Saturday, 1 December 2018

December 2018: indigestion




INDIGESTION


“The simple way to feed a healthy gut is to eat a varied diet, especially fruit and vegetables”...……[1]
Not easy, nowadays. We’re busy, and all those tempting ready meals, snacks, sweeties and drinks, are paraded in front of us all day, every day. They are not generally made with our best interests at heart. 
How do we cope? With indigestion. 
Drug companies have no incentive to search for a long-term indigestion cure - especially when that cure involves simple diet changes. It's like killing the goose that lays the golden eggs. Indigestion delivers trillions of dollars into their coffers every year. So they’re not going to tell you about simple dietary remedies: they’re too busy finding ways to give you temporary relief [2].
So what to do?

Indigestion is a general term that describes a group of unpleasant symptoms: pain in your upper abdomen, burning, discomfort, feeling full too soon while eating; and feeling unpleasantly full afterwards. 
Common factors that cause it include overeating, eating too quickly or fatty, greasy or spicy foods; smoking, anxiety, too much caffeine, alcohol, chocolate, carbonated beverages and medicines like NSAIDs, steroids, narcotics, or antibiotics.
Here is a list of possible problems, though they often overlap. 

Heartburn, acid reflux, and GERD are terms which are often used interchangeably. They actually have different meanings.
Acid reflux: most people reach for antacids when they’re experiencing indigestion and bloating, but low stomach acid is very often the culprit …. and you may be doing serious damage to your health while taking antacids. 
When stomach acid is too low, the proteins in your stomach can start to ferment, which creates pressure. This pressure pushes open the valve at the top of your stomach, splashing into your esophagus and causing acid reflux and heartburn. Gastroesophageal reflux disease (GERD) is the chronic form of this [3].
Simply supplementing the nutrients which produce stomach acid can fix the whole problem at its root: vitamins B2 (riboflavin), B3 (niacin) and B6 (pyridoxine) are the most common ones [4]. In fact, vitamin and mineral deficiencies can cause a vicious cycle of low stomach acid and malnutrition because they are all needed for the acid production [5].

Gastritis means the lining of your stomach is inflamed. Mostly caused by excessive use of certain painkillers, alcohol consumption, injuries or stress, it’s usually easy to treat. Changing your diet (and other ways!) normally cures it. See [6]. For if not dealt with early, ulcers can follow and increase the risk of developing cancer [7].

Gallstones may be the problem if your indigestion is worse after fried foods. The symptoms are very similar to general indigestion: bloating, burping, pain in the upper abdomen. It may come on after a fatty meal, starts 30-120 minutes after eating and is worse on the right-hand side where gallbladder and liver lie. Obesity, diabetes, a high-fat diet, sedentary lifestyle, and pregnancy increase the risk of developing them. Once you have them, see [8]. 

And then there is coeliac disease: see the Thought of September ’18 about gluten. 
If the pain in your stomach area radiates towards the back, you have pancreatitis [9].
For the causes, symptoms and prevention of stomach cancer, see [10]

You may or may not have heard of FODMAPs, the latest fashion in food research. ’Fermentable Oligo-, Di-, Mono-saccharides And Polyols’ can cause digestive discomfort in some people. A low-FODMAP diet might help to improve short-term digestive symptoms in adults with functional gastrointestinal disorders, like irritable bowel syndrome. But in fact, in the long term, these FODMAPs actually produce beneficial alterations in the gut flora and help avert problems. Apples, wheat, milk, beans, peas, onions, sweeteners: this is just a tiny fraction of foods you can’t eat if you want to avoid FODMAPs [11]. However, as luck would have it, you should not stick to it for too long for that’s very bad for your gut [12].

For indigestion in general, here are some things you can do to start with.
Do
cut down on tea, coffee, cola or alcohol
prop your head and shoulders up in bed – this can stop stomach acid coming up while you sleep
lose weight if you're too heavy
Don't
eat 3-4 hours before going to bed
have rich, spicy or fatty foods
take ibuprofen or aspirin – this can make indigestion worse
smoke
But see a GP if you are in bad pain, have lost a lot of weight without meaning to, have difficulty swallowing, keep vomiting, have iron deficiency anemia, feel a lump in your stomach, have bloody vomit or poo [13].

