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How it all began

I recently attended the RCGP Annual Conference … and whilst there had a bit of an epiphany.

Apparently … I have stuff to say that others want to hear.

For those not in the know the RCGP conference is the college’s national conference for GP’s (of which I am one), where we come together to learn from, laugh with and inspire each other.

I spent most of my seminar times in sessions looking at social media – how to use it, whether we should use it more or detox from it, how it effects us, how it effects others, the teenage brain and social media, etc, etc. Far from finding it the scary place of ‘lost in the ether’ I had imagined, I was inspired by what I heard and straight away set up a twitter account (@EcoGreenGP).

One of the few non-social media related seminars I went to was on green issues (@GreenerPractice)- my biggest and most urgent passion – and from that I realised I could use social media positively to make a diffference…and so I made initial plans for this blog. 24 hours later I had 16 twittter followers (2 weeks later it’s up to 40 .. I’m really ridiculously pleased with the fact!) and had some really positive comments – so thank you to all of you involved in that, you have helped me to go ahead and actually get this off the ground.

I plan to use this blog to discuss eco issues … so whether you are ‘interestedly concerned’, already an activist, just want to help change the planet or a sceptic with more pressing concerns such as finishing work on time and your pension, I hope you will read on. I’ll be very pleased for lots of people from all sort of backgrounds to find themselves here, and hopefully even continue reading, but as I write I will be thinking about talking with other GP’s and will at times use a bit of jargon, or talk about things that are going around the medical press.

My plan will likely evolve – as all good GP treatment plans will – and I would like to invite your comments and thoughts – to hear your ideas and expectations (!) to make this as useful a resource as I can for all who are interested already and those who become interested.

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Living Differently

Once again I seem to have had a longer break than planned. I have started a new job 3 days a week and whilst it is officially only a half day (1 session in GP parlance) each day, what with the round-about commute via my daughter’s school and my total inability to run to time in 10 minute appointments it does seem to take up the whole day. Fitting in regular writing slots therefore becomes quite a challenge. However it was thinking about this issue that gave me inspiration for today’s article.

Living Differently is something I have always wanted to do .. but it’s a nebulous thought and hard to pin down. I do know that it probably doesn’t entail driving half way around London to get to a school and then a workplace – that seems to be rather too mainstream and boring to count as “living differently”.  I also know that for me it does not involve a commune or even a multi-family house. But is does involve change, and change that I somehow know will be hard to do and easy to have done. The sort of change that I’ll put off and put off more, then think “why didn’t I do that sooner”. However I also am concerned that it is something that to be fulfilled how I am starting to see it, needs other people to embrace the same sort of changes – and that might be rather more difficult.  

I should think for most of us who are concerned about environmental issues, food provenance, or rounded health and well-being we are aware that we can / want to / should make some changes …and we start by living outside of the societal norms of consumerism, one-upmanship, economic growth mind-sets and disposable culture. We eat sustainable food; go to refill shops; upcycle our stuff; minimalise; swap, share and borrow; support environmental charities and fair trade; switch our car to electric; take the train; go glamping in the UK; use ethical banks and many other good. But is this really the “living differently” I crave? … And more importantly is it enough to make any difference?

Really living differently requires thinking outside the box, and if I’m honest I don’t really know where to start. Our entire lives are lived within a particular culture (or maybe 2 if we have immigrated from far-flung places or grown up in a country that has switched from communism to capitalism). We know only what we know, and thinking outside of that is challenging.

If I picture what I really mean by living differently I mean something like this:

I mean living in a community whereby everyone lives and works locally; where my work benefits you and yours benefits me; where many of us grow food for our community and those nearby – some do it as a hobby or a connection and social thing and a few do it as a job; where our children play outside together; where our roads are quiet and our bikes need constant attention due to their frequent riding; where we meet for coffee knowing that the coffee was grown organically, paid for fairly and transported cleanly, the milk is local and the cake is home baked; where the food we have to buy in from elsewhere is not packaged in plastic or filled with chemicals and where it is sold from shops that support not only our community, but the communities and environments from which they buy.

On top of this I also mean living near to those I know and love; having my extended family and my long term friends near-by; having mental and emotional capacity to welcome and get to know all those I don’t in the vicinity; of living life – not on top of each other (I’m quite and introvert and need my space) but in community with each other.

I know the benefits of all of this.

At the very least it will help to combat loneliness, depression, social isolation, drink and drug issues, crime, particulate pollution levels (and therefore asthma attacks), obesity (due to better metabolic health from better eating and more outdoor stuff), rubbish pollution, plastic waste. I’m sure there are many other things that would fall into place too

But I have no idea where to start and this fact leaves me feeling quite stuck.

The issues I see are around how those changes affect others, and how those changes don’t work if it’s only me that changes.  

If anyone has any ways to get unstuck I’d love to hear them.

If anyone wants to build Utopia with me, let me know .. but don’t expect a rapid response – the reality of change is always scary.

Covid Vaccination Ethics Essay

As many of you will know I really started this blog to talk about diet and health – and I will be continuing this long term .However through the pandemic I have written a few articles about my concerns of it’s handling and the changes to our society this has brought / may bring about.

This post is an essay I wrote for myself and then decided to send out to colleagues. I have not had a huge amount of feedback from it – so I don’t know if it has sparked debate, been ridiculed or been simply accepted as obvious, but for various reasons I have now decided to make it public. Some of it is thankfully moot now as the horrible idea of vaccine mandates has gone away (for now) in the UK…. but there are wider principles here that I think we all need to keep in our minds.

This therefore is a summary of my learning over the last 2 years and particularly the last 8 months. The conclusions are those I have come to personally from my extensive reading. I realise that others may not draw the same conclusions, although I do believe that the ethical guidelines we are expected to follow are fairly clear. I hope and pray you (particularly fellow medical professionals) find it useful and informative.

The references I have included are a small subset of all the information I have taken in over the last 18 months or so. Whilst they are not all related directly to the vaccination / mandate they have all gone some way to shaping my current understanding and views. I have tried to order and sort them for ease.

