Dr Rupy: Welcome back to the Doctor's Kitchen podcast with me Rupy. Today we're going to be talking about principle two, eat whole. And today I've got the pleasure of having Alexandra Swacker, a public health researcher at the World Health Organisation Collaborating Centre at Imperial College London. That is a mouthful. And it also happens to be my old university. We're going to be discussing how the complex arrangement of molecules found in food relate to health outcomes rather than just isolated compounds. Make sure you listen to the end because we're going to round out with tips to help you eat more whole every day and the kind of things that you'll find in my book as well. So, each element that makes up part of a food is integral to the system. The last episode was about individual chemicals that we've been able to examine and it's great because it gives us a wider understanding of why foods have health properties. But it's certainly not the bigger picture. And that's exactly why I've got my guest with me here today who specialises in the bigger picture and that is public health. So, thanks so much for being here today, Alexandra. It's fantastic to have you. Do you want to give us a bit of an overview of the kind of work that you're doing at my old university?
Alexandra Swacker: Absolutely. Thanks, Rupy. Thanks for having me here today. So, I work in research, like you said, at the World Health Organisation Collaborating Centre at Imperial, indeed a mouthful. So we as a centre actually specialise in primary care and public health and we do a lot of work regarding building health systems in around the world basically and focus a lot in the Middle East. However, my immediate specialty of research is nutrition within epidemiology. So physical ailments as well as looking at relationships between the microbiome, for example, and mental health.
Dr Rupy: So really like absolutely fascinating stuff because we're actually going to talk about fibre and the microbiome, which is the population of microbes that live in and around our body but largely concentrated in our gut in later episodes actually. But that's super cutting edge stuff, right?
Alexandra Swacker: It is and it's fundamental really for the well-being of the worldwide population.
Dr Rupy: Yeah, yeah, yeah, absolutely. My first question really is, what does eating whole actually mean? I think we need to get this probably defined early before we start actually start talking about being whole or eating whole. So what does eating whole actually mean?
Alexandra Swacker: Absolutely. Well, that's a great question. So, eating whole refers to foods that are as close to their natural form as possible and haven't undergone any chemical changes. So, fruits, vegetables, whole grains, meats, if you eat it, dairy, again, if you eat it. So, in comparison, some examples would be grilled chicken breast as opposed to chicken nuggets. So chicken nuggets have obviously undergone extensive processing, contain additives, whereas a chicken breast basically comes right off the chicken and you cook it.
Dr Rupy: Gotcha. Okay. So it's kind of like a whole eating exists on a continuum or a spectrum, right? So it's super hard to have the most whole form as possible because I suppose by process of heating, steaming, cooking of any element or even chewing something becomes processed.
Alexandra Swacker: Right. Yeah.
Dr Rupy: But we're talking about as closer to the sort of whole form as possible.
Alexandra Swacker: Yeah, and I think something important to note is when in doubt, look at the ingredients and if there aren't any, that's a good sign.
Dr Rupy: Absolutely, yeah. So, I know that a lot of the time people require something just really simple ideas of how they can eat more whole and I know in clinic when I when I talk to them about the addition of oil and salt and sugar to certain items that really they shouldn't really be there. That's an indication that it's probably a little bit more processed right on the spectrum of whole versus processed, right?
Alexandra Swacker: Yeah, exactly. Yep. So the more you have to add things, the more processed the food becomes.
Dr Rupy: Gotcha. And so what are the benefits of eating less processed and convenience foods?
Alexandra Swacker: Right. Okay, so by eating whole foods, foods that are less processed, you are eating foods that have been perfected by nature and they are already in their integral and perfect form. They contain the perfect water to fibre ratio for optimum digestion and the correct chemical composition for the body to absorb all the nutrients that it needs. So, a GP, tell me if I'm wrong, but the GP looks at the individual. So you have a case that comes in, they tell you their problems and you help them fix that, correct? So you look at the individual.
Dr Rupy: We try.
