Tiramisu

You CAN have a marvellous dessert for Christmas or any other day you like! I’ve made  low carb tiramisu in many different versions over the years and here is just one. We will be having this for Christmas dinner, which we always have in the evening, because I usually work Christmas day. If you can keep your hands off of it, you can make this a day ahead of the event.

First of all make your sponge. You can use olive oil or coconut oil for the oil, and you can add cocoa powder, about two  rounded dessertspoons for each cake,  if you like a chocolate sponge on your tiramisu. Although this recipe makes one sponge, I strongly suggest you make two, because everyone wants seconds of this dessert.  You can use the second one for another batch of tiramisu or use it for a regular low carb sponge.P1030199.JPG
2 large eggs, separated
60ml double cream
2 tablespoons of granular sugar substitute of your choice
50g very soft or melted butter (or other oil)
pinch of salt
120mg ground almonds
1 teaspoon baking powder
Preheat oven to 170C/mk 4
In a large bowl, mix together yolks,  butter, cream, granular sugar substitute and salt. Add  in almonds and baking powder.
In a separate bowl, beat egg whites till in soft peaks, fold in a large spoonful to cake mix to loosen it, then gently fold in rest of egg whites as this adds lightness to the sponge.

Put the oven for 25 minutes approximately. The cake is done when a cocktail stick comes out almost dry or the top springs back when gently pressed.

Disaronno_Originale_2

Now for the filling.

Separate 6 eggs. Beat the yolks with about 3 heaped tablespoons of granular sugar substitute. ( My combination is 2 xylitol + 1 splenda )

Add 500g mascarpone and some Amaretto or Kahlua or Tia Maria. Whip.

In a jug put 250mls of cooled strong coffee (preferably real) and ¼ cup brandy or rum or Kahlua or Tia Maria.

Whip the egg whites and then when stiff fold them into the boozy/cheese mixture.

Now in a fancy bowl put in a layer of sponge cut up. Dribble over the coffee mixture till wet but not disintegrating.

Then add a good layer of boozy custard.

Keep on till you have a layer of boozy custard on top.

Put chocolate shavings (crushed up flake = 15g carb per flake )or cocoa powder on top(less carby)

Put it in the fridge for at least 2 hours before serving to chill.

This keeps for a few days, if you can keep your hands off of it.

 

 

Make your basil plants last longer

 

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The Observer’s gardening correspondent James Wong has a great idea to keep your supermarket basil plant thrive.

As soon as you get it home, take the plant out of the container and divide the root ball into four. Cut away any weakling stems at soil level, leaving about 5 strong stems for each quarter plant. Plant each new clump in a good sized pot in John Innes number 2 compost or similar.

Water generously and place in a sunny sheltered spot on a windowsill or green house and let them grow.

Two of my favourite basil recipes are Caprese Salad, with mozzarella, tomatoes, basil, olive oil and balsamic vinegar and tomato and basil soup. Do you have any others you would like to contribute?

 

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“A cross-party long-term strategy is needed to combat obesity in children” says Brian Whittle

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Brian Whittle is a gold medallist runner who aims to introduce widespread after school childcare focussed on delivering high quality exercise and physical activities. This is a long term strategy which is fun for children yet could provide immense health benefits and even enhance academic performance.

There are studies which support the validity of Brian’s aims.  But do enough politicians have the long sightedness and will to ring fence funding that is needed?

In order to prevent obesity in our youngsters and the disorders associated with sedentary behaviour a culture change is needed. The unhealthy eating, snacking and reliance on screen based entertainment needs to be replaced by three good meals a day and movement to counteract the long hours sitting in the classroom. Many parents work long hours too, and would welcome group based physical activity for their children in a safe environment.

Brian is seeking support from leaders and health ministers from all parties.  Some headmasters are highly supportive and are delighted with the improved behaviour, reduced truancy and improved grades that they are seeing in pupils who have become more engaged as a result of fun activities after school.

