Dr Rupy: People are confused and they're making choices based on half truths. So they're saying, well, I don't want to buy something that's been flown in from another country because that's bad for food miles. Well, that food was providing an income for a whole community of people who live in a rural area who have nothing else. So I love that we all want certainty. I like certainty, but in this world, certainty isn't there for the taking. We have to make compromises and look at overall strategies and make decisions from a whole range of information.
Dr Rupy: Welcome to the Doctor's Kitchen podcast. The show about food, lifestyle, medicine and how to improve your health today. I'm Dr Rupy, your host. I'm a medical doctor, I study nutrition and I'm a firm believer in the power of food and lifestyle as medicine. Join me and my expert guests where we discuss the multiple determinants of what allows you to lead your best life. Food systems, health and sustainability. These are some hot topics and I'm joined by Barbara Bray who is a TEDx speaker and director of Alo Solutions, a consultancy driving and delivering food safety in supply chains and helping develop sustainable nutrition strategies for food businesses to talk about this subject matter. Prior to consultancy, Barbara worked in the Ugandan agribusiness sector after graduation and then she spent 14 years in the chilled food sector in the UK and France. We get into this during the podcast and her roles covered a number of different elements including food procurement, technical innovation and implementation of food safety systems. As well as that, she retrained to be a nutritionist and she's also the co-founder of the multidisciplinary platform Health and Sustainable Food, the director of the Oxford Farming Conference, member of the Food and Nutrition Group at the Institute of Food Science and Technology and trustee of the Nutrition Society. You can tell why I wanted her to be on the podcast to talk about this matter. To top that off, in 2019, Barbara was awarded an MBE for services to food and nutrition. As part of her Nuffield farming scholarship, her project, vegetable production for specific nutritional need, looked at international food policies and private initiatives to promote the consumption of vegetables which benefit our health. Definitely something I agree with. On the show today, we talk about regenerative farming, organic versus inorganic and the vernacular that we use to describe those different methods of food production. Better farming techniques and the use of agrochemicals, what healthy sustainable diets look like in other countries rather than our country and also how we can shape our food landscape, both the role of the government versus the consumer. This is something that I think is really important to discuss because I think whilst we have some control over our food choices, our environment dictates a lot of that. And if anyone's ever spent any time in hospital or a train for an extended period of time, you know how little choice you have. And it really depends on the powers that be that determine what you're going to ultimately eat. I think it's really important also to have a varied perspective on all things to do with food and planetary health and sustainability. And although myself and Barbara don't perhaps agree totally on everything, it's really important to shed light on different perspectives on subject matters that are this important. So I really hope you do enjoy this conversation. This is definitely something I wanted to discuss more. Here is my conversation with Barbara Bray, MBE. Barbara, thank you so much for coming on the podcast. It's an absolute pleasure to have you here. I I first came across your work rather late, I must admit, when you were speaking, I believe it was the New Scientist lecture series. And I thought it's wonderful what you're up to. So, so thank you so much for for giving up some of your time for us.
Barbara Bray: And thank you for having me. I'm really excited. It's a real pleasure and I love the podcast that you do.
Dr Rupy: Oh, brilliant. Thanks so much. I mean, I I I did a bit of a deep dive into some of your work and that led me obviously to your TED talk. And I wonder if we could start by talking a bit about your your personal story in terms of your health story, but but perhaps going into a bit of your background as well in the food industry and and how you became a nutritionist and and the kind of work that you do now.
Barbara Bray: It's an interesting and eclectic story because a lot of people they they start school at four and it's almost like a treadmill, you pop out the other end with a predefined idea of what you're going to do. And as a child, I was really passionate about food, how it was grown, how it was cooked, where it came from. My parents are both from Ghana in West Africa and they came to the UK as students. And when they set up home in in Northeast England, we had a small house with a garden and my parents would grow food and in the 70s, we had things like pick your own food where you could go to the farm and pick your own strawberries. And the kind of community that I grew up in, there were lots of farmers' kids, so people who had sheep, goats, arable farms. So farming was quite, it was in my environment all the time and I just thought that was normal that every market town had a sheep market or a cattle market. You know, I just thought that's how things rolled and then you go to London and you realise, oh, they don't have that here. So I had I always had that passion and that spark for food. And as a child, you don't really necessarily know what career paths are available to you. And that's where my school was really good because the minute I said, look, I'm interested in food, they said, well, career's day tends to be a bit teachers, nurses, secretaries, that type of thing. So we'll find a food professional to come to career's day. And they brought in a lady who worked in the dairy industry as a food scientist. And I spent the entire time just with this one lady. And at the end, I said, this is what I'm going to do. I'm going to sign up, I'm going to go to university, do a food science degree and that's going to be my journey. So what actually happened was I didn't get the grade I needed in chemistry and Reading University said, well, you've got the right number of points, you can do food technology instead, which turned out to be a blessing because it's a multidisciplinary degree that encompasses food microbiology, food marketing, food manufacture, a whole range of things that suited my personality and I was quite adventurous. And you also had time in industry, so you're able to go out to different projects and I worked in a factory that did things like coleslaw, I went to a chicken factory, I went to a research and development facility in Germany for a short while. And I also worked in the UK for one of the retailers in their head office. So by the time I finished my degree, I had a real good grounding of what the industry was about. And I decided that I didn't like what I saw. So I went back to university, I went to Cranfield this time to do a degree, a post-harvest technology masters. And that was in the 90s when the whole bag salad, fresh cut pineapple in a pot thing had just been invented. So I'm showing my age. There was a world that existed before fresh cut salad. So it was a really good time to get into post-harvest technology and look at crop quality and how you can extend the shelf life of freshly cut washed foods and make sure that they didn't cause any food safety issues and harm. So I went abroad for a short while and worked for a farm that was exporting fresh vegetables to the UK and also flowers to the to Holland, I think it was. And that was a real interesting experience because I got to see the other side of the coin. And then I went on to work for a development organisation, so funded by USAID, looking at export agriculture and helping farmers in Uganda to export to Europe and and to the UK. So that helped me again, learn a bit more about how the world works because I think you can just literally leave university, start work and then think, well, that's how it is. But it's really good to get a perspective from other countries and the problems that they have to navigate if they don't have an infrastructure, if they don't have good funding mechanisms for businesses to expand. So I then spent 15 years working for a company called Bakkavor. So I entered with the graduate recruitment system and it's an accelerated program. It's about getting people to management level and beyond. So I had a really good career with Bakkavor, working in procurement where at one point I had a budget of 40 million pounds a year just to buy tomatoes for retail and all the different factories. That was like a full-time job for four people. We had a team of two. Not including marketing and packaging and all that kind of thing, but in terms of just placing orders and liaising with growers all around the world, it was a tough gig. But again, a real good learning experience. So when I went on to the next stage of my career, which was working in the supply chain as a technologist and going to do supplier approval, a bit like the man from Del Monte where you rock up at a farm and you look at the food quality and the food safety and say, yes, we'll take this for our factory. And the beauty of that was I got to see also how in different countries the infrastructure works. So for example, if you're buying fresh cut lettuce or herbs from a country in North Africa, that business in that country is able to support the social structure of that community with either providing schools or health care. So in the UK, we take it for granted that we've got our NHS and we've got free schooling, but in some other countries, people are leaving school at 12, they might not have a job to go to, they might not have a source of food. And some of these businesses are helping put back into the community the kind of things that their society and their government can't provide. So that was a real eye opener for me and probably planted the seeds of what I do now in that that particular time frame. And then I finally went on to do technical management in food factories, so working mainly in the chilled produce sector with kind of healthy ready meals, the things that are made from vegetables. I never moved far from my chilled produce line. It's all about the healthy stuff. And when that finally finished, and that I finished that around the time of the new regulations coming in on food information. So when we changed our our labelling regulation in 2014, that was the time when nutrition started to become a focal point for the food industry. And I just felt that as the most senior person on site, I had to get a bit more knowledge. And that's when I went back to university to do a masters in human nutrition and the rest is history. That was just the start of a whole different journey.
