Simple red lentil dhal recipe

I really love lentils: they are just so versatile, but sometimes they fall off my menu because I (wrongly) associate them with long preparation time. In clinic this week, we had a lady who had a number of gastrointestinal issues which had lead her to exclude all grains from her diet, because she also had very little meat or fish in her diet, she was feeling very unsatisfied.  We suggested she try reintroducing red lentils, and gave her a simple dhal recipe to try.  It is full of flavour, deeply satisfying and takes no time at all. 

1 large red onion, finely chopped 
1 shallot, finely chopped
3 cloves garlic, squished 1 thumb sized knob fresh ginger, grated
1 tsp turmeric, (or use a thumb sized knob of fresh grated)
1 tsp fennel seeds 
1 tsp cumin seeds
½ tsp coriander seeds
3 cardamon pods
1 stick of cinnamon
1 large dried chilli, crumbled
250g red lentils, rinsed and drained
1 ltr of vegetable stock

Melt large knob of butter (or coconut oil) in a pan, add the red onion, shallot and garlic and gently cook until softened.
Add ginger, turmeric, fennel seeds, cumin seeds, coriander seeds, cardamon pods and cinnamon. 
Continue to cook gently allowing the spices to release their fragrance.
Add the red lentils and stir through onion mixture.
Cover with stock and reduce heat so that the lentils are gently simmering for 20-25 minutes. 
It may be necessary to add more water if the lentils look like they are drying out.

Serve as a side dish or main course.  If you have the willpower, it will store happily in the fridge for a few days where the flavours will intensify.

Nutritionally there is not much to say against this dish.  Red lentils are a good source of protein and fibre.  They are the most digestible lentils and do not need to be pre-soaked (although if you have a sensitive stomach then pre-soaking is recommended).   The use of turmeric, ginger and cinnamon mean that the recipe has anti-inflammatory properties and the sulphurous properties of the onion, shallot and garlic support the liver and one of its its detoxification pathways.

Optimising your nutrition on a vegetarian diet

There is a great deal of evidence on how a good vegetarian diet can be beneficial to health and studies suggest that overall vegetarians have lower rates of mortality than the general population. The Vegetarian Society attributes this to (VS-1, 2013) 

• the high levels of antioxidants and other beneficial phytochemicals that this type of diet contains, 
• the fibre content of a vegetarian diet which contributes to bowel health and to lower cholesterol levels,
• the absence of meat and the associated saturated fat which is linked to heart disease. 

Nevertheless, vegetarians need to be mindful that the absence of meat in their diet, can also lead to less than optimal levels of certain nutrients and will need to make sure that their diet contains appropriate alternatives to ensure that their needs are met by their diets. 

The key nutrients to think about are: 

Protein: 

The UK Reference Nutrient Intake (RNI) is set at 0.75g of protein per kilogram bodyweight per day for adults (BNF-1, 2012). It is important to try and include a protein source in each of your meals. Good vegetarian sources of protein are: 

• Eggs 
• Lentils 
• Legumes 
• Beans 
• Quinoa / Chia Seeds 
• Nuts and seeds 
• Avocado 
• Fermented soya products: natto, tempah and miso 

It is also worth considering using a good quality protein powder; such as Hemp or Pea protein which can be added to smoothie to give an additional protein punch. 

Vitamin B12: 

Vitamin B12 is an essential vitamin which plays a role in a number of functions in the body, deficiency of this vitamin can led to anemia and neurological problems (LPI-1, 2007). Vitamin B12 is derived from animal food sources, consequently if you are excluding (or eating only small amounts of) eggs and/or dairy produce as part of your vegetarian diet, it is worth considering a good quality B12 supplement. It is important to note that some sources state that you can get Vitamin B12 from fermented soy products and algaes such as spiralina; it is in an inactive state and therefore cannot be used by our bodies. 

