The Doctor’s Kitchen - Eat to Beat Illness: A simple way to cook and live the healthiest, happiest life

+ Spices Exotic spices, such as turmeric and cloves, have become a popular topic among those trying to lead a healthier lifestyle. While I welcome greater research into the exciting compounds found within these spices, especially as they may have a role in treatment of inflammatory disorders such as osteoarthritis, psoriasis and rheumatoid arthritis,

they are by no means the only ones. As a general rule of thumb, a wide range of spices contain dense concentrations of phytochemicals and micronutrients, which provide a variety of antioxidants that have the potential to reduce inflammation.

Rather than concentrating your diet around specific spices that you may not even enjoy or have access to, a simple strategy is to use those that you appreciate the flavour of. You’ll notice all of my dishes use plenty of spices and herbs and there is a clinical as well as culinary reason behind this. I’ve purposely included a section dedicated to making fresh pastes and spice blends from scratch (here (#litres_trial_promo)) and I hope they will encourage you to enjoy the process of using these amazing ingredients, ranging from mint, basil and marjoram to sumac, cinnamon and cayenne.

LIFESTYLE 360

These changes to the diet can serve to improve our balance from a state of pro-inflammation to one that is more harmonious with the intended function of our bodies. Your lifestyle, however, is important and these practices are just as impactful.

+ Slow down your eating I used to find myself running from appointments across the city with a snack in my hand, eating at my desk to sift through mounting paperwork during clinic or squeezing meals into a 10-minute break on an A&E shift. Many of my colleagues and patients relate to this. Even when we’re not rushed, we eat in front of screens, we scoff food at pace and hardly ever take time to appreciate the ingredients themselves. A measurement of stress in the body is a hormone called cortisol that is shown to be lowered if food is eaten slower and more mindfully.

The state in which food is consumed can be just as impactful on the body as the food itself. As a simple practice, I recommend patients take a few gentle breaths before starting to eat, and remove screens, in an effort to slow down the process so they can give their full attention to the food and perhaps the conversation around them.

+ Mind–body interventions Mind–body interventions, like Tai Chi and meditation, have been shown to reduce the expression of genes which code for proteins that lead to inflammation.

In many studies, different types of stress-relieving and relaxation techniques have demonstrated significant anti-inflammatory effects.

There should be no doubt that stress and psychological ill health are associated with inflammation and, conversely, stress-relieving techniques are anti-inflammatory.

When appropriate I discuss these studies with patients and I find that describing the clinical research underpinning my belief in the utility of mind–body interventions is really motivating for them. Think of mind–body interventions as any practice that encourages inner calm, whether that be the simple act of reading in a quiet space or meditation and yoga practices.

+ Walking If the thought of joining a yoga class or even deep breathing is too overwhelming, you’ll be pleased to hear about the mountains of research that consider the effectiveness of simple walks in nature. The Japanese practice of ‘shinrin yoku’, which literally translates as ‘forest bathing’, has a large body of evidence examining the physiological as well as mental health benefits of this practice.

Along with a reduction in heart rate, blood pressure and improvements in mood, forest bathing practices have reduced laboratory measures of inflammation such as cortisol and inflammatory proteins measured in the blood. Taking yourself to a park or forest at least once a week for a relaxing stroll could be one of the most hassle-free and effective ways to reduce your inflammatory burden without having to adjust your diet or do much at all.

‘If we can harness the incredible effects of not only our food, but the anti-inflammatory potential of our lifestyle, we could drastically reduce the problems that excess inflammation poses to our health.’

+ Sleep Given the number of homeostatic mechanisms that occur during sleep, it’s unsurprising that even a single night’s lack of shut-eye increases inflammatory signals in the body.

During sleep our blood pressure lowers, our temperature drops and levels of rejuvenating hormones like melatonin, which have powerful antioxidant effects, rise to their highest levels. As told in exceptionally certain terms in his book Why We Sleep, the sleep medicine expert Professor Walker has warned that a lack of sleep puts us at greater risk of diabetes, cancer and cardiovascular disease. It’s often noted that people with high inflammation, as a result of conditions such as arthritis, diabetes or obesity, often have disturbed sleep. It appears that inflammation and the proteins that signal inflammation have an interconnected relationship to sleep and may even regulate our need for slumber.

The advice for now is to at least allow yourself the opportunity to enjoy about 8–9 hours of rest per day. Put your electronic devices away a couple of hours before bed, eat early if possible and give yourself potentially the best dose of anti-inflammatory medication available to us.

If we can harness the incredible effects of not only our food, but the anti-inflammatory potential of our lifestyle, we could drastically reduce the problems that excess inflammation poses to our health. What this chapter represents is a medicinal package for many patients without the need for strong drug interventions. We will always need pharmaceuticals and as a doctor I do not hesitate to use them where appropriate. But the primary consideration should always be what we put on our plates and the way we live. These should be the first therapeutic interventions before we entertain more invasive measures that can carry a greater risk versus benefit.

