Antibiotic resistance and food (again)

'Mission San Juan Capistrano bells'
by Ballookey Klugeypop under a
CC license

Antibiotic resistance is the case where microorganisms become able to survive after exposure to antibiotics. Antibiotic resistance is not a new phenomenon. When resistance to multiple antibiotics is observed in pathogens then things become particularly alarming. Infections by multidrug resistant pathogens (superbugs) are very difficult - and sometimes impossible - to treat, especially when the patient's organism is weak.

I've written on superbugs before but recently antibiotic resistance re-surfaced in the news in a different way. As described by Maryn McKenna, seafood imported from South Korea to Canada was found with Pseudomonas bacteria, which turned out to carry a gene that enables the synthesis of a carbapenemase enzyme.  This is alarmingly important for a number of reasons:

• Carbapenamase enzymes can inactivate carbapenem, an antibiotic of last resort.
• Seafood is sometimes mildly processed, in some cases deliberately to retain flavour and texture, while in others it may simply be undercooked. In such cases, the bacterium found would be likely to survive.
• Non-resistant bacteria can acquire antibiotic resistance from resistant ones via horizontal gene transfer involving plasmids

If consumed, the bacteria in question could possibly make it to the gut. As they are not pathogens they would not pose a direct problem themselves but they would be likely to transfer antibiotic resistance to the gut flora bacteria. I am not aware of the probability of such chain of events but should it happen in individual consumers, it would create inside them a population of bacteria resistant to a class of last resort antibiotics. That's not a good thing to happen!

Carbapenem resistance in the food production system has been a concern previously. Unfortunately, this needs to be considered in tandem with the occurrence of carbapenem resistant infections that seems to be on the rise in Europe (but still under control).

The Canada seafood case highlights a different route of concern, where the consumers may be exposed to resistant non-pathogens (with the potential to be found on a variety of foodstuffs) rather than resistant pathogens, directly, or antibiotic residues in food, which could - in turn - potentially invoke antibiotic resistance.

There is a need for better monitoring of the various routes that can lead to antibiotic resistance. This is no small challenge, though (and it comes with a certain price tag)! However, without any need to panic, it is essential we understand what the risk is and adapt our food processing (and healthcare) practices accordingly. Such approaches work on the prevention front. Hopefully, we'll also make some more breakthroughs on the antimicrobial front, as well!

Food@Work

'Work' by Pierre Metivier
under a CC license

Last week I wrote on food consumption at school. Providing healthy food and in sufficient amounts there is something that few would object to. But what would people think on the need to provide healthy meal options at the workplace? Should be people be allowed, or even, encouraged to eat at work?

Yes, they should be allowed and actively encouraged to healthy (and balanced) nutrition options. Beyond the positive health effects, the associated break may help overall performance, promote the social environment at the workplace and, in brief, make things for employees and their employers better. It is a win-win case, really (although the exact practice to be adopted depends on the case and the economic environment)!

Practical experience, however, suggests that meal customs and provisions at the workplace vary considerably across businesses and regions to anything between no lunch at all and full, three-course meals. What makes it interesting is that scientific evidence has been in favour of lunch breaks for quite some time now, at least partly on the basis of forming healthy eating habits. Having access to (the right) food at work, within a break, also make employees more productive overall.

If it makes any difference, the International Labour Organisation has published a detailed study on the topic. Overall, it calls meals at work "a lost opportunity" since, often, they are either severely limited (or skipped, altogether) or do not encourage healthy/balanced nutrition. The study concludes on a wide set of recommendations for governments, employers, workers and trade unions.

On the other side of the argument, concerns exist regarding the cost - benefit ratio of providing healthy meals at work. A recent study by the Institute of Food and Resource Economics, University of Copenhagen, looking canteen takeaway meals, suggests that the overall benefit is modest compared to the cost, although the practice might be sustainable.

For me, the bottom line is simple: Meals at work are a very good way to keep the adult working population healthy (physically and mentally), productive and happy. The economics of each possible approach are a limiting factor. But there is no need to reach Google's standards in workplace meals (and, yes, they've given some thought on their canteens). but even humble, low cost but carefully thought of meal provision solutions (e.g., access to local shops or canteens) may be adequate, provided the right framework is in place. Such regulations framework could, for example, establish the right of employees to meal breaks, ensure a minimum variety of food offered by workplace business operators, including low-fat, low-salt, fruit and vegetable options, etc.