Dr Rupy: Wow. I mean, I have no idea how many times a person can go back to uni.
Barbara Bray: Seriously.
Dr Rupy: Yeah. I mean, that that varied experience really does give you a unique perspective on so many different aspects of why food is important to everyday life. I mean, you've mentioned the the impact on communities in in far-removed countries from here, the impact on obviously health and and how that's now become a focal point for the industry. And also the impact on the environment. I mean, I just want to pick up on one thing about the budget for tomatoes. I mean, that's just one produce that we would just walk past in a supermarket and not give it any second thought. But the magnitude of your decisions, the growing decisions of that one crop can have on planetary health, let alone human health, it just absolutely vast. I wonder if you could dive into a bit about your experience becoming a registered nutritionist and and what sparked sort of like your your further interest in this area of of food.
Barbara Bray: It came from that time back in kind of 2012 to 2014 when we were redesigning packaging and redesigning and reformulating the food because with the traffic light labelling where you've got your red, amber, green that shows the different macronutrients, you know, so it shows the fat, energy and so on. It was really easy for people to see, actually, I shouldn't be eating something with a red traffic light on. And retailers weren't keen to have anything that had a red traffic light. And yes, it's a useful tool, but the problem is if you're focusing on a specific nutrient, it doesn't necessarily mean that the whole entire food is bad because we're not looking at the whole nutrient profile. So something might be slightly too high in salt or it might have a high amount of fat. But we all need to have all these components in our diet across the entire day. So we need to be able to make better decisions about what we eat. And I just felt that as an industry, we weren't necessarily providing people with the best information. We were saying that have this because it's got a green traffic light on. It might not contain any vegetables, but you know, it's fat and it's salt and its sugar is low. So happy days. Well, that's only half the story. We should be focusing on have we had enough fibre? Have we had a wide variety of vegetables in that product rather than just ticking off the, you know, the fat, salt, sugar boxes and walking away. And that's when I went back to university. I thought, we need to do better as an industry. My my first degree doing food technology, we got one term of nutrition in it. And it was a 10-week term. And week one, the professor spent the whole entire session complaining that we only had 10 weeks for nutrition. So we actually had nine weeks for nutrition because she winged and moaned the whole thing saying, well, they've only given me this much time in the time.
Dr Rupy: That's that's more than I got at medical school. So I'm I'm really jealous of that.
Barbara Bray: You're not being paid to give out nutrition advice. Yeah. You know, these people are going out into industry and creating the food that we all eat. So you kind of want nutrition to be a focal part of that. But when I was going and doing my industrial placements, we were being told to take out fat and put in a fat replacement. We were being told to take out salt and replace it with potassium salts. We were being told to do all these things. And looking back, actually, they didn't add that much benefit because we were just focusing on a one-trick pony each time. A bit like when I worked in tomatoes, we were always told about the visual appeal and the taste, which is really important. But I was spending lots of time, money and research and development resource on creating packaging that was laminated plastic and that, you know, stays in the environment for years and years. But at the time, our our KPIs and our focus was about delivering some excitement and theatre for the consumer. And yes, there was a little bit of nutrition in there, but we didn't think about the consequences for the planet. And like you say, it's all connected. So when you focus on one thing, like one nutrient or one aspect, like taste or or colour, you you lose a bit of everything else. And I think now is the time for balance.
Dr Rupy: Yeah. And with your with your new found perspective after going and and doing your nutrition qualification, um and also having that varied experience within the industry, where do you think is a meeting ground to create a better labelling system for food products? Because I totally agree with you with regard to the the traffic labelling system. It's a great idea on the surface of it to give consumers more direction as to what things that they should be eating. But it it's manipulated in a way, not in a not in a um in a negative way, but it's manipulated in a way that isn't actually overall helpful because like you said, you can have a complete green sea across your packaging and and you know, that can signal to an unsuspecting consumer that this is a great product for my health. But it doesn't necessarily mean it's got the constituents of something that promotes health or, you know, will keep you healthy. Um so so I wonder if you have any ideas about where we should be going with with labelling in general.
