Time for change: Dr Federica Amati

The nutritional scientist explains why what we eat is the key to a long and healthy life

People 23 Mar 2022

Dr Federica Amati

Dr Federica Amati

If the pandemic has taught us one thing, it is the importance of science to our daily lives. I am a postdoctoral medical scientist by training, with a special interest in public mental health, and I am also a registered nutritionist. These days, I work with individuals through one-to-one nutrition consultations at my clinic at KX London, as a researcher at Imperial College London, and as a scientific consultant for a few great projects that have improving lives at their core.

I am an evidence-based nutritionist, so everything I recommend is based on clinical trials, understanding mechanisms of action and scientific research. But where individuals are concerned, there is no generalised approach that works for everyone, which is important to remember. Having said that, my particular interest is in the Mediterranean dietary pattern and its interplay with the gut microbiome, which forms the basis of the advice that I give and the name I give my food principles: “BioMed”. I particularly focus on supporting a healthy and diverse gut microbiome. I also like to work with women and mothers, as they are the ones who often choose the food for children, too, but are time poor, creating opportunities to improve nutrition in an achievable way.

What I’ve found is that some people can adhere to a diet based on a menu format, but most can’t, so we need to make nutrition more accessible than strict meal plans and complex recipes. I feel strongly that the important thing is to improve nutrition education and take a personalised nutrition approach. It means creating a baseline understanding as to why it can be difficult to maintain healthy food habits. It’s not that people are lazy or ignorant, but the food industry is a profit-making market and our food environment at the moment is geared towards profit, not health. So, one thing to consider is that if a piece of food needs lots of marketing, it’s probably not that great for you. You don’t see marketing for broccoli and raspberries, but you do see all sorts of claims for other things – products that are sold as being good for your gut. It’s worth being a bit sceptical about such claims.

Because I have a background in public health, I do have an appreciation of the context in which people eat, not just the science. This is important, as it helps to understand the drivers behind increases in obesity at younger ages and type two diabetes. My aim is to help people to feel empowered to take back choice and control for themselves. This is particularly important when it comes to what we feed our children.

But it’s hard to break away from myths. And one of those is that calories are important. They are not the answer – they are actually part of the problem. They are essentially an outdated measure of how much energy is given off by food burned in a test tube. Most calorie values were measured 100 years ago. It’s just not very useful for individuals to count calories in any context.

Another myth is the idea that food can be broken down into macros – proteins, carbs and fats. It doesn’t really work that way, as hardly any food is only one thing, unless you’re talking about something such as granular table sugar. So, while it’s important to get enough protein and enough fat in food, if you eat the right foods in a balanced way, you will get enough of everything.

The Mediterranean method

That balance is what lies behind the success of the Mediterranean diet. The notion that this is a healthy diet comes from observing the fact that so many populations from this part of the world have longer, healthier life years. Put simply, they live longer without illness. That’s an important distinction, because it is not just about a long lifespan. These days, the populations of lots of countries live longer, but many do so with chronic, debilitating disease.

However, as well as observation, there have been many, many clinical trials to back up the Mediterranean diet, which is primarily plant-based, with most of it being made up of whole grains, beans, nuts, seeds, pulses, vegetables and fruits. People think that “plant” equals lettuce. But there’s so much more to it. What we lack in the UK is regularly eating beans, pulses, whole grains and lentils. Then there’s extra virgin olive oil. I can’t stress how great it is for everything – cooking, baking, dressing – it is very stable for cooking and a powerful antioxidant with plenty of flavour. There is occasional consumption of fish and good quality meats and dairy, too, as part of the Mediterranean mix. But when you look at the way many people in the region consume these things, it’s from very different sources to ours: they fish locally and eat fish fresh, and often farm their own meat or buy it locally for occasional family meals. It’s not industrialised and eaten as an unrecognisable slice in a sandwich; the meat is also not from cattle farms.

The same is true of dairy products. So, for example, while it is true that the Sardinians eat a lot of dairy, they drink the milk and eat the cheese from their own, locally reared goats. You can’t apply a reductionist argument to diet – just because the Sardinians eat a lot of cheese and enjoy good health, that doesn’t mean we should all increase our consumption of cheese slices.

So, it’s quite simple really. Eat plants as a basis with plenty of whole grains, nuts, vegetables, legumes and beans. Add some high-quality fish, dairy, eggs and meat in small quantities, and only for some meals. Things like confectionery, pastries and fizzy drinks and juices are just not part of the pattern. Of course, on occasion we all have a birthday cake or a bag of sweets, but it shouldn’t be part of your daily pattern of food. The interesting thing is that everyone knows what a Mediterranean diet means, but they’ve forgotten that the local people who follow it are eating all these foods in unprocessed forms. You can have a pizza if it is made with wholegrain flour and leavened sourdough and with fresh tomatoes and fresh basil as part of a meal with plants – that’s very different from your frozen supermarket pizza.

Another part of the Mediterranean diet is coffee – think of the Italians. There is evidence now that coffee is good for you; it is well-tolerated by the body and it can help to reduce cardiovascular disease, type two diabetes and some cancers. There have even been some trials in which colon cancer patients having chemotherapy who drank coffee had better outcomes than their peers who didn’t.