INTRODUCTION TO ETHICAL GUIDANCE

As Doctors we are bound by various oaths and asked to follow numerous pieces of ethical guidance. The documents that I feel are pertinent for GPs being asked to either take part in the vaccination campaigns or provide exemptions are:

  • The Hippocratic Oath / Declaration of Geneva
  • The International Code of Medical Ethics
  • The UNESCO declaration on Bioethics and Human Rights
  • The GMC’s Good Medical Practice
  • The Nuremberg Code

The following are the most relevant statements from those documents:

Declaration of Geneva (2006)

  • I solemnly pledge to consecrate my life to the service of humanity;
  • I will practice my profession with conscience and dignity;
  • The health and wellbeing of my patient will be my first consideration;
  • I will not use my medical knowledge to violate human rights and civil liberties even under threat.

International Code of Medical Ethics (2017)

A physician shall –

  • Always exercise his/her independent professional judgment and maintain the highest standards of professional conduct.
  • Respect a competent patient’s right to accept or refuse treatment.
  • Not allow his/her judgment to be influenced by personal profit or unfair discrimination.
  • Be dedicated to providing competent medical service in full professional and moral independence, with compassion and respect for human dignity.
  • Deal honestly with patients and colleagues, and report to the appropriate authorities those physicians who practice unethically or incompetently or who engage in fraud or deception.
  • Not receive any financial benefits or other incentives solely for referring patients or prescribing specific products.
  • Recognize his/her important role in educating the public but should use due caution in divulging discoveries or new techniques or treatment through non-professional channels.
  • Certify only that which he/she has personally verified.
  • Act in the patient’s best interest when providing medical care.
  • Respect a patient’s right to confidentiality. It is ethical to disclose confidential information when the patient consents to it or when there is a real and imminent threat of harm to the patient or to others and this threat can be only removed by a breach of confidentiality.

UNESCO Declaration (2005, Article 6)

  • Any (all) preventive, diagnostic and therapeutic medical intervention is only to be carried out with the prior, free and informed consent of the person concerned, based on adequate information. The consent should, where appropriate, be express and may be withdrawn by the person at any time and for any reason without disadvantage or prejudice.

GMC – Good Medical Practice (subsection: Ethical Guidance for Doctors – Decision Making and Consent. Paragraphs 69-75 in particular)

  • Many factors influence patients’ decision making, but it’s important that nothing influences a patient to such an extent that they can’t exercise free will. If a patient can’t make a decision freely, they won’t be able to consent
  • Patients may feel pressure to have particular treatment or care. Pressure can come from others – partners, relatives or carers, employers or insurers – or from patients’ beliefs about themselves and society’s expectations.
  • You should be aware of this possibility and of other situations in which patients may be particularly vulnerable or susceptible to pressure
  • You should do your best to make sure patients reach their own decision, having considered relevant information (see paragraph 10) about the available options, including the option to take no action. You should support them to make a decision, following the steps in paragraphs 27–30 as well as:
  • giving them more time and a safe, quiet space to consider the options
  • making sure you have an opportunity to talk to them on their own
  • signposting them to specialist support services.
  • You must make sure your patient is aware that they have the right to choose whether or not to have treatment. You should not proceed with treatment or care if you don’t think it will serve the patient’s needs.
  • If, after following the guidance in paragraphs 72–74, you still believe a patient is under such extreme pressure to agree to or refuse a particular intervention that they can’t exercise free will, you should seek advice through local procedures, consult your medical defence body or professional association or seek independent legal advice. The Court may be able to make declarations and orders to protect adults where they are not able to freely make a decision.

The Nuremberg Code

My inclusion of the Nuremberg Code here is possibly controversial as it relates only to experimental treatments. Whether it therefore applies depends on whether you believe the vaccines still fall into the category of experimental. Having looked at a wide range of opinions and data, I believe they do however, I hope even if you do not feel this element is relevant, you will see the ethical principles above as enough to have concerns.

Whilst it is true that many aspects of drug development and approval are held up by red tape, and maybe do not need to take the full 10 years that is often quoted, it is also true that long term safety data, by its very definition, cannot be obtained truthfully in short-term or reduced length trials.  The phase 3 trials, of all the covid vaccines to date, are still underway and the first reporting form them is not due until 2023. For this reason I think it is relevant and appropriate to include the Nuremberg statements. Statements 1,3 and 10 are the most relevant.

  • Statement 1: The voluntary consent of the human subject is absolutely essential. This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, overreaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him to make an understanding and enlightened decision. This latter element requires that before the acceptance of an affirmative decision by the experimental subject there should be made known to him the nature, duration, and purpose of the experiment; the method and means by which it is to be conducted; all inconveniences and hazards reasonably to be expected; and the effects upon his health or person which may possibly come from his participation in the experiment. The duty and responsibility for ascertaining the quality of the consent rests upon each individual who initiates, directs, or engages in the experiment. It is a personal duty and responsibility which may not be delegated to another with impunity.
  • Statement 3: The experiment should be so designed and based on the results of animal experimentation and a knowledge of the natural history of the disease or other problem under study that the anticipated results justify the performance of the experiment.
  • Statement 10: During the course of the experiment the scientist in charge must be prepared to terminate the experiment at any stage, if he has probable cause to believe, in the exercise of the good faith, superior skill and careful judgment required of him, that a continuation of the experiment is likely to result in injury, disability, or death to the experimental subject.

THE ILLNESS, BASIC IMMUNITY AND THE VACCINES

Since SAR-CoV-2 emerged in late 2019 the understanding of it has grown, and the virus has mutated. We know that Omicron is much less lethal that Alpha. We know that over the 2+ years so far there have been literally thousands of strains and sub-strains (see references). We also know that in general the lethality in the older population and those with metabolic syndrome related disease is higher than that of flu, and in the younger and healthy population it is significantly less than flu. The most up to date IFRs show figures 4.9% for over 70s, dropping to 0.0013% in <19s. This includes data up until mid-2021, so does not include Omicron data. (Omicron is showing lower IFRs across the world in vaccinated and unvaccinated).  (See references).