Iron: 

There are two forms of iron; haem and non-haem iron. Non-haem iron is an oxidized form of iron or ferric iron (Fe III) and less easily absorbed by the body, this is the form of iron found in plants. Haem Iron or Ferrous iron (Fe II) is the more absorbable form of iron, but is only available through meat and fish. Therefore, it is important that your vegetarian diet contains good levels of iron containing foods (LPI-2, 2009).  Good sources of iron rich foods are: 

• Green leafy veg (Vit C too) 
• Pumpkin / Squash (Vit C too) 
• Pumpkin seeds & Cashew Nuts 
• Beans, Lentils & Pulses 
• Seaweed 
• Dried Fruits: Apricots & Prunes 
• Black Strap Molasses 

Additionally, Vitamin C works to reduce the ferric iron found in plant foods to its more absorbable ferrous form increasing overall absorption of iron (LPI-2, 2009). Including a source of vitamin C with your iron source foods is beneficial. 

Essential Fatty Acids (EFAs) - Omega 3 & 6: 

Essential Fatty Acids (EFAs) cannot be synthesized by the body and must be supplied in the diet. They are important components of cell membranes and substrates for signaling molecules, which control many important functions at a cellular level (BNF-2, 2012). In addition, EFAs are associated with reduced blood cholesterol levels and Omega 3 has a particular role in heart health (BNF-2, 2012).  Vegetarian sources of EFAs include: 

• Flaxseeds (whole, ground or oil) 
• Hempseeds 
• Rapeseed oil  
• Walnuts 

I am frequently surprised by the number of vegetarians, who subsist on a diet which is largely made up of pasta and cheese, but there are a myriad of options with a vegetarian diet, some menu ideas that also incorporate the above nutrients, include:

Breakfast 

• Chia seed smoothie 
• Bircher muesli 
• Porridge or yoghurt with stewed / dried apricots, prunes and figs 
• Poached eggs with spinach 

Lunch 

• Soup: spicy lentil, minestrone or miso 
• Three bean salad 
• Falafel or hummus salad 
• Omlette with mushrooms, parsley and tomato 

Dinner 

• Sweet potato with ratatouille 
• Stuffed pepper/tomato/courgette flowers with rice, lentils feta and parsley 
• Indian red lentil dhal, saag aloe, brown rice and cucumber raita 
• Mexican refried beans with corn tortillas, guacamole and salsa 

Snacks 

• Celery / Apple / Pear with nut butter 
• Hummus and crudities 
• Avocado, pea and mint dip with rye crackers 
• Flaxseed crackers with mushroom pate 

Resources:

The following are good sources of additional information and recipe ideas:

www.vegsoc.org

http://www.nhs.uk/Livewell/Vegetarianhealth/Pages/Vegetarianhealthhome.aspx

http://www.cookveg.co.uk/

http://www.nomeatathlete.com/

http://www.racheldemuth.co.uk/blog/

References:

BNF-1: British Nutrition Foundation. (2012). Protein. Available: http://www.nutrition.org.uk/nutritionscience/nutrients/protein. Last accessed 16th June 2013.

BNF 2: British Nutrition Foundation. (2012). Fat. Available: http://www.nutrition.org.uk/nutritionscience/nutrients/fat. Last accessed 16th June 2013.

LPI-1: Blumberg, J. (2007). Vitamin B12. Available: http://lpi.oregonstate.edu/infocenter/vitamins/vitaminB12/ Last accessed 16th June 2013.

LPI-2: Wessling-Resnick, M. (2009). Iron. Available: http://lpi.oregonstate.edu/infocenter/minerals/iron/. Last accessed 16th June 2013.

VS-1: Vegetarian Society. (2013). Vegetarian diet for health problems. Available: https://www.vegsoc.org/sslpage.aspx?pid=784. Last accessed 16th June 2013.

Turning up the heat with thermogenesis

At a recent clinic, the client who had been diagnosed with Raynaud’s syndrome; a circulatory disorder effecting blood supply to the extremities, was given the suggestion of introducing green tea for its thermogenic properties.  Given how much I like green tea I thought I would dig a bit further on understanding this concept.  As with many nutritional things, the answers were not straight-forward, and my research took me on a bit of journey.

