nutrients, it’s grown in better soil, it’s looked after and you are not consuming as many chemicals. Can the amount of fluoride in tap water be dangerous and in an ideal world would you advocate bottled water? Bottled water does tend to have a much higher mineral count in it so I would always buy decent bottled water for that reason. Fluoride is in the water yes and has been shown to have issues, with this again I guess it falls back to “the devil is in the dosage.”
A THOUSAND DAYS OF LIFE Scientists have identified the most crucial period of human nutrition – and it’s the first one thousand days of life. Professor Alan Jackson, professor of human nutrition within medicine at Southampton University, talks about the significance of early feeding, the role of diet in managing chronic illness and the threat from public enemy No.1 when it comes to healthy eating – sugar. By Pat Hagan SOMEONE who survives to the age of 80 notches up almost 30,000 days of lifespan. So you might think that leaves plenty of time for the body to make up for any nutritional deficiencies it might endure in the early stages of life. But there is now a consensus that the first 1,000 days of life – from conception to the age of two - are critical when it comes to laying the foundations for a healthy life. Professor Jackson, whose early career focused on tackling malnutrition in children, says science can now show that if the human body does not get off to a good start, it may never make up the difference. ‘If you grow well in childhood, your ability to cope with challenging environments is likely to be greater,’ he says. ‘But if you grow poorly in childhood, then you’re more likely to be vulnerable. ‘That is why currently within the United Nations global system, there is this emphasis on the first 1,000 days of life - from the time that you are conceived to how you grow as a baby in the mother, how you grow as an infant and how you grow as a child, particularly up to 2 years of age.
‘The body has needs and those needs are in part determined by the genes that you have. ‘So the better able you can meet the needs of your body at whatever stage or time of development you are at, then the greater your ability to grow well and be more resilient.’ The question is then, to what extent are nutritional ‘shortfalls’ involved in the whole disease process? And how important is good diet in terms of preventing illness? For the past decade, Professor Jackson has been working with the World Cancer Research Fund. It has focused on exploring the complex relationship between diet and cancer, highlighting the potential links between poor nutrition and several types of tumour. ‘The World Cancer Research Fund has invested a very considerable sum of money and carried out the largest systematic reviews in any part of medical literature,’ says Professor Jackson.
‘If there is a solid foundation of good growth and good health laid down in those first 1,000 days, then you are well set up for the rest of life.
‘It’s quite clear that something of the order of at least 25 to 30 per cent of cancers are caused by nutritional considerations.
‘If that is not set down well, then you are as it were ‘always trying to catch up’.’
‘As smoking declines diet, nutrition and physical activity will come to be the dominant determinants of cancer risk.’
Most of us, he concedes, have to do some catching up at some point. But for some the challenges are greater and this makes them more vulnerable to illness and disease when it comes along.
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‘Quite clearly, growing during childhood is taking in food and depositing it as your own body tissue.
So if diet can prevent, or at least reduce the risk of some potentially fatal illnesses, can it ‘cure’ them once they have set in? ‘It’s a challenging question,’ he admits.
‘We don’t know the answer. ‘My suspicion is that it might well do but that is probably the more important agenda going forward.’ He points to what he calls ‘forever’ conditions – chronic and incurable illnesses – that don’t go away but do respond well to good diet. Cystic fibrosis is one, phenylketonuria is another. ‘Children born with cystic fibrosis do extremely well and a part of that is ensuring that their nutritional health is maintained. ‘So, it doesn’t cure disease in the sense of curing an infection or cutting out a tumour, but it cures the disease in terms of the process expressing itself as an inability to function well or normally.’ Knowing the effects of good diet is one thing. Putting it into practice is proving to be an altogether bigger challenge. Professor Jackson believes the real hurdle is getting everyone – from food manufacturers to consumers – to commit to radical change. And one of the biggest battlegrounds of late has been sugar. It has emerged as public enemy number one in the healthy diet debate. But how big a problem is it really? Professor Jackson says: ‘When you are talking about sugar, you are talking about sucrose. ‘Biologically, sugars are an integral part of our metabolic machinery.
‘For example our gastrointestinal tract and respiratory tract are protected because of the production of mucins. ‘Most people would call that mucus but it is made up of mucins that form a physical barrier that keeps us healthy. Mucins are sugar related compounds.’ But dietary sugars are a completely different matter. ‘The clearest example is sweetened carbonated drinks which contain very large amounts of sugar for their volume and very little in the way of nutrients. ‘Some young people consume very large quantities of sweetened drinks and therefore consume very large amounts of sugar and that is not good for them at all. ‘Then you have a variety of foodstuffs which contain rather a lot of sugar and by and large too much sugar limits the quality of your diet.’ Tackling the sugar crisis is not impossible, he believes. A good example of how it can be done is with salt, sugar’s predecessor as most-hated food ingredient. Salt levels in processed foods have gradually been reduced because public health bodies worked closely with food manufacturers, rather than fight against them. ‘It was known that you could progressively reduce the amount in food gradually and the population wouldn’t know. In time they would end up consuming less salt. ‘That is exactly what has happened. The consumption of salt now is significantly less than it was 15 years ago without anybody noticing. ‘The food industry has to a considerable degree honoured their reasonability and the UK is amongst the best in the world in terms of having achieved its salt reduction. ‘It required considerable planning and effort in the set up to get agreement across the board – but difficult things take a long time.’ With a background in artificial feeding, Professor Jackson is just as interested in how proper nutrition can benefit those with gastrointestinal disease.