More than 2.3 million children in the UK are overweight or obese and even the under 12s are showing signs of high blood pressure, cholesterol abnormalities, type two diabetes and liver disease.

Dr Tim Lobstein, director of the Childhood Obesity Programme says,  “ It will be tragic if it is not tackled. Chronic diseases are moving forward at an ever increasing rate. Our kids are eating themselves into an early grave. We will have the first generation to die at an earlier age than their parents. Britain along with some other southern European countries are at the top of the list. While soft drink and confectionery sales have rocketed, and TV watching, computer games, and other sedentary media have grown, exercise has fallen. Unless the obesity epidemic is brought under control we are facing the prospect of medicating kids at primary school and for the rest of their lives. If we can just find a way of encouraging healthy growth then we can avoid an enormous amount of grief in the future. Unless we start teaching our children in schools about raising children, feeding them properly, exercise and the difference between good and bad food, then we are just going to exacerbate the problem.”

Getting children to become more physically active and achieve normal weights has been found to improve attention, planning and thus have knock on effects on academic performance. ( Davis CL et al Pediatr Exerc Sci. August 6 2015)

Children who are more active in late childhood can demonstrate lower body weight and lower risk factors for cardiovascular disease and diabetes by their mid- teens.  This means an hour of moderate to vigorous exercise a day. A national approach involving the collaboration of various government agencies would be needed to produce widespread benefit. (Stamatakis E. Pediatrics Vol 135 No 6. 6 Jun 2015)

For younger children under the age of 6, three hours of activity, spread throughout the day is recommended by the US Institute of Medicine. They hope that such recommendations can help reduce overweight and obesity which is currently at 27% in this age group.

For adults at least 30 minutes of activity a day is recommended. The good news is that the earlier you get into exercise the more the habit is like to stick.  Swimming, dancing, walking, running, yoga, jogging, tennis, basketball and football are all suitable. The fitter you are in early adulthood, the lower your total mortality rate and cardiovascular disease rate. There is a clear dose response between exercise and fitness and fitness, well-being and mortality rates. (Shah et al. JAMA Internal Medicine 1-9)

Even if you have been sedentary for years or cannot tolerate 30 minutes a day, it is recommended by the American Heart Association that you start with walking.  Apart from benefits to the individual there is a benefit in health care costs in the future. ( AHA 6 Dec 15)

Emma and I are already into the exercise habit. It certainly is more of a challenge in Scotland with our awful weather and long, dark, winter nights. What good ways have you found to keep active and support your children to be active?

 

 

 

 

African Lamb Stew

AubergineINGREDIENTS

1.2 kg of lamb stew meat

2 aubergines

1 ½ teaspoons sea salt

1 teaspoon freshly ground black pepper

2 tins of chopped tomatoes

1 tablespoon coriander seeds

½ tsp cumin seeds

2 tsp grated nutmeg

3 tablespoons oil

3 pcs red chilli finely chopped

2 tablespoons grated fresh ginger

5 cloves of garlic

1 teaspoon vinegar

1 stock cube

sour cream

2 tablespoons chopped flat-leaf parsley

1 tablespoon chopped coriander leaves

 

METHOD

Crush the coriander seeds and cumin seeds, using a mortar and pestle (or if you don’t own a mortar and pestle you can put seeds in a plastic food bag or cling film and use a rolling pin to crush the seeds.)

Mix crushed seeds with salt and nutmeg and rub spice mixture well into the meat.
Melt oil/butter (I always use both, gives a lovely flavour, the oil stops the butter from burning), add meat to the pan and brown on all sides. Cut the aubergine into cubes and fry with the meat for 2 minutes whilst stirring all the time.
Add the ginger and chilli and let everything cook for a further 2 minutes, then add add the garlic, vinegar, stock cube and tomatoes. Cover and simmer for 1 hour.

Season with salt and pepper. Serve up in deep plates, place a big dollop of sour cream on top and sprinkle with the fresh finely chopped parsley and coriander to finish.

