When vegetarian diets aren't healthy

For decades, the media has espoused vegetarianism as a dieting regime. A recent example is the publication of the book collection by Kim Barnouin and Rory Freedman titled Skinny Bitch (Running Press, Inc.). Using an obnoxious, foul-mouth tone, the authors advocate a natural vegan diet to make you happy, healthy and, you guessed it, skinny.

But any true vegetarian knows that their eating pattern isn’t for the calorie-obsessed. They understand the importance of eating healthy portions of food that include a variety of high-energy items like nuts and seeds, legumes, whole grains, and in some cases high-fat dairy products. 

Being a vegetarian, especially a vegan, requires making a serious commitment; meals eaten at home and away need to provide enough protein, vitamins B12 and D, calcium, zinc, omega-3 fats and iron.

A low iron intake -- and the subsequent fatigue and “brain fog”-- is one of the biggest reasons a vegetarian lifestyle is abandoned. According to the professional association, Dietitians of Canada, vegetarian male and female adolescents, pregnant women and female endurance athletes are at the greatest risk of iron deficiency. This explains why the Recommended Daily Allowance (RDA) for iron for vegetarians is 1.8 times that of non-vegetarians. 

When carefully planned, vegetarianism can be a safe lifestyle choice for even nutritionally high-risk groups such as pregnant and breast-feeding women, babies, children, teens and seniors. 

However, the true motivations for being vegetarian may speak volumes about the quality of the diet and the state of one’s health. If the real intent of going veggie is about rigid weight control and not about animal rights, environmental sustainability, or the non-weight-related health benefits of vegetarianism, a dysfunctional relationship with food and body may be lurking.

Recently, the Journal of the Academy of Nutrition and Dietetics published a study that interviewed a small sample of vegetarian women who struggled (or once struggled) with an eating disorder. The researchers found that 68 per cent of the group perceived that their vegetarianism was related to their eating disorder, which emerged after the onset of their illness. 

As a clinician who has worked in the area of eating disorders, this study finding makes sense to me: at the onset of the illness a person can begin by dieting and avoiding fat, progress to excluding foods containing fat (such as meat and dairy products), and before long declare themselves a vegetarian. 

Vegetarianism doesn’t cause an eating disorder; many different factors come into play to kickstart the mental illness. But the vegetarian way of life may help to disguise and maintain the disorder because it’s a socially-acceptable way to restrict food.

Many vegetarians aren’t dealing with a latent eating disorder. Yet, when it comes to population groups who tend to be extremely weight and shape-focused, such as male and female teenagers and endurance athletes, vegetarianism may be a signal to parents, teachers, coaches and health care providers that these individuals are struggling with disordered eating, if not a full-blown eating disorder.

Probiotics and Mental Health

We can’t deny the existence of the gut-mind connection. Ask anyone who suffers with irritable bowel syndrome or inflammatory bowel disease about the damning impact anxiety and stress has on their digestive tract conditions.

But what if our gut helped us cope better with anxiety and depression?

Researchers at Acadia University, in Wolfville, Nova Scotia, are pondering this very question. Dr. Susan Potter, a clinical psychologist, and Zoë Hunter, an honours psychology student, are investigating whether probiotics can enhance our mental health by improving the state of our gut. 

“Probiotics are food sources such as yogurt, cheese and fermented goods that contain beneficial bacteria that grow naturally in the body and support life. The probiotic connection in humans has been researched in reference to diarrhea, irritable bowel syndrome, immune system regulation, and others, but not yet to anxiety and depression,” said Hunter.

The inspiration for the study came from Dr. Potter watching an episode of CBC television’s The Nature of Things with David Suzuki. The show, titled The Autism Enigma, explored various prevailing theories for the developmental disorder, paying much attention to the bacterial theory: the impact gut bacteria disturbances in infancy may have on brain development. 

Overuse of antibiotics, food allergies and intolerances, or dramatic changes to traditional diet -- particularly in the case of immigrants -- are thought to be common culprits in disrupting the gastrointestinal microbial ecosystem.

Some scientists and parents of autistic children believe that probiotics can provide waves of benign, beneficial bacterial to the gut that outnumber nasty intestinal bugs -- bacteria that may be pathogenic and support the development of many disease conditions, including autism.

While Professor Potter’s area of research isn’t autism, she was intrigued and questioned to what extent an abnormal gut bacterial population might influence human behaviour in general. 

A review of past relevant studies revealed that probiotics can reduce anxiety and depressive-like behaviours in animals, such as mice and piglets, with these symptoms. Researchers propose that probiotics alter the stress receptors in the body.

“There are also anecdotal reports of improvements in anxiety and behaviour among humans following treatment with probiotics. However, controlled studies of the effects of probiotics on anxiety, depression and other aspects of nervous system functioning are needed in humans. This is why we decided to carry out this research,” said Potter. 

““This is the first [human clinical intervention trial] of its kind that we are aware of, ” added Hunter. “Probiotics are so accessible to the general public. The trial has huge clinical relevance. Wouldn't it be great if individuals suffering from anxiety and depression could benefit from simply eating more probiotics like yogurt and cheese?” 

Potter and Hunter launched the Probiotics and the Microbiome (meaning gut microbial ecosystem) study on August 1st and are recruiting participants from across Canada. To be eligible to participate, interested individuals must be Canadian residents over the age of 18 who suffer from symptoms of anxiety or depression, and currently not taking probiotics or antibiotics. 

A detailed list of eligibility requirements and a link to the online questionnaire can be found right here. The study enrollment deadline is September 7th, 2012. 

published in the Vancouver Courier, August 24th, 2012

Using Summer's Vegetable Bounty

If you have a vegetable garden -- or gone a little crazy at your local grocer or farm market -- you’re most likely looking for different ways to use summer produce. Look no further. 