Thermogensis very simply is the production of heat in the body and also increases metabolism.  It can be triggered by a number of different factors, Geissler and Powers identify four forms (Geissler et al, 2009):

• Cold induced
• Diet induced
• Psychological
• Drug induced

Cold induced thermogenesis has two forms: shivering and non-shivering, however, in both cases it is an involuntary function of the body intended to generate heat and raise the body’s core temperature when exposed to a cold environment.  As such cold induced thermogeneis is a key part of the body temperature regulation.  Non-shivering thermogensis and its relationship with brown adipose tissue is coming under the research microscope, since it may provide some answers for weight management and obesity.  Brown adipose tissue has been described as a furnace, consuming calories to generate heat.  Until recently it was thought the humans lost much of their brown adipose tissue after infancy, but studies have shown that some brown adipose tissue is retained in adulthood although how much depends on your sex, age and weight.  The question for scientists is whether this brown fat can be safely activated in humans.  Can it be activiated only by cold?  Or do other substances activate it?  If activiated in humans would it simply induce us to eat more rather than lose weight?  As yet there are no definitive answers (Kolata, 2009).

The metabolism increasing properties of thermogenesis and the use of diet induced thermogenesis (DIT) in weight loss and management has been under the spotlight for sometime.  In simple terms, by requiring more energy to digest these foods; the offset to the calorific value of the food is higher and therefore consuming these foods can assist with weight loss.  At the macronutrient level, the thermogenic hierarchy is said to be alcohol, protein, carbohydrate and fat (Westerterp, 2004), which gives some insight into the premise of high protein diets such as Aktins and Dukan.  However, it is important to note that DIT only constitutes between 5-15% of daily energy expenditure (Westerterp, 2004).  The more variable component of daily energy expenditure is Physical Activity (PA) which coupled with overall calorie intake is likely to have a more significant impact on weight loss. 

Things become more interesting when you look at psychological and drug induced thermogenesis since these tend to tap into the sympathetic nervous system (SNS) or our fight or flight response.  Psychological thermogenesis is related with stress, which is inextricably linked to the sympathetic nervous system.  When triggered by a fright or a stress the adrenal glands release the hormones adrenaline and noradrenaline, which induce a cascade of responses in our body as it prepares for fight or flight.  The primary response is from the cardiovascular system which will increase heart rate, and therefore blood flow to the periphery of the body.  This activity tends to increase body heat and may induce sweating and may in part account for why people under long term stress may experience significant weight loss.  However, the SNS will also suppress appetite, since you are unlikely to want to consider food, when you think you might become the next meal for a sabre-tooth tiger.

The drugs (or stimulants) in drug induced thermogenesis can artificially stimulate the SNS to produce thermogenesis.  Caffeine falls squarely into this category, so while that after dinner coffee may in the short term increase the body heat and metabolism, it also stimulates body responses that longer term are not so positive.  The stimulation of SNS will also prompt the adrenals, kidneys, and bladder functions into increased urination.  Dehydration resulting from increased urination cools the body temperature and a lack of regulated blood flow to the intestines reduces the warmth needed for proper digestion, which is already lowered since digestion is not a necessity during fight or flight.  Finally, caffeine will stimulate the liver to release stored glycogen (sugar) molecules to provide fuel for flight or fight, but the liver will need to replenish its glycogen store, which can then result in strong cravings for sugar (Gagne, 2008).

So why propose green tea, which also contains caffeine for its thermogenic qualities if overall it could have a cooling effect?  In addition to caffeine, green tea is rich in two additional components: catechins and theanine.  Catechins are a class of phytochemicals which are potent antioxidants and also inhibit inflammation.  Their potential disease fighting capability from cardiovascular disease to cancer is the subject of considerable research.  Other studies have suggested that catechins, in particular Epigallocatechin gallate (EGCG) contained in green tea, amplifies the thermogenic effect of caffeine  (Dulloo et al, 2000).  This is where Theanine, another component of green tea comes into play.  Theanine is an amino acid and an antioxidant, but more significantly acts as an antagonist to caffeine.  The natural balance of caffeine and Theanine in green tea offers all the calming effects of Theanine but also offsets the agitating effects of caffeine.  In addition, the calming effects of Theanine do not include any drowsiness or impairment of clarity of thought (Owen et al, 2008).