Food@School

'School canteen drenched
with golden sunlight 3'
by Edmund Yeo
under a CC license

Balanced nutrition is a challenge in most places in the world. Even where food is plenty. School meals and school food, in general, is an important factor for raising a healthy new generation. This applies independent of the actual socioeconomic environment, i.e., irrespective of whether children come from families with limited access to food or have family backgrounds lacking healthy standards in nutrition. Thus, the food supply system in schools (dictated by any "Food@School" policies) needs to aim towards two objectives:

• Offer affordable food providing a wide set of nutrients, at a reasonably sufficient quantity in a balanced fashion, and
• Train children into becoming responsible food consumers, actively seeking for nutrition balance and healthy choices.

As you may be guessing, those are not easy objectives for a variety of reasons, including - in no particular order:

• Elevated costs in providing free or subsidised food
• Limited know-how and/or resources needed to design, promote, implement (and enforce?) healthy school lunches
• Limited know-how and/or resources to support healthy food choices through education
• Low(er) priority at the policy agenda
• Insufficient or unclear regulatory framework
• (Possibly) limited continuity and support of such schemes at the home environment
• Low acceptance by the children of the options offered to them (consumer perception concerns do not only apply in adults!)

Luckily, not all the reasons above apply in all cases. But even having a single of those being applicable can have a detrimental effect in the outcome of any Food@School policies. The good thing is that by addressing any single one of those, the situation in the others is likely to improve - a kind of positive spill-over effect!

Mother Jones (amongst others) has recently featured an inspiring article on Jessica Shelly, the director of food services for Cincinnati's public schools. She, not only managed to meet regulatory guidelines for the formulation of school lunches (such as those dictating the use of whole grains) at a very low cost per meal but effectively altered children's attitude towards healthy food employing simple things such as:

• allowing kids to tailor their meal (salad bar)
• seeking for new recipes that would be part of a healthy and balanced diet but also appeal to kids
• listen to what the kids have to say on the food they consumed through a kind of customer satisfaction programme (all kids can do that and some have been doing it very, very successfully!)
• encourage teachers to join kids while eating, thus using them to set an example of food choices
• changing the name of dishes to make them more marketable

I'm sure that one could also add several more bullet points on the list, such as:

• Involve kids in designing meals or individual food products
• Enhance food science and nutrition training throughout school
• Take advantage of the culture-food links
• Use special events, campaigns, competitions, etc. to keep kids engaged on food and nutrition aspects
• Try to engage the kids' families on balanced nutrition issues

Clearly, not all such changes would be feasible in every school or region. In fact, many schools do not have restaurants but rather canteens - and, even canteens may be a luxury for some places. But Jessica Shelly's moves can be adapted as needed and then adopted in most places, even in a slow and incremental pace.

I'm positive that they will deliver promising results!

Acrylamide: A shady side of yumminess

'Homemade freedom fries'
by sean dreilinger under
a CC license

EFSA has recently published a draft scientific opinion indicating concerns regarding acrylamide intake and its potential role as carcinogen.

If that is as alarming as it sounds, why don't we take action now to eliminate it from our food?

And, at any rate, what can we do about it?

The brief answer to the latter is that acrylamide is not easy to get rid off entirely, as is forms during common food processing, both at the kitchen level and the industrial level. But, yes, we can reduce it further by modifying the cooking and processing steps. "Brown it lightly, don't burn it" is the simple rule to follow!

The answer to the former, however, is a bit more difficult to give using hard data to back it up, because total acrylamide intake is normally rather low and there is not too much evidence on the effect of acrylamide consumption on consumers, yet. So right now, reasonable caution is the most prudent thing one can advise.

OK. If you are still with me and can bear with me for a little longer, here is the slightly more detailed version of the story...

Acrylamide is a chemical compound formed in starchy foods when they are heated at high temperatures, starting at low rates from about 120 ^oC,  for prolonged time. It is just one of the many products of the so-called Maillard reaction, which actually is a large set of reactions, that take place when amino acids (the building blocks of proteins) and reducing sugars are heated together. The Maillard reaction products contribute considerably to the brown colour and the characteristic taste and flavour of baked, grilled, fried, etc. products.

Most of the food-contained acrylamide comes from the consumption of potato crisps, fried potatoes and coffee. Other starch-containing food that have been subjected to high temperatures, such as rusks, bread, etc., also contain acrylamide but typically in lower (or much lower) concentrations. EFSA's draft opinion quotes a mean intake that ranges from 0.3 to 1.9 μg/kg body weight. Indicatively, smoking also adds to the acrylamide intake by 0.5 to 2  μg/kg body weight. Once consumed, acrylamide is metabolised either to N-acetyl-S- (3-amino-3-oxopropyl) cysteine or Glycidamide. It is mainly the latter metabolic product that raises the concerns for acrylamide's genotoxic and cancerogenic properties.