Obesity in children needs a whole family approach

Obesity in children is mainly determined by the parents.  Although single genes only account for 2% of childhood obesity, your chances of being obese are a massive 70% if both parents are affected, 50% if one is affected and only 10% if your parents are not obese.

Health care researchers have identified the most important messages for the whole family.

5 fruit and vegetable portions a day

3 structured meals a day

2 hours maximum screen time a day

1 hour minimum exercise a day

0 sweetened drinks a day

Success for the child depends on how successful their own parents are in losing weight and keeping it off. The parents must buy into a change in lifestyle or their child will not get a benefit. Eating healthy meals, mainly at home, and avoiding the fast food and snacking culture are important.

Pre-schoolers and their families are best helped by group classes but for adolescents individual therapy works best.

Based on BMJ Learning module. Most research is was based in Canada.

Can shared decision making thrive in the current medical culture?

According to a Cochrane review patients are much more satisfied and have better health outcomes when their health care decisions are made in the context of full information and free choice. Patients said that “being in control” was what they most cherished.

At the present time the NHS doesn’t really support true shared decision making and options are likely to become even more limited with a shortage of doctors and strain on budgets. There also is considerable conflict when it comes to following guidelines which are designed for populations rather than individuals. Should a doctor really let the patient take the consequences of their individual choice or would they just be putting themselves at risk from a General Medical Council hearing?

Yet, not all patients want the most expensive treatments. When given full options a fifth of patients decided to avoid or defer surgery for instance.

What is meant to happen is that patients get given option grids with all the risks, benefits and uncertainties of possible investigations and treatments.  They are then asked, “What is the most important thing to you?” and then the doctor is meant to guide the patient accordingly.

Take bowel cancer screening. Currently all 50 year olds get sent a pack for this along with their birthday cards. Nice that someone remembers eh? They then get given the usual barrage of one sided messages about how bowel screening is really easy and could save your life.

If you care to look at this in more depth bowel cancer screening gives a total mortality benefit of six days to the screened population. The main problem is bowel perforation which occurs in 1 in 800 procedures. This is more likely to happen when going round the bends of the bowel.  Diagnosis of this can be delayed. Presumably with the shared decision making model all this is taken into account and the patient gets a truly informed choice.

Breast screening and statins are similarly pushed with considerable information asymmetry in the NHS.  There is no total mortality benefit to women from breast screening or statins yet that does not stop them being promoted. Not much has changed regarding how health care information is put across to patients in decades. An authoritarian stance is taken by the health care promoter and the patient is treated like an idiot.

With shared decision making it is likely that less money would be spent on useless investigations and treatments. If someone particularly wanted to avoid breast cancer “at all costs” they may be happy to be able to have screening perhaps more frequently than occurs at present, or perhaps they may be offered bilateral mastectomy. Many women would however decline to have mammography and that would be a saving not only for the procedure but for the unnecessary surgery and treatments that follow.

Shared decision making certainly doesn’t occur in diabetic clinics. The high carb / low fat diet is a product of “politics based medicine” rather than “evidence based medicine”.  Shared decision making is not for everyone. There will always be people and situations were doing what a doctor thinks is best is the most appropriate option.

But for a lot of non-acute health issues it is appropriate.  I can only hope that shared decision making doesn’t wither on the vine but a large shift in medical culture will be needed before it becomes regular practice.

Based on BMJ Learning module by Alf Collins.

Eight Quick Dips

Tomato Base:

4 large, ripe tomatoes

1 heaped tsp of tom puree

½ tsp brown sugar

a few drops of sherry vinegar

olive oil

Method

Chop tomatoes until pulpy, add all ingredients escept oil, stir and then drizzle oil over.

Variations

Herby – add chopped oregano and basil to taste.

Spicy – add a large splash of tabasco, 1 tsp Worcestershire sauce and a good sprinkling of celery salt.

Sweet and chunky – stir in 2 heaped tbsp caramelised red onion relish, a chunk of diced cucumber and a few slices of green jalapeno.