Here are a couple of recipes, adapted from the cookbook, Everyday Food: Great Food Fast (Martha Stewart Omnimedia, Inc., 2007), that use the seasonal glut of zucchini, sweet peppers, tomatoes, and any other veggie you have on hand that would taste good roasted. For those of us who have a grill or barbecue, by all means, go ahead and put it to work. I’ve included a grilling option. 


Be sure to make the fresh salsa recipe to accompany the crisp tostadas. I rarely prepare my own salsa. But after tasting this recipe, I’m hooked. I don’t think I’ll ever go back to store-bought. 

photo by Linda Watts

Roasted or Grilled Summer Vegetable Tostadas
Serves 4


What You Need:
3 medium zucchini, trimmed and cut into 1/2-inch width pieces (about 1 1/2 pounds)
3 large sweet peppers, cored, seeded and cut into 1/2-inch width pieces
1/2 medium red onion, cut into 1-inch wedges 
5 tablespoons extra-virgin olive oil, plus more for grates if grilling
salt and pepper to taste
4 medium-sized flour tortillas
4 ounces feta or goat cheese, crumbled (about 1 cup)
1 lime, cut length-wise into quarters (optional)
basil for garnish (optional)

What To Do:
In a large bowl, toss zucchini, peppers and onion with 3 tablespoons of olive oil. Season well with salt and pepper. Lightly brush both sides of tortillas with remaining 2 tablespoons of olive oil. Set aside.


To roast vegetables, preheat oven to 450 degrees. Place zucchini, peppers and onion on a large rimmed baking sheet and roast for 20 to 25 minutes, or until golden and slightly caramelized (hint: to get this effect don’t crowd vegetables on the sheet or toss them around too much while cooking). In a medium, non-stick skillet, toast tortillas over medium heat for 1 minute on each side, or until golden. 


If grilling, heat the grill to medium-high and lightly oil the grates. Working in batches, grill veggies until tender and lightly browned. Total cooking time is about 8 minutes. Turn once during cooking process to ensure both sides are evenly grilled. Set aside. Grill tortillas for a total of 2 minutes turning frequently to prevent burning.


Immediately pile roasted or grilled veggies on top of each tortilla and dot with cheese. Drizzle with lime juice, if using. Serve with fresh tomato salsa.


Fresh Tomato Salsa
Makes 3 1/4 cups


What You Need:
5 vine-ripened tomatoes, cored and cut into quarters
1/2 medium red onion, finely minced (about 1/2 cup)
1 jalapeno chile (ribs and seeds removed), finely minced
2 garlic cloves, finely minced
1/2 cup chopped fresh cilantro
juice of 1 lime
1/2 teaspoon salt


What To Do:
Remove seed sacs from each tomato quarter and dice flesh into 1/4-inch pieces. Transfer to a medium bowl and add red onion, jalapeno, garlic, cilantro, lime juice and salt. Stir to combine and cover with plastic wrap. Allow to sit at room temperature for 30 minutes to allow flavours to meld. If making further ahead, place in refrigerator for up to 3 days.


published in the Vancouver Courier, August 3, 2012

Low Sugar Raspberry Jam

While juicy tomatoes, crisp corn-on-the-cob and multiple shapes of zucchini abound, nothing announces summer’s arrival like perfectly plump raspberries. Savouring the sweet-tart flavour of this delicate, velvet-textured fruit can be one of the most sensual experiences of the season.


Of all the summer produce available to us, a cup of raspberries is one of the highest sources of dietary fibre, not to mention a decent provider of the nutrients, manganese, folic acid, magnesium, vitamin C and potassium.


To boot, the professional organization, Dietitians of Canada, reports that some scientific evidence suggests that raspberries may decrease our risk of developing lung cancer because of its content of quercetin -- a powerful antioxidant that’s responsible for the bramble fruit’s intense red colour.


For maximum flavour and quality, it’s best to eat or freeze raspberries within one to two days of bringing them home. Because raspberries are highly perishable, extreme care should be taken when storing them. After removing any stems and spoiled berries, place the raspberries back in their original container, unwashed, and store in the refrigerator. When ready to use, lightly rinse the bramble fruit with water in a colander and drain well. Let dry on paper towels or an absorbent tea towel.


Raspberries can be frozen by spreading them out on cookie sheets and then placed in the freezer. After 24 hours, transfer individually frozen raspberries to a heavy plastic bag or container, label with the date, and put back in the freezer. The berries should keep for a year. Defrosting raspberries is best done in the refrigerator overnight. This allows the fruit to retain its shape as ice crystals slowly melt.



One of my favourite ways to prepare fresh raspberries is making a no-cooking-required freezer jam with little added sugar. The recipe uses pectin crystals that are specifically designed for freezer jams with a minimal sugar content and the end result maintains the fruit’s fresh, subtly tart, flavour. Be sure to use the Certo product indicated in the recipe below. Different Certo pectins are not interchangeable. 

photo by Linda Watts

Stash a few jars in the back of your freezer for the colder months ahead. On dreary, wet winter mornings, home-made raspberry jam will taste like sunshine spread on toast or dolloped on freshly-baked scones. It’s also delicious swirled into yogurt or as a topping for ice cream or pavlova.




Quick Raspberry Freezer Jam


What You Need:
3 cups (750 ml) crushed raspberries (use a potato masher)
4 teaspoons (20 ml) fresh lemon juice
2 tablespoons (25ml) granulated sugar
1 package (49 grams) Lite Certo pectin crystals


What To Do:
Combine all the ingredients in a large bowl until there are no traces of pectin crystals. Let stand for 30 minutes, stirring every 10 minutes. Divide mixture evenly into sterile jam jars leaving a 1/4-inch (0.5 cm) head space in each container. Let stand at room temperature for 24 hours once the lid has been tightly secured. Store in refrigerator for 3 weeks or in the freezer for 8 months. Makes about 3 cups.

Science and the Mediterranean diet

Over the past thirty-five years, the main focus of North American dietary recommendations have been to reduce our intake of fat. Not surprisingly, the public has come to associate dietary fat with obesity, cardiovascular disease and cancer, while low-fat or fat-free eating is synonymous with heart health, a trim physique and overall well-being.  


