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  1. christmas brusselsChristmas is coming and before too long families all over the UK will be sitting down to their traditional roast dinners, with turkey, roast potatoes and of the trimmings. For most of us those ‘trimmings’ will include the humble Brussels sprout. This small green vegetable may be the most divisive part of Christmas with some of us having a major passion for them and others considering them to be vile objects, barely deserving the label of edible.

    From a nutritional perspective, the sprout is not particularly remarkable. A 100g serving has an energy content of 40 kcal and delivers 3.8 g of dietary fibre. They are a very rich source of vitamin K and a 100g serving can provide 169% of the US recommendations for adults. Sprouts are rich in potassium (389 mg/100g) and ascorbic acid (40 mg/100g) but are otherwise are no different to any other green leafy vegetable. Brussels sprouts are brassicas and as such share many of the characteristics of the other members of the cabbage family.

    Sprouts may carry benefits which until relatively recently were unrecognised. As a cruciferous vegetable the Brussels sprout rich in a variety of sulphur and nitrogen-based compounds which may have anti-cancer properties. These compounds occur in two main groups based on chemical structure. The indoles are nitrogenous compounds which in the uncooked vegetable exist as glucobrassicin. Glucosinolates make up the other class of compounds and in the uncooked vegetable are present as glucoraphanin. Both chemicals form part of the plant defence system against infection and when plants are damaged by cutting, chewing or heating they break down to form smaller derivatives. The main derivative of glucobrassin is indole-3-carbinol, whilst glucoraphanin breaks down to a range of molecules called isothiocyanates, of which the major form is sulfopharane. When isothiocyanates and indole-3-carbinol are ingested they undergo further transformation in the acid environment of the stomach. The resulting derivatives activate enzyme pathways which are responsible for the elimination of xenobiotics and in this way, are able to inhibit the initiation of cancers. Some indole-3-carbinol derivatives have also been shown to induce apoptosis and inhibit proliferation of cancer cells. The same compounds are also present in cabbage, cauliflower, bok choy and cress and there are also reports that they may have beneficial effects in neurodegeneration.

    The reason for the split view on the taste of sprouts comes down to the same groups of molecules which contribute to the potential health benefits of sprouts. Sulfopharane is the breakdown product of glucosinolates in sprouts. It is the compound which gives sprouts that vaguely sulphurous smell as they cook and is released in greater amounts if the sprouts are overcooked. The biology of taste is now well understood and we know that there are genetic differences in  the types, numbers and patterns of taste buds and receptors in the tongue (see https://www.nottingham.ac.uk/biosciences/research/research-themes/taste-map/taste-map.aspx). These differences mean that some people sense and respond to certain bitter compounds in an exaggerated manner. These people are termed supertasters. In contrast non-tasters are unable to detect the same compounds and show no response. Our humble sprout causes such division at the dinner table because the supertasters (sprout-hating) can detect the sulfopharane, yet the sprout-loving non-tasters are unable to sense it.

    So, on Christmas Day as you settle down for a great meal with family and friends, give a thought for the humble sprout. It may be far more complex and deserving of your consideration than you may think!

  2. whats next

    Many of you will have recently graduated or are entering the final year of degree studies and so that awkward question of what comes next may be uppermost in your mind. It’s a tricky time, making that transition from undergraduate study to the next stage of life and it isn’t uncommon for students to question what they have studied and have second thoughts about their future career path. Back in the mists of time when I finished my degree I had no idea what I wanted to do, but was pretty sure that I didn't want to do any more studying or be anywhere near a university. Now 2 more degrees later I am firmly wedded to the academic life and to be honest still don't really understand how I got here.

     So if you’re finishing a degree in dietetics or nutritional sciences, what are your options?

    Work
    You may have started your university course with a particular career in mind. For those of you studying dietetics this will have undoubtedly have been clinical practice working in the NHS in a variety of settings. However three or four years down the line, your dreams may have changed, become more ambitious or even evaporated. The good news is that a background in nutrition is more relevant than it has ever been and the opportunities available in the food industry, public health and research are wide and varied. The Nutrition Society have produced some really useful careers-related materials that you may find useful https://www.nutritionsociety.org/membership/students/careers-support, including interviews with people at different levels of their careers and dietitians who have changed direction.