Focus on quality

But, really, it all comes down to quality food. The level of processing your food has undergone is predictive of how unhelpful it will be for your biology. This is the thing that is associated with what we call chronic low-grade inflammation, and related to problems such as diabetes, Alzheimer’s and dementia.

The science is quite clear now that snacking is not a good idea. Having small snacks instead of proper meals is not great. Eating when we’re hungry, at meal times, is better, especially if you’re grazing ultra-processed foods. But even if you stick to meal times, if your diet is full of processed foods then you will be causing chronic inflammation ­­– a bodily reaction in your immune system that is not healthy if it is sustained for long periods of time. If your diet is poor and is not counteracted by exercise, reducing stress levels and anti-inflammatory foods, then this inflammation can stay elevated and cause oxidative stress. Anti-inflammatory foods are things such as pulses, beans and colourful fruits and berries: the things you find in the Mediterranean diet.

Indeed, it’s hard to think of a modern disease that isn’t caused by chronic inflammation, aside from those caused by an external infectious agent, so there’s your answer. Even joint pain, and simple stuff that people might brush off, can be traced back to a poor diet. But here in the UK, the majority of us eat too many pro-inflammatory foods and not enough of the good stuff.

It’s not rocket science: what it boils down to is that we should all be eating more plants. Go to the greengrocer and pick up fruit, vegetables, nuts, herbs, spices, legumes and seeds.

The right foundations

Essentially, what we need to understand is how and what we eat is so important. It not only provides fuel, but also minerals for our neurons to fire and amino acids that build up proteins for our muscles; it contributes to how we process oxygen, and how we sleep, repair and recover. What we eat every day is literally what creates our selves. As human beings, we constantly replace old with new cells in our body. And these are formed from what we eat, so what you choose to eat every day is what’s going to make you. It’s like building a house. You want a strong foundation; you want it to be weatherproof – so you have to have good materials.

This idea of diet actually creating what we are is one of the reasons I like working with nutrition in pregnancy and early childhood. We talk about the importance of the first 1,000 days – which we time from the moment the child is conceived to its second birthday. This is the period of maximum growth and development, during which all of your tissues and organs are formed. The blueprint for the rest of your life is set at this time. In the womb, organs are created. If a mother is malnourished, the child’s kidneys will look different from those of a child whose mother was well nourished, and the ability of the pancreas to create insulin is affected. Why not equip women with knowledge, so they can go into pregnancy in the best nutritional state they can be in? After all, it’s not just beneficial for the child’s health but also for the mother’s, too.

To improve things, we should be educating teenage girls in UK schools about nutrition, which at present we are not. I believe there’s a big piece of work to be done on this – a focus on the importance of nutrition for women, explained to them at an age when they are ready to absorb information that will help them throughout their entire lives.

Practically speaking, we also have a problem with nutrition in early childhood over here. Schools in the UK are really behind. The government is trying to introduce standards ­– there is a will behind it, but there’s no enforcement. Funding is an issue, of course. We need schools to be able to have the funds to purchase a variety of healthy plant foods to prepare on site. Up to 65 per cent of diets in early childhood are made up of ultra-processed foods. Consider that nurseries have no food standards at all – and that your tastes are set by three years of age.

There’s just not enough public awareness of the issues, so there’s not enough public pressure. Diet is so important at school. It affects ADHD, how kids’ immune systems function to protect them from infections, their ability to learn – all sort of things. And the pandemic has shown us how metabolic health and good dietary health have been an important factor – in not catching Covid-19, not getting too ill from it and not dying from it.

Education is key

If we want to stop the worrying, growing trend in obesity, diabetes and cancers, we need to raise public awareness of the importance of good food, so we do not become the first generation that dies before our parents. Luckily, we can still do things in adulthood to help our bodies thrive, even with a disadvantaged start. Getting to know your unique biology and response to food is a key part of that journey and one of the companies I am working with, called ZOE, is offering just that. Backed by science, using the latest data analytics and evidence base from world-leading universities to create unique, personalised scores for foods to match individuals’ biology is the future of personalised nutrition becoming a reality.

Speaking of parents, it’s little wonder that they don’t know enough about this area, as they receive no nutritional education. Even doctors and other medical professionals only receive a few hours’ training on the subject during their studies. I work with a thinktank that’s trying to improve nutrition education. Called the NNEdPro Global Centre for Nutrition and Health, we teach women to cook healthy meals so they can then teach others to do the same, and we train doctors, nurses and carers on the principles of nutrition. It sounds basic, but we don’t have home economics lessons at school any more. Kids sometimes leave education without knowing how to prepare a basic nutritious meal for themselves.

This needs to be addressed. It’s a huge task, but some countries are doing better than us. Chile labels ultra-processed foods with a health warning like cigarettes, for example – imagine a health warning on breakfast cereals and granolas, rice cakes and vegetable crisps, things you might be forgiven for thinking are good for you but are actually ultra-processed foods that disrupt your metabolism and helth. Finland also does a very good job of teaching children about nutrition at school, and they have low rates of obesity.

Finally, if there’s one take-away from all this that I would like people to remember, it’s the following: taking the time to prepare whole food from scratch and eating that food, even if it’s just for yourself, is a good investment for health later in life.

For more information about Dr Federica Amati, visit her website: federicaamati.com. To contact her, email info@amatinutrition.co.uk