Data on infection rates and hospital admission is on the ONS website, but can be quite difficult to interpret in terms of what it might show for an individual. However there is an API website which is more easily navigated and can be helpful. https://app.powerbi.com/

We now also have data from across the world, but particularly from Israel who have been ahead of the game in their information gathering, that suggests natural immunity confers both broader and longer lasting protection than vaccine immunity (see references). There are other studies that find vaccine immunity may be better in the short-term, but at what cost – both financial and health risk?

Where it is safe to do so, allowing natural infection could give better immunity to the individual, and give us useful data to study this further. Long-term it is very likely to provide better herd protection, especially given how soon people have been needing vaccine boosters. Independent studies in this area are much needed. It is for these reasons that I think it is good that we were able to vaccinate the old and vulnerable – those for whom it is not “statistically safe” to catch Covid – but not necessarily good to vaccinate those who are statistically at very little risk (either due to age / health, or having recovered from a previous Covid infection).

We in the GP profession are used to providing the service of vaccination, and usually do so willingly and without worry. However I believe there are differences in this vaccination programme that we should potentially be concerned about:

  • Vaccinate those for whom this illness poses almost no risk
  • Vaccinate those who have already recovered and therefore have immunity
  • Vaccinate those who are being (even willingly) coerced – initially free football tickets / cinema tickets / fast food vouchers, now escalated to “no jab no job”
  • Vaccinate without providing risk benefit analysis / discussion
  • Use a product still in phase 3 trials (not due to finish until 2023) and under EUA*, giving it to large swathes of the fit and healthy population, without due and appropriate information.

On top of this we now know the effectiveness of the Covid vaccine is well below what was initially thought and what it would need to be if we were wanting to aim for wiping it out / stopping it in its tracks. (see references). We can also clearly see that even these effects are waning against the newer strains (Dr Steve James describes this well).

With regards to safety, the data from the Yellow Card reporting system and the US equivalent (VAERS) is damning (see references). Even allowing for an element of population hysteria and therefore increased reporting numbers, the safety profiles of these vaccines appear “problematic” to say the least. There are known and acknowledged short-term risks including myocarditis, blood clots (including VITT), neurological disorders (including Bell’s Palsy, Transverse Myelitis and Guilenne-Barre Syndrome) and anaphylaxis, and the long-term risks are completely unknown – including any impact on fertility, carcinogenesis or autoimmunity – as the vaccines have not completed phase 3 safety trials (see letters linked and references within them).

Finally, these vaccines are not fully approved. They have Emergency Use Authorisation only. I have looked at how this is granted, and it can only be granted IF there are no alternative established treatments available. The wording of this could mean that there would have to be an alternative vaccine, however as the vaccine trials have only looked at reducing severity of symptoms it ought to mean there is no other drug that would reduce the severity of the symptoms. I am not convinced that this is the case (see references).*

CONCLUSION

Firstly as a doctor my first obligation is to the patient in front of me. Failure to act in my patient’s best interest is criminal negligence. (see references) In my 20 years so far in medicine there have been a handful of occasions where I have felt a pull from relatives / colleagues / bosses to do one thing, but have felt I needed with the patient’s permission and in the patient’s best interest to do something else… but only a handful, and in reality only minor – things like sending an elderly man back to hospital when he was obviously (and he agreed) discharged too soon, despite his wife asking him to “see if he could cope at home” and the on-call not being keen to have him back; or fighting for a patient to be moved by the council from third top floor flat when they had suffered an RTA leaving them with severe back problems and an amputated leg. But generally I have found that in the UK, with free-at-the-point-of-service healthcare the patient’s best interests, the policies and procedures of the NHS and actions of all professionals involved have tallied up.

However now I believe that situation has changed. 

I consider that, as a doctor, I have been placed directly between our patients and the state. – The state gives me my livelihood, but I owe my patients my best ethics and morals.

Currently it seems to me that as a doctor I am in a position where in order to protect patients and uphold the ethics on which our profession is built I will knowingly have to go against the express wishes of the state and their policies which are being enacted by the NHS.  

The government has asked my profession (General Practitioner) to ensure that as many people in the population are vaccinated against Covid as possible, and they have asked those working in mainstream NHS General Practice to deliver that vaccination programme. Within that policy is: the inclusion of those for whom the illness of Covid presents almost no risk; those who have recovered already from Covid and therefore have a reasonable (if not excellent) degree of immunity; and now also some for whom it is no longer a free choice to which they can legally consent.  (See references below).

I do not understand how as a doctor, upholding the ethics above, I can ignore the threat of mandatory vaccination (or other intervention) and practice without protest in an environment whereby our ethics have been usurped. If mandatory vaccination of NHS staff (and already of social care staff) goes ahead I do not see how it is possible to fully uphold the ethics above. If I choose to remain in the system to try and protect as many patients as possible from the corruption that loss of ethics brings, I conclude that I must exempt a healthy working age individual from vaccination if they ask for it and I must continue to fight against the use of any mandatory interventions in this and future situations.

Furthermore I conclude that I am not able to recommend vaccination, or partake in the delivery of the vaccination programme, of anyone under 18 (and probably under 24 or even 30) who is otherwise healthy, as I believe the risks of vaccination outweigh the benefits for these individuals. (see open letters and safety concerns references)

Secondary to this I also believe that as these drugs do likely fall under criteria of the Nuremberg Code, given that their phase 3 trials do not come to an end until 2023, the level of consent required (and the amount of time needed to ensure each patient is aware of their position) renders the programme of mass vaccination impossible and therefore I am not able to participate in that programme. I do not believe that the mass vaccination programme of those who are fit, healthy and at low risk has been ethical, moral or justified, and therefore I believe that I have a duty to act (in the best interests of my patients) to discourage those for whom risks of vaccination could well outweigh benefits.

Furthermore I have come to believe through writing this, that it is the failure of the medical profession to stand strongly on our ethical principles and scientific understanding from the start that has allowed things to get this far and vaccination mandates to even be considered. Others have suggested that maybe we just retreat and count this as “losing a battle” rather than walking away from the war, however I believe that this is sacred ground we would be giving up, and that return from that is likely impossible without many more casualties along the way. 

