Adam Grice is a Leeds-based GP, a National Institute for Health and Care Research Doctoral Research Fellow at the University of Leeds, and a recent BJGP and BJGP Open Editorial Fellow.
I was excited to recently receive my copy of Tim Spector’s The Food for Life Cookbook,1 which was a timely prompt for me to revisit what I understood about nutrition. Two years ago, my wife, also a GP, and I overhauled our diet. We recognised we were in our mid-30s, were conscious of our health, and felt a sense of responsibility to better educate ourselves, not only for our patients, but with a view to starting a family.
My keen interest in nutrition began 20 years ago during medical school, when I simultaneously competed in athletics across varying distances and terrains including road-running, cross- country, mountain-running, and track. I considered myself a serious athlete, competing internationally and achieving lifetime bests of 14 minutes for 5 km and 65 minutes for half- marathon. It was abundantly clear to me that I needed to take nutrition seriously, and I educated myself through the performance nutrition literature available at the time.
Making sense of our health
Beyond what I learnt in medical school, my sports nutrition knowledge, and the Eatwell Guide, I didn’t revisit the nutrition literature again until 2022. As a busy clinician pursuing a clinical academic career and trying to keep active through triathlon, I thought I was eating ‘healthily’. Arguably I would take as many shortcuts as possible to save time, for example, purchasing smoothies and juices, believing I was getting the essential nutrients I required, without much thought to the degree of processing and possible additional sugar I was consuming. Likewise, I would purchase lunch, usually a sandwich on whatever bread was provided, not giving a second thought that this may actually be ultraprocessed, but consciously considering the filling, attempting to achieve a small quantity of salad to accompany whatever meat I selected that day. I would even convince myself that the occasional sweet treat would be fine as this would be mitigated by exercise. I did, however, try to prepare one fresh meal once a day, which I would occasionally batch cook, including a modest variety of fresh vegetables.
“I couldn’t understand … no matter how much I trained, how much I addressed my diet … why I was the heaviest I had ever been and why I felt exhausted.”
On reflection it was likely inevitable that, with a busy career and less opportunity to engage in the volume of physical activity I had been accustomed too, things would change. I couldn’t understand, however, no matter how much I trained, how much I addressed my diet (within the realms of my understanding at the time), and how much I addressed other lifestyle factors such as sleep, why I was the heaviest I had ever been and why I felt exhausted. Was this age, or was this something else? I felt frustrated.
A friend from medical school, who I had intercalated in sports science in relation to medicine with, shared my passion for addressing our health through our lifestyle behaviours, and signposted me to Rangan Chatterjee’s Feel Better, Live More podcast.2 I listened to several episodes and was then, for the first time, introduced to Tim Spector. Originally trained in rheumatology and epidemiology, the co-founder of ZOE, the science and nutrition company, transitioned to genetic epidemiology and eventually, triggered by experiencing a mini- stroke, developed a devotion to understanding the relationship between nutrition, the gut microbiome, and health. His work has been cited in many previous BJGP Life articles, and he is recognised for his popular books, including The Diet Myth, Spoon Fed, and the Sunday Times best-seller, Food for Life. For me his ability to articulate the most recent research evidence on diet and nutrition into easily digestible and practical guidance has been invaluable in shaping my own approach to food, but more importantly that of my patients.
The Food for Life Cookbook
His most recent book, The Food for Life Cookbook, a collaborative effort with ZOE, takes the comprehensive learnings from Food for Life and provides ‘over 100 delicious and achievable recipes’. Acknowledging my unwavering ‘sweet tooth’, I was pleased to see two separate chapters on sweat treats and snacks that address the importance of not being restrictive, but to learn how to combine ingredients to produce pleasurable nutritious food. The cookbook opens with an introduction that essentially summarises the key principles from Food for Life. These include eating 30 plants a week; which may seem daunting but, as outlined, when you consider this encompasses nuts, seeds, herbs, and spices in combination with diverse fruits, vegetables, and grains, this is easily achievable, and the evidence highlights this is a key strategy for a healthy gut microbiome. This leads nicely to the importance of ‘eat the rainbow’, which isn’t a new concept, with consumption of foods that cover the whole spectrum of colour ensuring we get an abundance of polyphenols. If you have ever listened to an interview podcast with Spector, you will be aware of his celebration of fermented foods. Prebiotics come from food that we can’t easily digest, such as fibre, which support our healthy gut bacteria.3 Fermented foods are probiotics, live microorganisms that help increase the diversity of bacteria in our gut, and the waste products of our gut bacteria produce health-benefiting postbiotics. Good-quality fermented foods such as Greek yoghurt with kefir and kombucha can be easily brought from the shops, and while I haven’t quite mastered home-grown sauerkraut and kimchi, this is an ongoing ambition.