More tips for those who get bloated:
  • Eat small meals, eat slowly, and chew well.
  • For some people, fruit causes bloating when eaten straight after a main meal. Eat it separately, 30 minutes before, or two hours after. And don’t have raw veg and fruit at the same meal. They require different enzymes to digest.
  • Eat proteins first. They need lots of hydrochloric acid for proper digestion. If the stomach is first filled with carbohydrate foods which don’t require this acid, the protein will remain undigested. And eat salads and breads with the meal or last, not first.
  • Eat yoghurt and other lactic acid foods with every meal, like sauerkraut, sourdough bread, cottage cheese, garlic.
There are herbs and spices which improve digestion, each in a different way: aloe vera, aniseed, caraway, cardamom, cayenne, chamomile, coriander, cumin, dandelion, dill, fennel, ginger, lemon balm, marjoram, mint, nutmeg, parsley, rosemary, turmeric. Try and see what suits you. In general fresh is better than dried, due to the high levels of preservatives used [14].
Bone broth, too, is excellent [15]. 

Oyez oyez: Bad news for the producers of aspirin. A recent trial shows that taking daily low-dose aspirin doesn't prolong health in otherwise healthy people aged 70 and older. In fact, the group taking aspirin had a slightly increased risk of death (https://health.usnews.com/health-care/articles/2018-09-16/is-daily-low-dose-aspirin-really-worth-it-for-seniors).


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EAT:
Veg: Brussels', beet, sprout tops, cabbage, celeriac, celery (with Stilton!), corn salad, Jerusalem artichokes, carrots, salsify, kale, kohlrabi, landcress, leeks, parsnips, pumpkin/squash, rocket, spinach, swede, turnips, winter (= black) radish, endive, winter purslane.
Meat: wood pigeon, pheasant, wild duck, goose, grouse, partridge, venison. For (Christmas) game recipes, see [16].
Fish: coley, megrim, hake, clams, crab, cuttlefish, mussels, oysters, scallops, whiting
See also [17] for what to eat this month.

PLANT:
Shallots are traditionally planted on the shortest day. You can still plant garlic.
If you leave veg in the ground, apply a thick mulch (straw, bracken or newspaper): for protection, and so as to get them out easily.

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The following recipe appealed to my sense of humour. Though it’s nice as well, and dead simple! Serve for a party, or for guests after dinner.
The better the quality of the cheese of course, the better the apple.
SPICED APPLE CHEESE BALL
240g grated Cheddar, 125g cream cheese, 1 small squashed garlic clove, pinch red pepper, paprika, 1/4 cinnamon stick, small bay leaf.
Mix cheeses, garlic and red pepper well. Shape into a ball, tapering it a bit at the bottom, and make an indentation in the top to resemble an apple. Chill for 30 mins.
Coat heavily with paprika; cover and chill 1 hour. Insert cinnamon stick and bay leaf into the indentation to resemble apple stem and leaf. Serve with crackers.

FANCY LAMB CHOPS for 2.
2 lamb chops, 1 tblsp olive oil, 2 tsp Worcestershire sauce, (15g butter), 1 sprig rosemary, 1 clove garlic, 60ml ruby port, some olives (much nicer with their stones I think!).
Mix oil and Worcestershire, dip the steaks in it. Cook the lamb as normal in this oil mix, but ab. 5 minutes before the end put in the finely chopped rosemary, garlic, port and olives. If the lamb did not have much fat, add butter. Cook till it’s all done, maybe let the sauce reduce if necessary. 