Thermogenesis is a very natural process within the body and can be triggered in a number of ways.  Not all of these mechanisms are entirely positive and therefore caution should be applied, if seeking to increase metabolism for weight loss or management.  However, if you feel a chill and looking for some additional warmth from your food, consider adding some of these thermogenic foods:

• Cayenne pepper and other hot peppers are one of the most commonly known thermogenic foods.  Hot peppers are thermogenic because they contain capsaicin, which has both satiating effect as well as increasing DIT (Mishra & Pratt, 2012).  Another theory as to why cayenne helps with weight loss is similar to the reasons behind curry’s effectiveness: it’s difficult for most people to overeat hot or spicy food.
• Black peppercorns: contain peperine which has a similar effect to capsaicin.
• Mustard Seed: in Ayurveda, mustard seeds are recommended for digestive problems, because of heat they generate. Mustard plasters are also indicated for respiratory and circulatory problems, helping to stimulate blood flow and soothe inflammation. More recently, a study conducted by Dr Jeya Henry at Oxford Brooks University found that a small amount of hot mustard – less than one teaspoon – can boost metabolism by 20-25%.
• Ginger: Traditional Chinese Medicine (TCM) holds that ginger “restores devastated yang” and “expels cold”. A recent pilot study also showed enhanced thermogenesis and reduced feelings of hunger with ginger consumption. 
• The three Cs: Cardamom, Cinnamon and Cloves: are considered warming spices and can also increase metabolism, improve digestion and nutrient absorption.  This nicely brings us back to tea since these three spices are the key spices in chai tea.  

The following Masala Chai recipe is taken from Madhur Jaffrey's Indian Cooking (1983) p. 196:

1-1/2 cups water

1 inch stick of cinnamon

8 cardomom pods

8 whole cloves

2/3 cup milk

6 tsp. sugar (or to taste)

3 teaspoons any unperfumed loose black tea

Put 1-1/2 cups water in saucepan. Add the cinnamon, cardomom, and cloves and bring to a boil. Cover, turn heat to low and simmer for 10 minutes. Add the milk and sugar and bring to a simmer again. Throw in the tea leaves, cover, and turn ff the heat. After 2 minutes, strain the tea into two cups and serve immediately.

References

Dulloo AG, Seydoux J, Girardier L, Chantre P & Vandermander J. (2000). Green tea and thermogenesis: interactions between catechin-polyphenols, caffeine and sympathetic activity. The International Journal of Obesity. 24 pp. 22-258.

Gagne, S. (2008). The Energetics of Cooling Foods?. Available: http://www.macrobiotics.co.uk/articles/coolingfoods.htm. Last accessed 7th June 2013.

Geissler CA & Powers HJ (2009). Fundamentals of Human Nutrition. China. Churchill Livingstone. pp.15-16

Kolata, G. (2009). Calorie-Burning Fat? Studies Say You Have It. Available: http://www.nytimes.com/2009/04/09/health/research/09fat.html?_r=0.  Last accessed 6th June 2013.

Mishra, S & Pratt, M. (2012). Effect of capsaicin on satiety and diet-induced thermogenesis. Presented at conference of Nutrition Society of New Zealand. pp.1-6. Available at: https://radar.brookes.ac.uk/radar/file/0ea2dd4b-5e74-b2d6-52da-af5136ba1876/1/Pratt2010effect.pdf  Last accessed 7^th June 2013

Owen GN, Parnell H, De Bruin EA, Rycroft JA. (2008). The combined effects of L-theanine and caffeine on cognitive performance and mood. Nutritional Neuroscience. 11 (4), pp.193-198

Westerterp, Klaas R . (2004). Diet induced thermogenesis. Nutrition & Metabolism. 1 (5) http://www.nutritionandmetabolism.com/content/1/1/5

Vitamin C

Vitamin C is a potent vitamin with a wide range of functions beyond its most common association with its cold fighting capabilities.  It is a water soluble vitamin and is not specifically stored in our body (excess tends to be excreted in urine) although high concentrations of vitamin C can be found in the brain, pituitary and adrenal glands.  Unlike other mammals, humans are unable to synthesize Vitamin C for themselves, so it is essential that our diet contain sufficient levels of this vitamin. 