Although nutrition researchers, policy makers and educators have cautioned consumers about the cardiovascular implications of consuming too much animal-derived saturated fat and any amount of trans fats (found in many margarines, fast-foods and commercially baked goods), nutritional guidance that promotes the avoidance of other types of fats has done us a disservice. 


According to Dr. Emilio Ros, an international researcher and director of the lipid clinic at the Hospital Clínic in Barcelona, Spain, eating less fat means we devour something else.


“If you reduce fat, you tend to increase carbohydrates and it’s been known for some time now that some carbs [particularly those that are highly refined and quickly digested] are bad for our weight, diabetes risk and heart health,” said Ros, who was recently in Vancouver for the 10th Congress of the International Society for the Study of Fatty Acids and Lipids.


Reducing our saturated fat intake by eating more processed carbs adversely affects our cardiac health by raising our blood triglyceride levels and lowering the good type of cholesterol, known as high-density lipoproteins (HDLs). 


But replacing saturated fat with unsaturated fats -- namely monounsaturated and polyunsaturated fats, and omega-3 fatty acids found in olive oil, avocado, walnuts, almonds, hazelnuts and fish -- appears to improve our cholesterol levels and prevent heart disease. 


Much of what nutrition scientists know about the health benefits inherit in a high unsaturated fat intake comes from studying the Mediterranean diet, an eating pattern that’s primarily centered around nutrient-rich vegetables, fruits, legumes and whole grains. Small portions of fish, seafood and poultry often replace red meat, which is used as a condiment or reserved for special occasions. Dairy products are consumed in moderate quantities.


Leisurely, home-cooked meals in the midst of physically active days, are an integral part of the Mediterranean lifestyle. On an almost daily basis, modest amounts of wine is imbibed with food; sugary carbonated drinks are rarely consumed. And homemade sweets are considered a treat.


Ros emphasizes that the Mediterranean diet is based on a traditional eating pattern of the 1950s and early 1960s found in natives of Crete, Greece, Italy and Spain. 


“[Today] few people in Mediterranean countries follow the traditional diet and activity level of their ancestors; there’s been a progressive westernization of dietary habits with an increasing consumption of meat, dairy products, industrially-prepared foods, and sweets,” said the nutrition researcher. “Refined sugars and fats in low-cost foods together with increasing sedentariness underlie the epidemic of obesity in the Mediterranean and other areas of the world.”


The scientific basis for the beneficial health effects of the Mediterranean diet isn’t fully understood. We don’t know whether it’s related to the greater ratio of unsaturated to saturated fats, or some other dietary or lifestyle component. Chances are, the benefits are a result of several nutrition and lifestyle variables at play.


At this point, all we can say is that compared to the contemporary Western way of eating, research correlates the Mediterranean diet with increased longevity and lower rates of heart disease, type 2 diabetes and other chronic illnesses.


If North Americans want to reap the potential health perks of this traditional diet, we need to accept that lifestyle and way of eating in its entirety, not simply choose the bits and pieces that appeal to us -- such as drinking wine at meals, dressing our food with olive oil, or munching more nuts.


published in the Vancouver Courier, June 8, 2012

Roasted asparagus using flavoured oil

Although asparagus is available to us year round, mid-April to June is the best time to eat these delicate spears. For optimal taste and nutrition, cook this veggie the day it’s purchased. If that’s not possible, keep it in the fridge for up to five days by wrapping the bottom of the stalks in a damp paper towel and placing them in a paper bag in the crisper drawer. 


Storing asparagus well helps preserve its high content of folic acid (also known as folate) but it’s also a good source of beta carotene, potassium, vitamin K and fibre. 


One of my favourite ways of preparing asparagus is roasting it with a flavoured oil, a recipe that I’ve adapted from Shirley O. Corriher’s book, Cookwise: The Hows and Whys of Successful Cooking (HarperCollins, 1997).

photo by Linda Watts

Flavoured oils are a subtle way to lower our fat intake; they pack more flavour than their plain cousins, so a little goes a long way. Neutral-tasting vegetable oils, including mild extra-virgin olive oils, can be infused with the essence of herbs, citrus zest, or dry spices, to amp up the taste of roasted or grilled vegetables, meat, chicken, fish or seafood. They can also form the base of more intensely flavoured salad dressings, marinades and sauces.
                               
But infused oils can be a breeding ground for bacteria. Any substance containing water or moisture -- such as garlic, shallots, onion, citrus peel, fresh peppers, fresh herbs or spices -- that’s submerged in oil, may support the growth of the bacteria, Clostridium botulinum, which can cause botulism food poisoning. 


C. botulinum bacteria grows in conditions where there is no oxygen. Storing oil in a sealed container doesn’t prevent contamination. What’s worse, is there are no obvious signs, appearance, taste or smell-wise, of spoilage. 


To be safe, make small quantities of flavoured oil at any one time and use it within a few hours. If made ahead of time, refrigerate the oil for no longer than a week. Leftovers containing infused oil should be refrigerated and used within ten days, frozen, or discarded. Never store home-made flavoured oil at room temperature. 


Although garlic infused in oil is especially known to cause harm, Health Canada states that it’s safe as long as it’s served immediately, or stored in the fridge on a continuous basis and used within a week. 


Health Canada also recommends checking the label on commercially prepared garlic-in-oil products. If salt or acid is in the list of ingredients, then the product has been preserved. As long as you follow the directions for storing it, you don’t need to be concerned about food poisoning. 


Roasted Asparagus with Lemon-Chili Oil
serves 6


What You Need:
1 shallot, minced
1 teaspoon dried red pepper flakes
1/4 teaspoon ground black pepper
1/4 cup canola, grapeseed or peanut oil
1 teaspoon water
Finely grated zest of 3 small lemons
1 pound asparagus (about 24 to 30 stalks)
salt to taste


What To Do:
In a small saucepan, bring the shallot, red pepper flakes, black pepper and oil to a light boil, then reduce to a very low heat. Simmer for about 4 minutes. Remove the pan from the heat and let stand for 5 minutes. Stir in the water and the zest of 2 lemons (save the rest of the zest for garnishing). Let mixture stand at room temperature for one hour and then strain the oil into a small container.