ALOO KEEMA - MINCED LAMB with POTATOES
This recipe is slightly more complicated than my normal fare. Don't be put off by all the ingredients though: use what you have, and/or substitute, and don't worry! You can make lots and freeze some for the future. 
450g minced lamb, 2 cubed potatoes, cubed, 3tblsp oil, 1 bay leaf, ½tsp mustard, 3 green cardamom pods cracked open,  2½cm cinnamon stick, 2 chopped onions, 3 chopped garlic cloves, ½tsp ginger, 180ml chopped tinned tomatoes, 1/4tsp turmeric, chilli powder, 3tblsp yoghurt, salt. Chopped coriander leaf to garnish.
And coarsely grind together:
1tsp cumin seeds, ½tsp coriander seeds, black peppercorns, 4 cloves, 1/4tsp fennel seeds.
In a pan with lid, heat up oil slowly. Add bay leaf, cinnamon stick and cardamom pods. Add onions, cook till they turn light brown, 3-5 mins. Add garlic and ginger and saute for about 1 min. Add ground spices, toast for another min. Add tomatoes with turmeric and chilli. Cook for 3-5 mins or till you see oil separating on the sides of the pan. Add potatoes, mix, reduce heat to low. Let cook, covered, for 10-15 mins till the potatoes are nearly done. Remove lid, turn heat to high and add lamb. Heat for ab. 8-10 mins on medium, stirring often. Add yoghurt, 60ml water and salt, mix. Completely switch down the heat, cover and simmer for ab. 25 mins. Stir and check periodically to ensure it's not sticking. Add more water if needed, but not too much!! Remove lid, check salt and cook on high again for 5 mins till everything comes together. Garnish with chopped coriander, serve warm with flatbreads and salad.
My chicken (3k) was probably too big, it seemed to need quite a bit longer, but once done the taste was delicious.
FESTIVE CHICKEN serves 4-6.
150ml red wine, 100g tomato paste, 3 sprigs of thyme, 3 sprigs of marjoram or ½tsp dried, 100ml red wine vinegar, 1 whole chicken cut into 8 pieces (approx. 1½kg), salt and ground black pepper, 500g small potatoes, 3 onions in quarters, 6 carrots cut into quarters lengthways.
Mix wine, tomato paste, herbs and wine vinegar. Season chicken pieces with plenty of salt and pepper then marinade in fridge for at least 30 mins. Boil potatoes for 1-2 minutes, drain. Place onions, carrots and potatoes in a tray big enough to fit chicken as well, pour over 125ml of water. Preheat oven to 200°C. Arrange chicken pieces skin side up, on top of the veg. Pour the rest of the marinade over. Cover with foil and roast for 30 mins. Remove foil and baste chicken with the cooking liquid. Roast uncovered, for another 15 mins or until the skin is crisp. Serve immediately.


For more recipes, check old winter Thoughts. Or go to https://thoughtforfoodaw.wordpress.com, which still has eight recipes for this year.
We also have an alphabetical index of subjects, which you will see if you click on this month, in the top right hand corner.

Next month:"Listen when the body whispers: don't wait for it to shout!" To see this now, go to https://thoughtforfoodaw.wordpress.com and scroll down.


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[1] “What’s up with your gut?” Chloe Lambert in the New Scientist 15/9/18 - see 'New Scientist - gut problems' on the right hand side of this page.
[4] in, respectively:
B2: liver, mackerel, kale, cabbage, (+ brussels, broccoli, meat, cheese, almonds, mushrooms, marmite/brewer’s yeast, eggs, milk. Damaged by light. 
B3: (esp. organ) meat, fish, peanuts, mushrooms, legumes.
B6: garlic, cauli banana, kale. potatoes, nuts/seeds, fish, poultry/meat, dried fruit, capsicum, broccoli, marmite/brewer’s yeast, whole grains, beans/peas, potatoes in their skins.
[5] https://bodyecology.com/articles/low_stomach_acid_symptoms.php
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New Scientist - gut problems

The surprising foods that are messing with your gut
By Chloe Lambert (New Scientist 15/9/18)


We're finally starting to understand which foods are causing tummy troubles for so many, and the culprits challenge everything we thought we knew about healthy eating.

The simplest way to feed a healthy gut is to eat a varied diet, especially fruit and vegetables

SOUTH Beach, paleo, vegan, juice cleanse… and FODMAPs. Short for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, the name FODMAPs certainly doesn’t have instant appeal, but a diet focused on avoiding these substances is catching on with the public and the medical profession alike. The low-FODMAP diet is based not on celebrities’ waistlines or detox bunkum, but on the premise that a healthy gut leads to a happy life. So popular is it proving that there are now claims the diet could alleviate everything from indigestion to chronic fatigue.
Over the past few years, we have become much more clued up about the extensive influence of the gut in health and disease, and the impact our lifestyle choices can have on what some researchers like to call our “second brain”. Gluten, a protein found in grains such as wheat, barley and rye, has taken much of the blame, with a growing number of people claiming that they have some sort of gluten intolerance. Global sales of gluten-free food rose 12.6 percent in 2016, and specialist supermarket aisles now heave with gluten-free products, even though the idea that people can be gluten-sensitive even if they don’t have the autoimmune disorder coeliac disease has been largely debunked.