Spector addresses the important topic of protein, highlighting that protein is found in all foods and not just those that are perceived to be protein rich, such as animal products. He outlines not only does overconsumption of animal products have consequences for our health, but also for sustainability with respect to the environment. Well recognised plant-based, protein- rich sources include beans, legumes, nuts, and seeds. One of the more pressing modern-day challenges surrounds how we navigate ultraprocessed foods (UPFs). In addition to Spector’s work, Chris van Tulleken’s Ultra-Processed People,4 previously reviewed,5 breaks down what UPFs are and the consequences to health and particularly our appetite, with overconsumption being a problem. Essentially, any degree of processing alters the matrix of the original food and consequentially how our body metabolises it. The further away from the original food source a product is, the more ultraprocessed, and the more likely there are added chemicals, such as emulsifiers and preservatives. van Tulleken also sympathetically articulates the challenge of nutrition equity given there are educational skills required for preparing and cooking food, as well the financial costs of cooking equipment, safe storage, and the food itself, an important consideration when having conversations with patients.
The introduction to The Food for Life Cookbook ends with advice regarding time-restricted eating, how to use the book, and home storage of food in the cupboard, fridge, and freezer. There are finally a few pages of frequently asked questions including what oil to use, frozen versus fresh, and organic food. I historically and naively didn’t give much thought towards organic produce, due to the relatively higher cost, and therefore neglected the important consideration of chemicals used to develop and preserve plant and animal produce, which is important when preparing our food prior to consumption. Spector sensibly outlines how to navigate organic food on your personal budget, recognising that non- organic, plant-based foods are beneficial, and, if feasible, to target foods that are more likely to have been sprayed with herbicides and pesticides, such as strawberries and oats, compared with things you can peel, such as oranges and avocados. Overall, organic foods are presented as the better choice and support organic farming, which has wider environmental benefits, specifically soil care.
“The Food for Life Cookbook is inspirational and helps practically bring the science to your plate.”
Nutritional science and our patients
You don’t need to have read Spector’s previous works to reap the benefits of this cookbook, but if, like me, you had been transformed by the new nutritional science, The Food for Life Cookbook is inspirational and helps practically bring the science to your plate. The variety of suggested recipes for the whole day and plethora of easily accessible ingredients to make them leads to a mouth-watering desire to start cooking. What is particularly useful are some of the add- ons, such as the home-made fermented salad dressings towards the end and how to store them, helping to avoid unnecessary ultraprocessed options and making nutritious lunches more feasible.
Most patients I encounter who want to address their diet are overweight or obese, and I expect the same is true for many GPs up and down the country. Two-thirds of the current UK population are overweight or obese and I wholeheartedly empathise with them.6 Modern lives are busy, and not only are there challenges with eating well but there are many barriers to engaging in regular physical activity. Having an up- to-date understanding of nutrition, the challenges associated with navigating how food is marketed, and how we can ensure what we put in our basket is nutritious and beneficial for health helps me engage in more informed conversations with patients. What is potentially more difficult is having conversations with patients where nutrition is not necessarily perceived as a significant contributing factor, such as in the increasing prevalence of anxiety, depression, and irritable bowel syndrome.
Overall, I have found the recent accessible literature on food nutrition, the gut microbiome, and UPFs enlightening and informative. While I appreciate this is anecdotal, when my wife and I made dietary changes nearly 2 years ago, we quickly noticed positive changes, particularly increases in energy and moderated appetite. We have taken all this learning and ensured we incorporated it into our weaning strategy for our new family, but that’s another story.
References
1. Spector T. The food for life cookbook: 100+ recipes created with ZOE. London: Jonathan Cape, 2024.
2. Chatterjee R. Feel better. Live more. https://drchatterjee.com/blog/category/podcast (accessed 22 Nov 2024).
3. ZOE. What are prebiotics, probiotics, and postbiotics and how do they work? https://zoe.com/post/prebiotics-probiotics-postbiotics (accessed 22 Nov 2024).
4. van Tulleken C. Ultra-processed people: why do we all eat stuff that isn’t food … and why can’t we stop? London: Cornerstone Press, 2023.
5. Elhassan HMO. Books: Ultra-processed people. Why do we all eat stuff that isn’t food … and why can’t we stop? Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X735765.
6. Office for Health Improvement and Disparities. Obesity profile update: May 2023. 2023. https://www.gov.uk/government/statistics/obesity-profile-update-may-2023 (accessed 22 Nov 2024).
Featured Photo by Scott Warman on Unsplash.