Citrus fruits such as oranges, lemons and limes have long been associated with being good sources of vitamin C, however, there are plenty of other sources some of which have significantly greater quantities than citrus fruit, including:

Fruit	mg/100g	Vegetables	mg/100g	Green Leafy Vegetables	mg/100g
Rosehips (wild) Blackcurrants Kiwi Papaya Strawberries	426.0 181.0 92.7 61.8 58.8	Chilli Peppers Bell Peppers Broccoli Brussels Sprouts	144.0 128.0 89.2 85.0	Thyme Parsley Kale	160.0 133.0 120.0
Orange Lemon Juice Lime Juice	53.2 46.0 30.0

(NutritionData, 2012)

There is however a rub, the values above are calculated on the raw (uncooked) state of these foods.  Due to its water solubility and its propensity to oxidise anything between 10-90% of Vitamin C content can be lost as a result of wilting, cutting, cooking or processing.  For example broccoli may lose 27% (down to 64.9 mg/100g) of its vitamin C when boiled and drained (NutritionData, 2012).  Perhaps the natural packaging (and relative longevity) of citrus fruits is more of a contributory factor to the availability of vitamin C rather than the actual quantity of vitamin C they contain?

Vitamin C is involved in a number of functions in the body:

• Antioxidant Capabilities: The value of an anti-oxidant is that it will readily “bind” with and effectively neutralise potentially damaging free radicals.  These are produced by the body (as part of every day function) and as a result of exposure to pollutants, for example smoking.  Vitamin C is a potent anti oxidant and is capable of protecting a number of different molecules, including proteins, lipids, and DNA, from damage (LPI–1, 2009).  This in turn can reduce the oxidative stress on the body which plays a causal role in a number of chronic illness, including cancer and cardiovascular disease.
• Vitamin C also facilitates the recycling of other anti-oxidants, particularly Vitamin E and may prevent Vitamin E becoming pro-oxidant (or a free radical) itself. (Hamilton, 2000)  The extent of Vitamin C’s anti-oxidant capabilities in relation to diseases where oxidative stress plays a causal role, continues to be investigated but no definitive answers have been forthcoming. (LPI-1, 2009 & ODS, 2011).

• For the Immune System: Vitamin C can be found in high concentrations in the immune cells, and while it is commonly believed that it is Vitamin C which helps fight a cold or winter virus, studies to date would indicate that it is more likely that Vitamin C protects the immune cells enabling them to fight invading organisms (LPI–1, 2009).   As a consequence, it would appear that Vitamin C assists in the prevention of colds, but does not necessary treat a cold (LPI-1, 2009).

• In Collagen synthesis: History tells us that scurvy in sailors was a result of a deficiency in Vitamin C.  Although rare today, scurvy is a disease whose symptoms include bleeding and bruising, hair and tooth loss, joint pain and swelling. Such symptoms appear to be related to the weakening of blood vessels, connective tissue, and bone, all of which contain collagen (LPI–1, 2009).  Vitamin C is an essential element in the synthesis of collagen, which forms the matrix and foundation for our skin, arteries, tissues, ligaments, tendons and bones (LPI-1, 2009 & ODS, 2011).  The supplementation of vitamin C to assist with post-surgery wound healing directly relates to its role in collagen synthesis (Akhilender Naidu, 2003).
• As a co-factor: as with collagen synthesis, Vitamin C is also critical to the synthesis of neurotransmitters and hormones, including serotonin and noradrenaline.  It is also assists in the synthesis of L-caritine which in turn assists with the conversion of long chain fatty acids into energy (LPI-2, 2012).  As a consequence, sub-clinical deficiency of Vitamin C can be associated with fatigue. (LPI-1, Akhilender Naidu, 2003)
• Cholesterol: Vitamin C is necessary for the conversion of cholesterol to bile acids for the breakdown  and excretion of fats.  When there is a deficiency this transformation is slowed down and so cholesterol can accumulate in the liver and lead to the formation of gall stones (Akhilender Naidu, 2003). 