    Further study
    Further study isn’t something that I would enter into lightly. Postgraduate courses are expensive and tough going and so real commitment is necessary to make it a worthwhile experience. In the area of nutrition there are many opportunities available to study to Masters level. For somebody who already has a nutrition or dietetic background these will generally provide greater depth in specific areas of nutrition such as clinical nutrition, animal nutrition, public health nutrition or advanced dietetic practice. The latter is especially useful for registered dietitians who want to enhance their knowledge and skills, often studying part-time alongside clinical practice. A Masters can be a great way to stand out from the crowd and distinguish yourself from rivals in the job market who have BSc degrees.

    If your ambition is to go on to a research career then a Masters of some sort may not be the way to go unless your first degree is not at 2:1 level or better. With a good degree direct entry to PhD programmes will be possible. However, if you are tempted by a PhD but unsure whether it really is for you, then you might want to consider a Masters of Research degree. These are generally one year courses in which there is little or no taught element and the time is spent on a major research project. This gives good training and experience in the whole process of data collection, lab or fieldwork, data analysis and writing and can help make that decision about whether research is your thing.

    There are many good reasons to do a PhD. If you love research (maybe your final year project at undergraduate level was a great experience and you caught the research bug) and like the idea of contributing brand new, advanced knowledge to society then this is the way forward. A PhD gives you the opportunity to become THE world expert on your area of study and at the same time develop great transferable skills in communication, IT, time-management and self-organization.  Many PhD opportunities are now offered as part of a Doctoral Training Package which includes specific training in these sorts of skills and gives you a lot more choice over what specific project you will take on. If you want to work in research either in an academic setting (which brings with it amazing freedom to think and try out new ideas) or in industry, then a PhD is essential if you want to climb the career ladder.

    Doing a PhD can be tough. Doctorates don't come easily and it can sometimes be a lonely time of hard work and extreme stress, but with the right project, the right supervisors and the right colleagues, you can also have a lot of fun and emerge from the process happy, fulfilled and able to have the title Dr printed on your credit cards!

  3. Quack

    I am actually a pretty even-tempered and tolerant person, but every now and again am reduced to ranting, apoplectic rage by things that I see on the television and in printed and e-media. The triggers for these lapses of reason are generally outrageous claims about the amazing and totally fictitious properties of foods. These are sometimes individual products which are being marketed by unscrupulous pseudo-nutritionists. One of the first that caught my attention and got me engaged in a grumpy email correspondence with the supplier was Hawaiian Noni.  Noni is a tree related to coffee which yields a fruit which unfortunately smells rather like vomit, and like most other fruits contains a range of oligosaccharides, polysaccharides and phytochemicals. Noni is now widely available as a supplement in health food shops or as juice. The particular quack that I tackled was a retired US army officer who made claims that noni cured practically every disease under the sun (cancer, coronary heart disease, kidney failure, diabetes) and reduced mortality by 60%. I found that last claim particularly irksome as one thing we all do eventually is die, so mortality will always remain at an inconvenient 100%.

    Other annoying claims from the pseudo-nutritionists generally refer to ‘superfoods’. Superfood even has a dictionary definition (‘a nutrient-rich food considered to be especially beneficial for health and well-being’) and a quick Google search will reveal endless articles such as ‘The 52 best superfoods’, ‘Superfoods you need now’, ’25 greatist (sic) superfoods and whey they’re super’. The truth is of course that there is no such thing as a superfood. The term is a marketing gimmick to tempt the unsuspecting, health conscious public to part with their money. Superfoods are just foods at the end of the day. Yes, they are nutrient dense and will enable people to follow a healthy diet, but they won’t prevent disease, cure disease and in many cases do not even have a discernible physiological effect. For example, goji berries have been widely touted as a superfood that will protect against cancer, coronary heart disease, boost the immune system and improve life expectancy. There are no reliable scientific studies that back up any of these claims however, and these superberries are merely good sources of micronutrients, just like any other fruit.

    Don't get me started on juicing and spiralizing.