Now the gut health tide is turning once again, and it appears that gut problems linked to certain foods like bread might be real for many. What’s more, the secret to dealing with these problems could fly in the face of established healthy eating advice.
The most common cause of gut problems is irritable bowel syndrome (IBS), a catch-all term for a poorly understood constellation of symptoms including bloating, diarrhoea and constipation. It affects millions, although it doesn’t appear to be on the rise, with the incidence in the West put at between 5 and 15 per cent of the population. If, however, it feels like you can’t go to a dinner party without someone talking about their gut problems, that might be down to a shift in awareness. “People are noticing symptoms more and reporting them,” says Peter Gibson at Monash University in Melbourne. “Sixty years ago we had no criteria to diagnose IBS, and people with gut symptoms just put up with it.”
“Too much fibre, fruit and veg could be causing a rise in gut complaints”

IBS symptoms overlap with those of coeliac disease. For coeliacs, consuming gluten causes symptoms such as diarrhoea, constipation, cramps and fatigue, and triggers a faulty immune reaction which damages the lining of the gut. Although unrelated to IBS in origin, coeliac disease has been attracting attention because it is proving to be more common than previously thought, affecting 1 per cent of people. However, many who test negative for it – showing no signs of making antibodies in response to gluten, or of gut damage – still complain that wheat products make them feel unwell. This has been labelled non-coeliac gluten sensitivity, although the condition remains controversial.
Some argue that gluten is poorly digested by many people, and that its ubiquity in modern, processed food is at odds with the diet that the human gut evolved to deal with. “Wheat is a friend that has outstayed its welcome for some of us,” says David Sanders at the University of Sheffield, UK. Scepticism over whether gluten can cause symptoms in non-coeliacs has been fuelled by the fact that cutting it out has become a fashionable lifestyle choice. Studies show that many non-coeliacs are choosing to avoid gluten because they believe doing so is healthy, despite little evidence for its benefits.
In one study of 22,000 adults in the US, the proportion eating a gluten-free diet more than triples from 0.5 percent in 2009 to 1.7 percent in 2013, although the proportion who had coeliac disease stayed roughly constant. Also in 2013, 30 per cent of adults in the US reported trying to cut down on gluten.
“The gluten-free craze is a marketeer’s dream and the perfect worried-well scenario,” says Kevin Whelan at King’s College London. “We are seeing people avoiding it in the belief this will help them lose weight or improve their overall health. But beyond coeliac disease, gluten’s role in optimising health is nowhere near what people think it is.”
Even if gluten is not itself the culprit, we are now understanding why so many people believe they are sensitive to it. A growing body of evidence over the past few years points the finger at FODMAPs. These carbohydrates are present in numerous foods, including wheat, which contains some called fructans. “If you go on a gluten-free diet you reduce probably 50 per cent of your FODMAPs,” says Gibson. Rather than having some sort of sensitivity to gluten, it seems that for some people with IBS, FODMAPs could be the trigger.

