The only nutrition advice you’ll ever need

Eating well at every age, with Dr Federica Amati

Photo by Mirjam Letsch on Unsplash

You can’t move for nutrition advice on Instagram these days: don’t eat dairy, cut out gluten, take these supplements, do this detox, don’t drink coffee, drink more coffee, don’t eat meat, eat only meat… Sadly, much of it comes from people with neither the training nor the clinical experience to know what they’re talking about.

So thank goodness for Dr Federica Amati. A postdoctoral medical scientist and AfN accredited nutritionist; she lectures medical students about nutrition at Imperial College London and is head nutritionist at ZOE. She is that rare thing in this space: someone who truly knows their shit.

Her book, Every Body Should Know This, is indispensable for anyone interested in how best to fuel their body. It also contains some hard truths for many of us. 

As someone who struggled with breastfeeding, and hated all of the judgement and shame around giving my baby formula (I wrote about this recently, in relation to cancer), it’s easy for me to feel defensive when this topic comes up - as it does in Dr Fede’s book. But I’m interested in getting to the truth, even if it’s an inconvenient one for me, so I pinned her down for a very honest conversation about misinformation, being unpopular, and her best nutrition advice for YOUR stage of life…

Your book is about ‘life course nutrition’ - what is that?

There are periods of our lives when there is great physiological change, and nutrition becomes even more powerful. I started out researching the impact of nutrition in pregnancy and early years, looking at maternal Mediterranean diet and reduction of risk for both mother and baby. I realised that there is this whole world of research showing how early nutrition impacts our health long term. ‘Life course nutrition’ is the academic term for this, which is not sexy, but to me it was mind-blowing.

When I was pregnant ten years ago, I saw it as a chance to eat loads of chocolate - perhaps because I associated diet with weight (not something I cared about during pregnancy)…

Maternity groups and some women online do a disservice to each other because there's so much: ‘Have two pieces of cake, have a glass of wine if that’s what you feel like, don’t worry if you don’t feel like exercising…’ It’s framed as supportive because of the pressure that women are under from elsewhere, which is true, but it's not helpful. It’s not what the science tells us. This is where I get really unpopular!

How do you strike a balance between informing people and not making them feel judged or patronised?

I just want people to have the right information. There's so much misinformation in pregnancy. Cutting out allergens, for instance, is the opposite of what you should be doing. I’ve had women say: ‘I’ve cut out gluten, dairy and eggs because my masseuse told me it would help soften my joints for birth.' It’s crazy. All I’m saying is, once women know what their bodies need, they can get the foundation of a healthy diet in first, before the cake. I’m not saying don’t ever have cake. I love cake!

Let’s talk about breastfeeding. I struggled a lot, and switched to formula after only a few weeks, which made me feel so much guilt and shame…

I’m not trying to make this about shaming women into breastfeeding. It’s important that women are informed. For the mother, breastfeeding reduces the risk of breast and ovarian cancer. For the baby, it reduces the risk of atopic eczema, allergies, asthma, obesity, diabetes, metabolic disorders… But it should not be all on the woman.
I found breastfeeding incredibly difficult. There was blood, there was mastitis; it was horrible. I wasn't prepared for it to be eight hours a day for the first few weeks. No one gave me any advice on getting a good latch, or told me about nipple guards.

This is very relatable!

Exactly. Rather than putting pressure on individual women - we have enough already - we need to put pressure on the system. Public health support, education, training, breast milk donor banks… we don’t support mothers enough. Most of us don’t live near our families, and you get pretty shitty maternity support unless you have a job that pays for it. The NHS breastfeeding clinics have all been scrapped, and now the UK breastfeeding rate is the lowest in the world.
Look, if you formula feed, the risk is relative so it’s not always a huge deal. But, since so many things are stacked against our children’s health, this is something we can do that does help, and is free, and women should have all the support they need to do it.

You talk about a ‘golden window of opportunity’ for optimising our kids’ health, which is the 1000 days from conception until age two.

That’s the highest sensitivity period; the point at which nutrition has the biggest impact. But a lot of the science that we have around the first thousand days comes from extreme cases, where there was malnutrition. The majority of people reading this will probably be in a pretty good place, even if they didn’t tick every box. And there are plenty of other windows, such as a big growth spurt in mid-childhood, and adolescence, when nutrition has such an impact on mental health.