Preheat oven to 500 Fahrenheit. Place an oven rack on the top shelf of the oven. Trim the asparagus stalks by snapping off the wooden ends and place on a rimmed baking sheet. Drizzle 3 to 4 teaspoons of prepared lemon-chili oil over asparagus and toss with hands until stalks are well-coated. Arrange stalks side by side so they aren’t overlapping. Roast 6 to 7 minutes. 


Remove from oven and spoon another 2 teaspoons of lemon-chile oil over the asparagus. Sprinkle with salt and 2 tablespoons of the remaining lemon zest. Serve right away.



Published in the Vancouver Courier, May 25, 2012

Pizza dough made easy

I love making my own pizza. Compared to take-out or store-bought varieties, homemade is fresher, tastier and cheaper. But I’ve always struggled with creating the crust; I’m notorious for whipping up pizza dough that’s sticky enough to hang pictures on the wall. 


Recently, I discovered a dough recipe that’s changed my experience for the better. It’s made in a food processor and doesn’t require any fooling around with yeast and water temperature, or special flours. 


The recipe, which is an adaptation of one written by New York Times food columnist and cookbook author, Mark Bittman (published in the New York Times, April 17, 2012), is perfect to prepare with young kids. There’s no need to hand-knead the dough; the food processor does the kneading for you. When it’s time to roll or stretch it out, the dough pretty much cooperates. And best of all, making this recipe shouldn’t create a big mess in your kitchen.


Make the dough ahead or within an hour of wanting to eat dinner. I often prepare and freeze the dough a few days before I want to use it. The time spent chilling makes it even easier to roll into your desired shape and thickness.

photo by Linda Watts

Mark Bittman’s Pizza Dough
makes enough for two 10-inch thin-crust pizzas


What You Need:
3 cups all-purpose flour, plus extra for flouring hands and work surface
1 teaspoon instant yeast if freezing dough; 2 teaspoons, if making pizza immediately
2 teaspoons salt 
2 tablespoons olive oil, plus extra for oiling baking pans
1 cup water


What To Do:
Place 3 cups flour, 1 teaspoon yeast (if freezing dough), 2 teaspoons salt and 2 tablespoons olive oil in a food processor. Pulse machine about five times to combine ingredients. Turn machine on low setting and slowly drizzle in water through the feed tube. Near the end of the drizzling, the food processor will get noisier and rock a bit as the ingredients come away from the sides of the processor and the dough forms. 


When all the water is added, the dough shouldn’t be sticking to the sides of the container. If it does, add more flour, one tablespoon at a time, with the machine running. If the dough is too dry and refuses to come together, add more water, one tablespoon at a time. Turn machine off once dough forms to prevent it from toughening.


Using clean, lightly-floured hands gather the dough together and gently pat into one large ball; slice into two equal parts. Wrap each half in plastic wrap. If freezing, place dough balls in a large zip-lock bag and freeze for no longer than a week. When ready to use, allow the dough to reach room temperature before rolling out. If you’re making pizza right away, let each plastic-wrapped dough balls rest at room temperature for at least 20 minutes.


Preheat oven to 450 F. Lightly oil two baking pans and set aside. Lightly flour a clean counter top or large cutting board, and remove each dough ball from plastic wrap.  Gently roll or pat out dough with a lightly-floured rolling pin, or your hands, into desired shape and thickness. If dough isn’t cooperating because it’s too elastic, let it rest for about 10 minutes and then go back to it. Once rolled out, transfer dough to each baking pan and pinch edges to form a raised outer edge. 


Layer pizza with your favourite toppings and bake until the bottom of the crust is crisp and the top of the pizza is browned and bubbling, about 10 to 20 minutes.


published in the Vancouver Courier, May 11, 2012

Gluten for Punishment

If you've been keeping up with the latest food and diet trends, you’ve most likely heard the buzz about gluten-free eating. In the last five years there’s been an explosion of gluten-free articles in the media and gluten-free products in the marketplace.  


British Columbia’s Silver Hills Bakery has gotten on the bandwagon by introducing two bread products: gluten-free Mack’s Flax and Chia Chia. 


“Finding healthy, gluten-free products proved to be a challenge [for consumers], so it was a natural fit that we wanted to help inspire healthier living for all dietary needs,” says Brad Brousson, co-founder of Silver Hills Bakery and vice-president of sales and distribution. “They’re the only 100 per cent organic, vegan, whole food gluten-free breads out there.”


Gluten is one of several proteins naturally present in wheat, rye and barley. While obvious sources are bread products, pastas and most breakfast cereals, gluten may also be found in salad dressings, sauces (including soy sauce), seasonings; soups, prepared meats, candy, flavoured coffees and teas, and corn- and rice-based cold cereals.


Although eating gluten isn’t an issue for many of us, others truly suffer. According to Dr. Scott Whittaker, a gastroenterologist at St. Paul’s Hospital and professor in the Department of Medicine at the University of British Columbia, a small percentage of the population have the genetically-determined illness, celiac disease (CD), and another segment of the public -- a larger group -- have a more broadly defined condition called gluten intolerance or gluten sensitivity.


Whittaker explains that when an individual with CD consumes gluten, it triggers an immune response in the body that causes an inflammatory reaction in their small intestine. This in turn damages the small intestine lining. And since that lining is the direct pathway for nutrients to enter our bloodstream, proteins, fats, calcium, iron, other minerals and vitamins may not be properly absorbed. 


“The degree to which people run into problems [with nutrient deficiencies] and experience symptoms depends upon the severity and duration of the inflammatory reaction in their small bowel,” said Whittaker. “And the thing that we’re learning, from doing more screening, is that the majority with CD don’t have the classic symptoms of diarrhea and steatorrhea (fat malabsorption).”