This is a subject on which I believe the medical community should have come together so that we could dialogue, stick to our medical guidelines and treat each other and our patients with compassion and respect. In many ways it seems that the time for debate is past, and it deeply saddens, and at times angers, me that more in our community are not standing up or openly wrestling with these issues. However it is never too late to start standing up for what is right, and I hope I and others can continue to do that throughout my lifetime. 

ADDENDUM: I understand the vaccines now have CMA (Conditional Marketing Authorisation) rather than EUA – The MHRA describe CMA as being granted “where there is comprehensive clinical data that is not yet complete, but it is judged that such data will become available soon”

REFERENCES

Strains and sub-strains

https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/

https://www.nature.com/articles/s41598-020-70827-z

Mortality Risks (general, excess deaths and by age)

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregistrationsummarytables/2017

https://freopp.org/comparing-the-risk-of-death-from-covid-19-vs-influenza-by-age-d33a1c76c198

https://ourworldindata.org/grapher/excess-mortality-p-scores-average-baseline?country=NOR~GBR~USA

https://ourworldindata.org/excess-mortality-covid#excess-mortality-p-scores-by-age-group

https://www.nature.com/articles/d41586-021-01897-w

https://www.ukmedfreedom.org/open-letters/open-letter-to-mps-re-covid-19-vaccine-mandates-for-employees (contains IFRs by age group)

Natural vs Vaccine Induced immunity

https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v1

https://www.science.org/content/article/having-sars-cov-2-once-confers-much-greater-immunity-vaccine-vaccination-remains-vital

Safety concerns

https://www.bmj.com/content/375/bmj-2021-068665

Emergency Use Authorisation and other treatments

https://www.duke-nus.edu.sg/core/core-regulatory-perspective/making-sense-of-emergency-use-authorisations-(euas)-for-covid-19-vaccines-and-considerations-for-the-road-ahead

https://en.wikipedia.org/wiki/Emergency_Use_Authorization

Criminal Negligence

https://www.gov.uk/government/organisations/civil-service-medical-profession/about

Extra information, and useful organisations:

https://www.covid19assembly.org/

https://www.ukmedfreedom.org/resources/evidence-database-links

https://www.promic.info/informed-consent

https://www.promic.info/discrimination

https://www.pandata.org/

https://www.youtube.com/watch?v=CwQpg62Kflg https://www.ukmedfreedom.org/open-letters/ukmfa-open-letter-to-royal-college-of-gps-rcgp-re-prevention-and-treatment-of-covid-19

Breakfast Smoothies

I haven’t written for ages as once again I was consumed by covid-based thoughts (a similar vein to Dr Malcolm Kendrick if you want to check out his blog), yet wanting to write about food…. However as spring comes into bloom the cold fog in my brain is lifting and new food ideas are springing to mind. This year, this has been helped along by the new discovery of an independent supermarket near my daughter’s school; one of those treasure trove places you are more likely to find on a remote Greek island, where I want to buy one of everything (just to try) and all the tomatoes (because they are so darn good you can smell them as you walk in). Definitely a REAL FOOD place. I have discovered the delights of potato flour, urid dahl, kabanos and multiple ways with pickled vegetables (not to mention brine kept cheese!)… but as I am still new to a lot of them, and they are not maybe the most commonly available food stuffs, I will write instead about smoothies.

Smoothies have become my new ‘best friend of the early morning’. My daughter’s new school regime requires us to leave the house rather earlier than we are used to, and she is in no fit state to concoct herself the type of breakfast (or eat it before leaving) that is needed to sustain her through all the dance and drama she is doing. A protein filled smoothie however, with a tiny bit of preplanning, and a chewable oat bar on the side does the job rather well. She can drink it in the car or on the train, on route to school.

Smoothies are inherently adaptable and almost anything goes, although there are 2 basic rules I would advise:

  1. Try not to put too many strong flavours together
  2. DO NOT mix milk with fruits containing citric acid (this is not only citrus fruits, but also kiwi, pineapple, nectarine and a few others) … it curdles.

Through using a mix of fruits and vegetables, varying what my daughter gets in her diet is not difficult. I buy a whole selection of different frozen fruits and before going to bed each night put a couple of mixed handfuls into a bowl to defrost. – That is the “tiny bit of pre-planning” I mentioned earlier. In the morning I add all the other things I want to put in it and whizz it up in the liquidizer. – 2 mins morning preparation tops.  

As I am making this for breakfast and my daughter is very active it is important she gets a good mix of proteins, fats and good carbohydrates. My basic additions are below, but there is also no problem missing any of these out if you don’t fancy them.

  • A raw egg – don’t be put off, it adds no flavour, and makes the smoothie smoother as well as giving the perfect kick of easily digest-able protein and some good fats filled with omega 3.
  • A handful of dark green veg – anything I’ve got in the fridge from broccoli to kale to lettuce, or a bit of frozen spinach if the fridge is lacking.
  • A spoonful of chopped nuts, milled flaxseed
  • A spoonful of live natural yoghurt
  • A spoonful of baobab powder and or Vitamin powders / drops
  • Some water, milk, nutmilk or fruit juice for extra liquid

Depending on the fruit / veg I will try to also add some herbs or spice – Ginger works really well in a green smoothie, vanilla or cinnamon in a berry based one, mint, basil or a smidgeon of chilli if I’ve used tropical fruits. Sometimes nutmeg or allspice make an appearance for variation.

With this she will eat a homemade oat and peanut butter bar (literally melt good quality unsweetened peanut butter with a bit of honey and stir in oats until it stick together, press into a tin and refrigerate, cut into bars) so that she is also chewing something to aid digestion and gut health.

The NHS talks about limiting smoothies to 150mls daily because liquidised fruit will give a lot of free free sugars and lead to tooth decay. I’m sure this is a problem if eaten in excess, however I believe their is a more fundamental issue with too much smoothie which needs to be combatted as we are giving them to our daughter at least 4 times a week. That is that not chewing our food leads us to not break it down properly and therefore can give rise to gut issues such as Bacterial Overgrowth (SIBO) and lack of satiety leading to obesity. For this reason eating something chewy whilst drinking a smoothie alongside can be helpful.