    Of course the big problem here lies with the untrained, pseudoscientists who sell this material and make a good living from their books and web marketing that are target a ever more diet conscious population. Anybody can call themselves a nutritionist without training or registration and that poses a real threat to people’s health and pockets. I will blog on that topic another time.

    Recently Marinangeli and Harding published an article in the Journal of Human Nutrition and Dietetics (http://onlinelibrary.wiley.com/doi/10.1111/jhn.12359/full) about the specific health claims made about foods which deliver ‘sustained energy’ by virtue of their glycaemic index. The general claim that is made is that if a food evokes a low glycaemic response after consumption, it must be digested and metabolised more slowly, hence releasing energy more slowly giving a sustained effect on the body. The authors of the article state that companies who make this claim are doing so in a way which confuses consumers and presents information about the biological effects of such foods in a misleading way. This is yet another example of how marketing of foods can use loopholes in legislation to exploit the widespread desire to eat more healthily

    I think that this blog post might be a bit ranting, for which I apologise, but this is a really important issue. Obesity and other nutrition-related problems are the biggest health concern in the UK today and the budgets available for health promotion and the visibility of appropriately trained, knowledgeable individuals are but a fraction of the marketing budgets and profile of the ‘bad guys’. I’d been interested to see some comment on other examples of quacks at work, or ideas about how we can make our profession stand out from the noise and the nonsense. 

  4. handsholding

    Dietitians have key responsibility for assessing, diagnosing and treating individuals who have diet and nutrition-related problems and diseases. At the heart of this lies the deployment of effective communications skills which can encourage and facilitate behaviour change in individuals and groups of people. Often when people are first diagnosed with serious and lifelong diseases such as diabetes, the enormity of the diagnosis and the complexity of the dietary advice that they are given cannot be properly absorbed. Patient-centred consultations in which the dietitian builds a rapport and takes time and care to individualise advice are of huge importance. These communications skills do not come naturally to the majority of people and so have to be taught, practiced and developed.

    This need for training is now widely recognised in the dietetic profession across the world and approaches to training that involve innovative methods, are being rolled out by universities who train students in the dietetic and nutrition professions. One of the big challenges is to enable students to practice their skills in a safe environment without accessing real patients. This challenge can be overcome by using simulated patients who might be volunteers, other students or in some cases, professional actors. These simulated patients can help students develop and refine their skills before going on clinical placements and finishing their professional training.

    Gibson and Davidson reported the findings of a study which examined the impact of simulated patients in Australian dietetic students in their 3rd and 4th year of training (http://onlinelibrary.wiley.com/doi/10.1111/jhn.12352/epdf). The study looked at whether students benefitted from having repeated consultations with simulated patients rather than a single experience. It was found that whilst students who had good communications skills after a single consultation had only modest improvements in skills, students who struggled with these skills made greater improvements and developed skills to make them better prepared for clinical placements.

    Kirsten Whitehead and colleagues developed a tool for the assessment of communications skills in dietetic consultations (DIET-COMMS: See http://onlinelibrary.wiley.com/doi/10.1111/jhn.12136/abstract). This tool was intended to provide a simple, validated process for use in the training of students who will be engaged in consultations to encourage diet-related behaviour change in patients, and for post-registration dietitians who want to assess or refine their skills. The DIET-COMMS tool and a training package for using it is available at http://www.nottingham.ac.uk/toolkits/play_13244. This site also has some fantastic video examples of good and bad consultations that are useful viewing for student dietitians. Use of tools such as DIET-COMMS will provide simple means of assessing performance of key communications skills that are accessible to students and trainers alike. 

  5. Now later

    As a university teacher I am always very aware of how challenging some of the assessment are that we set our students. This is often not because the concepts are difficult, but because the assessments involve long pieces of writing. We ask for essays, literature reviews, dissertations and theses, and yet our students have generally come to us because they have a passion for science and for hands-on practical work. For many of you each assignment brings the challenges of 'how do I get started?' and 'how do I plan and structure my writing?'. Sad to say, as teachers we sometimes don't give you an awful lot to go on.