Barbara Bray: For me, I think having a nutrient profile so people can see across the range of nutrients where they need to be. So not focusing on one single thing, maybe a scoring system that says overall out of 100, it's pitched at 85 or 35. So people at least know where in the pecking order they are and you can see the range of things that have been measured. And various countries are trialling things like that at the moment. And I think within the EU, they've been looking at it for years, it's never got off the ground, but you're starting to see different countries looking at how they can tell that story to the population and make it easier for them to make the right decisions. And I I do think that is the direction of travel. If people want a one-stop shop and a one signal, then we have to go to something that takes into account lots of different aspects of the nutrition of that food. I think the problem may come is when we also start wanting to make things visible from a sustainability point of view. So when you're saying, well, yes, it's great that that food provides all of these nutrients, but in terms of water scarcity, greenhouse gas emissions and everything else that comes with biodiversity loss from monocropping, how do you then explain that? And I think, yes, it's great we could have a nutrient profile, but it needs to be in conjunction and sit within a wider conversation about how good is that food for the planet as well.
Dr Rupy: Yeah, I I don't want to digress into a conversation about Brexit, um because obviously that that's that's an issue that sprung to mind straight away when you're talking about how the EU have been investing in this for a number of years. But but I guess um my my question is, what what does that look like in the future? And which way do you think we are moving in in terms of are we going to be looking at different two different labelling systems, one for planetary health and environmental benefits and a separate one for human health? Or is this going to be amalgamated into one? And the other thing to add to that is the sort of um the politics around nutrition. So you've got various bodies in the UK, you've got Saken, you've got AFN, you've got BDA, can they actually agree on what a nutrient profiling system should look like? Who are going to be the stakeholders involved in that decision? And is it something like you suggested out of 100 or is it out of five? Do you know all these different things? What what's actually going into that?
Barbara Bray: Wow, you touched on the politics button. I'm confident that we have all the brains that we need in the country to make the right decisions. I think the politics is what gets in the way. So it's about finding our way through and there's always going to be a compromise. I think, you know, if you take it from the point of nutrition, you then focus on the nutrient profile and getting that right. But I think if we do that, we we lose that piece about sustainable nutrition. So I think it is important to look at the wider aspect of food. Food isn't just nutrients that you take in. It's it's part of our culture, it's part of how we socialize. So I think there's a risk if you just go down the nutrient profiling route that you can start demonizing things and saying, well, you know, you shouldn't be eating this and you shouldn't be eating that. What we really need to do is have a rich variety of foods. Yes, we want to have more plant-based, but it's about enabling people to make better decisions. And I think if we're able as a a nutrition community to bring in stakeholders who sit outside of that pure nutrient focus, that will make things better for everybody. Whether politically we have the will to do that, I really don't know. I'm less confident with that bit than I am with the fact that we've got all the tools in the toolkit from a knowledge point of view and the behavioral studies to to fall back on. We've got a whole wealth of experience and depth of knowledge in that area, but I don't think we've really tapped into what could the future look like and and what does good look like if we want to have responsible food production, sales and consumption all the way through the system.
Dr Rupy: If you're if you were food are, I'm going to push you on this point, uh for the UK and you're responsible for that decision, what what do you think that should look like? Given all your experience in terms of consumer behavior, what's accessible, what's understandable to the average person shopping in a supermarket who might not have any interest in nutrition. Um so perhaps not no one listening to this podcast, but but what what do you think that should look like physically on on a packet?
Barbara Bray: I think we can probably go down two or three areas. So there's the obvious shopping physically where it's on a packet. So a tool where that gives us a full score across a range of of parameters. But then also we're shopping digitally a lot more. So having that ability to be able to access that information. I think the danger with going with just one or the other means you always leave some people behind. So I think whatever system we use, it's got to be clear and concise, but you've also got to be able to provide extra information if that's what people want. But it's a a slow process because you have to bring everybody with you. And I think a lot of people just want to pick something up really quickly or click on it. But I do think going back to this overarching, yes, one scoring system is the way to go. But we do need to be able to explain to people and break it down and say, it might, you know, you split it down and say the scoring is this, but this is what it actually means for these key areas. So people are at least guided. And if they want to make further decisions, they've got the information about that to do that. But I think there are a lot of people who are just time pressed, cash poor and having to make decisions quite quickly about can I eat today or have I got time to cook? And we don't want to make things we don't want to put a barrier in front of people to choosing their food or make them feel guilty about the choices that they've made. And I just think food politics at the moment is a lot about shaming. So saying to people, well, you shouldn't be eating this and you shouldn't be buying that or the consequences of doing this is X. And people are confused and they're making choices based on half truths. So they're saying, well, I don't want to buy something that's been flown in from another country because that's bad for food miles. Well, that food was providing an income for a whole community of people who live in a rural area who have nothing else. So I love that we all want certainty. I like certainty, but in this world, certainty isn't there for the taking. We have to make compromises and look at overall strategies and make decisions from a whole range of information and not just kind of go, I'll take that because it's good. There'll be some decisions that we make about what we eat that aren't perfect, but we have to roll with it. And I think having one scoring system that encompasses a whole range of parameters that people find it easy to understand is the the best shot we've got at doing this.
Dr Rupy: Yeah, I I I'm glad we're talking about this because I think people need to get comfortable with the imperfection of our food system and the imperfection inherent in any choice that we make. Um something that that I think has been cropping up time and time again on the back of the Eat Lancet report and the planetary health diet um that was, you know, fantastically well publicized and I even had um uh Dr. Demeo on the uh on the podcast talking about it after it and it's brilliant. It's it's a fantastic piece of research. But I think that's kind of spiraled into people's beliefs that, well, I'm just going to eat plant-based by any means necessary. And I guess with your varied experience, is that necessarily true? Is it should we should we be moving towards a 100% plant-based system where sometimes the plant-based foods that we have available to us in the supermarket shelves might incur pretty pretty massive mileage in terms of collecting that that basket of goods.