  1. Chewing our food helps to release more nutrients from it – not just from physically breaking it down but from enzymatically breaking it down.
  2. Chewing releases more saliva – which contains a number of those enzymes, and a gut protection agent to prevent harm to our oesophagus
  3. Chewing our food causes changes further down in our gut, due to the stimulation of messenger hormones, to actually help us also absorb more nutrients from the food.

https://www.intestinal.com.au/chewing-food

https://www.nhs.uk/live-well/eat-well/water-drinks-nutrition/#:~:text=Fruit%20and%20vegetable%20juices%20and,counts%20for%205%20A%20Day.

As I said smoothies are inherently adaptable, and if you don’t use vitamin powders in them, and stick to frozen berries/fruits unless you are growing your own, they are relatively cheap for the nutrition they provide. Just be wary of having too many and of having them by themselves and so not chewing – you won’t get the best from them if you do.

30 Plants a Week

Last week I was listening to a science podcast which was basically an interview with Tim Spector. I think it probably came out in line with the launch of his individualised diet app (which I have to say I can’t wait to try when it becomes available in the UK). He mentioned, as an aside in one of the questions, that the “optimum” number of plants to try and fit into a week’s diet was 30, and he went on to explain that this was not about portions, but about variety and is to do with improving the health of our gut microbiome.

As this is not really what the interview was about there was not a lot of detail. Because of this I’m not sure if things like flour count – although he did say “unprocessed plant food” so I guess probably not. However he did clarify that it includes even small amounts of herbs and spices. After listening I thought it would be interesting to count up the plants in my diet in one week as I thought 30 sounded like rather a lot.

I want to encourage you that in fact 30 is not nearly as hard as one might think. … although maybe easier if you like herby / spicy food as I do, than if you stick to the traditional meat and boiled veg of a 1950’s UK diet. I hope that my list below gives you ideas and inspiration. It is not in any way meant to put you off or look like a gloat!

Below is my list of foods consumed in 4 days. The plants are in bold and if part of a dish are held together in brackets, with the dish name in italics:

Saturday:

  • Breakfast – Pain-au-chocolat, Tinned peach, coffee, Pear
  • Lunch – Clementine, Celery, Cheese, Pate, (flavoured Houmous containing Lemon, Coriander, Chickpeas, garlic, sesame seeds)
  • Dinner – (spiced Butternut curry containing Butternut squash, peas, chilli, ginger, cinnamon, butter, cumin) (Chickpea and tomato curry containing chickpeas, tomatoes, coriander leaf -otherwise known and cilantro, coriander seed, onion, garlic, cumin, ginger) (Raita containing yoghurt, cucumber, mint) (Chicken tikka containing oregano, paprika, turmeric, cardamon, nutmeg, ginger, chilli, cumin, coriander seed, yoghurt) Cauliflower

Sunday:

  • Breakfast – toast, cheese, marmalade, tea
  • Lunch – carrots, peppers, aubergine sweet potatoes, celery, sage oregano, pork (all as a traybake roast) potatoes tossed in paprika, cauliflower, peas
  • Tea – bought pizza bases with home-done toppings – tomato, oregano, olive oil, garlic, olives, peppers, prawns

Monday:

  • Breakfast – Paleo Co granola containing coconut, almonds, sunflower seeds, pumpkin seeds, cashew nuts, almonds, brazil nuts, cocoa powder, hazelnuts, linseeds, chia seeds, cocoa nibs, with milk
  • Lunch – Cheese salad containing Lettuce, spinach, tomato, cucumber, peanuts, radishes, drizzled with my absolute favourite … salad cream!
  • Dinner – left overs from Saturday and Sunday with added eggs.

Tuesday:

  • Breakfast – scrambled egg with crispy onion bits and spinach
  • Lunch – cheese salad same as Monday
  • Dinner – (bean chilli black beans, onions, tomato puree, garlic, cumin, paprika, peanut butter, cocoa powder), rice, cheese, (salsatomatoes, onions, cilantro, mint), smashed avocado with black pepper and lemon juice

What this really made me realise is the value of herbs and spices in our diet. Since doing this a couple of weeks ago I have made sure that even if I am just doing traditional English food I try to add a herb to the vegetable, or a rub to the meat to increase not only the flavour but also the nutritional / gut microbiome value.

I want this post to encourage you to see where you are at with the “30 a week” idea, and see how you can easily add to it if needed.

10 Ways With Carrots

A few months ago I did a post “10 Ways with Eggs”. Since then as part of the Real Food Campaign I have agreed to do a few different “10 ways with” articles as resources for the campaign website, and thought I would also post some of them here.

Carrots are cheap, nutritious, and in my view delicious. They are also far more versatile than most people think. Carrots contain a large quantity of a compound called Beta-Carotene, which is an anti-oxidant (think anti-cancer, anti-aging, anti-chronic inflammation) that your body converts to vitamin A. It is this that gives rise to the “carrots help you see in the dark” saying – as vitamin A is necessary for good eyesight and healthy eyes. As well as this carrots contain useful amounts of vitamin K (helps with good blood clotting), potassium and several B vitamins, and are rich in soluble fibre.

A Simple Carrots:

  • Raw crunchy carrot sticks: Can be eaten alone or dipped in hummous, flavoured or plain mayonnaise, cream cheese, pate or even soft boiled egg.
  • Raw and grated: They can be added to salads or stirred with some finely shredded cabbage and a combination of mayonnaise and yogurt for a traditional coleslaw. (Side Fact – Coleslaw apparently originated in New Zealand, and according to the Kiwis should never have onion in it .. .but I will leave that to your taste buds. The yoghurt is used either with mayonnaise or alone, to give a quick and minor fermentation reaction, softening the vegetables and increasing their available nutrition by breaking down their cell walls)
  • Steamed or boiled: have fun cutting into all different shapes – circles, sticks, small cubes, long slanting chunks – and depending on the size of your pieces cook for 5-10 minutes
  • Roasted: cut into approx 5cm long 2-3cm wide chunks and toss with a little olive oil or melted butter. Add either some ground black pepper or some ground coriander +/- dried coriander leaf. Stick in a hot over for 20-40 mins depending on your oven and your desired finish.
  • Mashed/pureed: cut into chunks and boil in only a small amount of water until soft (10+ mins). Use a masher or stick blender to mash to a pulp. Add a bit of salt, pepper and butter. Can be also combined with other root veg.
  • Pickled: Grate or thinly slice carrots and press into a sterilised and still warm glass jar. Add bay leaves / juniper berries (do not use juniper berries if pregnant) if you wish. Bring some pickling vinegar up to the boil and whilst still bubbling pour into the warm glass jar, until carrots are covered. Seal with lid and leave to cool. Can be eaten as soon as cold or left for a few days to mature. – keeps in the fridge about 4 weeks. Eat like all other pickles.