Instead, many individuals are coming into their doctors’ and dietitians’ offices with more vague symptoms such as unintentional weight loss, bloating, gastrointestinal discomfort, fatigue and iron deficiency -- symptoms that overlap with other conditions, namely irritable bowel syndrome, chronic fatigue or fibromyalgia. Some individuals may even have “silent celiac disease”: they have no or very subtle gastrointestinal symptoms despite the evidence of significant injury to their small intestine lining.  


Shelley Case, a Regina-based registered dietitian who specializes in celiac disease and the gluten-free diet, says that physicians and other heath care providers are now realizing that the prevalence of CD in the North American population is much higher than initially thought. Once believed to be 1 in 10,000, research over the past decade has revealed that 1 in 100 people have the condition.


Case, who authored Gluten-Free Diet: A Comprehensive Resource Guide (Case Nutrition Consulting Inc., 2010), adds that because the condition is being mistaken for other illnesses, only 5 to 10 per cent of those with CD are being diagnosed. That means at least 90 per cent of people with the disease are walking around unaware.


To boot, recent U.S. research indicates that six per cent of the North American population may have what is described as non-celiac gluten sensitivity. Unlike CD, it isn’t an autoimmune disease where sufferers develop long-term complications but the symptoms are similar.


“At this point we really don’t know that much about non-celiac gluten sensitivity. There are many unanswered questions, like: do these individuals have tolerance levels or can they possibly grow out of the condition?,” Case said. “And we don’t have an accurate test for diagnosing non-celiac gluten sensitivity. The only way to diagnose this condition is to rule out CD while the individual is still eating gluten. If the tests are negative, a gluten-free diet trial is initiated to see if symptoms resolve.”


CD can develop at any age. We can have the genetic markers for the condition from birth and be perfectly healthy eating gluten until a stressful event (puberty, pregnancy, surgery, or an illness such as a gastrointestinal infection) switches on the immune system and causes us to lose our tolerance for gluten. 


Interestingly, the number of people diagnosed with the condition has doubled over the past 15 years and, according to a study by Italian celiac expert Dr. Carlo Catassi, the fastest growing age group of North Americans being diagnosed is 40 to 60 year olds. This begs the question: why are so many older folks developing CD? 


One thing is for certain: it’s not because of changes in wheat protein from the hybridization of plant strains -- a theory espoused by Dr. William Davis, author of Wheat Belly: Lose the wheat, lose the weight, and find your path back to health. 


Case, who sits on the Grain Foods Foundation Scientific Advisory Board in the U.S. and has consulted with wheat genetic scientists, said: “Genetically modified wheat isn’t grown in North America and isn’t in the U.S. or Canadian food supply. Wheat protein content hasn’t significantly changed over the years – it’s actually lower than the ancient grain, Kamut. However, one thing that has shifted is the baking industry’s increased use of vital wheat gluten to produce better volume and texture so we may be eating more gluten than our ancestors did.”


Recent research has shed light on a possible reason for the increased prevalence of CD and other autoimmune diseases: changes to our intestinal bacterial composition. The quality of our diet, using acid reduction medications, or over-using antibiotics may be disturbing the ratio of good-to-bad bacteria in our digestive tract and interfering with the digestion and absorption of gluten.  


Whittaker, however, is more cautious about discussing prevalence theories. “We have more accurate diagnostic techniques and there’s good evidence that the rate of CD has increased but what’s not clear is the reason for the rise. Until we have more research, we [health care providers and the media] have to be careful about putting out theories because people may make changes to their lifestyle based on speculation,” said the physician.


But is there any harm eating gluten-free products when we don’t have CD or any kind of gluten sensitivity? After all, doesn’t eating a gluten-free diet help with weight loss?


“A gluten-free diet doesn’t equal weight loss,” said Case. “It’s not gluten, per se, that causes us to drop pounds; it’s the reduction in calories from eating less bread, pasta, pizza and baked goods.” 


“If you compare some of these gluten-free products [with gluten-containing items] they are often higher in calories because of the levels of sugar and fat needed to make the ingredients cohesive and make the product palatable,” she added.


“And eating gluten-free doesn’t mean it’s always healthier, either. Nutrition-wise, you may not be getting the fibre, iron and B vitamins in a lot of gluten-free items unless you’re using bread products, cereals and pastas enriched with these nutrients and/or eating more nutrient-dense gluten-free whole grains.” (Note: Silver Hills’ gluten-free breads are enriched.)


That being said, Case emphasizes that you can eat a healthy gluten-free diet if you start eating more nuts, seeds, legumes, fruits and vegetables, lean proteins, low fat milk products, and good gluten-free whole grains.


Those who follow a gluten-free diet because it’s the latest food trend, concern Case. “Because of all the hype in the media about celebrities going gluten-free, the people who really do need it medically often aren’t being taken seriously by others or when they eat out in restaurants,” she said.


If you believe that gluten is causing health problems, Case says it’s important to be tested; CD affects about one per cent of the population. And it’s crucial that you’re eating enough gluten-containing foods (e.g., 2-4 slices of bread/day) for at least six to eight weeks prior to having the celiac blood work and biopsy done for the tests to be accurate. If the CD tests come back negative and completing a trial of eliminating gluten from your diet significantly improves your health, you may be among the six per cent who have non-celiac gluten sensitivity. 


“I strongly advise anyone with CD or non-celiac gluten sensitivity to consult a registered dietitian who specializes in the area because the gluten-free diet is one of the most complex to follow,” said Case. 


For more information on the gluten-free diet, celiac disease and gluten sensitivity, visit here and here. 


Originally published in the Vancouver Courier, March 16, 2012

The limitations of body mass index (BMI)

“It never fails,” says my friend, Beth. “Every time I have an annual check-up my doctor wants to talk about my weight.” And at each appointment she dutifully answers his questions about her lifestyle. But Beth feels he’s only half-listening. Distracted crunching numbers on a calculator, he determines her body mass index (BMI) and how many pounds she’s over her ideal weight.