Barbara Bray: Definitely. When you look at how a lot of the plant-based foods that came out for veganuary have been designed, I wouldn't say they've been designed with sustainability in mind, whether that's sustainable for planet, people or prosperity. It's really been thrown together to create excitement and theater and whilst all that's very good, I think if you're selling a plant-based food where you can't make a claim that it contains one portion of your five a day, you need to take a hard look at that product because you know, if we're supposed to be eating five portions of fruit and veg a day minimum and you can't get one of those from a plant-based product, something has gone horribly wrong because at the end of the day, it's not adding any value nutritionally. It might be adding a bit of sat fat and a bit of salt and so on and calories to keep us going, but realistically, if we haven't been able to get a whole range of nutrients from that meal, then what have we actually achieved? And in terms of buying commodities and trading things that might have come from countries that have got really difficult climate conditions to contend with, we might have exacerbated that. So I do think we need to look at this whole 100% plant-based theory with a proper lens and not through rose-tinted spectacles because we know that to have a a truly integrated system, it takes animals and plants. Not necessarily saying you have to eat all the animals, but it means that if you've got animals grazing in a certain way on the land, that adds to the the value of the soil health, which means that the plants grow better. So, you know, I'm oversimplifying it, but we we can't exist without animals. That's not how it works. We have a symbiotic relationship with them. And so removing them completely from the system doesn't it's not a magic bullet that solves all our problems. And also we need to look at how different regions are working with animals too. So in the UK, for example, working with cattle, so whether you've got dairy or beef herds, we know that those animals aren't producing as much methane as some in other countries. I listened to a a talk at the UN by a lady from India and she said we've got plenty of cows in India, but they're very inefficient. They produce way more methane than the other cattle in in different countries. If we could just breed our cattle better and reduce the numbers, that would actually have a massive impact on improving emissions. So it's about understanding that balance and where the problem is actually coming from and where we can make a difference, you know, what can we do to pick that low-hanging fruit and how can we start to make changes rather than saying, well, having 100% plant-based is going to solve our problems. Actually, it will just shift our problems because we'd still need to address the quality of nutrition from what we're eating.
Dr Rupy: Yeah, definitely. I I want to move on to actually some of your research and sustainable diets and what that actually looks like in other countries. Um but I guess one thing that you touched on there, um that I'm trying to learn about a lot more myself is um this whole concept of regenerative farming where you do use animals in a way that improves the biodiversity of the soil, that the microbial diversity of the soil itself. Can you speak a bit about whether regenerative farming is uh sort of the um the way we should be moving towards if that's something that is going to have that incredible impact on carbon capture and and and actually improving the quality of the produce that we create?
Barbara Bray: Yeah, it's it's funny. I like to chat with my friends and colleagues. I'm a trustee of the Oxford Farming Conference. So we have these conversations on a regular basis. And I'm also a Nuffield farming scholar. So our group WhatsApp, you know, the last week has all been about water and water scarcity and and things like that and people trying to talk about the best way to manage effluent and you know, it's quite serious on WhatsApp group. But I think what tends to happen is or what we're seeing is the way that language is used. And I was talking to one of my Nuffield farming colleagues and she said when she goes around, she's a a consultant who works with farmers who have a whole range of mixed farming. And she says a lot of them are using regenerative agriculture techniques, but if you gave them a questionnaire and said, are you doing regenerative agriculture? They'll say no, because they don't want to be associated with a cult or a movement. They just want to do their day-to-day work. But actually, you know, their hedge laying and the way they move their animals around their crop around the farm and the type of crop rotations that they practice, the actual theory behind it is exactly the same as regenerative agriculture. Language can be so inflammatory and it polarizes people into a hard left or a hard right. And there's all these kind of people milling about in the middle doing what they need to do and trying to make the right decisions, but kind of being pushed away from having those conversations because it's very difficult to have them in a neutral way because you're seen as, well, you've got livestock so you can't be good or you've got, you know, monocropping so you can't be good. And actually, people are trying to do lots of things in their in their landscape and going on to specific schemes like Leaf, which is linking environment and farming to look at how they can increase the biodiversity. And at the same time, our membership of the EU meant that certain types of pesticides and and you know, herbicides have been taken away from us over the years and have been replaced by types of systems that work with nature. So you can call it nature-friendly farming, integrated pest management, whatever name you want to give it, but it's meant that as a a group of nations, we've all been trying to adapt and work better to reduce the chemical footprint across the the whole arsenal across the whole range of farming systems. Some farming systems can do it more easily. So the sector that I started in, the whole tomato, peppers, cucumbers, protected crops, they literally sit in a greenhouse with a sealed door and some flaps to let the air in and out and you can control that environment really easily. Vertical farms again, you can control that so you don't have to use pesticides and insecticides in the way that you do in open field. But even in open field, we're we're learning new techniques all of the time about how we can reduce that chemical footprint and work with nature. And I think the work that has been done has been monumental. Yes, there's still some distance to go, but I do think we need to move away from trying to polarize people and just accept that we're on a journey and we need to work together to get to that destination of having holistic produced food that that's really good for our planet, prosperity and for people.
Dr Rupy: To use another polarizing uh uh word, organic versus inorganic, which I'm sure you knew that was going to ask you about. Do do you with that with that reduction in chemical footprint, do you think that's the type of farming if we can call it an organic type of farming? I know I'm using the word again. Um is that the direction of travel that you think we should be heading toward?
Barbara Bray: In my personal opinion, it's not the direction of travel. And I I will direct you to another um video that I have done. It was called um oh, what was it called? Love to cook. Do you know what? I can't remember. I think that's it. Yeah. Um oh, I've sent you the link anyway, so. In that video, I talk about organic versus conventional and how we do need some kind of treatments to make sure that we're not losing crops in the field. So there are certain things that will protect crops in the field from attack from insects or climate change activities that means that if the the atmosphere is too moist or the soil is too moist that the plant can't grow in the right way. So there are certain products that are used for specific reasons. It's not it's a bit like medicine when you're prescribing a drug, you want a targeted solution. You're not going to trying to give a drug that captures everything. You want a specific outcome from when you apply it. And farming is a lot like that. You can have some things that are more blanket and you can have some things that are targeted. But the problem is if we go down the route of focusing on organic because it takes up more land space, we don't necessarily have that ability to carry on increasing the production with the population that we have. So we have to look at how we can get more food produced from the same amount of land. So an activity that increases that that land requirement isn't helpful. But you also need to look at the the climate changing climate impact. So for example, if you're using an organic system and it means that you're having to use more fuel, for example, for the number of times a tractor has to pass over it or more intensive type of of intervention with that product, it means that it's not necessarily better. So there are some crops where yes, there is clear daylight between the two, but it's not across the board. And I think if you fall into organic versus conventional, you lose a lot of the nuances where certain crops, you know, the difference between organic and conventional is a lot lower than others. And it's about finding the right system for the right crop in the right location rather than having system A versus system B. And there are elements that you can take from both, I think, to make or more than both, it's, you know, whether it's regenerative, organic or rewilding, whatever it is, there's always going to be elements that you can take from each of those to find what's best for that location and that, you know, that geography.