B Carrot Recipes:

  • Halva: A sweet Indian desert, sort of similar to rice pudding really. There are loads of recipes out there, but the basics are as follows – Grate carrots, and put in heavy bottomed pan with some milk, a cinnamon stick (or tsp ground cinnamon), some cardamom, and optionally a bit of turmeric (gives a more earthy flavour) and/or some cloves (add a slight spiciness). Put a lid on and simmer slowly until complete mush. Turn off heat, stir in sugar or honey to taste (I only use about 1 tbs, but most recipes say a lot more than that) and some double cream. Serve warm.
  • Carrot Cake: I’m sure you can find many recipes. This was originally a recipe from the wartime Ministry of Food, but it was clearly one of the better ones and has stuck around, albeit with added sugar (which is actually not needed at all to make the cake), butter and cream cheese!
  • Carrot pancake: make pureed carrot from above. Break eggs into a bowl, add a little flour to pull it into a dollop-like batter, then add the carrot puree. If needed add a little extra milk or water to create a pancake batter consistency, then cook as usual for pancakes. Best served filled with curried potatoes and chickpeas, but also remarkably good with stewed apple and a little maple syrup.
  • Carrot infused quiche: Similar to the pancakes, simply add carrot puree into the beaten eggs, with some salt and pepper. Part fill a pastry case with other quiche fillings (ham, cheese, roasted mediterranean veg etc – avoid fish, it doesn’t work at all with the carrot flavour-wise) then pour the egg and carrot mixture over and bake for 40 mins like a normal quiche

I hope you enjoy some new ideas here, and as I am always saying with food – muck about with it and try your own ideas.

Seasonal Eating

Anyone else find it harder to eat healthily in this ridiculously cold 2021 Spring season than they normally do? I am craving hot chocolate, pastries, maybe even a suet pudding and custard, and definitely a rich meat and root veg stew. It got me to thinking more about seasonal eating.

We all know that seasonal eating is better for the planet (less mileage, less chemical input etc) but there is now increasing evidence that seasonal eating is also better for us.

Firstly, and not surprisingly, the food (we are talking fruit and veg here really) is likely to have more general micronutrients (vitamin and mineral content) in it. It will be relatively more local and so has been picked ripe (rather than under-ripe to allow for long travel time) and it has not sat for so long between picking and consumption. As a plant matures or ripens it draws more nutrients from the soil / converts more from the sun so its nutritional value increases. As it sits once picked, before eating, micronutrients start to degrade and so its nutritional value reduces. … so veg from across the world has the double whammy of not having had so long to gain vitamin and mineral content whilst ripening, and losing much of the little it did have in transit.

Secondly, the food we produce local to where we live, is dictated by soil and climate conditions…. and we, it transpires are also affected by those conditions. What we need in terms of nutrition in the the winter, is slightly different to what we need in the summer. Water rich fruits and vegetables grow in the summer – preventing us from dehydrating, along with fruits such as tomatoes that contain caratinoids to help our skin protect against sun damage. In the autumn and winter we get the rich, heavier root vegetables that give us increased starches to help us guard against the cold – both by giving energy to produce more internal body heat, and by making us fatter – literally giving us the ability to put on a layer of insulating fat. We also get the really dark green winter cabbages – full of compounds that help beat the winter blues. In the spring many of our native seasonal veg contain high levels of antioxidants to help rejuvenate our bodies after the winter shut-down.

So I guess the reason I am still craving those high energy, high starch foods, is that the weather is still cold and grey and miserable. I still need energy to create my own warmth. And the reason I’m still craving chocolate? – At this time of year I am usually increasing my serotonin levels through sunlight exposure… but without that I need the tryptophan of chocolate to do the same thing.

Hospital Food

I have recently had the experience of being a hospital inpatient. This was for a planned orthopaedic procedure and took place at a prestigious NHS hospital. In the admissions lounge (which doubles up as follow-up clinic) there is a poster that says “Are you on the MEND” with MEND standing for Medications, Exercise, Nutrition and something I can’t quite remember right now with my painkiller addled brain! It gave me hope that maybe my food in hospital would be ok. … probably the thing I had worried about most, and certainly the concern that had most effected the amount of luggage I was now carrying. Obviously we in the UK are all aware of the stereotype of hospital food – much like that of 1980’s school dinners – but most of us also know, or presume at least that things have moved on. We just don’t know by how much.

So, aware I was going to be in hospital for around a week, unsure how much food a standard portion would be (I eat rather more than your average 90 year old having a hip replacement or in with the flu), on opiate painkillers after the op (which cause excessive constipation), and with no visitors to bring me grapes due to the ongoing Covid restrictions, I had armed myself with a huge number of high fibre foods, some kombucha and a decent amount of extra protein in the form of bags of nuts, and some actual beef collagen powder.

To be fair, the care at the hospital was exemplary: the ward staff helpful and kind; the surgeon, a good bedside manor; the anaesthetist fully understanding of all my worries about being put to sleep; the other patients in my bay a pleasure to be with. … but the food, and indeed some of the staff serving it, were well .. random. Some was actually very tasty, some seemed to be home cooked, but other meals were most definitely prepacked microwave, aeroplane type concoctions – on one day even served in their plastic tray rather than on a plate. One day I was allowed a cheese salad as a side to my main choice, the next I was told salad was a main meal and I couldn’t have 2 main meals. (To clarify here, the salad was not a main meal unless you were a 4 year old at a party – half a tomato sliced, approx 2 leaves shredded iceberg and 4 slices of cucumber, with a slice of ham / cheese / an egg or whatever other protein you’d asked for with it and the other main meal I wanted did not come with added vegetables – it was only bean stew and rice.) It gave me and my fellow bay-mates some good laughs albeit if with a tinge of frustration.