Health care providers use BMI to assess whether a patient’s weight is in a healthy range for their height. BMI is calculated by dividing our weight in kilograms by the square of our height in metres. 


According to the World Health Organization and Health Canada, BMI is classified into ranges of health risk. Adults with BMIs less than18.5 are labeled underweight, which is associated with osteoporosis, undernutrition and eating disorders. BMIs between 18.5 to 24.9, are  considered to be within the normal weight range and carry the least amount of health risk. BMIs from 25.0 to 29.9 are interpreted as overweight, while greater than or equal to 30, as obese.  These latter values are associated with an increased risk for diabetes, cardiovascular disease and certain cancers – health conditions linked to having a high percentage of body fat.


But BMI doesn’t directly measure body fat. According to Scott Lear, an associate professor and researcher at Simon Fraser University, the problem with BMI is it tracks our weight, which consists of bone, lean tissue, water and fat. 


Lear, who studies the relationship between body fat and risk for diabetes and heart disease, says: “From a health perspective, we are mainly interested in body fat not weight, per se.” 


“BMI doesn’t tell us where a person may be carrying excess body fat,” adds Lear.  “And we know that fat around our waists carries a greater risk for diabetes and heart disease than body fat elsewhere.”


A waist circumference (WC) measurement is a useful indicator of abdominal fat. WC measures equal to or greater than 102 centimetres (40 inches) for men and 88 centimetres (35 inches) for women, are associated with an increased risk of the aforementioned health problems. In general, risk increases as WC increases, even if our BMI is in the normal weight range. 


BMI isn’t a reflection of lean body mass either. Lear emphasizes that BMI may mislabel muscular adults. Endurance athletes may be classified as overweight; heavyweight boxers, as obese. Their large muscle mass inflates their weight, which raises their BMI and, thus, overestimates their health risks. 


When determining a person’s ideal weight range, health care providers can’t hang their hat on body mass index and waist circumference alone. Genetics, bone structure, body type, existing health issues and lifestyle need to be considered.

We come in all shapes and sizes. An ideal weight range shouldn’t be dictated by our unrealistic cultural norms. Instead, it should be defined by our ability to exercise on a regular basis without feeling fatigued; meet our nutritional needs by moderately eating a wide variety of foods; and use restraint with booze, drugs and cigarettes. 


published in Eyes On B.C., March 1, 2012

Drinking to your health?

In France, a common expression when toasting loved ones is: À votre santé! Translated, this means: To your health! And it turns out that research is revealing that moderate drinking may improve our well being. In fact, people who drink alcoholic beverages moderately have a much lower risk of heart attacks and strokes than those who abstain or abuse it. 


Studies that focus on alcohol consumption and health show that it doesn’t matter what type of beverage contains the alcohol. It appears alcohol itself provides the majority of the cardio-protection by favourably influencing our blood cholesterol -- which prevents plaque from clogging our arteries -- and providing an anti-coagulant effect that reduces the likelihood of blood clots.


Wine, particularly red wine, may provide additional benefits because of polyphenolic compounds that are concentrated in grape skins. While both red and white wines contain phenolic compounds, they’re more abundant in reds since these wines are made with the skins.

 “So far over 200 polyphenolic compounds have been identified in red wine and many act as antioxidants,” says Iain Philip, the senior wine instructor at the Art Institute of Vancouver and part-owner of Barbariain Wine Consulting.

 “One compound getting most of the attention is resveratrol, which appears to have a positive effect on cardiovascular health. But researchers aren’t clear whether it’s the individual components in wine that provide the health benefits or if it’s how all the different compounds work together.”


But do these studies looking at wine and health take into consideration other factors that improve our physical well being? Wine drinkers are usually from higher social-economic classes and have access to good medical care, not to mention healthier lifestyle choices. Drinking wine won’t impart the same benefits if we aren’t eating well, maintaining a healthy weight, avoiding smoking and exercising regularly.


The key to deriving the positive health effects of wine and other alcoholic beverages is not over-imbibing. Excessive drinking increases our risk of coronary heart disease. 


In Canada, moderate drinking is defined as 1 to 2 standard drinks daily with a maximum weekly total of 9 and14 drinks for women and men, respectively. A standard drink is 12 ounces of beer at 5 per cent alcohol by volume (abv), 1.5 ounces of spirits at 40 per cent abv, or 5 ounces of wine at 12 per cent abv. A wine that’s higher than 12 per cent abv will provide more than a standard drink in each glass.


Our drinking pattern matters as much as the volume we consume. If we drink, we should have a little on a regular basis and not save up our weekly total for the weekend.


If you don’t drink alcohol now, don’t start because of possible heart health benefits.   For a variety of reasons, some of us shouldn’t go near the stuff. But if you do like a beer or glass of wine, relax and enjoy yourself being mindful not to over-indulge.  


published in The Beacon, February 1, 2012

Using caution with calcium

As is almost always the case in life, having too much of a “good thing” doesn’t mean we’ll be happier or healthier folks. And when it comes to our eternal pursuit of health and well-being from dietary supplements, this adage is proven true time and time again.


In a study published in the British Medical Journal, researchers reported that calcium supplements could increase the risk of heart attack by as much as 30 per cent.


According to University of British Columbia nutrition professor, Dr. Susan Barr, this carefully conducted study revealed that high intakes of supplemental calcium, consumed without vitamin D, appear to slightly increase the risk of cardiovascular events in older adults. 


However, Barr cautions that the effects of taking both a calcium and vitamin D supplement are still not known since the study only included trials of large calcium doses.


“The study authors speculate that a possible mechanism for the increased risk of heart attack may be due to rapid increases in serum calcium [meaning the amount of calcium in our blood], which occur after consuming a large supplemental dose”, says Barr in an interview. 