Dr Rupy: Yeah, so I understand that concept of of making sure that you have the right system for the right crop, the right uh environment, the right country, um all those different factors that uh you need to take into account. Is is there any um worry, I guess, of the overreliance on uh agropetrochemicals for uh crops, but not not from the perspective of the environment, but also on human health that that you're pragmatic about or wary about?
Barbara Bray: I like to look at the whole risk piece. And I think this is where sometimes it goes a bit wrong. I'm a real fan of Ben Goldacre. I don't know if you follow any of his work. He is brutal with people who misinterpret risk. So I'm hoping that he's not watching this if I get it wrong. But I think you you can you can learn a lot from him because he talks about the overall risk of something. So when things are reported, they tend to say there's a X percent increase, but you have to look at the absolute. So were you working from a 1% incidence of it happening or a 25%? So in that case, if, you know, something has a 1% increase and it's was a base of 1%, it's not massive different, massively different. And I think sometimes people will talk about the impact of agropetrochemicals on our diet. And I'll say, well, if I walk out onto my street, I live in Manchester, the fumes that I'm breathing in from the cars far outweigh anything that I'm going to ingest into my body. And it's about having that perspective of where is the biggest toxic load coming from and how we respond to that. Because I think a clean air campaign would improve our health quality far more than saying, well, actually, if we ban that one particular herbicide, everybody's going to be okay because that's just disingenuous, it's not going to happen. It might be a nice to do, but in terms of adding value from a health quality point of view, we know that living in cramped housing, you know, living in poverty, breathing in polluted air has a much bigger impact on our health. And I think sometimes people overplay the the relevance of diet in all that. It's just one of those factors. And if you can't get all the rest right, having a perfect diet doesn't solve any of those problems.
Dr Rupy: Yeah, yeah, I I really appreciate that perspective actually because I think a lot of people and it it might be unfashionable to say it, particularly right now, particularly for the audience who who might be of a completely different opinion, but you know, I think we have to look at the overall burden and our overall toxic load. And to your point, you know, I'm in the middle of London right now and there are fumes that I'm ingesting when I go on the tube, it's cramped, there's I'm breathing in other people's air. There's so many different elements that uh increase my own personal toxic load. Food against all those different elements is is further down the list. It's definitely very important and I think, you know, it warrants further conversation about it, but it's it's certainly something that I think can spiral into an unhealthy obsession with with clean food. And and I think we we witness that quite a bit. Um I I also sort of take on the flip side a slightly different opinion when it comes to um uh the the use of chemicals and and whether we should be pragmatic about reducing that that chemical load as well. And and to use an analogy in medicine, for example, you know, um I try and lessen the number of medications for patients by any means necessary. And yes, that's lifestyle and yes, that's all the other exercise and and and social prescribing and all the all the rest of it. But it it's it's really because I'm pragmatic about the potential side effects that and the unknown unknowns. Um you know, recently was recalled and this is something that when I started in medicine, it was just something that you could get from pharmacies and now it's we know that it has uh associations with with cancer and a whole bunch of other side effects. So for me it's like, okay, there are things that we know today that are most likely going to change in the future. And I think that that pragmatism, that worry is something that that plagues me a bit. And and that potentially that's extended to farming. I'm not too sure if you you agree or or whether you you have any thoughts on that.
Barbara Bray: It's about balance again because there there are always going to be consequences. So if you remove a chemical that's the only chemical that's available for a certain crop not to be plagued by a pest, then the consequence of that is we go without that food. So it's finding that middle ground, isn't it? There'll be some things that you can remove more easily than others. So I think rather than having a blanket thing of saying, well, we need to reduce all chemicals, we need to reduce the ones that we can live without. I think is the most pragmatic way of doing it. And yes, there's always going to be a little bit of push back, but people do find ways of adapting. What I think is wrong is where there's a sudden decision to take something away and people haven't had the time to develop an alternative. I think that's where the fear and the stress comes from and the shouty behavior is like, well, I had this yesterday, I can't use it tomorrow, but I haven't got a plan B. What am I supposed to do? And when somebody's livelihood depends on selling that product at the end of the year and that is their entire income and you're like, no, you'll be fine. You can see how that's not going to land, can't you? So I think we need to have those sensible conversations. If a group of growers or producers are saying, this is our last shot to be able to do something and produce this and make a profit, we need to find an alternative quickly. We need to listen and facilitate that process to find an alternative before we take the only thing that they've got in the toolkit away. And if you talk about what we touched on earlier, antimicrobial resistance, it's a little bit the same with human health because there was so much over prescribing for so long that now we're in a situation where the the medication of last resort isn't working. We don't want to get to that in farming. We want to be able to have that that place where we can always say, yes, this particular intervention is going to work. Not that we're going to use it every time, but when we do want to use it, it's going to be there and it's going to be effective. And the whole one health piece brings all that together, human health, animal health, crop health, and it's I do think it's important to look at it in the round.
Dr Rupy: Yeah, yeah, absolutely. I I want to bring you on to the the subject of your um your your study actually, um uh that I I told you before this, I haven't read in its entirety. I've just read the executive summary. But I I wonder if you could introduce the this concept of what uh healthy and sustainable diets look like in in other countries because I think we take a very eurocentric approach to what a healthy plate looks like. And if you look at the healthy plate, for example, in the UK, I have a lot of patients from Korean backgrounds, Indian backgrounds, different African backgrounds, you know, it's it's not what they it's so far removed from from what they're used to eating. So for me to suggest a kale salad is like, well, what are you talking about? Where do I even get that ingredient from? So yeah, I wonder if you can introduce us into some of your studies and and your thoughts about that too.