Eat for (#ulink_ff94e13b-0d33-59fc-9aad-7c13382d3772)

Immunity (#ulink_ff94e13b-0d33-59fc-9aad-7c13382d3772)

(https://open.spotify.com/episode/3FaLsrUvLm7POpPprLlI9q)

(https://open.spotify.com/episode/1w1DvkxV8HSN6DhpuDJHG5)

The purpose of this chapter on immunity is to get you thinking about immune health in a different way. Rather than thinking of immunity as an isolated system that requires ‘boosting’ with individual ingredients, think about it from the perspective of making healthy lifestyle choices to build your metabolic and energy reserve. This strengthens all of the specialised cells and organs needed to support your body’s natural immunity and homeostatic mechanisms.

Your immune system is a collection of proteins, organs and parts of the body that work in unison to protect us from harm. This includes everything from the acid found in your stomach to prevent harmful bacteria invading your gut, to the thick protective protein layer of your skin that physically keeps harmful microbes out. Immunity also includes the complex network of specialised cells that work in superb coordinated sequences to maintain the harmony of your internal ecosystem.

We need a resilient immune system to protect us from infective organisms like viruses and bacteria, but we also rely on this complex network to protect us from the malfunctioning of our own cells. Immunity is traditionally thought to be just our defence system, protecting us from harmful microbes that live in the external atmosphere, but it also ensures the correct functioning of our internal environment. Our immune system is responsible for identifying and appropriately clearing away mutated or malfunctioning cells that can lead to, for example, inflammation and uncontrolled growths that can become tumours.

Trillions of times a second, chemical reactions are occurring in your body and as a product of normal metabolism and sheer probability, some cells are created that are malfunctioning or damaged.

In addition, normal radiation from the sun or environmental pollution from smoke inhalation can also damage your skin and lung cells respectively and this needs to be dealt with. We rely on our body to clear these damaged cells effectively, so they don’t lead to further negative effects. This is the job of our wonderful immune system. It is what we depend on to carry out these processes and it does so with beautiful precision and efficiency without us having to think about it.

The wonderful thing about our immune system is that it is everywhere. You might think of our detoxification system as our liver and kidneys, or our mental activity centre as our brain, but our immune system has to be prepared to step into action at any site in the body. Whether it’s to protect us from a skin-cut to the leg that could be an entry point for bacteria invading the bloodstream, or recognising a malfunctioning cell in an organ and clearing it away so it doesn’t develop into a growth, your immune system is ready.

I hope this gives you a broad idea of the magnitude of immunity and why simply eating or medicating ‘to boost’ it is a misnomer. I appreciate it’s a nice idea and an easy-to-understand concept; you eat something, it ‘boosts your immunity’ and you become a common-cold-kicking superhuman. But in reality, our bodies do not work like that. Our vast interconnected systems of cells do not simply respond to one element like Echinacea or zinc. It is called your immune system because it is an incredibly complex network of cells that require balance and harmony, and for this reason alone I hope you can already appreciate that there is no ‘silver bullet’ nutritional supplement or pharmaceutical product that magically improves your immune health.

GUT HEALTH

There are particular sites in the body where immune cells interact with each other and are developed, including the bone marrow, the spleen in your abdomen and lymph nodes dotted around your body such as the neck and groin. Of particular anatomical significance, however, is our gut. Our digestive system is the closest contact to the outside world. Everything we eat and drink from our environment is covered in microbes and we have been in constant communication with them in our environment throughout our evolution via this 30-foot long tube. But rather than being fearful of them, it’s important to realise that most of the microbes that live in our digestive tract are integral to our health. Our microbiota, the population of microbes including viruses and fungi but predominantly bacteria, are mostly situated in the large intestine. As we have discussed, this huge population of foreign cells is responsible for digesting food, releasing vitamins from ingredients and maintaining our health

(see here (#ulink_7335bc0a-074f-57c7-b0ee-b9537c39105b)). The lining of the gut has to be super thin so the products of digestion and metabolites from gut microbe activity can pass through into the blood in order to be transported around the body.

The thin gut lining facilitating transfer of nutrients is necessary, but it’s also a route for harmful microbes and products to pass into our blood which could lead to damage, therefore our immune cells need to be constantly assessing and recognising friend from foe in these areas. It is relentless work to keep our human cells in harmony with foreign microbes, as well as detecting which of these organisms we need to get rid of. This is why so many immune cells are concentrated in our digestive tract and it explains why the gut has the largest amount of ‘lymphoid tissue’ that contains cells of the immune system.

So, instead of simply using the analogy of an aggressive military force to describe our immune system, I like to see our immune cells as having just as much of a peacekeeper role in the complex world that is your human body. This is because the majority of cells contained within the body don’t actually belong to us. Microbial cells outnumber our own human cells and our health, particularly our immune health, depends on us keeping this population of microbes thriving. This objective is best served with a diet and lifestyle that nurtures them.