Research has repeatedly shown that we’re better off getting calcium from food rather than pills; the increase in serum calcium is much less when the nutrient is coming from dietary sources such as low fat milk products, fortified soy beverages and some leafy greens. 


“This finding supports the concept that if calcium supplements are needed because of food dislikes, a milk allergy or lactose intolerance, they should be taken with meals and in divided doses”, adds Barr.


The University of California, Berkeley, Wellness Letter recommends that we spread our calcium intake throughout the day so we don’t exceed 500 milligrams from food and supplements at any one time. Taking in more of the nutrient is futile because the more we get at one sitting, the smaller the proportion our bodies absorb. 


A good rule of thumb is to take no more than 300 milligrams of elemental calcium from a supplement at a meal or snack. Check the package label to see how much elemental calcium the supplement provides per tablet or dose. 


Also look on the package for the type of calcium used in the supplement; those made with calcium carbonate, calcium citrate or calcium citrate malate are considered high-quality because they’re well absorbed by the body.


Calcium carbonate requires stomach acid in order to be absorbed properly, so it’s best to take this supplement just after finishing a meal or snack. Calcium citrate and calcium citrate malate aren’t as dependent on stomach acid; they can be taken before or after eating. 


Although it’s important to consult with your physician first, anyone taking medications that reduce stomach acid such as Prilosec or Zantac should consider taking calcium citrate. Lower amounts of stomach acid means calcium carbonate won’t be well absorbed..


Calcium citrate or calcium citrate malate are most likely better choices for individuals over 50 since stomach acid production tends to decrease with age.


Ultimately, it’s important for us to aim for the recommended daily intakes of calcium (1000 mg for adults 19 to 50 years of age; 1200 mg, for those who are older) and not exceed them excessively. 


If we’re taking a calcium supplement to meet our needs we should also be consuming vitamin D to promote its absorption. Health Canada recommends that all adults 50 and older take 400 International Units (IU) of vitamin D each day. And unless we’re under medical supervision, our intake shouldn’t exceed 2000 IU.


For more information regarding calcium-rich foods, visit the B.C. Dairy Foundation to order their Calcium Calculator brochure.

The scoop on multivitamin mineral supplements

Recently a reader wanted to know my thoughts about multivitamins. He wondered: are there any benefits in taking a multivitamin daily or is it a complete waste of money? Have tests been done to know if the body actually absorbs these vitamins like we do from real food?


The answer to the basic question, are multivitamin mineral supplements good for our health, is complicated. We can safely say that multivitamin mineral supplements appear to have no serious adverse effects but, to date, there is not enough evidence to support their efficacy in preventing cancer and chronic diseases in adults. 


According to Marion Nestle, a nutrition professor at New York University and author of What to Eat, the science surrounding supplements is never straight-forward. Similar to other areas of nutrition research, it’s difficult to do. 


Nestle explains when researchers conduct observational studies and compare the overall health of people who take supplements to those who don’t, the ones who take supplements appear to do better. But when scientists perform clinical trials, a more rigorous study design, the results are quite different. Clinical trials rarely show much benefit from taking supplements. 

Like many nutrition researchers, Nestle believes the most probable explanation for the different results is that people who take supplements are healthier to begin with. If you take supplements you are most likely well-educated, physically active, a nonsmoker, a light to moderate drinker, and financially-secure. 


Nestle, who also wrote Food Politics: How the Food Industry Influences Nutrition and Health (University of California Press, 2002), calls it as she sees it: the supplement industry has a tendency to ignore or even attack inconvenient research results. Supplement trade associations and companies work hard to convince us that our diet is deficient in nutrients and want us to believe supplements are the answer to our health problems. 


Supplements are big business. Nutrition Business Journal, an executive publication focusing primarily on the nutrition industry, estimates Canadians spent $1.83 billion on vitamins and other supplements in 2006. 

Health Canada takes the position that we likely don’t need a multivitamin mineral supplement if we are eating a well-balanced diet according to Canada’s Food Guide. Unlike supplements, food contains carbohydrates, protein, fat, and fibre that give us energy and help control our blood sugar. While a multivitamin mineral supplement can provide an average of fifteen of the more than fifty essential nutrients our body needs, it won’t give us phytochemicals, the powerful disease-fighting compounds that occur naturally in fruits and vegetables.


But not all of us have stellar eating habits. For one reason or another, we don’t eat a wide variety of healthy foods or get enough food energy. A limited food budget, dieting, food allergies, multiple food dislikes, or strict vegetarianism can put us at increased risk of vitamin and mineral deficiencies. In these cases, a multivitamin mineral supplement, with rationale nutrient levels, would most likely be beneficial.


Those following restricted diets should consider seeing a registered dietitian who can assess their nutritional intake and provide guidance on improving eating habits and possible supplement use.
You don’t have to pay big bucks for a multivitamin mineral supplement . Expensive brand name products are no better than generic store brands. To answer the reader’s second question: your body doesn’t know the difference between a nutrient from food and a nutrient from a supplement (no matter how much it costs). 


Always look on the supplement label for the eight digit product licence number preceded by the letters NPH or DIN-HM, which stand for Natural Product Number or Homeopathic Medicine Number, respectively. This is proof the supplement was reviewed and approved by Health Canada in terms of safety, effectiveness, and quality. 

Want an easy, healthy meal idea?

After feasting on too many treats over the holidays, I’m all about eating light and healthy meals right now. But easing up on the fat and calories doesn’t mean I’m depriving myself of delicious food.


Years ago, while taking cooking courses at Dubrulle - Vancouver’s beloved culinary school - I learned of an easy French cooking technique that produces flavourful and nourishing meals. 


Preparing food en papillote [pah-pee-YOHT], entails steaming lean cuts of chicken, fish, seafood, or vegetables in packages made of parchment paper, which is available in gourmet kitchenware stores and well-stocked supermarkets. Aluminum foil can also be used. 