After researchers noticed that people with IBS felt more tired when they ate lots of FODMAPs and less so on a low-FODMAP diet, there has been hope it might help people with chronic fatigue syndrome, who also have a high incidence of IBS. But Gibson says the evidence so far is weak and the diet’s effect on fatigue only happens among people with IBS.
Although it is appealing to think that we might all benefit from fewer FODMAPs in our life, “if you don’t have bowel problems there is absolutely no rationale for being on a low-FODMAP diet”, says Gibson. “This is not a diet for good health.” One drawback to the diet is that it cuts out foods that are important sources of vitamins, fibre and nutrients such as calcium. Recently, there have also been concerns that it depresses levels of good bacteria in the gut, and the long-term consequences of the diet remain unclear.
Many people trying to avoid FODMAPs struggle to work out which foods to eliminate. “It has helped an awful lot of people,” says Peter Whorwell, a gastroenterologist at the University of Manchester, UK. “But for one patient it will be tomatoes, the other lettuce, the other none of the above.”
Intriguingly, a third of people with IBS who try the diet reap no benefits at all. For them, some researchers are now looking at a more controversial alternative.
When it comes to gut health, one of the most common pieces of advice has been to eat plenty of fibre, such as wholegrain bread and fibrous vegetables, which help keep the gut working properly and can also reduce the risk of cancer and cardiovascular disease. But it now seems that fibre may also be part of the problem. Some types of fibre release gas when fermented in the bowel, causing irritation in sensitive individuals.
Whorwell was one of the first to demonstrate that reducing fibre could be beneficial in IBS, with a study finding that wheat bran made 55 per cent of people with IBS feel worse and only 10 percent feel better. The idea has been gaining ground, although it has lately been overshadowed by the fuss over FODMAPs. Whorwell often advises his patients to try switching from wholegrain to white bread. “Fibre is just as important as FODMAPs in aggravating irritable bowel,” he says.
Whorwell even speculates that a push for healthier diets – high in fibre and fruit and vegetables – may be contributing to a rise in gut complaints. “Thirty years ago, nobody had heard of five a day,” he says. “It amazes me how many vegetables people are eating these days.”
The trouble is that advising patients to eliminate both FODMAPs and fibre flies in the face of good nutrition. In future, IBS treatment will probably involve supplements containing targeted combinations of beneficial, slow-fermented fibres, says Whelan, who is studying fibre’s effects on the gut.
And although gastroenterologists remain divided over the issue of gluten, some believe it may yet prove to have adverse effects beyond coeliac disease. “The research evidence is nowhere near catching up with the marketing machine,” says Whelan. “But I think non-coeliac gluten sensitivity exists. Some people, when given a gluten challenge, do get symptoms, though identifying who they are and how they differ from people actually responding to fructans is difficult.”
The good news for those with gut problems is that the diversity of symptoms and causes are being investigated like never before. For those who don’t, however, it might be time to step off the bandwagon, says Sanders. “If you don’t have any symptoms, you don’t need to be on any of these diets.”
What to eat for a healthy gut
Probiotics – foods prepared with live “good” bacteria, such as yogurt, or supplements – have been shown to help with conditions like irritable bowel syndrome; they may also be beneficial for people with weakened immune systems. But their long-term effects on overall health are not yet known.
Fermented foods and drinks such as kimchi, sauerkraut, kombucha and kefir are gaining in popularity. Their effects on health again aren’t yet clear, but consuming them won’t do any harm and might improve the microbial diversity in your gut.
For people in good general health, prebiotics, which encourage the growth of good bacteria, are the way to go, says Monika Fleshner at the University of Colorado, Boulder. “It’s difficult to introduce a bacteria that will stay there and colonise,” says Fleshner. “If you provide existing bacteria in the gut with prebiotic nutrients that will help their growth, it seems a more natural way to support your gut ecology than trying to ingest a live bacteria and hoping it sticks.”
The simplest way to feed a healthy gut is to eat a diversity of fruits and vegetables. But for prebiotics, good sources include green bananas; vegetables in the sunflower family such as artichokes, radicchio, lettuce, chicory, tarragon and salsify; and those related to lilies such as leeks, asparagus, onions, garlic, shallots and chives.

No junk please
Gastroenterologist and science writer Giulia Enders recommends cooking carbohydrates such as potatoes and pasta and later eating them cold or reheating them. The period of cooling makes starch more resistant to human digestion, meaning it stays intact to feed microbes in the large intestine.

Tim Spector at King’s College London has shown that intermittent fasting may encourage the growth of helpful anti-inflammatory bacteria. He also recommends avoiding junk food, because additives such as emulsifiers seem to kill good bacteria. In a bit of DIY research, Spector found that when his son went on a fast-food diet for 10 days, his gut microbes reduced by 40 per cent. Don’t try that at home.
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December 2017: drink!?