Having a robust and well-functioning gut population protects and bolsters our ability to deal with infections on several levels. Specific gut microbes maintain the integrity of the gut wall, preventing harmful pathogens or materials inappropriately entering the bloodstream. They secrete their own antibiotic and anti-fungal chemicals that attack harmful microbes, preventing them from colonising the gut. Beneficial microbes support an anti-inflammatory environment, which again is why good gut health improves cardiovascular disease and diabetes. The microbes themselves produce and release micronutrients that support our immune cells as well as protecting us from harmful environmental toxins.

Keeping our microbiota in shape improves our immune health and involves eating colourful vegetables, fibre and a wide variety of whole foods. Dishes such as the Ethiopian Berbere Curry (see here (#litres_trial_promo)) or the Pea Orecchiette (see here (#litres_trial_promo)) are great ways to achieve this.

AUTOIMMUNITY

Because of a general recognition of the importance of the gut microbiota in immune-related diseases, researchers are increasingly looking at gut-focused treatments for problems related to imbalances in our immune system. Sometimes our immune cells can inappropriately send signals to fight infection or attack normal human cells that are perceived as foreign. This is a simplified explanation of autoimmunity which is different to something like hay fever or dust-mite allergy, which is an exaggerated immune response.

It’s recognised that those who suffer from autoimmune conditions including psoriasis and rheumatoid arthritis tend to have imbalances in their gut populations.

The research is still in its early stages but we also recognise that those who suffer from exaggerated immune responses, like in the case of asthma and eczema patients, may lack certain populations of gut bacteria that harmonise the body’s immune response.

This has led to the hypothesis that repopulating the gut microbiome with beneficial microbes may improve symptoms.

A theory gaining popularity to explain one of the causes of some autoimmune (AI) diseases is that the immune cells have been exposed to products that have entered directly into the bloodstream via ‘gaps’ in the lining of our digestive tract.

These products have not been properly processed and identified by the immune system cells within the gut, and thus trigger an aggressive response that leads to harm of the normal tissue. It’s still under a lot of debate but it’s interesting to note that gut-focused treatments for AI disease, where potential triggers have been removed allowing the gut wall to repair itself, have led to some remarkable results.

I don’t have the space to dive into a full discussion of such a nuanced topic in this cookbook, but there is some interesting research on the horizon as well as a lot more we have to learn about process behind AI conditions and therapeutic dietary strategies. I suspect that it is more complicated than just nurturing the microbiome, but ensuring a healthy and thriving gut population using food could be a good starting point for helping with these illnesses and a lot of well-respected scientists in the field are in agreement on this.

ELIMINATION DIETS

It’s my responsibility to be honest about the validity of these interventions and assess whether you could benefit from them. There has been a lot of speculation regarding AIP (autoimmune protocol) diets and, although these appear to be restrictive and eliminate perfectly healthy items from your food, there have been some interesting and significant outcomes gained from their use. Depending on the condition, these short-term therapeutic dietary interventions may be beneficial, but I hasten to add that they should be actioned with the guidance of an experienced practitioner. I’m mindful of the scaremongering tactics surrounding components of food: gluten in flour, lectins in beans and other common ingredients. My advice is to maintain a high suspicion of anyone blatantly brandishing a single food as harmful for everybody and making outlandish and unhelpful claims. It makes no scientific sense to suggest gluten is bad for all citizens of the UK, for example, and I discussed the many reasons behind this in my first book. But I do believe there is a case for some patients to trial dietary strategies and many rheumatologist and immunologist colleagues are starting to use them carefully with interesting anecdotal successes.

MITOCHONDRIAL SUPPORT

In recent years, we’ve also begun to recognise the profound importance of a component of our cells called mitochondria. These are found in all of our cells and have been traditionally referred to as the ‘powerhouses’. These incredible batteries provide energy for all normal cell functions, but they’re also critical for recognising when an immune response is required.

Cutting a longwinded biology lesson short, we require healthy, functioning mitochondria for a robust immune system that can boost its metabolic activity to adapt to the increased demands of when your immune system needs to be more active. Whether it’s fighting an infection or balancing oxidative stress, your immune cells require more energy, and mitochondria are key to this. Supporting your mitochondria by preventing damage and providing them with fuel is therefore an essential immune-supporting strategy. Things that damage mitochondria include high-sugar diets and stress, and this gives us one explanation as to why poor diet and mental pressure appear to have detrimental impacts on our immunity.

This is a very new area of research, so the evidence base behind what to eat for mitochondrial support is lacking, but that shouldn’t stop us from being able to make reasonable, educated adjustments to our lifestyles that we can be sure are safe. Even if we cannot accurately determine that they are specifically supporting mitochondria, they are certainly beneficial to your body in many other ways.