Alexandra Swacker: Right. I'm sure you do a great job. Public health looks at the population as a whole. So we look at why there's a rising prevalence, why there's a decline in something. And as far as nutrition and its role in public health, so the global burden of non-communicable chronic diseases is increasing rapidly. So those would include diseases such as diabetes, heart disease, obesity, high blood pressure.
Dr Rupy: Okay, so those are not transmitted by infection basically.
Alexandra Swacker: Right, exactly. Yeah. So you can't cough on someone and give them diabetes.
Dr Rupy: I hope not. Otherwise the tubes in London would be terrible.
Alexandra Swacker: Yeah, blood pressure would be through the roof for sure. So those are on the rise and what is concerning is that not only is the prevalence increasing, but they are showing up earlier in life. So younger people are getting these conditions. And the WHO, the World Health Organisation, projects that by the year 2020, so that's what, it's not very far off. That's only barely three years. That these non-communicable chronic diseases will account for almost three quarters of deaths worldwide.
Dr Rupy: Right.
Alexandra Swacker: So that's a huge number. And to be more specific, type two diabetes will be almost tripling in the next decade alone.
Dr Rupy: Yeah, yeah.
Alexandra Swacker: So the thing with this class of chronic diseases is that they are largely preventable. And there are two ways of which we can prevent them. One, through diet, which we will be talking about today, and two, through physical activity, which we might also touch on a little bit.
Dr Rupy: Yeah, yeah, we should, definitely, yeah.
Alexandra Swacker: I hear a lot of people talk about diet and diet is the way forward and the general advice that you'll hear from your typical GP is to eat a healthy diet and then to go to the NHS website and then find out what a healthy diet is. Whereas really, we, I mean, the whole purpose of the podcast is to try and give people actionable tips as to what does that actually mean. So whole food, like we've just described, is one of the key things that we can do to mitigate these sorts of diseases of of lifestyle. And I've come across studies that just by reducing the convenience and processed items that we have in our diet on a weekly basis, parameters can improve, like blood pressure, cholesterol ratios, BMI, even though those things in isolation aren't markers of overall health, but collectively, they can be very powerful, right?
Alexandra Swacker: Yes, they can. Absolutely. So you're right in the sense that a GP can sometimes give ambiguous advice when it comes to diet and nutrition. And sometimes assume that when they say eat a healthy diet, that the patient will automatically know what they're talking about. So it's great that you are doing these podcasts. It's wonderful and it's making all this information a lot more accessible to the general public.
Dr Rupy: And there are plenty of GPs that do a great job as well. I don't want to...
Alexandra Swacker: Oh, yeah, no, no, no, no, not downplaying the role of GPs and also what you have five minutes. So that's not very fair either.
Dr Rupy: I wanted to talk about multivitamins and the isolated chemicals that we find in supplements and stuff like that. Given what we know about eating whole foods and the different compounds that we find in whole foods and the fact that they're attached to fibre and other micronutrients, is there a role for for multivitamins and isolated chemicals to supplement?
Alexandra Swacker: Well, the answer is yes and no. So ideally, you would eat colours of the rainbow, which would give you all the vitamins you need. However, people who do eat a monochromatic diet are going to need to supplement. So while they're not ideal, in order to avoid deficiency induced diseases, conditions such as anaemia, which is an iron deficiency or scurvy, which is a vitamin C deficiency, they they clearly would need to supplement.
Dr Rupy: Which worryingly we're seeing, aren't we? Scurvy, which is unbelievable if you think this is a disease of Victorian times or even before that where we didn't have access to fresh fruit and vegetables. And now in an era of abundance, we're seeing it.
Alexandra Swacker: Yeah. Okay, cool. So, I mean, we've talked about processing foods and stuff. There are a lot of foods that are marketed as sort of like superfoods, uber healthy for you, but I suppose by virtue of the fact that they come in sprinkles or powders or those sorts of like formulations, that's essentially a processed food, right? So do you do you know anything about whether the processing of certain foods, let's take acai berry powders, that's very popular right now, the the purple sort of supplement that you get in smoothies and stuff. Does that actually retain nutrients? Does it keep the nutrients of the berries themselves or is that something that's lost through the actual packaging and transportation process?