He is passionate about the need to invest in training for structured nutrition programmes and says it can lead to considerable savings in reduced hospital stays. But how and when is parenteral nutrition appropriate? ‘Well, if you take out someone’s gastrointestinal tract, then they have intestinal failure.
CAREER AT A GLANCE ‘I’m basically a clinician and a paediatrician. ‘I have spent my time looking at evidence for improved nutritional care and support of patients. Originally that was in children with severe malnutrition in the Caribbean and, since I came to Southampton in 1985, in terms of nutritional support of patients.
‘That is absolute and they will need parenteral nutrition unless someone transplants their gastrointestinal tract.
‘I worked very closely with Professor David Barker, understanding the nutritional determinants of the early origins of adult chronic disease.
‘So parental nutrition is used in my book for intestinal failure, which may be acute, it may be chronic, it may be total, it may be partial, it may be reversible or it may be irreversible.
‘Along the way I’ve done some molecular, cellular level work, clinical studies and population studies.
‘Therefore how likely you are to come off it is determined by which of those factors are at play. ‘The most common form of intestinal failure is perioperatively, which is self-limiting and a short period of support gets people into their usual form of eating. ‘But if someone takes out your tract you will be on it for life unless you are transplanted. ‘Those are the extremes. The challenge for clinicians is to help you make progress and it is impressive how, with decent parenteral support, patients who previously would have never been considered capable of coming off nutrition, have. ‘I have seen patients with very substantial intestinal resections that didn’t look like they would ever come of parenteral nutrition being able to because the gut has adapted to cope better than it did previously. ‘These people aren’t cured. But their bodies have responded to the insult and accommodated to do the best they can.’
‘And for the past 10 years I have been involved with the World Cancer Research Fund looking at the evidence in and around nutrition, physical activity and cancer.’
NUTRITION, A BALANCING ACT Whether you are on parental nutrition or you’re just into nutritional health and wellbeing, it’s all about making the right choices… By Geraldine Bedell
Nutrition is not a word that makes me feel warm and happy. Eating, I love. Food and restaurants and lunch with the family and suppers with my husband I love. Cooking, even. But nutrition always makes me think of a friend of mine who can tell you the calorific value of six beansprouts and the fat content of three fluid ounces of semi-skimmed milk. My friend sees food as fuel - which of course, at one level, it is. She exercises furiously and eats a fiercely controlled diet to maintain an ideal weight. All of which is very splendid. And quite boring. I can see that it’s important to understand the chemical components of food. If I were sick or had a hormone imbalance I would want to know as much as possible about how to eat to feel better. I recently had to see a gastroenterologist, who told me that a majority of the population has some sort of wheat intolerance, which is unquestionably interesting and useful information. Yet, while I want this knowledge, I also want to be able to retire it to the back of my brain, because the one thing I do not want to be about food is joyless. For my exercise and diet-conscious friend, salt and fat are enemies to be seen off. She can be very sanctimonious about anyone who eats, say, cream teas, or heavily seasons their pasta water. She is not a nutritionist. I’m not either, but I do know that the general thinking is that not all fat is bad for us (and that opinions have changed about this in recent years). I also know that a diet high in salt is bad for people with high blood pressure, but that a study published in the New England 10
Journal of Medicine, monitoring more than 100,000 people in 18 countries, found that a low sodium diet isn’t good either. We lay people have to be careful with our partial knowledge, which rarely takes into account the person eating or their circumstances. Not that science is really what my friend’s approach to food is really about. Like a lot of dieters, she imbues certain foods with moral values: lettuce good, butter bad. And once you do that, it’s easy to get things out of proportion. It’s just food, I quite often want to shout. It’s not the devil. It’s not out to get you and you are not, despite what you say, ‘being good’ if you don’t eat cake. People who see food as either polluting or improving can very quickly acquire an air of superiority. If you are striving to be a better person through your food intake, you can quickly become judgmental about what other people eat. When you are on a punishing regime, it’s hard to be relaxed about other people with their fish and chips. They may believe they’re getting away with it, the dieter thinks – and surprisingly often, says - but they are going to suffer in the long run. Nutrition is a serious subject. For some people, it is a matter of life and death. But it is perhaps best left to nutritionists. Modern nutritional science emerged with the isolation and identification of certain nutrients in food and discovery of their effects on the incidence of certain diseases. But the relationships can be more complicated than they first appear.
Several studies show, for example, that eating large amounts of fruit and vegetables tends to protect against heart disease and certain cancers. But the results aren’t replicated if people take supplements containing those nutrients. Similarly, the famed superiority of the Mediterranean diet doesn’t seem to be about the foods that make up the diet so much as their overall quality and balance. In the developed world, food is plentiful, a situation for which we are almost certainly not evolved. Our genetically-programmed greed undoubtedly requires some disciplining. So we do have to think about what we eat. But we are also lucky to have access to rich cultures of good eating, developed over centuries, tried, tested, and honed to make people healthy and happy. Food is almost certainly best for us when it is cooked with care, shared with love, and eaten with people who cheer us up. So perhaps we also need not to think too much. My favourite nutritional guidelines come from the American author Michael Pollan. They require no weighing or counting: ‘Eat food. Not too much. Mostly vegetables.’
Source/credit: World Health Organisation Regional Office for Europe
The Voice of Healthcare
Our next issue of Ark will focus on Integrated Care. If you would like to contribute please email Rachel at rmcclelland@cmemedical.co.uk If you would like to request hard copies or if you would like to receive future issues of Ark please email arkmagazine@cmemedical.co.uk POWERED BY