Barbara Bray: I was just making me laugh because as a child, I'd come home from school and say to my mother what I'd had for lunch, be like beetroot and celery and she's like, what even is that? It was really interesting. As part of my Nuffield farming scholarship, it's a travel scholarship and you have 18 months to travel to various regions in the world of your choice and carry out your study. And my study was vegetable production for specific nutritional need. And I wanted to look at what the the kind of guidance, the dietary guidance was in different countries and how that's being implemented and what the outcomes are, whether there's anything we can learn from that. So I went to a whole range of countries, mainly around, I went to Hong Kong, I went to Shanghai, then I went through South Korea, traveled into Australia and New Zealand, and did a few other countries around as well. And what I found was, particularly in places like Shanghai and South Korea, when you look at the dietary guidance that you've got in those countries, they do focus quite heavily on vegetables. They don't do this whole five portions of fruit and veg a day. In those countries, they'll talk about the number of portions of vegetables that you need to have and the types and the colour. So they'll say, well, this many green, this many from the pink and orange range. So you know, they've they've taken it right down to its depths. But the difference is, it's not just about how they've said how a diet should look like. When you actually walk on the street, and I talk about this in my TEDx talk where I was thinking, you know, I've been newly diagnosed as pre-diabetic and I was about to leave the country and be on the road. And if you did that in this country, you'd be living out of the Shell petrol stations and the fast food joints and so on and so forth. And I just didn't know what fast food or casual dining was going to look like in these places. But I was pleasantly surprised because I could go and start my day in in Seoul, for example, at a train station with a really nourishing chicken porridge that was made from rice and oats and seaweed and kimchi. And yeah, where can I do that? In the UK, maybe King's Cross has changed its its menu recently. I don't know, but the sorts of foods that I was coming across were very wholesome. So in terms of fibre and presence of vegetables, they ticked all of the boxes. So it's one thing that a country is is telling its population to follow a specific dietary rule or guidance. It's another thing that you're actually able to access those foods quite easily. And that was just in the cities. When I moved out into the more rural areas, it was still easy to see fruit and vegetables being sold. And you know, the whole market experience for me was a real eye opener, just wandering in a market in South Korea and everything's out. There's just tables of produce and you know, obviously all the the meat is in one area and the veg is in one area, but they'll sell whole pig's heads and you know, the fish was all out there and it was great to see food as it came, not completely processed into something unrecognisable from the original animal. Um the vegetables all with the roots and the heads still on and it was just great to be able to touch that and feel that and realise that actually we have a completely different relationship with food in this country and we're very about the convenience and and getting fed really quickly, but there's a disconnect with how that food was grown, where it came from and the value that it adds to our life and how we how we engage with it.
Dr Rupy: Yeah, absolutely. And you know, I I can visualize those colorful markets as well, like from my travels in Southeast Asia and and different parts of India as well. I can I can definitely see that. And I think, you know, in the UK, particularly if you you go to farming towns, we do have pockets of that. But I think the the difference is when you go on a train to get to a particular market town, what you're going to be offered is a white bread sandwich with not much filling, uh a pasty and maybe some crisps. Whereas I remember vividly watching a Rick Stein um food program and he was traveling in, I think it was Thailand. And on the train, he got like a rice dish, a bit of egg on the side, some red peppers, a little bit of green. I was like, you can't get that on a train in the UK. That's it's crazy, you know. Um and and the kicker is he would have paid like pence to to go on that train as well and and for the dish. So so I guess that that disconnect is sort of obvious to to everyone living in the UK. What where do you think we can actually change that food environment? Because I think the food environment is is the kicker in all of this. You know, it's not information, it's not, you know, the the access to food, although that is that is an important consideration. It is the genuine food environment that we all operate in.
Barbara Bray: I think you're right. Until we change the food environment, people can't change their choices because you can only choose from what's available. And if it's not there, how do you make that choice? So I think where we need to work together is in the food service sector and with retail and look at how we can make choices that are the right choices easier to access. And I think it's been too easy for people to hide behind, well, if we sell that, no one will buy it. And I remember the Oxford Farming Conference last year, one of the retailers did say that, you know, people don't want to buy the healthy stuff. And I get that. I worked in the the chilled produce sector for years and we we'd always launch amazing salads and beautifully presented products and they'd sit on the shelf for a week or so and then we'd track the sales and we're like, it's not going to make it to the end of the season. Meanwhile, the deep fried crispy potato slices were flying off the shelves. You know, we couldn't make them fast enough. The butternut squash salad with pumpkin seeds, you know, it just wasn't. So there is a point in that. And I think where we can make a difference is how we present food in places where it could be hospitals, schools, prisons. I think if you have a centrally procured system where people are going to work or people are living, and in those places we can serve healthier food and a wider choice, it makes it easier. And the example I give in my TEDx talk is what Google have done. So at their head office, they don't sell food, it's actually free, but people, you know, they go and choose their food. And what Google have done is they've put in things like water in front of the fruit juice and the fizzy drinks. So the first thing you see is the water. And then the salads and the fresh cut produce is ahead of all the other products. So you pick that up first. And it's been tried in in various organizations. So there's a fast food chain who also looked at when you touch the the kind of keypad thing in the store, they put the the things that they think people should really be focusing on like the water and the the products that got a little bit more leaf in them. They put those up first so people see those things first and are more likely to choose them. So we know that by changing the food environment that people are in, you help change those choices. It's a little bit of nudge technology, but it is about putting the right things or the better things in front of them. Also knowing that if somebody feels like going out for an ice cream, that's what they're going to do. We shouldn't stop people from doing that. That's part of the pleasure of socializing and having fun and and doing that kind of thing. But it's when it becomes a daily thing at the expense of all the foods that we should be eating that help maintain our immune health and just keep us going. That's when it becomes a problem.
Dr Rupy: Yeah, yeah, I I really agree with that. And I think, you know, using um nudge psychology and some of the um some of the really interesting work by David Halpern inside the nudge unit at uh number 10 Downing Street. He's written a fantastic book. I think it's called inside the nudge unit about all the different tactics that the UK government uh used to uh improve health, improve taxation revenues, as well as um just general uh behavior amongst the population. Uh liberal paternalism, I think is sort of the overarching concept of, you know, still providing you both water and a fizzy drink, but giving it to you in a way that makes you more likely to choose the thing that's going to benefit your health. Um which which I'm I'm a big fan of. Um I guess one of the things that I I think warrants further discussion and certainly nothing that we're going to figure out here is how do we actually get change in those arenas? And the one thing that really is a bug bear for me, obviously, is hospitals, whenever I work in A&E, I see that lovely person pushing around the trolley with the fizzy drinks and the, you know, chocolates and stuff around the A&E waiting room. And you're like, this is really not the place for people to have just this as an option. Obviously, still provide it to them, but don't only give them that. Um where does that lie? I mean, in your position as a consultant, where where would where would you like to see more change happen?