    Making a start to a piece of writing can be incredibly tough. There are so many other interesting things to do. Just pop out to see how a friend is getting on and then start... Check Facebook quickly and then start… The flat is an awful mess, better tidy up and then start… Procrastination is easy and it also often covers up a basic fear of writing. Anxiety can stem from a variety of sources that range from the sheer volume of the task (a 10000 word dissertation is a massive job)  through to over-concern about making it perfect. All of these concerns can have a detrimental impact on what you're writing, makes the process painful for you and ensures that it takes you a lot longer. You are your own worst enemy when you're writing.

    So to get started, what do you do? Well although I am an experienced writer (I love to write!) but I still suffer from writer's block and struggle to get things underway. My approach is to keep things simple. What is the word limit for the piece? What are the sub-headings that I am going to use? From there I can allocate words to topic- each sub-heading gets a number of words allocated and then I start to just write key words down for each section. Then I start to add the flesh. Importantly I don't write from start to finish. The introduction is sometimes the last thing that I write. Writing is a psychological thing and the thing that stops us doing it effectively is confidence. So, build confidence by picking off the easy sections of the piece first. If you have to choose between 200 words describing statistics on breastfeeding in the UK, or 500 words that discuss contemporary literature on reasons why women choose not to breastfeed, then it's obvious what to go for. Write that easy stuff first. If you're writing a 2000 word piece and break that down into ten 200 word sections then by doing three or four easy bits first, you are suddenly 30% of the way to finishing without breaking sweat.

    Each piece of writing that you have to do will be different and will follow different rules depending upon who the target audience is. Obviously if you are preparing an information leaflet or writing a blog post, then that's going to be very different to producing an academic essay or a dissertation. One key step has to be to look at examples that are equivalent. How do they look? How are they structured? What little tricks are used to make them interesting and readable? Authors often make good use of sub-headings, graphs, diagrams and clear paragraph structures to ensure that their writing is appealing.

    I have produced a series of blog posts entitled 'How to Write' which were originally aimed at academic writers who are new to trying to get their work published. I've had good feedback from lots of people about this series and apparently they are really useful to undergraduate and postgraduate students. So, if you're putting together a dissertation or a thesis or maybe you've got the chance to go and present your work as an abstract at a conference, why not take a look and see if it helps you write.

  6. gut bacteria

    One of the most important areas of human nutrition research at the moment is focused on the gut microbiome. This term describes the population of bacteria which live in the human intestine, which comprises more than 1000 different species and tens of trillions of cells. It is estimated that around a third of the make-up of the microbiome is common to all humans, but the remaining two thirds varies in terms of species and the extent of gut colonisation and that, with the number of different permutations of colonists that are possible, is essentially a specific pattern that is unique to each individual. As these bacteria express more than 3 million different genes, their activities within the human gut have a large number of effects on human physiology.

    A review article by Milani and colleagues, published in the Journal of Human Nutrition and Dietetics, describes the effects of the gut microbiota on human health. These are highly varied and depend upon the nature of the species involved. Whilst some bacteria are pathogens (eg E. coli, B. fragilis_ and are linked to adverse health outcomes (irritable bowel syndrome, necrotizing enterocolitis, colorectal cancer) others (eg Lactobacilli, Bifidobacteria) are now known to have basic activities that promote health and are a fundamental part of human physiology and metabolism:

    • Digestion and adsorption
    • Vitamin synthesis
    • Immunomodulation
    • Inhibition of growth of pathogens

    In addition to these functions the gut microbiome is now understood to influence aspects of metabolic function, appetite and influence risk of obesity and diabetes. The nature of the gut microbiome is shaped by a number of different factors. These include genetics, exposure to microbes in the environment and the diet. A lot of the features of the microbiome are set in early life. Babies are born with a sterile gut and initially acquire microbes during delivery (vaginal compared to caesarean deliveries differ in the microbes that babies acquire), breast or bottle feeding, infections and exposure to pets. As we age the microbiome will respond to further infections, rounds of antibiotic treatment and the nature of the food we consume. As set out by Milani and colleagues, there are differences between the microbiomes of meat-eaters and vegetarians and bacterial species respond to dietary intakes of fibre and possibly fats.

    If you would like to know more about the role of bacteria in human health, then the review article is short, easily digested and free to access at the Journal of Human Nutrition and Dietetics website.