Alexandra Swacker: Well, the whole concept of superfoods and superfood powders and sprinkles that you call them. I don't know if it's called a sprinkle. I I call it sprinkles. What did you say? Sprinkles? It probably means something else in the US, right? Like the sugary sprinkles you put on cupcakes. I saw in my mind an image of like confetti. Yeah, yeah, yeah, yeah. It's like green confetti. Yeah, exactly. So a lot of those honestly are backed by somewhat of a pseudoscience and great marketing. So you call anything super and it's going to sound amazing, right? Yeah. So yes, these foods in their natural state are wonderful and if you can eat those whole berries, acai or blueberries or blackberries, in their natural form, that is ideal and that's how that's how the body is going to absorb these things. So in response to the processing of these so-called superfoods, I'll tell you about a few studies that I have that I brought for you here today. Yeah, I have copies for you. Yeah. I'm always up for studies. Yeah, yeah, yeah. So, number one, there are actually in three different food groups. So the first one that I'm going to tell you about is was conducted by the School of Biological and Population Health Sciences at Oregon State University. And the study they conducted was to see whether healthy compounds in cruciferous vegetables can be easily obtained through supplements. So cruciferous vegetables are things like broccoli and cauliflower. Exactly. Kale. All the good stuff. Yeah, kale, another superfood, right? Yeah, super in quotation marks. What it is, it's a superfood, but you need to eat it properly. Yeah. And that's exactly what this study found is that the answer was no. There's absolutely no health value that comes from the food in a supplemental form. And the reason is because the cruciferous family contains an enzyme called myrosinase. And when that enzyme is heated up, it basically it basically dies. So it becomes ineffective. And without that enzyme, the body is not able to absorb the nutrients that come out of these vegetables. And the same happens when it gets heated up too much. So that kind of goes into play with learning how to cook your vegetables properly. Which I'm sure you address in your book. I know I do. Yeah. You are a mind reader. Literally, yeah. It's literally stuff that I talk about in my book and the fact that we don't want to overcook sprouts. Yeah, because it will destroy the enzymes that the body needs to absorb the nutrients. And it destroys the flavour as well because it becomes mush. And flavour as well as function is what the Doctor's Kitchen is about. We want to try and promote that as much as possible. Wonderful, wonderful. So the best way, actually, while we're on this topic, we should clarify that the best way is to steam. I was looking at me. I was like, I don't know. Come on. Yeah, I mean, so I teach a technique in the start of the book where you put a little bit of hot water into a saucepan, you put the vegetables in, you cover it, and that way it's kind of like steaming without the expense or the the steamer is massive. You put them on your worktop and they take up all the space and stuff. So I've done it my whole life, just in a pot, like a centimetre maybe of boiling water and cover it. And and perfect. And with broccoli, I usually leave it till it just when it boils and turn the fire off. And that's it. Right, like I said, it retains all of its nutritional compounds, the body can absorb everything that it needs. Otherwise, all the antioxidants and all the good stuff would be lost in the water that it gets boiled in. So there's no point. There are lots of different benefits of of different sorts of vegetables and fruits that we can find on our supermarket shelves as well. So it's not doesn't have to be about broccoli sprouts or acai berries. The number of different ones that we have access to are incredible. Red cabbage, sweet potato, cherries, beets, artichokes, red chicory. They're just so many beyond just the expensive ingredients, right? Yeah, yeah. And they're just as beneficial. Yeah, exactly. Yeah. Great, great. So the next study that I'll tell you about was actually done on omega-3. And this study was done by the National Institute of Health and it looked to see if there was if omega-3 provides any benefit for cognitive function. And what they found was that omega-3 supplements actually do not help with cognitive decline. And they the study suggests that the best way is actually eating whole foods in which omega-3 is naturally occurring. So that would be walnuts, that would be salmon, for example. All these sorts of natural fats that we find in a plant-focused whole diet. So whole walnuts, whole pumpkin, whole almonds, wild fish in particular found. And I've even come across some supplements, I don't know if you've heard of them, but they're based on algae and they have a high content of the long chain fatty acids, DHA and EPA that you can find. So it's actually an option for vegetarians or vegans if they still want to supplement with omega-3 