December: let’s have a look at alcohol, again.
Alcohol and health was mentioned before: in the ‘drinking’ issue of December 2014. However, the issue can do with some more digging.
Every so often you read about the health-giving effects of, say, red wine, or how drinking alcohol in moderation might be good for your bones. These stories always mention ‘moderation’, which is of course an important problem.
I myself have never been particularly tempted by alcohol. I’m an eater, not a drinker. And after cancer treatment twelve years ago, I found that even one glass of wine made me feel the same as I had felt during the six weeks of chemoradiation. So that was it: never again.
My husband drinks regularly, but never even has a hangover. Mind you, he stays away from  the cheaper stuff.
People are different. During your lifetime you learn what suits you or what you can live without. And what you can’t live without, regardless of the consequences.
I found some interesting websites about the pros and cons of alcohol [1].
Apparently, the older you are, the more you can drink, says a, possibly dated, study from 2002. Men over 85 years old can drink as much as 5 units a day without ill effects [2]. Hurray .....
However, just recently they found that the positive side of alcohol has been overstated [3]. Studies which showed that moderate consumption might be good for you, may have been misguided. The abstainers in them often included people who had cut back, or stopped drinking, because of ill health or old age. This made non-drinkers look like a far less healthy group than the general population [4].
The type of alcohol is not as important as the amount of alcohol consumed and the pattern of intake. The latest UK government guidelines tell us not to drink more than 14 units a week, best spread evenly over 3 or more days: 6 pints of beer, 6 glasses of wine, or 14 pub measures (25ml) of 10% spirits. That is, unless you’re young, old, thin, sick or on medicines .…… For the complete list, see [5].

See also:
and (not too un-) healthy drinking tips: http://thehealthydrinker.com/2010/03/10-healthy-drinking-tips/.
and for a lovely not (very) alcoholic drink which is actually very good for you, ask me about water kefir. I can send you some grains.

Here is some more general stuff: 

You might also want to look at our tips for preventing and curing hangovers in the 2014 December issue [6].

And, just in case you're stressed - why on earth? ;-) - here are some suggestions:
http://www.telegraph.co.uk/men/active/mens-health/11303498/How-to-deal-with-the-stress-of-Christmas.html. 
And look at http://blog.naturalhealthyconcepts.com/2017/11/17/healthy-holiday-eating/ for ways to  get through December without too much damage.

Oyez oyez April 2018 latest guidelines at http://www.bbc.co.uk/news/health-43738644 - spoilsports!

EAT:
Veg: Brussels', beet, sprout tops, cabbage, celeriac, celery (with Stilton!), corn salad, Jerusalem artichokes, carrots, salsify, kale, kohlrabi, landcress, leeks, parsnips, pumpkin/squash, rocket, spinach, swede, turnips, winter (= black) radish, endive, winter purslane.
Meat: wood pigeon, pheasant, wild duck, goose, grouse, partridge, venison. For (Christmas) game recipes, see www.gametoeat.co.uk/
Fish: coley, megrim, hake, clams, crab, cuttlefish, mussels, oysters, scallops, whiting.
PLANT:
Shallots are traditionally planted on the shortest day. You can still plant garlic.
If you leave veg in the ground, apply a thick mulch (straw, bracken or newspaper) for protection, and so as to get them out easily.


RECIPES

LENTIL, CARROT and KALE SOUP with CREME FRAICHE and DILL recpics for 6.
600g green or brown lentils soaked overnight, 3 large carrots cut into 1cm slices, 125g cleaned chopped kale, 1 chopped leek, 5-10 tblsp tomato puree, 2.5l (homemade) chicken stock, 4 tblsp butter, 2 tsp coarse seasalt, juice of half a lemon, 120ml creme fraîche or sour cream, dill, 60ml red wine (optional). 
Drain the lentils. Sweat carrots and leeks for 10 mins in butter. Add liquid, tomato, lentils (and wine); cook till the lentils are done. Blend or mash. Stir in the finely cut kale and salt, boil for however raw or cooked you like the kale. Add lemon juice, creme fraîche or sour cream, heat through and serve sprinkled with dill. 