So how big is the risk?

EFSA follows the Margin of Exposure (MOE) approach. MOE is the ratio between the dose where no adverse effect is observed to the estimated human exposure. To estimate the risk level, MOE is compared with the product of the uncertainty factors that need to be taken into consideration. Those are factors applied to data obtained from animal studies and account for the various differences between species (taking into consideration safety factors, as well). In the current case of examining acrylamide's genotoxic and cancerogenic properties, EFSA calculated a MOE much higher lower than the product of the uncertainty factors, thus indicating concern.

Acrylamide production during food processing is not a new story. In fact, there are indications that acrylamide content has been reduced lately as awareness for acrylamide concerns increases.

Currently there is little evidence through human studies on any alleged effects of acrylamide. Evidence comes mostly from animal studies, where acrylamide's consumption effects have been observed. Such toxicological studies often study consumption regimes unrealistically higher than normal human intake, within non-typical diets. The latter implies that the ingestion of acrylamide is not accompanied by ingestion of other ingredients that may - in vivo - play a role in its actual effect. Despite those uncertainties, that doesn't mean that acrylamide concerns should be dismissed. Rather that caution should be advised and studying of the issue should continue.

In Europe, sampling and analyses for acrylamide content in food has been ongoing for several years now. Parallel to that, the food industry has been using an acrylamide "toolbox" in an effort to reduce acrylamide content in processed food. At the industry level, there is also the possibility to use different raw materials (less prone to acrylamide formation), enzymes (to break down or modify the protein content that contributes to acrylamide formation), etc. All those are steps towards the right direction and take place in parallel to the efforts to fully characterise the risk.

Acrylamide, as mentioned previously, also forms during cooking food at home. There, the rule of thumb is "Lightly brown it - Don't burn it!". Which goes together with the common sense advice to maintain a balanced diet with variety in the foods consumed.
 
Note: Various organisations across Europe have produced relevant FAQs or info-sheets. If you are in Europe, it's worth checking at your national Food Authority's website. E.g., BfR (DE), ANSES (FR), EFET (GR), FSAI (IE), FSA (UK), AECOSAN (ES), etc.

Read me?

'Reading the paper' by State
Library of Victoria Collections
under a CC license

This time, I'll stay clear of food science and, for a change, I'll start with the bottom line:

We live busy lives, we do a lot of necessary or not-so-necessary things, most of which compete for our attention. That is why reading has become so difficult. That is why reading (long articles) online doesn't really stand a chance!

Here, I got it out of me. So now I can start again, the normal way this time. But I promise to keep it short. I have to.

I met a friend the other day and, at some point during our conversation, just after starting the 2nd pint, if I recall correctly, I vaguely mentioned something about this blog. The response I got was shockingly honest: "Yes, I know you blog but I haven't read any of your posts." That was the point I started thinking "Hey, you are supposed to encourage me or, at least, discourage me in a gentle way and you have just done neither". Instead of speaking my thought, I took another sip of my beer and said nothing.

The truth is that we get easily distracted. It is not a new thing. After all, distraction is nothing more than an attention shift from what we currently do onto something else. In our cave times, lying on the grass and getting distracted by the sound of animals fleeing at the sight of a hungry tiger could have been a life saver. This is certainly different to reading an article online and getting distracted by a twitter notification but the underlying mechanism remains the same.

There have been studies on that, both academic and informal, such as that on Slate. There are indications that the way we read and interpret, itself, is changing. Some of the observations, such as word/ page scanning, apply to both online and printed media. Regardless, they all seem to converge to the conclusion that keeping our attention on long online articles is tough. Some studies move onto providing advice for content developers (well, in this case, that is me). In brief, the things to do are:

• Put important things on top
• Use emphasis in a way that facilitates page scanning
• Keep it short and simple, avoiding unnecessary web design bells and whistles
• Use photos/ videos/ media contextually related to the text

I promise I'll try to stick to those rules. Although I'm not sure if all of those can be followed every single time. I may give it a try on a post on acrylamide in food.

And for those of you loyal enough to stay undistracted till the end, a great presentation from Apollo Robbins, pickpocket, magician, security consultant, etc. If you want subtitles (in many languages) visit TED.