for other reasons. But that's yeah, that's super interesting. That's important also to address different dietary needs because we're not here to convince people to follow one diet or another, but rather that you can be this religion or that religion or have this dietary preference or that one and still have the capacity to eat whole foods. I think one thing to mention as well with the processing of certain products that you can find on the shelves, the fibre and micronutrient content can actually be adversely affected as well, right? So any form of processing, whether it be cold pressing as well as heat pressing, can actually affect the nutrient availability of some of your studies have shown. So you're going to hear this a lot, but the the best way is to eat foods in their whole form as possible, right? But it's it you know, it's it's really up to personal preference. I found people that still have green sprinkles, as I call them, or like, you know, superfood blends and that kind of stuff. If you can afford it and it makes you happy, you feel great on it. I don't have I'm very open-minded to this and I'm very open-minded to the new research that might say the opposite. In fact, I came across some a study looking at broccoli sprouts in particular where they had a powdered form and they supplemented people's diets. I think it was done in China where they have exposure to a lot of environmental pollutants. And they found that their blood level of the environmental pollutants that they were looking at, something that we find in cigarette smoke, like benzene, actually reduced significantly whilst they had a very small amount of these broccoli sprout supplements. The equivalent that you find in 30 grams of broccoli sprouts is what they had in these capsules. And it was pretty, yeah, it was pretty amazing. And I think, you know, they attributed it to sulforaphane, which is a type of plant chemical that you find in broccoli sprouts, but you can also find them in things like brassica vegetables and all the different sorts of greens that we have access to up and down the country. But that's interesting. It was conducted in China. It was. Where there is probably a pretty high level of contamination, right? So I imagine that it would be due to the antioxidant properties of the broccoli sprouts. Yeah, yeah. There's a whole, I think, a whole bunch of different mechanisms by which phytochemicals in particular can have an effect on things like environmental pollutants, but also the ability to remove pollutants from your your blood. So whether that be antioxidant mechanisms, so removing scavenging oxidants, whether it be upregulating certain enzymes that actually improve the process of removing pollutants, an effect on genes, so the actual genes that govern how well we reduce environmental pollutants in our body, and inflammation as well. This it's really, really complicated. I'm sure there's lots of other things to it. But that's, yeah, that's one of the studies I found. Super interesting. Yeah. I think I might have referenced that in my book. I can't remember. There was quite a few references that I put in the book. I did a lot, a lot of work for it. It was, yeah. I bet you did. Yeah. How long did that take you? It took a good three, four months, but I'd been doing the back work for it for seven or eight months, actually. Yeah. Wow. Long process. Well, congratulations for finishing it. So, the impression that I want to give to listeners is that with every mouthful of food, there are tens of thousands of different molecules that enter your system and progress through so many different complicated metabolic processes. So it can never be really as simple as I eat this particular vegetable, fruit or food for X and that helps with Y. And it's likely that it's the multitude of compounds that we find in whole foods as well as the arrangements and the relationship that that has with our cells that leads to positive and negative outcomes, right? So it's it's very complicated to get your head around, but Well, absolutely. From a public health point of view, I think I get a lot of resistance from from patients saying, you know, this is all great, but healthy eating is expensive. Like, how do I do this on a budget? Well, healthy eating is very expensive when you buy packaged products. So if you go to Whole Foods, for example, you can whole paycheck. Exactly. Yes, you can fill up one grocery bag and spend quite a bit of money. And that's because they really charge a premium for these packaged products. However, there are many other options for buying organic produce at Tesco, for example, is seems very economical. I mean, all the supermarkets I've seen here. Other supermarkets are available. Yeah, yeah. So, I don't know, Waitrose, what what have you guys have here, you know? They all tend to have large varieties of produce. So for your fruits and vegetables, I really don't see them as being costly. And if you base your diet on those, fantastic. For grains, I suggest shopping in the bulk section if you can find one. That