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Food for thought

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Scrolling through the headlines on the BBC health news website you can’t help but be swamped by food related stories. A quick look today gave me: “Broccoli slows down arthritis” and “Blueberries cut type 2 diabetes risk”. So should we all be dashing to Sainsburys (or an alternative establishment) to stock pile broccoli? Just how seriously should we take all this research and what advice should we be giving to our patients?

Not a day goes by at the moment when there isn’t some sort of food and health related story. We all know to avoid eating too much processed meat for fear of developing bowel cancer, fruit and veg are generally good news, foods high in salt, fat and sugar are bad and don’t get me started on horsemeat. The time when I found all this advice the most confusing and conflicting was in pregnancy. Is alcohol in moderation safe? Just how much caffeine can you have before you risk increasing your chance of miscarriage (who knew there was so much caffeine in a chocolate bar – up to 50mg?) Are peanuts safe? How about smoked salmon? Or tuna?

Some things are clear: no mouldy cheese, runny eggs, raw shellfish or rare steak. Suddenly pregnancy doesn’t seem like such a good idea… However, in some areas even the advice on the NHS website is a little confusing. It states that the USA suggests you avoid pre-packaged meat but the NHS does not. Some countries advise steering clear of cured meats and smoked fish due to a risk of toxoplasmosis but the NHS does not. You can now officially have peanuts with a clear conscience as evidence has swung the other way regarding allergy. When I was pregnant I decided to ask my midwife whether I could give into my cravings and have a smoked salmon sandwich. Absolutely not she said. The next midwife I asked said yes, of course, tuck in. So is it safe or not?

I think most anxious first time mums cut out anything that may have the slightest whiff of a risk. No smoking, caffeine, alcohol or any of the foods mentioned on the NHS website (which, in my experience, is pretty much every food you fancy when struggling through the haze of morning sickness). But the mums we really need to worry about are the 12% who continue to smoke and the 1% who consume alcohol regularly throughout pregnancy. How do we direct resources towards that group rather than the ‘worried well’? NICE guidelines from 2010 recommended that midwives use a breath test to monitor for carbon monoxide. It was thought that this might spur women on to stop smoking and also give the midwives evidence to present to smoking household members if the mum-to-be was being affected by passive smoking. Of course the Daily Mail reacted to this proposal in their usual measured way: ‘Fury at smoking breath test for mothers-to-be’, and another ‘outrageous’ medical story was born.

I guess the point I’m trying to make is that food advice is currently too confusing; it’s tempting to ignore it all and put it down to the latest media fad. Our current approach to food education seems to target the already health conscious and make them more anxious but not necessarily reduce the number of people who are doing the really risky things. Yet another example of the challenge to better target health education to those who need it most… just something else to add to the to do list.

Dr Laura O'Loghlen is an ST1 who lives in Cheltenham and works in Gloucestershire

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