Piquant pepper – chop 4 Peppadew peppers, a handful of black olives and add to the tomato base along with some chopped parsley.

Speedy salsa – add 1 chopped tomato, cut into chunks, along with 1 finely chopped red onion, the juice of 1 lime and a small bunch of chopped coriander.

 

Creamy base:

150g plain yoghurt

85g mayonnaise

salt and black pepper

Method

Mix all ingredients together thoroughly.

 

Sweet roasted garlic – roast the unpeeled cloves from ½ a garlic bulb with a drizzle of olive oil for 15 min at 190C/170c fan/gas 5. Peel, crush then stir into the base.

Blue Cheese – chop 50g Dolcelatte into small chunks, stir into base, making sure that cheese is well incorporated.

Thai – style – slice 2 spring onions into fine slivers, mix into base then swirl in 2 tbsp sweet chilli sauce.

What experts say about getting blood out of stones

Is getting blood out of you a trial for health care staff? If so, help is at hand, according to Associate professor Keith Dorrington and Clinical Pharmacologist Jeffrey Aronson from Oxford University.

They reckon, that perhaps taking blood in the opposite direction, could be the solution for someone for whom the regular tourniquets, hands and feet in hot water, hanging the arm or foot down and gently tapping and stroking veins has failed.

When you have a chronic condition like diabetes, but possibly more so with cancer treatments, someone is always after blood samples. Sometimes a lot. A good sized black pudding’s worth some days. Or at least that is how it seems. When the red stuff fails to flow, all sorts of tricks can be employed but sometimes all you get is tears on both sides. From my own experience I would say that sometimes the best thing to do is to leave it to someone else. Once you have tried two or three times, confidence is lost on both sides and it is best to jack it in.

William Harvey described the circulatory system in the 17th century. The blood flows from the heart to the periphery, that is the hands and feet, and then back up arms and legs via the veins to the lungs and then back into the heart. The Oxford due have discovered that if you put in a small venflon into the smallest vein it will gradually fill up with blood that was intended to go back to the lungs if you put it in facing the fingers.  Worth a try?

Based on BMJ Article 17 Jan 2015

When you are a food addict, what can you do to re-claim your body?

Susan Pierce Thompson PhD is a neuroscientist who used to be pretty hefty in her teens and twenties till she went on a 12 step programme along the lines of alcoholics anonymous but dealing with the issue of food addiction.  She has stayed very slim for the last 12 years and reckons she knows what keeps us from losing weight and keeping it off long term. Indeed she teaches about this subject at university and has recently started online classes with team support to help the food addicts get “happy, thin and free”. She calls her programme Bright Line Eating.

The basics of this is that the “everything in moderation” mantra does not work with the seriously addicted food addict. Flour, sugar and anything that even tastes sweet gets the heave-ho permanently. Could you do this? Of course you could, if you want to get thin and stay thin. But Susan recognises that breaking your intentions happens and that the most important thing is to resume your plan immediately rather than beat yourself up about it, or use a minor deviation as an excuse to binge with a vow to start on Monday again.

Rats as well as humans seem to fall into three groups. The ones who seem able to resist temptation without a problem, the ones who can resist it for a while but then will give in, particularly if under some sort of stress, and the highly addicted who just can’t leave sugar, sweet stuff, refined flour products and white potatoes in all their forms alone. Susan says that modern foods and patterns of eating have hijacked the brain and sap willpower, induce cravings and set up feelings of hunger. Indeed she has found that rats rate sugar water as more pleasurable than cocaine even when they had been made into serious cocaine addicts by researchers.

The taste of anything sweet seems to be a problem. Saccharine, and all artificial sweeteners have the ability to induce cravings, even stevia. Although fat and salt make food more palatable, and humans eat more of it when laced with butter, cream, olive oil and salt for instance, they don’t set up the same addiction circuits. It is the flour/sugar items such as chocolate, ice cream and pizza that are the top addictive foods for most westernised humans, with potatoes and potato products coming in fourth.

