By Farihah Choudhury
Current MSc Nutrition for Global Health student

Farihah is a Master’s student interested in public health nutrition, particularly lifestyle disease including obesity as a product of changing food environments, food sustainability and food culture.

On my walk home in London, from Bloomsbury to Whitechapel, I traverse through Holborn, Farringdon, Barbican and City. The principal hubs for suits and commuters, looking for lunchtime meal deals or a quick pick-me-up between 8am and 6pm Monday to Friday, like clockwork.

Emma Berry

Freelance ANutr, NHS and Uni of Aberdeen. NHD contributor

I am not a professional nutritionist… Well, I am, but not one currently working in nutrition. In fact, I work part time in health and research engagement, while also doing a full-time PhD in Health Research.

If you’re looking for tips on how to talk to your cat, hacks for drying your washing quicker, or the top five holiday destinations for bog snorkelling in 2020, you might want to look elsewhere! This here is the NHD Blog: the latest feature from Network Health Digest.

Chronic kidney disease (CKD) is a progressive disease in which kidney function is lost over a period of years. It has a number of consequences including cardiovascular diseases, osteodystrophy, pericarditis and anaemia. It is most commonly caused by diabetes or untreated high blood pressure, but can also arise due to inflammatory disorders. The progression of CKD is classified as stages 1-5, with stage 1 representing the very early phase with mild impairment of glomerular filtration rate, and stage 5 representing full renal failure.

The rising prevalence of obesity and the impact of excessive body fatness on risk of Type-2 diabetes, cardiovascular disease and certain cancers are well-documented and are rightly a focus for public health interventions. With obesity rates increasing in adults and children, all developed countries are reporting high levels of obesity among women of childbearing age. This has important consequences for maternal and foetal health during pregnancy and potentially for the longer-term health of the children of obese women.

Over the last two decades there have been many claims that what children eat has a major impact upon their performance at school, with many studies claiming that breakfast, in particular, is a strong contributor to concentration and learning during the school day. There is also a well-recognised phenomenon called the ‘post-prandial dip’, which is a drop off in physical and cognitive performance following a lunchtime meal.

The positive relationship between consumption of fruit and vegetables and human health is very well established. Increasing intake of vegetables, in particular, reduces the risk of many types of cancer, partly through displacement of cancer-risk factors (e.g. meat) and maintenance of healthy weight, but also through the delivery of anti-cancer agents such as the isothiocyanates that I discussed in my Christmas blog about sprouts. In the light of these positive effects, the World Health Organization has set a minimum daily target of 400g of fruit and vegetables in the diet for all countries. In the UK, this has become the driver for the ‘5-a-day’ public health message. This sets the goal of consuming five 80g portions of fruit or vegetables, which can be in raw form, cooked from fresh, frozen or canned, and eaten either on their own, or as elements of more complex composite foods which use them as ingredients.

Christmas is coming and before too long families all over the UK will be sitting down to their traditional roast dinners, with turkey, roast potatoes and of the trimmings. For most of us those ‘trimmings’ will include the humble Brussels sprout. This small green vegetable may be the most divisive part of Christmas with some of us having a major passion for them and others considering them to be vile objects, barely deserving the label of edible.

From a nutritional perspective, the sprout is not particularly remarkable. A 100g serving has an energy content of 40 kcal and delivers 3.8 g of dietary fibre. They are a very rich source of vitamin K and a 100g serving can provide 169% of the US recommendations for adults. Sprouts are rich in potassium (389 mg/100g) and ascorbic acid (40 mg/100g) but are otherwise are no different to any other green leafy vegetable. Brussels sprouts are brassicas and as such share many of the characteristics of the other members of the cabbage family.