helps a lot in reducing costs. Absolutely, yeah. And for people who do eat meat, you actually don't need that much. Yeah. Half of your plate should actually be fruits and vegetables. Yeah, yeah, totally. I actually talk about that a bit more on my podcast that's coming out called eat plants or eat more plants really. So like it's probably the best evidence base that we have for eating, right? A largely vegetarian diet versus meat. I I do some work with a charity community kitchen called Made in Hackney and it's exactly trying to do that, disparage this belief that healthy eating is expensive when you teach people to be savvy shoppers and look for where you get whole foods, where you can actually get those massive bins of of beans, legumes and different sorts of whole grains. It's super, super cheap. And you know, just witnessing like the sort of realization of how they can do this on a budget is is really, really encouraging, you know. It is encouraging. Yeah. I actually talk about being a savvy, I keep on mentioning a book here. I teach you how to prepare food from scratch as well. So things like soaking and sprouting and food prep tips on Sundays and midweeks and stuff like that. There's lots of little tips and and stuff like that that you'll find in the book as well. So, I just want to ask you one question. Or did you have something else? Well, I was just going to say back to what you're saying about incorporating a mainly plant-based diet. The World Health Organisation also recommends that as a strategy for combating this rising prevalence of of chronic diseases. And an interesting fact actually is that preventable chronic diseases, like we talked about that are preventable through diet and exercise, cost the NHS 18 billion pounds a year. Right, yeah, yeah. So if which is like 20% of the budget. That's huge. Yeah, it's huge. So if we could get that under control, we could reallocate those funds into maybe. And I think, you know, that's actually an underestimate of the proportion of the budget because, you know, the cost to dependents, the cost on sick days, the cost on all that kind of stuff has massive, massive effects, right? The difference between whole raw and whole cooked. I mean, we briefly touched on this, but I'm seeing a lot of people trying to convince people to eat completely raw to retain all nutrients. So this is kind of like a prevailing myth amongst a lot of people, actually, a lot of educated people as well. So I'd love your opinion on that. Okay. The more raw foods that you can eat, now when I say foods, I mean fruits and vegetables. I don't mean like chowing down on like raw rice. No, no, no. Fruits and vegetables, salads, try to eat the majority of that raw because that is the way that you're going to obtain the greatest proportion of nutrients. So, raw food essentially means eating food that has not been cooked or processed or heated above, I think it's 40 degrees. Whole food is essentially raw food, but it also incorporates food that has been cooked. So it would include rice, it would include legumes, it would include meat, again, like I said. So the two kind of symbiotically work together very well. There are some foods, however, that do need to be cooked to reap the entire benefit of them. Of the nutritional content, right? Exactly, right. So we we talked about steaming broccoli and that is actually better for you. You'll notice that when you buy broccoli, it's a nice green, but it's a little bit dull, right? When you steam it, it becomes beautifully vibrant. Yeah, and that's when you know that it has reached optimum perfection. Tomatoes are another food that need to be cooked to release a chemical called lycopene. And the reason is because tomatoes store that in their cell walls and it needs to be heated to release that for the body to be able to absorb it. So for tomatoes, actually, the best products are like pizza sauce, pasta sauce, tomato paste, which you can make yourself basically by simmering lots and lots of tomatoes. Yeah, yeah, yeah, yeah, sure. But it's because it contains such a high concentrate of lycopene. And while cooking decreases the quantity of vitamin C, for example, in tomatoes, the the ratio of decline in vitamin C and the increase of lycopene is significantly greater. Okay. Right. So, all right, that's yeah, that's that's really interesting. So eat mainly whole foods, have some raw, have some cooked in your diet. Do the best you can really. The best you can. Exactly. Because I think it's about balancing the convenience of whole foods in modern society. Sometimes, you know, we have to navigate choices on a daily basis. We're surrounded by convenience foods and we need to appreciate that everyone's situations are completely different from each other. Yeah. We don't all have time to, you know, sit around and stuff. No, and there's no judgment. People do the best they can. We're just providing the information so that hopefully they can acquire more information to make better choices. Totally. Absolutely. Health really does start in the kitchen