When you get a craving for something, parts of your brain are being affected by chemicals that you have no control over. Cravings and hunger are controlled by the hypothalamus. This is your body’s thermostat that controls all sorts of complex processes through the release of hormones.

Your willpower centre is in the anterior cingulate cortex and behaviour is controlled here. The problem is that behaviour gets more difficult to control if you have to withstand temptation for just 15 minutes. It gets even harder to control behaviour when the blood sugar is low or you are already tired, have already had your temptation tested, are feeling emotional or have been focussing on tasks. Susan calls this the “willpower gap”. You know what you are meant to do but you just can’t seem to help yourself from doing something else. Like opening that packet of biscuits.

Your brainstem is where leptin is active. Your brainstem is the most primitive part of the brain and the most basic functions that keep you alive such as breathing reside here.  The trouble is that insulin resistance leads to leptin resistance, and although your brain stem may be flooded with leptin, telling you that you are full, the leptin resistance means that the message doesn’t get through, and your brain stem thinks you are starving. Mindless eating ensues just as mindless breathing continues.

A major step in resolving this impasse is that insulin levels need to be lowered. And what raises insulin the most? Yes, sugar and starch.  This is why a low carb diet, as we describe in our book, can help you lose weight and get your appetite under control. It is all down to physiology.

Susan goes a bit further than we do, however, in that all sweet stuff, with the exception of sweet fruit, is banned. Also all flour products are completely banned. This is because those people who have very serious food issues are more susceptible to dopamine, the reward hormone.

Dopamine is active in the nucleus accumbens. It goes up in response not only to food stimuli but also to sex stimuli for example. Indeed Susan describes sugar as the pornography equivalent of sex. I have to agree with her here.

In large magazine shops you often see rows of women’s magazines on one side and men’s magazines on the other.  The men’s magazines seem to be mainly all about becoming more competent in something eg music, muscle building, computer know-how, with some soft pornography thrown in. Women’s magazines have “how to be more nurturing” magazines with pets, home decorating and crafts taking about a quarter of the space. The rest seems evenly split between “how to make lovely food” often featuring beautifully iced sponge cakes with lashings of cream on the one hand, and “how to get thin from not eating beautifully ices sponge cakes with lashings of cream on them”. I’ve often thought of food articles and particularly photographs as being porn for women.

So, back to dopamine. What a great hormone. You have lots of it and you feel like you rule the world. The downside is that your reward feeling gets worn down by the never ending waves of  dopamine and you tend to need a bigger fix for the same wonderful feelings over time. Also if dopamine becomes depleted you can feel pretty unhappy and also can need another fix to bring it up.  This is a reason why Zyban, the anti-smoking drug can induce suicidal depression.

Zyban, also known as varenicicline,  makes the craving for cigarettes stop by blocking dopamine. When you smoke, you don’t get the hit. Instead you think, “This fag is lousy, why the hell am I smoking it?” This makes it somewhat easier to break the smoking habit. The downside is that you can feel lousy about everything. And sometimes the effect is unpredictably tragic.

Despite the common belief  that we are in control of our behaviour rather than our brain chemicals, Susan is so convinced of the chemical superiority over willpower, that she builds methods of how to resist the hijack into her diet plan.

Dr Thompson knows that a chemically affected brain really has the belief that the body is starving and that flour and sugar are even more powerfully addictive than heroin or cocaine for about a third of the population. She knows you can’t reason with your brain stem. Instead it reasons with you.

That little voice says, “I deserve that”. “It’s only one time”. “It’s only a little bit.”  As more and more exceptions to our dietary plan creep in, we watch ourselves breaking rules, and the belief that we are incapable and lacking in some way, especially compared to thin people, reduces our feelings of competency. Our self-esteem goes down the plug hole. As I have said before, a prominent bariatric surgeon told me that the drop out rate with bariatric patients was particularly high because of the very low self- esteem that this group of people have.

