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Dec 2017/Jan 2018: Issue 130

FACE TO FACE goes back in time Fear based health claims by Emma Berry

NHD-EXTRA: NEWS MAYOR OF LONDON PLEDGES CRACK DOWN ON HOT FOOD TAKEAWAYS NEAR TO SCHOOLS Mr Khan is supporting the governments’ Any takeaway strategy to tackle childhood obesity by outlets which are putting restrictions in place where hot granted planned perfood takeaway outlets are close to schools. mission will be Almost 40% of children in the London required to sign up to area are overweight or obese by the time the Healthier Catering they finish primary school, which is the Commitment, which highest proportion in England. promotes healthy changes to the way There are over 8,000 fast food caterers and food businesses prepare outlets in London and a typical fast and cook food. This initiative encourages food meal contains around 60% of the grilling, baking and adding less salt as recommended daily calories, 50% of healthier alternatives to current practices. salt and saturated fat and no fruits or Mr Khan has said, ‘I am working vegetables. There is strong evidence hard to create a healthier London to show that regular consumption of and this must start with the food that takeaway foods is associated with weight our children eat. As promised in my gain, therefore, the restrictions seen in the manifesto, I am using all of my powers plan are welcomed as part of the overall through my new London plan to strategy to tackle childhood obesity. prevent new takeaways from being built A draft of the London Plan, a just down the road from schools as part document outlining the capital’s of a package of measures to tackle the overall planning strategy, states that ticking time bomb of childhood obesity any new takeaway outlets should not and help us all to lead healthier lives’. be permitted within a walking distance More information on this story can be found at www. of 400 metres near to an existing or london.gov.uk/press-releases/mayoral/mayor-cracksproposed new school. down-on-new-takeaways-near-schools BREASTFED BABIES ARE LESS LIKELY TO HAVE ECZEMA AS TEENAGERS Researchers from King’s College London, Harvard University, University of Bristol and McGill University have discovered that babies whose mothers had received support to breastfeed exclusively for a sustained period from birth have a 54% lower risk of eczema at the age of 16. A study published in the Journal of the American Medical Association (JAMA) Paediatrics, has found a 54% reduction in cases of eczema amongst teenagers whose mothers had received support to breastfeed exclusively. The PROmotion of Breastfeeding Intervention Trial (PROBIT) included over 13,000 Belarussian teenagers. This study is the largest randomised trial ever carried out in the field of human lactation, with total of 17,046 mothers and their newborn babies being recruited between June 1996 and December 1997. Whilst the study found that the breastfeeding promotion intervention provided protection against eczema there was no reduction in risk of asthma. More information on the study can be found at https://jamanetwork.com/journals/jamapediatrics/articleabstract/2661823 www.NHDmag.com December 2017/January 2018 - Issue 130



FACE TO FACE Ursula Arens Writer; Nutrition & Dietetics Ursula has a degree in dietetics, and currently works as a freelance nutrition writer. She has been a columnist on nutrition for more than 30 years.


Ursula meets amazing people who influence nutrition policies and practices in the UK.

Ursula travels back in time to 1890, to meet: SIR ROBERT WILLIAM BURNET Author: Foods and Dietaries: a Manual of Clinical Dietetics Member of the Royal College of Physicians Chief Physician: Great Northern Central Hospital

Perhaps feeling weak and woozy was a normal state after time travel. I had retro-zoomed 127 years back to 1890, but only had a short time to meet up with Sir Robert Burnet. He had just published the world’s first book on clinical dietetics and had kindly agreed to meet me at his office on Upper Wimpole Street in London. How had he come to be so interested in nutrition? And how did he find the time to write a book on dietetics? And what were the kinds of medical conditions that could be treated with food edits? And were there any obese people in 1890? Although we were time-warped and in different dimensions, he was able to share some of his expert thoughts. “My book was suggested by the habit, which for a number of years I have followed, of writing out in detail directions for patients. I like to give definiteness to directions: the hours of taking food and the quantities to be given at each time, as well as the kinds of food most suitable. “The knowledge of the physiology of digestion is the root of sound practical dietetics. As is the knowledge of the components of foods, which can be grouped as nitrogenous elements (albuminoids, proteids), carbohydrates, hydro-carbons and lastly, salts and water. “When the dietary is full and the digestive organs are vigorous, the surplus food assimilated is stored up, and an increase of body-weight takes place,

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moreover, even in healthy persons some of the food taken is incompletely digested and is thrown off in the excreta. “In youth, when muscular and nutritive activity are greatest, larger supplies of aliment, and especially of the tissue formers, are well assimilated. On the other hand, old people are apt to make the mistake of adhering to a diet consisting more largely of albuminioids than the diminished wants of the system in advance age require - the result is discomfort or distress induced by the inability of their organs to excrete nitrogenous waste matter. “Fresh vegetables and fresh meats are bearers of extractives and salines, apart from their actual nutritive value. Evil consequence speedily follow the withdrawal from important vegetable salts - such consequences reach their climax in attacks of scurvy and allied disorders. PRACTICLE ADVICE

So much for the theory: what about the practicalities, I mind-asked him. “For invalids, foods cannot be too good or too simple, and must be daintily served. Many nurses, not to speak of medical men, hardly appreciate fully the help that attention to such details bring to those under their care.