Sprouts may carry benefits which until relatively recently were unrecognised. As a cruciferous vegetable the Brussels sprout rich in a variety of sulphur and nitrogen-based compounds which may have anti-cancer properties. These compounds occur in two main groups based on chemical structure. The indoles are nitrogenous compounds which in the uncooked vegetable exist as glucobrassicin. Glucosinolates make up the other class of compounds and in the uncooked vegetable are present as glucoraphanin. Both chemicals form part of the plant defence system against infection and when plants are damaged by cutting, chewing or heating they break down to form smaller derivatives. The main derivative of glucobrassin is indole-3-carbinol, whilst glucoraphanin breaks down to a range of molecules called isothiocyanates, of which the major form is sulfopharane. When isothiocyanates and indole-3-carbinol are ingested they undergo further transformation in the acid environment of the stomach. The resulting derivatives activate enzyme pathways which are responsible for the elimination of xenobiotics and in this way, are able to inhibit the initiation of cancers. Some indole-3-carbinol derivatives have also been shown to induce apoptosis and inhibit proliferation of cancer cells. The same compounds are also present in cabbage, cauliflower, bok choy and cress and there are also reports that they may have beneficial effects in neurodegeneration.

The reason for the split view on the taste of sprouts comes down to the same groups of molecules which contribute to the potential health benefits of sprouts. Sulfopharane is the breakdown product of glucosinolates in sprouts. It is the compound which gives sprouts that vaguely sulphurous smell as they cook and is released in greater amounts if the sprouts are overcooked. The biology of taste is now well understood and we know that there are genetic differences in  the types, numbers and patterns of taste buds and receptors in the tongue (see https://www.nottingham.ac.uk/biosciences/research/research-themes/taste-map/taste-map.aspx). These differences mean that some people sense and respond to certain bitter compounds in an exaggerated manner. These people are termed supertasters. In contrast non-tasters are unable to detect the same compounds and show no response. Our humble sprout causes such division at the dinner table because the supertasters (sprout-hating) can detect the sulfopharane, yet the sprout-loving non-tasters are unable to sense it.

So, on Christmas Day as you settle down for a great meal with family and friends, give a thought for the humble sprout. It may be far more complex and deserving of your consideration than you may think!

Many of you will have recently graduated or are entering the final year of degree studies and so that awkward question of what comes next may be uppermost in your mind. It’s a tricky time, making that transition from undergraduate study to the next stage of life and it isn’t uncommon for students to question what they have studied and have second thoughts about their future career path. Back in the mists of time when I finished my degree I had no idea what I wanted to do, but was pretty sure that I didn't want to do any more studying or be anywhere near a university. Now 2 more degrees later I am firmly wedded to the academic life and to be honest still don't really understand how I got here.

 So if you’re finishing a degree in dietetics or nutritional sciences, what are your options?

Work
You may have started your university course with a particular career in mind. For those of you studying dietetics this will have undoubtedly have been clinical practice working in the NHS in a variety of settings. However three or four years down the line, your dreams may have changed, become more ambitious or even evaporated. The good news is that a background in nutrition is more relevant than it has ever been and the opportunities available in the food industry, public health and research are wide and varied. The Nutrition Society have produced some really useful careers-related materials that you may find useful https://www.nutritionsociety.org/membership/students/careers-support, including interviews with people at different levels of their careers and dietitians who have changed direction.

Further study
Further study isn’t something that I would enter into lightly. Postgraduate courses are expensive and tough going and so real commitment is necessary to make it a worthwhile experience. In the area of nutrition there are many opportunities available to study to Masters level. For somebody who already has a nutrition or dietetic background these will generally provide greater depth in specific areas of nutrition such as clinical nutrition, animal nutrition, public health nutrition or advanced dietetic practice. The latter is especially useful for registered dietitians who want to enhance their knowledge and skills, often studying part-time alongside clinical practice. A Masters can be a great way to stand out from the crowd and distinguish yourself from rivals in the job market who have BSc degrees.

If your ambition is to go on to a research career then a Masters of some sort may not be the way to go unless your first degree is not at 2:1 level or better. With a good degree direct entry to PhD programmes will be possible. However, if you are tempted by a PhD but unsure whether it really is for you, then you might want to consider a Masters of Research degree. These are generally one year courses in which there is little or no taught element and the time is spent on a major research project. This gives good training and experience in the whole process of data collection, lab or fieldwork, data analysis and writing and can help make that decision about whether research is your thing.