Nutritionally speaking, when recovering from trauma of any kind one has an increased calorific need. As well as this there is a need for certain specific micro-nutrients, that may be different depending on the surgery that has been done, and increased protein for all to aid healing. Bones obviously require increases in calcium and vitamin D, whilst and vitamin C and zinc support collagen repair (ligaments and tendons) and decrease inflammation. Omega 3 also helps reduce inflammation and it is also thought that green vegetables and brightly coloured berries can be particularly good at decreasing inflammation around orthopaedic sites due to their antioxidant effects.

So how did my hospital food fair when looking at those nutrients.

I believe I did get enough protein, particularly when I added in my home brought nuts. I also think that through my own considered choices I got enough calcium (yoghurts for breakfast – although some days I couldn’t eat them as they were so sweet – and cheese and crackers as pudding). A few days running I ate the offered salmon – so that ticks my omega 3 box. .. and certainly it was good that each day had the same, but varied menu. However I did not get anywhere near enough in the way of green vegetables and fruit. – meaning that my zinc, vitamin C and vitamin D levels were probably compromised and that my (and all my bay-mates) bowels were problematic.

I had taken with me a 1l carton of V8 juice; some beetroot, ginger and turmeric shots; kombucha; a packet of ground nuts and seeds (containing significant flax) for my breakfast yoghurts; nak’d bars (main ingredients cashew and date) and some dried fruit. These additions I think served me well – certainly I opened my bowels a full day or 2 sooner than my bay-mates – but I question whether they should be needed.

I am so grateful for everything we get on the NHS, and I am aware that fruit and veg, in our topsy-turvy world, cost more than docusate and senna (laxatives), but when a hospital wants to remain at the top, and get the best results for each patient, maybe the nutritional element of recovery should be factored in a little more to their food choices. Maybe we, as patients in the modern world where money is tight, will have to bring in our own extra food, but I do think that if that is the case we should at least be provided with a list of what might be helpful. It should not rely on the knowledge of the individual patient to affect the recovery experience they have.

More about Ethical Sustainable Real Food

I’ve written a fair bit about “real food”; What I mean by it and why I think it is important. Many of you who have seen my posts before will know that I am an ambassador for the Real Food Campaign (RFC). However today I am going to introduce a slightly different way to think about food … the LOAF acronym. This focuses on food and it’s production and manufacture being loving to all the people, plants and animals involved in its chain.

LOAF stands for Local, Organic, Animal Friendly and Fairtrade, and it is used in various settings including my church to talk about loving our neighbour and caring for our planet. A few years ago several of us at my church decided to try and get through Lent buying only LOAF fitting foods. It was much harder than you would think, and certainly significantly more difficult than it surely should be. I went on my first shop armed with a small and I thought very simple shopping list:

  • Apples
  • Milk
  • Carrots
  • Potatoes
  • Sausages
  • Chicken
  • Eggs
  • Chocolate

It was February. I know from experience growing up with my parents that home-grown apples can easily be stored over winter, and that carrots are often still being harvested in February. I also know from my history lessons that Queen Victoria was purported to eat a different variety of apple every day of the year, from her own orchards. (Myth maybe!) Yet in my local supermarket I couldn’t get any UK grown (let alone local) apples. I also could get any organic carrots and was told by the assistant very convincingly (but wrongly) that the season was shorter for organic veg, so the organic carrots had ended. I managed ok on Potatoes – organic from Lincolnshire (I’m in Hertfordshire, so ok, but not brilliant from a food miles perspective), RSPCA assured, organic and free range sausages, and the same for chicken (very expensive, but that’s why we have it rarely). I got some organic fairtrade chocolate, and the milk was organic, but had travelled across the country several times being apparently a “mix from farms in Herefordshire and Yorkshire”. So out of the 8 things on my shopping list I had got organic for most, local for almost none, fairtrade for the one needed. I have to say, that the the local issue really bothered me and I gave up. … One tiny shopping trip and I lost the will to continue.

It really made me think. I am passionate about the right food from the right places with the right credentials. … So passionate I sometimes end up paralysed in the middle of the supermarket unable to decide whether to buy the organic apples from South Africa or the non organic ones from the UK. (Why I can’t have organic from the UK I don’t know, they are a native and staple crop!) If I find it hard to buy within good sustainability ethics – when I have a good budget and the passion to try, how would others not so passionate, or without the budget possibly fair and what could we do to make it easier?

I am still wondering.

I think encouraging people to grow their own, eat seasonally and buy from local farms if possible is good (as per the RFC), but I also think that maybe we need to see bigger. We need to find ways to encourage the supermarkets to think LOAF. – Maybe asking them on social media, writing into their head office, taking in leaflets to leave on the checkouts. I’ve done all of these now at various points, but it’s never going to be a quick and easy win. Maybe I should also think about writing to my MP (although he’s bored of me at present with my covid related letters to him), or as we are going to try and do through the RFC, maybe a group of us can find out about any local co-operatives that we could advertise to others by word of mouth.

The idea of LOAF food is to be better for people and planet. Personally I feel that LOAF buying and Real Food are hugely intertwined. Both require a level of commitment, but both can be ways of bringing joy into our eating, rather than just eating for the basic nutrition – although we might also find the nutrition is better. We just need to find a way to ensure it is easily accessible to all, and the choice to change is a simple one.

Can we have more of all good things?

Last week I had an addition to my regular veg box – a magazine by the amusing name of “WickedLeeks”. It seems this is something I have been missing in my Riverford experience, as it turns out they have quite an active website. https://wickedleeks.riverford.co.uk/ I was very pleasantly surprised by the content, which I found far more interesting to read than my regular BMJ and BJGP medical journals. (Particularly at the moment when one cannot escape “covid this and covid that on every page”) One article in particular caught my eye, and I thought was worth writing about.