The UK RNIs for Vitamin C (Ascorbic acid) are as follows:

UK RNIs:	INFANTS		CHILDREN		MALES		FEMALES		PREGNANCY & LACTATION
[Note: mg = milligrams (1/1,000 of a gram]	months	mg/d	years	mg/d	years	mg/d	years	mg/d	months	mg/d
	0-3 4-6 7-9 10-12	25 25 25 25	1-3 4-6 7-10	30 30 30	11-14 15-18 19-50 50+	35 40 40 40	11-14 15-18 19-50 50+	35 40 40 40	Pregnancy Lactation 0-4 4+	+10 +30 +30

(BNF, 2009)

If supplementing Vitamin C, it is suggested that you take divided doses 2-3 times a day with meals for optimal effect (UMMC, 2011). There is a low risk of toxicity resulting from an excess of Vitamin C; if taken in too high levels (>2000mg/d) symptoms such as diarrhea nausea and stomach cramps can be experienced. (ODS, 2011) High intakes of Vitamin C have also been associated the formation of oxcalate kidney stones, and so those predisposed to the formation of kidney stones are advised against taking high dose (>1000mg/d) vitamin C supplements (LPI, 2009).

Vitamin C has a synergistic relationship with non-haem iron, in that it enhances the absorption of non-haem iron. A fact which is particularly important for those following a vegetarian or vegan diet. Non-haem iron is an oxidized form of iron or ferric iron (Fe III) and less easily absorbed, but is the form of iron found in plants. Ferrous iron (Fe II) is the more absorbable form of iron, but is only available through meat and fish. Vitamin C works to reduce the ferric iron found in plant foods to its more absorbable ferrous form increasing overall absorption of iron (LPI-3, 2009). Conversely, someone with hemochromatosis, an inherited condition where too much iron builds up in the body, should not take vitamin C supplements (UMMC, 2011).

Smoking has a negative impact on Vitamin C levels in the body. This is attributed to the increased requirement for anti-oxidant activity placed on the body by smoking. It is suggested smokers or those using nicotine patches may need an additional 35 mg per day (UMMC, 2011).

Recipies with Vitamin C in mind:

• Ministry of Food (WWII) recipe for Rosehip Syrup from Make it and Mend it
• Blackcurrant smoothie from So Femine.co.uk
• Jalapeno, Lime, Kale Slaw from Kris Carr of Crazy, Sexy, Wellness
• Broccoli Salad from Jamie Oliver
• Syrian Tabbouleh from Syrian Foodie in London

References

Akhilender Naidu, K. (2003). Vitamin C in human health and disease is still a mystery ? An overview. Nutrition Journal. 2 (7), Available at http://www.nutritionj.com/content/2/1/7#B24.

BNF: British Nutrition Foundation. (2009). Vitamins. Available: http://www.nutrition.org.uk/nutritionscience/nutrients/vitamins. Last accessed 2nd June 2013.

Hamilton, I.M.J., et al. (2000). Interactions between vitamins C and E in human subjects. British Journal of Nutrition. 84 (3), pp.261-267.

NutritionData: Conde Nast. (2012). SelfNutritionData. Available: http://nutritiondata.self.com/. Last accessed 3rd June 2013.

LPI-1: Frei, B. (2009). Vitamin C.  Available: http://lpi.oregonstate.edu/infocenter/vitamins/vitaminC/. Last accessed 2nd June 2013.

LPI-2: Hagen, T M. (2012). L-Caritine.  Available: http://lpi.oregonstate.edu/infocenter/othernuts/carnitine/index.html. Last accessed 2nd June 2013.

LPI-3: Wessling-Resnick, M. (2009). Iron.  Available: http://lpi.oregonstate.edu/infocenter/minerals/iron/. Last accessed 2nd June 2013.

ODS: Office of Dietary Supplements (2011). Dietary supplement fact sheet: vitamin C. Available at: http://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/#h1. Last accessed 2nd June 2013. 
UMMC: University of Maryland Medical Centre. (2011). Vitamin C (Ascorbic acid). Available: http://www.umm.edu/altmed/articles/vitamin-c-000339.htm. Last accessed 2nd June 2013.