Steaming is the ultimate low-fat cooking technique but it has the reputation of producing humdrum diet fare. Cooking en papillote creates food with clean, vibrant flavours. The parchment packet keeps fragrant aromas in close contact with its edible contents. 


The recipe below can be adapted to a variety of ingredient combinations. Try it with fresh spinach, chopped tomato, or thinly sliced sweet peppers, fennel or mushrooms. Instead of soy sauce and honey, experiment with a splash of dry white wine, orange juice, or chicken or vegetable stock. Substitute garlic and gingerroot for fresh or dried herbs, or thin lemon slices and capers. Besides sole, other mild-flavoured, firm-fleshed fish, such as sole, tilapia, snapper or cod, work well. Use the freshest fish your wallet can handle.


Since my Dubrulle days, I’ve taught a number of my patients the en papillote method and many are surprized how quickly they can assemble dinner for themselves; ordering take-out pizza takes more time. But the real selling point tends to be realized after the meal, when clean-up involves fewer dirty pots and pans. The parchment paper or foil is simply tossed away. Now, how easy is that?


Asian Sole en Papillote
Serves 4

What You Need:
2 small bundles of baby bok choy, chopped 
4 (6 ounce/ 175 grams) sole fillets
1 medium carrot, peeled and sliced into match-stick pieces
salt and pepper to taste
2  teaspoon vegetable oil
2 to 3 drops sesame oil (optional)
2 tablespoon low-sodium soy sauce
2 teaspoon honey
1 large garlic clove, minced
1 teaspoon minced fresh gingerroot
pinch of red pepper flakes
2 green onion, finely chopped


What To Do:
Preheat oven to 425 F. Cut four square sheets of parchment paper, each measuring about 12 x 15 inches (30 x 38 centimetres). Lay sheets on a clean work surface and fold each sheet in half crosswise, crease with your fingers and then lay flat again. 


Divide baby bok choy among parchment sheets, mounding it on one side of the fold. Top with a sole fillet that has been seasoned with salt and pepper. Sprinkle carrot over each fillet. In a small bowl combine vegetable oil, sesame oil (if using), soy sauce, honey, garlic, gingerroot and red pepper flakes. Drizzle evenly over each fillet. Sprinkle with green onion. Season with salt and pepper to taste. Fold over parchment paper leaving a little air inside so the ingredients can steam. Fold edges around each package to seal tightly. 


Put packages on a rimmed baking sheet and cook for about 12 minutes. If the fish fillets are thicker than an inch you’ll need more cooking time. Open a package to check for doneness. The fish should be opaque in colour and flake with a fork. Transfer each package to a plate and open at the table. Serve with brown rice or quinoa and more veggies if desired.

Earth to Table: A cookbook review

Many of us are now realizing what some chefs have known for years: the healthiest and most delicious food comes from local farmers, fishermen, and artisan suppliers. 

We’re learning more and more about our modern food industry and discovering insomnia-inducing details like the high economic, environmental and health costs attached to imported food that appears cheap at the cash register. 

Local sustainable agriculture and eating is becoming the new normal. We simply want to feel good about the food we’re eating. 

Chef Donna Wadsworth has ran her Vancouver catering company, Savoury City, based on socially-responsible values since it opened over eight years ago. 

Wadsworth has created a sustainable business that is ethically and ecologically-sound. But most of all, Savoury City provides customers with flavourful healthy food – menu items are made from scratch using locally-sourced seasonal ingredients.

Jeff Crump is applying his local food philosophy in Ancaster, Ontario. Crump is executive chef of the Ancaster Old Mill and his passion for good food came from working in world-famous restaurants and doing extensive research. 

A true academic, Crump identifies investigative food journalist Michael Pollan (author of An Omnivore's Dilemma: A Natural History of Four Meals, In Defense of Food: An Eater's Manifesto and Food Rules: An Eater's Manual) and chefs Thomas Keller (of The French Laundry restaurant in Napa Valley) and Alice Waters (of Chez Panisse in Berkley) as major influences on his career. 

When Crump started at the Old Mill in 2002 he brought with him community food suppliers and forged a strong business relationship with a nearby farmer. 

Before long, all the restaurant kitchen staffers were in the farmer’s field planting, weeding and harvesting delicious produce that would be end up on the menus. 

Crump and Old Mill pastry chef, Bettina Schormann  share their experience going back to the land in their recently released book, Earth to Table: Seasonal Recipes from an Organic Farm(Random House Canada 2009, $29).

Earth to Table is more than a cookbook. In many ways it reads like a novel reminiscent of Barbara Kingsolver's Animal, Vegetable, Miracle: a literary piece that integrates seasonal memoirs with didactic segments and recipes.

Stunning food photography highlight seasonal ingredients that are easily found in B.C. Professional and amateur cooks will be inspired by recipes like Penne with Asparagus Carbonara in spring, Corn on the Cob with Chili Lime Butter in summer, Mile-High Pumpkin Pie for fall, and Hanger Steak with Beet Horseradish Relish in winter.

Crump and Schormann encourage us to make the most of seasonal fare by including how-to sections on foraging for greens, berries and mushrooms; canning and preserving summer produce; planting an herb garden; and shopping the farmer’s market. 

Serious foodies or not, readers will enjoy intimate interviews with six world-renown like-minded chefs such as Thomas Keller, Heston Blumenthal (of The Fat Duck, England), and Matthew Dillon (of Sitka and Spruce, Seattle). They offer honest and thought-provoking insights on their own experiences and philosophies regarding local sustainable cooking and eating.

Like most of the chefs profiled in Earth to Table, Crump and Schormann don’t consider themselves political activists and they’re not interested in trying to convert any of us into locavores. 

“Bettina and I want readers to enjoy the book and come to their own conclusions about what kind of food they want to eat.” says Crump during a recent visit to Vancouver. “For us it’s about quality and taste and it just so happens that preferring locally-grown seasonal food is good for the environment, keeps our money within the local coffers, and allows us to meet some really interesting people.”