Barbara Bray: I'd like to see more change happen at Treasury. I don't think Treasury talk to Defra and you know, Department for DHSC. I can't remember the new title. So I think it's about having those conversations because if Treasury are deciding how much money is allocated to different budgets for food, then the buck stops with them. People downstream are only choosing from the budget that they've got available and that's after the event. And I don't think we look at the whole piece in a sustainable way. We say, well, how much have we got to spend on X? Let's divvy that up and carry on regardless. And I think if we took it from a different point of view and say, how do we keep hospital patients healthy, school children healthy, prison population healthy, workers in factories healthy, then we'd change the way that we do it and we'd budget differently and budget so that people got at least that one good meal a day. So if you look at what WFP are doing with their school feeding program that was announced for 2030, I think it was announced just last week, they're acknowledging that COVID has had a massive impact worldwide on children being able to access healthy food because when they're going to school and they're getting a meal, that was for a lot of kids, the one place where they ate well. And if we don't get that bit right where people are having a touch point where they're not having to prepare the food themselves, somebody else is making it. If we can't get that bit right, it makes it so much harder to do everything else because we're not all eating at home every single day. And I think that out of home piece, so, you know, I work in the food industry, I go into food factories all the time. A lot of people prepare their own food because it's cheaper, but I think we need to be able to offer workers across the board, whether they're in an institution or in a factory, a good, healthy meal every day because that's what keeps us upright. That's what keeps us healthy. And by compromising there, it makes life really difficult, especially in places where in manufacturing, people might be earning around that sort of 9 pounds an hour level. It's really hard for them to maintain good quality life because by the time they've paid their transport to work and back, a roof over their head, what's left to pay for food is actually not that much. And even people with a bit more are having to kind of make decisions about, well, I'll eat something that's a bit more filling and a bit more now rather than think about something that's going to give me a healthy, sustainable life and body. And I I just think we we're not doing ourselves a good service if we're letting the Treasury dictate how much we're going to spend on food throughout the whole estate.
Dr Rupy: Yeah, exactly. And I think, you know, at an NHS level, um the amount of money spent per plate of food offered to patients was well below 1 pound in in a number of different hospital trusts as well. So it definitely comes at that level. And I you know, I've spoken at a number of events with healthcare caterers, um and at the healthcare caterers Association. And they are up for the challenge of improving the nutrient quality, but they have to make it sustainable from a business point of view. And if that's the budget they have to work with, then you're going to get a plate of filling food rather than nutritious food. And I think that there's that's definitely an area that that warrants attention. The other thing that I think um and I should have uh mentioned this a little bit earlier that I keep on hearing in the ether and there's an article, I think it came out in the Times a couple of years ago or one of the newspapers is that we have a limited number of harvests left and the nutrient quality of the food that we produce is declining. Is there any truth in in that that that you come across or?
Barbara Bray: I think that's a little bit broad brush because obviously every crop is different, the way it is, we talked about it earlier, the geography of the land. So it's about how we manage that and keep a sustainable system in place so we can have harvests for the next 40, 100, however many. The piece around the decline in nutrients, there's the way it's also measured is part of that whole equation because what we normally do is there's a sampling exercise that goes on every so often where products are taken from different locations and sampled. So it's not necessarily consistent. So it's not like in in some of the research centers where they've they've measured the the crop in the same field for years and years and years. You can if you take that data, that's reliable, but if you're just taking the shopping data, you can't say, well, that that carrot always came from the same place, we can measure the nutrients. But I think what has happened when you look at how seed breeding in crops happens, people have always been looking for a crop that's going to be really robust, that's going to survive the climate conditions of either flooding or drought, depending on what kind of summer we're having. And a lot of the time, the breeders haven't looked at the nutrient quality or the nutrient density of the actual product. They focused on maybe getting a high level of starch or carbohydrates or whatever it is that's that's relevant for that crop to keep that crop in good condition and haven't really worried about the minerals and vitamins unless they were playing an active part in looking after that particular plant. So I think that's where we can start to make a difference. And there's some really interesting work happening now on biofortification that's been in the pipeline for the last 10 years or so where people are looking at how you can add nutrients to the field and that it gets taken up by the crop or if it's in a protected setting like a vertical farm or a protected cropping situation, how you add that into the water. So the crop takes up the nutrient or you manipulate the environment so the crop has a higher level of minerals and a higher level of vitamins because in the UK, we're we're not in a bad place from from a nutrient point of view, but we are suboptimal, which just means that everybody isn't quite getting what they need, especially certain groups of the population, for example, older adults, teenage girls, particularly around things like folate and iron. And when people then restrict their diet on top of that, it means they've got less access to those nutrients because they might say, well, I'm going to go for a purely plant-based diet, but if they're not having the sort of plant-based diet that gives them five a day, you're already struggling to get those key nutrients like your folate and and so on and so forth. So you know, vitamin A, I think is another one where people just aren't getting the right amount. And if you're having a plant-based diet and you're not getting those nutrients, then something has gone very wrong.
Dr Rupy: And just to focus on that for a moment, what are the areas around our diet in the UK that you feel need most attention in terms of either the micronutrients that you've just mentioned or or just the the macronutrient categories?
Barbara Bray: I would say when you look at the Saken, we referred to Saken earlier, the reports and when you also look at the um national diet and nutrition surveys, they're talking about things like fiber. And I think over the years, we've been very good at saying cut out salt, sugar, fat, blah, blah, blah. We haven't been very good at saying, well, we need to add these things into our diet. And I think the gut health trend has helped with that. So people now recognize that fiber is something that they need. And that is one key nutrient that we all need to have more of. But the micronutrients, it depends on where you are in the population as to what your needs are. And I think the advent of personalized nutrition or even customized nutrition so that we say, well, people who've got X or people who do Y need more of this particular micronutrient. I think that's useful. So we know, for example, boys don't necessarily need as much iron as girls because they're not menstruating. So it's about focusing that activity on that core population group who need it. Women of pregnancy age need more folate, so focus that activity on them. And if everybody else needs a bit more vitamin A, make that something that we we focus on across the range. So it it is horses for courses and I do hope that personalized nutrition will start to move people down that line of travel of being able to work out what they need for them. And you know, it works across all different different needs and categories. So if somebody's not just about age, it could just be about how they're living their lifestyle and what particular nutrients they need for them. I think that would be really helpful.