BEETROOT, APPLE, PEAR, WALNUT and STILTON SALAD
Personally I prefer raw (only washed, not peeled) grated beetroot, but by all means use cooked beet if you like.
2 beet, 2 apples, winter salad leaves like corn salad and rocket, 2 conference pears, 4 tbsp lightly toasted walnuts, 2 tbsp olive/walnut oil, 2 tbsp balsamic vinegar, 1 minced garlic clove, 75-100g Stilton or soft, crumbly goat's cheese, pepper, sea salt.
Grate beet and apple coarsely. Mix. Whisk oil and vinegar, add garlic, salt, pepper. Dress beet and apple with 1/2 the dressing. Use remaining half to lightly dress the leaves - you may not need all of the dressing. In the centre of the dressed leaves, add mound of grated apple/beet. Core pears, cut into 1cm thick slices and arrange around the beetroot/apple mound. Break walnuts up a bit and arrange over leaves and pears. Finish with crumbled Stilton or goat's cheese, and pepper.

MARMITE SPAGHETTI with LEEKS, serves 4 - 6.
375g (wholewheat) spaghetti, 800g leeks (or more!) weighed after cleaning, 60g butter, 1-2 tsp marmite (or more!), grated mature cheese to serve.
Chop the leeks. Boil up some salted water, add the spaghetti and leeks. Meanwhile melt butter, add marmite and 1 tblsp pasta water, mix. The spaghetti and the leeks will be ready at the same time. Drain; reserve the water. Pour the marmite mix over spaghetti, adding some reserved pasta water if required. Serve with plenty of cheese.

And if you are having a vegetarian Christmas, why not try this one?
SOMERSET TOURTIERE
480ml cooked lentils, 480ml walnut halves; 10 chopped mushrooms, 180ml grated floury potato, 120ml dry cider, 1 tblsp olive oil, 1 large diced onion, 3 minced garlic cloves, 300ml water/stock, 1 tsp dried thyme, 1/2 tsp dried savory, 1/2 tsp ground sage, 2 bay leaves, salt, pepper, 1/4 tsp cinnamon, 1/8 tsp ground cloves, 1/8 tsp nutmeg, 1/2 tsp worcestershire sauce (optional), pastry dough for 1 double pie crust of 23cm diameter.
Sauté the onion in oil until it begins to soften, add mushrooms. Sauté until most of their juices have been released. Add garlic, sauté for 2 more mins. Grind the walnuts. Mix in the lentils, walnuts, broth, wine, thyme, savory, sage and bay. Season and simmer until most of the liquid has evaporated. Remove bay and add: liquid, cinnamon, cloves, nutmeg and potato. Cook until the potato is soft, about 10 mins. Season. Chill for 1 hr.
Roll out one dough disk on a lightly floured surface into a 30cm round. Transfer to the pie dish, leaving an overhang. Fill with lentil mix. Roll out the remaining dough disk into a 10″ round. Place dough over the filling. Fold overhang over the top crust and crimp the edges. Brush the crust with milk. Cut three 6cm slits in the top. Let rest for 1 hr, or put in the fridge till tomorrow. Preheat the oven to 200°C. Bake for 30 mins. Reduce heat to 180°C; bake until the crust is golden and the filling bubbles, for 40-50 mins. Let cool for 20 minutes before serving.

And here it comes, finally, the drink!
MULLED CIDER 
Two 500ml bottles of good strong dry cider, 3 squashed cardamon pods; a lump of ginger about the size of the top joint of a thumb; the rind of an orange without the pith; 1 star anise; 10 cloves; ½ tsp mixed spice; half a thinly sliced apple; a good slug of rum/brandy.
Stud the orange peel with cloves. Place everything apart from the rum/brandy in a pan, bring to the boil. Turn down the heat, simmer gently for 10 mins. Spices can of course be varied according to taste and the contents of your cupboard. 





If you want to see more recipes for December, see other years (click on 2017 and then on December, on the right hand side). Or go to https://thoughtforfoodaw.wordpress.com, which still has eight recipes for this year.
For an alphabetical index of subjects, which you will see if you click on this month in the top right hand corner. 
Next month: teeth. 

[1] http://www.marksdailyapple.com/alcohol-the-good-and-the-bad




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