There are many good reasons to do a PhD. If you love research (maybe your final year project at undergraduate level was a great experience and you caught the research bug) and like the idea of contributing brand new, advanced knowledge to society then this is the way forward. A PhD gives you the opportunity to become THE world expert on your area of study and at the same time develop great transferable skills in communication, IT, time-management and self-organization.  Many PhD opportunities are now offered as part of a Doctoral Training Package which includes specific training in these sorts of skills and gives you a lot more choice over what specific project you will take on. If you want to work in research either in an academic setting (which brings with it amazing freedom to think and try out new ideas) or in industry, then a PhD is essential if you want to climb the career ladder.

Doing a PhD can be tough. Doctorates don't come easily and it can sometimes be a lonely time of hard work and extreme stress, but with the right project, the right supervisors and the right colleagues, you can also have a lot of fun and emerge from the process happy, fulfilled and able to have the title Dr printed on your credit cards!

I am actually a pretty even-tempered and tolerant person, but every now and again am reduced to ranting, apoplectic rage by things that I see on the television and in printed and e-media. The triggers for these lapses of reason are generally outrageous claims about the amazing and totally fictitious properties of foods. These are sometimes individual products which are being marketed by unscrupulous pseudo-nutritionists. One of the first that caught my attention and got me engaged in a grumpy email correspondence with the supplier was Hawaiian Noni.  Noni is a tree related to coffee which yields a fruit which unfortunately smells rather like vomit, and like most other fruits contains a range of oligosaccharides, polysaccharides and phytochemicals. Noni is now widely available as a supplement in health food shops or as juice. The particular quack that I tackled was a retired US army officer who made claims that noni cured practically every disease under the sun (cancer, coronary heart disease, kidney failure, diabetes) and reduced mortality by 60%. I found that last claim particularly irksome as one thing we all do eventually is die, so mortality will always remain at an inconvenient 100%.

Other annoying claims from the pseudo-nutritionists generally refer to ‘superfoods’. Superfood even has a dictionary definition (‘a nutrient-rich food considered to be especially beneficial for health and well-being’) and a quick Google search will reveal endless articles such as ‘The 52 best superfoods’, ‘Superfoods you need now’, ’25 greatist (sic) superfoods and whey they’re super’. The truth is of course that there is no such thing as a superfood. The term is a marketing gimmick to tempt the unsuspecting, health conscious public to part with their money. Superfoods are just foods at the end of the day. Yes, they are nutrient dense and will enable people to follow a healthy diet, but they won’t prevent disease, cure disease and in many cases do not even have a discernible physiological effect. For example, goji berries have been widely touted as a superfood that will protect against cancer, coronary heart disease, boost the immune system and improve life expectancy. There are no reliable scientific studies that back up any of these claims however, and these superberries are merely good sources of micronutrients, just like any other fruit.

Don't get me started on juicing and spiralizing.

Of course the big problem here lies with the untrained, pseudoscientists who sell this material and make a good living from their books and web marketing that are target a ever more diet conscious population. Anybody can call themselves a nutritionist without training or registration and that poses a real threat to people’s health and pockets. I will blog on that topic another time.

Recently Marinangeli and Harding published an article in the Journal of Human Nutrition and Dietetics (http://onlinelibrary.wiley.com/doi/10.1111/jhn.12359/full) about the specific health claims made about foods which deliver ‘sustained energy’ by virtue of their glycaemic index. The general claim that is made is that if a food evokes a low glycaemic response after consumption, it must be digested and metabolised more slowly, hence releasing energy more slowly giving a sustained effect on the body. The authors of the article state that companies who make this claim are doing so in a way which confuses consumers and presents information about the biological effects of such foods in a misleading way. This is yet another example of how marketing of foods can use loopholes in legislation to exploit the widespread desire to eat more healthily

I think that this blog post might be a bit ranting, for which I apologise, but this is a really important issue. Obesity and other nutrition-related problems are the biggest health concern in the UK today and the budgets available for health promotion and the visibility of appropriately trained, knowledgeable individuals are but a fraction of the marketing budgets and profile of the ‘bad guys’. I’d been interested to see some comment on other examples of quacks at work, or ideas about how we can make our profession stand out from the noise and the nonsense.