Dr Rupy: Yeah, I I I definitely see the the trend towards personalized nutrition as a positive one. Um even looking at, you know, buckets of health goals and and people who have established cardiovascular disease versus those who have metabolic disease and what their needs are. Um to them because at the moment, it appears that we have a uniform sort of plate that's for everyone and we know A, it's a eurocentric plate and B, it's not necessarily encompassing individual preferences and um needs as well. Um so I think that's a really important one. And you mentioned vertical farming and a few other methods of um uh food tech that are being used to improve yield and quality of plants. Is there is there food tech on the horizon that you're most excited about?
Barbara Bray: There's always something coming up. I mean, I I spend a lot of time talking to the people at the small robot company and getting really excited because the work that they're doing about digital and and electronic weeding, identifying areas where plants need support and extra help so they can reduce the amount of of chemicals that are used. I think that is absolutely amazing. But also when you look at vertical farming, the types of plants that we can grow there. So the high value things like herbs or you can use it for plant propagation that then goes into the field. So that it's the way in which we engage with the technology that I think is also important. We tend to get excited about new things and say this is a magic bullet, it's going to solve all these problems, but it's always about horses for courses, taking the right technology for the right location, for the right crop. It's not an answer to everything. And I just think being able to control crops so that we get better yields but also better nutrition is something that really excites me. So I'm very passionate about the biofortification piece in that we can improve the nutrient density and quality of our foods just by tweaking what we give the plants. So we are what we eat eats. If we look after the plants and we look after the livestock and feed them well, then when we eat, we get the benefit of that. And I think that message sometimes gets a bit lost, but I can't remember who I heard that from. It was some eminent scientist, I think in Ireland. We are what we eat eats, but she's right.
Dr Rupy: Yeah. Yeah, yeah, absolutely. I have to look that one up actually. Um I I I I totally get that a lot of things are out of the control of the consumer level. So, you know, we talked about Treasury investing in uh better food procurement and actually giving the opportunity to change and and and shape our food landscape. At a consumer level, I'm just trying to get into the shoes of a listener who's like, okay, I understand this. I understand there's some huge issues with air miles, but then also you have to marry that up with livelihoods of people in different uh farming countries. How should we approach our typical supermarket shop at a very general sense when you go into a market or whether it's in the supermarket at all, you know, how how should we broadly be changing our food shopping habits to take into all the considerations around environmental health as well as sustainability?
Barbara Bray: I think it's it's easy to kind of tell people, oh, you've got to do X or you've got to do Y. And I look at my own fridge and yes, there are lots of vegetables in there because that's what I do and that's who I am. But it's it's sometimes it's just easier to get things like a takeaway or a ready meal just to get through the day. And I think there shouldn't be any shame in that. But it's about making at least one small change. And one book that I can recommend is climate and oh my word, I've forgotten the name of the book. Um food and climate change without the hot air by Professor Sarah Bridle. Because what she's done there is she's signposted people to changes that they can make. For example, if you're going to have bread, wholemeal bread, but don't toast it because that adds to the greenhouse gas emissions. So how you cook your food actually has a massive impact on the greenhouse gas emissions. How it's produced is relevant, but a lot of the time, sticking one thing, if you stick one jacket potato in an oven, or even two, if you're a two-person household, actually, it doesn't matter what the farmer did, you've just knocked it out of the park with the greenhouse gases cooking that potato. So it's about thinking not just of the shopping bit, but the the preparation and consumption. So I'd recommend people read that book and have a look because one of the nice things that she's done is she's given a a link to a set of notes where you can see what the nutrition is of a particular food. So you can have a look at the difference between french fries, jacket potato and mashed potato, for example, and look at the the nutrients so you can see what the energy value is and you know, all the different things that are to do with that. So you can decide whether having a jacket potato because you can see the greenhouse gas emissions is a good idea today or whether you should be making just a, you know, a chopped quick thing with your potatoes that uses up less greenhouse gases, but it's also still quite healthy. So it helps you make the better decisions. Not that you can live your life purely by I need to do what's the lowest greenhouse gas emissions and the more fiber, you know, life's not like that, but it at least it helps with those decisions and you think a bit more about what you can do as a consumer. So once you've got it in your home, don't waste it. Just make sure if you you've got a meal plan that is going to include all of that food, but also think about how you're cooking something. And if you look at Southeast Asia, there's a lot of stir frying and and quick ways of of cooking food that really fascinated me when I was going into people's kitchens. The way that people are cooking is a lot more energy efficient than what we do. And that is really important when we're looking at how we can have an impact on that side of things.
Dr Rupy: I'm definitely going to read that book because I I haven't really taken into account the mechanism by which I cook food before. I mean, I I'm acutely aware of like, you know, if I get a takeaway, uh I try and at least go to the store myself, whether it would be walking or biking or whatever, rather than ordering it on an app and then getting someone to hop on a moped and you know, expand all that. There's all these different considerations, I guess. But you know, as a general steer, I'd be fascinated in knowing just how many different greenhouse gases are being emitted from the the process of cooking. Um this has been fascinating. Thank you so much, uh Barbara for your for your work and uh and giving up your time as well. Um and I've I've definitely learned a whole bunch of things that I'm going to put into practice straight away.
Barbara Bray: I'm so pleased. It's been great speaking to you and hearing your side because I don't know obviously your your audience that well. I'm an audience member myself, but you don't get to know who else is really listening to this. So I'll be really interested to see what questions come out and uh I'll still enjoy watching your recipes and using them regardless of the greenhouse gas emissions.
Dr Rupy: That's great to hear. Thank you so much for listening to today's podcast. I really hope you found it useful. Please do share it with anyone that you feel would benefit from this information and I will see you here next time.