and there are no miracle cures for it. There are no miracle pills or sprinkles or, you know, tablets or supplements. Yeah, yeah. No matter what the marketing claims, it really does start in the kitchen. So. Okay. I'm just going to round up with just general tips on how to eat more whole foods and less convenience products with the aim of increasing nutrient density of our meals. So, Tupperware is your friend. It's the best way to guarantee having access to a healthy lunch, particularly if you work in the NHS and you only have access to the hospital canteen at work. I always go to work with my Tupperware where possible. It's super, super easy. Or any office environment, right? Any office environment, exactly. Yeah, the lunch options can be particularly poor if you work in areas where there isn't access. Or expensive. And expensive as well. So it definitely takes all those boxes for me. Meal prepping is sometimes life-saving. Prepping at the start of the week is brilliant and I tend to make staples like butternut squash, lentils, the different sorts of legumes that we've just been talking about, sweet potato, and then during the week, I fold in fresh ingredients. And that way, it changes up the taste, the flavours, and it keeps it manageable for you as well. Rupy, meal prepping might be an abstract concept for some people. Is that something you address in your book or maybe that's a sequel? That is something. That's a sequel. Yeah. So meal prepping is really the act of preparing staple foods at the start of the week so you can enjoy them later. So you cook in big batches. So I might, for example, do four sweet potatoes that I roast at the start of the week and I keep some of them in the fridge so I can fold in different sorts of vegetables into that, maybe some fresh lentils, maybe some spinach, maybe some different sorts of spices and herbs as well. Fantastic. Navigating supermarkets can be a mindful. I used to be someone that used to go to the store hungry and that's just plain destined to fail. Get cookies and the convenience foods and the crisps and that's where you're actually going to fall down. So don't shop hungry is one of the things I would say. Wholesome snacking at work. So prepare yourself. In hospital, for example, we only have a vending machine and I'm sure lots of different working environments only have access to those sorts of convenience foods. And stores themselves are lined with quick releasing sugars that I used to depend on. So, you know, if you keep snacks in the house, you're going to eat them. And the alternatives that I always talk about include nuts, seeds, whole fruits, which are delicious and they're satiating. And I try and tell my patients to indulge out of the house as well where possible because if you keep them in, they're likely going to be eaten. But having said all of this, food is for enjoyment. And some people being strict with yourself is necessary. For others, it's the complete opposite. And I think, you know, we need to be respectful of everyone's situation. So these are by no means rules that everyone needs to abide by, but more so suggestions and strategies to make healthier habits. If I'm hungry and there's crisps or there's a box of celebrations on the ward, I'm going to be eating them. And I think it'd be wrong to pretend otherwise. But for some people, it's an all too often occurrence and they need to be mindful, but others, it's something that you don't need to unnecessarily focus on. I just want to end on a quote from an influential book that I read last year from Professor Colin Campbell, who writes in his book Whole, "The only way to see the miraculous complexity of nature is to allow ourselves to do so." And what he means by that is that by getting overly simplistic about the exact proportions of certain compounds and molecules in a food, we miss the bigger picture of how those molecules relate to each other, to our body and the environment as well. There is an absolute universe of science in each mouthful of food and it's near impossible to explain with current understanding, as we've found out. But to reach a healthier lifestyle, we know that we can rely on simple advice of eating whole foods where possible. I think that wraps it up. Make sure you subscribe to the Doctor's Kitchen podcast on iTunes, Audioboom or whatever your favourite podcast player is for notifications so you don't miss new episodes. You don't want to miss the new episodes. Find my lovely inspirational guest, Alexandra Swacker on @alexandra.swacker on Instagram and more of her work at the Imperial College School of Public Health Collaboration with the WHO. That's a bit of a mouthful. Socials, tweet us at @doctors_kitchen for any comments. Check out the Instagram, YouTube and my blog thedoctorskitchen.com and don't forget to pre-order a copy of your book and I will personally come to your kitchen, deliver some Tupperware for your meal preps. I don't think I can do that, but it's the thought that counts and I will see you next time. You can hold me to that. Cheers. Bye bye.