Any tips for getting kids to eat more healthily?

Some advice around this is so formulaic, like: ‘You have to expose your child to a food eight times before they’ll eat it.’ I don’t have time to work out how often I’ve exposed my kids to chickpeas! But eating as a family can minimise food waste because, if they don’t eat it, then you can eat it, or put it in the fridge for tomorrow. Set an example. They’re more likely to eat it if they see you eating the same.
Outside of mealtimes, make healthy foods accessible. I call this ‘health architecture’. Children are products of their environment, but this works for adults as well. Fill your home with things that you want to eat more often. Have a fruit bowl on the table, watermelon fingers and plain yoghurt in the fridge, a jar of mixed nuts on the countertop. Make them visible. Kids will eat what they see. 

So, if pregnancy and childhood are a key time, and our bodies are at their most resilient during our 20s and 30s, what happens at menopause?

We ran the largest menopause study at ZOE, with age-matched women, who were pre-, peri- or post-menopausal. We looked at blood sugar, insulin and lipids, and saw that post-menopausal had the worst response on all fronts. Their metabolism is not as flexible, their insulin response is elevated. The impact of this is that you’re less efficient at clearing fat and sugar from your blood, your pancreas is having to work harder, and that can lead to a higher risk of type two diabetes and weight gain. This is why women are catching up with men on rates of heart disease.

Does that also increase your risk of other things, like cancer and dementia?

Yes, most chronic diseases could be classified as metabolic diseases, which were extremely rare up until 100 years ago. Cancer is a metabolic disease, although it varies between types of cancer. But there are things that help make menopause less impactful on health: HRT is one, having a healthy BMI is another. 
Unfortunately, we also found that peri- and post-menopausal women were more likely to choose high-glycemic foods. Menopause brings high stress and low energy, particularly if your sleep is affected, then you feel worse and crave those sugary foods. What’s happening is that women go into it without understanding the physiological metabolic change that is happening, and then choose foods that don’t help.
The good news is that we can mitigate this with diet. From our study, the women who reported eating more plants - regardless of whether or not they ate meat - had a much lower likelihood of all the the risk factors and symptoms of menopause.  

But it’s not all about food, right?

Nutrition is the most powerful tool you can use to make a change today. But just as you can't out-train a poor diet, you also can’t out-eat chronically bad sleep. Food and lifestyle go hand in hand. Nutrition is not a silver bullet, because nothing is. You still need social connection, sleep, movement, stress management and mental health.

What’s your advice for anyone who feels that they might have missed some of these windows of opportunity, and not made the healthiest choices in the past?

Do not worry about missing windows. Make the most of the ones you're in. It doesn’t matter when you start. Deciding to embrace this will have an impact at any age. I would just love for people to really enjoy food again - with the knowledge that it tastes great and it's doing you so much good. You will reap the rewards, today, and in 20 years’ time. This is not about perfection. It's about enjoying life, and being healthy 80% of the time so that you can have the cake at the party or whatever.
Every single time you make a dietary choice, every single time you make a nourishing meal and enjoy it with your friends or family, you are depositing in your health bank, and it's the highest return on investment of any bank you've ever seen.

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Written by anyone else, Dr Fede’s book could sound scary; a litany of things you haven’t done throughout your life. But she writes with such warm compassion and sciencey expertise that you can’t help but get on board.

After my initial panic that I’ve negatively impacted my own health and that of my kids with my choices in the past, Dr Fede has talked me down by explaining that the human body is resilient and adaptable and it’s never too late to make changes.

While it might seem complicated to adapt how you eat to each life stage, Dr Fede’s point isn’t that there’s a different diet for each decade; it’s that there are certain windows when your lifestyle has the biggest impact. These include childhood, which sets the tone for life, and then midlife (terrifyingly known by some medical professionals as ‘sniper alley’), when chronic diseases become apparent. 

The actual nutrition advice largely stays the same throughout: eat a wide variety of plants, including beans and grains, with smaller amounts of fish, dairy, eggs, nuts, seeds, and that all-important extra virgin olive oil.

Any change that you make now, no matter how small, will have an impact. Because, as Dr Fede herself says: ‘It’s never too late, and it’s never too little.’

Every Body Should Know This: The Science of Eating for a Lifetime of Health is available to buy now

Dr Fede’s key takeaways for health and happiness…