Susan says that very clear boundaries are necessary to get back on track. A lot of planning, daily preparation, long term habit change and support is necessary to overcome addictive eating. Emergency action plans and support are needed for the inevitable breaks in willpower.  But, she says that dopamine receptors recover in time and that as insulin resistance disappears, the insatiable hunger goes with it. She says that reliance on willpower is the single biggest mistake dieters make. Instead you need a whole system to deal with false hunger, addiction and social pressures to eat flour and sugar.

Restorative behaviours such as meditation are important. So is getting out in nature. Anything other than food that boosts your willpower battery is good. Exercise is not part of the plan for most people because it can be a step too far when good eating habits are in the process of being embedded. She thinks exercise can be too much a sap on a person’s willpower unless it is already an entrenched habit.

The path to being slim and healthy is not easy so a different way of looking at the problem is welcome. In particular simple calorie measuring is no good for some people if sugar and flour are part of the calories. Also low carbing may not be extreme enough for some people and cutting out all sweeteners and sugar rather than keeping to small amounts of sugar and starch may be necessary.

Based on an online webinar by Susan Pierce Thompson PhD. October 14 2015.

What’s new for type one diabetics?

NICE have released their new guidelines for type one adults. This paper was given some prominence in September’s BMJ as well as other papers that could be of interest to diabetics, their carers and health professionals.

In many respects the adult guidelines are similar to the children’s guidelines. Structured education gets support as does advice to aim for a hba1c of 6.5% (48) or lower provided hypos can be minimised. Of course this is virtually impossible if a high carb diet is followed but is much easier if the low carb dietary advice and precision meal to insulin matching as we describe in our book is done.

Levemir twice a day is the recommended basal insulin for all new patients and Lantus is advised only for those who refuse to use a twice daily bolus or perhaps need assistance from others for injection. We know that Lantus has some gaps in coverage as a 24 hour insulin and that it is less stable in heat and light than Levemir. It also stings on injection. Levemir also gives fewer hypos. Of course if someone is happy with Lantus, they can stay on it.

Life expectancy for type ones is currently 13 years less than for people without the condition. Fewer than 30% of adults achieve a hba1c of 7.5% or less.

Although the Cochrane collaboration noted a small degree of success with a low glycaemic diet strategy for type twos, this was not seen in the research that NICE looked at for type ones and therefore they don’t recommend low glycaemic as a dietary strategy.

Blood sugar targets are suggested to be ideally 5-7 first thing in the morning, 4-7 before meals and 5-9 at least 90 minutes after meals. Adults are advised that 4-10 blood sugar tests may be required each day. Before each meal and before bedtime are minimum testing times.

NICE want type ones to stick to their finger tips for blood sugar testing. This is the most accurate as hypos can be missed if other parts of the upper limb are used.

It is recommended that hypos are evaluated at least annually by a scoring system. The idea is to seek out those people for whom these are a problem and then fix it. NICE say this should not involve simply raising blood sugar targets. The obvious thing is to match insulin to meals, activity and basal needs more closely. If structured education around this appears to fail then the person should be considered for pump therapy and real time glucose monitoring.

Meal insulin boluses are recommended before meals. After meals is a strategy that works for toddlers but adults are expected to be able to adjust their insulin to meals and that means that they must be able to carb count.

So what can we expect from the implementation of these guidelines? There is still no clarity over diet and exactly how patients will get near normal blood sugars just by carb counting without actually restricting the amount they consume isn’t explained. There certainly will be a lot more adults who could be considered for pumps. But these are relatively expensive and require a lot of training. Setting strict blood sugar targets and hoping that technology will solve the problem has been going on for decades now. Why should it work now? NICE admits it hasn’t worked so far with more than 70% of type one adults having wildly high blood sugars. I would have been very interested to know what percentage of adults with diabetes achieved the target blood sugars of 6.5% or 48.

NICE do admit that to implement their proposals the medical workforce will need to be sufficiently trained to deliver the structured education and to help individual diabetics with their problems.