The article is called “Ecological Farming Can Feed UK if Diets Change”. – Not the catchiest title, but the picture of walnuts at the top caught my eye. – It is about a recent report commissioned by the FFC (Food and Forestry Commission) in which the question being looked at was “is it possible to feed the UK through agroecological practices?” and fantastically they have found that the answer is Yes. In fact they have apparently shown that a decrease of 38% carbon output would occur almost as a by product of using a model that has numerous other benefits:

If we were to switch to the model suggested we would end up with:

  • increased biodiversity
  • increased soil health
  • increased tree coverage
  • increased self-sufficiency of the country
  • decreased pesticide use
  • decreased food miles
  • decreased processed foods and refined sugars in our diet

In order to achieve this we need to switch as a nation from a diet based on pork, chicken, grains and refined carbohydrates to a diet high in nuts, vegetables, “home grown” eggs (of course giving us occassional chicken meat from what is called “spent hen”) and a reasonable (but not high) quantity of meat (and hopefully dairy) from non-intensive naturally grazed, calf-at-foot ruminants (cows and sheep), whose grazing will help increase soil fertility and biodiversity. To me this seems like there is a possibility of “More of All good things” – rather than a trade off, one good thing for another. That’s really exciting!!!

When I read about the changes needed in the UK to make this work I thought “that’s my diet” .. which was a pleasant surprise, as I’m always worried my bi-weekly, much enjoyed, joint of beef is killing the planet. It is a diet I’ve pretty much been on for the last 10 years, and as such I can say with quite a lot of conviction that it’s a good one. I won’t say it will be a miracle diet, or even that everyone will find it easy to change, but I want to encourage you to try it. … Personally since switching from grain based to more nut based diet, and since I have “Cut the CRAP” (Colourless, Refined, Artificial, Processed) foods I have more energy, I sleep better, I have less pain in my back, I no longer get frequent reflux or IBS symptoms, I have lost weight, I have better skin, my nails and hair are super-healthy.

The down side at the moment is it’s really expensive and a lot of the nuts I eat come from abroad. …. But they don’t need to, and if we grew them in the UK we’d have these gorgeous trees lining our streets, gardens, parks etc too. In fact I looked up nut trees native to the UK and there are 5 – Hazel (some versions of the nuts are called cobnuts, who knew they were the same?), walnut, sweet chestnut, beech and oak ( I did not know acorns were human-edible!). How amazing would that be. .. and it really does make me wonder why we clear trees to make space for grains!

I really hope this commissioned study is taken notice of and it’s plans and ideas are put into action. I dream of a food-based utopia in the UK – and if we do this properly maybe we’ll be heading in the right direction, and surely that is worth making some changes for.

10 ways with eggs

I have become an ambassador for the fledging organisation The Real Food Campaign. One of the jobs I will be doing within that is helping to create a resource of recipes and ideas for those who are wanting to switch to Real Food. (see either the real food campaign website above or my post https://ecogreengp.home.blog/2019/11/28/real-food/). We believe that real food is all the things I am passionate about, and that it boils down to “Good for You, Good for the Planet”.

I thought I’d begin thinking about ways to use eggs. As I written about our chickens before, we clearly eat (a lot) of eggs. Eggs are definitely good for us, and if the chickens are treated well, and fed well then chickens and eggs can be good for the planet. Maybe we can’t all go as far as the HomeAcre homestead (https://www.theselfsufficienthomeacre.com/2019/09/your-guide-to-raising-eco-friendly-chickens.html) but we can make small steps – buying local and/or organic, keeping your own free range flock (until a few weeks ago when a fox got in we had 6 chickens in our garden – fed with a combination of chicken feed, weeds from the garden and leftovers from our plates – we will be getting more as soon as lockdown allows) or even going in with some friendly ‘allotment neighbours’ for a few chickens on the plot.

Here are ways to then cook your eggs to give yourself a non-meat protein boost and not end up feeling everything is ‘too eggy’.

A. Simple Eggs

  1. Boiled: Medium or Soft – with toast soldiers or cucumber sticks as my daughter prefers) or peeled and smashed onto toast / onto a salad / into a sandwich; Hard – in a lunch box to eat whole, mashed with mayonnaise, sliced and added to rice dishes (kedgeree anyone?)
  2. Poached
  3. Fried
  4. Scrambled: by themselves or with cream and butter – different people in my household say different things about these. You can leave it soft or cook it longer. Keep going long enough and you get what I call “crispy egg” – a bit like those onion bits you can get to sprinkle on salad.
  5. Baked / Coddled: these are really traditional ways with eggs, yet few people now know them … both require the breaking of egg(s) into a small oiled dish. For baked eggs those are just put into the oven as they are, for coddled eggs they are placed in a water bath before putting in the oven. They can be topped with (or placed on top of) ham / spinach or even cream / cheese etc or left plain.

B. Eggs Plus

  1. Take your simple scrambled egg and make it into a full meal by stirring in any of the following: cooked bacon or ham, cooked chopped veg (peppers, onions, leaks all work particularly well), cooked or raw mushrooms, a sprinkle of cayenne / dash of tabasco. Then tip it onto toast, or even better, a round of Irish Potato bread.
  2. Omlette – French or Spanish – two totally different meals with the same name in my opinion. – fill with whatever takes your fancy. French omlette is a fast meal, Spanish omlette takes a good while (an hour or more on the hob) as the potatoes should be slowly cooked in the olive oil until tender before the egg is added and then the whole thing kept on a low heat to set.

C. Egg Recipes

  1. There are a few thoughts on this in my post on breakfast (https://ecogreengp.home.blog/2020/02/14/eating-cheaply-healthily-and-sustainably-part-1/) – particularly recommend Berry Pancake which we serve at any time from Saturday morning for breakfast to dessert when having friends over for dinner.
  2. Egg Fry – this is basically a stir fry I do of whatever appropriate veg are in my fridge, along with some good seasoning, which I then add beaten egg to, in a slow steady stream, constantly stirring, so I end up with tiny bits of egg that I cook until crispy. … then just bung the whole thing on a plate.
  3. Yorkshire Puddings and pancakes – recipes people often don’t fiddle with, but are very adaptable and the egg quantity can be increased easily if you want it to be your many protein in a meal.

There are many many ways to use eggs – these are just a few.

Do let me (or better yet the Real Food Campaign) know your ideas.