“Today I have advised on dietaries for chronic gastric catarrh. Small quantities of food should be fed at short intervals - partaken of very slowly cool food (never hot, but not actually cold). Midmorning, I advise to administer a small glass of peptonised milk with the chill taken off, added to which a teaspoon of malt extract. Or a teacup of chicken tea with a plain biscuit. For lunch a breakfast-cupful of good whole-beef tea, i.e. with some of the meat dried, pounded and mixed with the liquid, and a finger of toast. Later, milk flavoured with tea and a thin slice of bread and butter. Then at 10 before sleep, a teacup of water arrowroot with a spoon of brandy. “Dietaries for stomach ulcer vary greatly, because symptoms vary greatly with intensity and urgency. Physiological rest for the stomach is of little avail without all efforts to avoid bodily fatigue and exertions. All foods must be of the mildest kind - pulp and pap and small amounts of food may be better retained if a very few minims of laudanum or liquor morphia in a spoon of water is given before food to prevent vomiting. Another option is the administration of predigested foods per enema; peptonised milk, peptonised gruel, beef peptones, malt extracts with, if necessary, a spoon of brandy. In order to be well retained, the enema must be small in bulk, the temperature luke warm, and it must pass gently and slowly into the bowel. That the large bowel possesses to a certain extent powers of absorption in not now questioned, and there can be no doubt that nutrient enemas are most valuable in certain circumstances to enable the patient to hold out until the crisis that called for their use has passed.” CHRONIC CONDITIONS

I was desperate to tell Sir Burnet that the food components he described as vegetable salts, would come to be identified as vitamin C, but this discovery would need another 40 years to be announced. Also, nutrient administration per enema was not now recognised as a route of absorption, but perhaps some fluids could be retained in dehydrated states? Feeding of invalids under Sir Burnet’s supervision seemed to be offered with great care and great caution, but with few of the foods or methods in use today. What about advice for more chronic conditions (I mindasked him.)

“Whilst a certain plumpness of body is desirable. Yet an excess of fat, besides being unsightly, is a burden to its possessor, and many plans for reducing superfluous fat have been suggested. Evil results have often followed sudden changes in diet, especially a great increase in nitrogenous materials, to the exclusion of the carbohydrates. Familiar diets are those of Banting and of Ebstein: the latter has the recommendation of more variety and, for example, potatoes are allowed in very moderate quantities: the diet is thus kept from being so irksome and the patient is able to persevere longer. The corpulent should also be encouraged to take exercise, but avoid any violent exertions that strain the heart and blood vessels. “In no other disease, probably, are the beneficial effects of a well-chosen dietary so marked as in cases of diabetes. There is some defect in assimilation of starches and other carbohydrates leading to the symptoms of a tormenting thirst, a harsh dry skin, a red beefy tongue and a sweetish odour of the breath. Starches and sugars must be excluded as far as it is possible to do so: the patient must be convinced by a sufficient explanation of the necessity that exists for his self-denial and thus his hearty and loyal co-operation will be secured, Even with the best resolutions there is danger of the diet becoming very tiresome if not altogether unbearable, and he will require considerable force of will if he is to adhere strictly to rule. He may eat all meats except liver. He may eat fish, eggs, game and all poultry, butter, cream, cheese, spinach, pickles, vinegar and oil, salads, nuts, olives and almond biscuits. He may drink tea, coffee, cocoa made from nibs, claret, burgundy, chablis, hock, dry sherry, whisky etc. For patients who find it difficult to adhere entirely to unsweetened foods, a recent description is of a safe sweetening agent called saccharine: a very small quantity only is required, and use with ordinary care in very moderate quantities, no harm results from its employment.” Sir Burnet was still explaining foods suitable for diabetes, but again I was overcome with nausea and blurred senses: it was time to return to the here and now. But I hold the original 200-page copy of Food and Dietaries: A Manual of Clinical Dietetics and think of the dedication of this man, in the promotion of the importance of foods in the care and treatment of disease. Dietetics has come a long way since 1890.

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