As a doctor specialising in the nutritional management of health and disease, you might imagine that food assumed an important influence in my life from an early age. Actually, nothing could be further from the truth. Both my parents worked full time, and we never had hired help in the home. With five children to feed, my poor mother's focus was most certainly on food quantity, not quality. Accordingly, she amassed a repertoire of about half a dozen rapid-fire, but uninspiring, dishes that were circulated on a rota system throughout the week.
Affectionate piss-taking was the main form of communication among us children, and my mother's culinary efforts were duly renamed Briffa-style. Shepherd's pie, lamb curry and Irish stew became shepherd's piles, lamb slurry and Irish spew respectively. A flan my mother often made comprising the residue from other meals was referred to as 'phlegm'. We always had a catering-sized jar of piccalilli on hand to camouflage the taste of anything truly awful. This we referred to as 'the antidote'.
When I left home to go to medical school, my dietary habits slid further downhill. I subsisted mainly on pizzas, kebabs and Kentucky Fried Chicken. For most of my training, I shared a dilapidated Victorian house in Finsbury Park with four friends. Occasionally, I ventured into the kitchen to prepare a meal for me and the boys. I cooked pasta, which I only did one way. In our house, my tomatoey, bacony, mushroomy sauce became as infamous as my own mother's fare. Maybe it is true what they say about children turning into their parents.
Another area where I just might have been influenced by my parents is in my choice of career. Both my parents are doctors, yet neither of them encouraged me to follow the same path. In fact, they very rarely talked about medicine at all. If my parents did steer my course in some way, they were subtle about it. Whether subliminally influenced or not, by the age of 11, I was pretty much set on being a doctor. I went straight from school to start my training at University College London Medical School.
Starting medical school turned out to be a bit of a culture shock for me. The product of a state-education in suburban Essex, I had spent my school years feeling like I could hold my own academically. Overnight, I morphed into an intellectual minnow in a sea full of able-minded sharks. Rather than attempt to compete, my reaction was to opt out. I failed my first year exams, coming a spectacularly dismal 139th out of 140 in anatomy. I was not entirely deterred, however, and got through on the re-takes.
After two years studying basic sciences such as biochemistry, neurophysiology, genetics and microbiology (all of which I found as dull as dishwater), I enrolled on a one-year BSc degree programme in immunology. This duly completed, it was time to progress to the hospital wards. For the whole of my time at medical school, I wore my hair long. I suppose this would have been fine if I had been a brilliant student. But in truth, I found studying medicine an immense chore, and never really applied myself to the task. My patchy knowledge, coupled with my ponytail, meant that I was generally viewed as cannon fodder at ward rounds and tutorials. During one particularly excruciating cross-examination, the professor of medicine at my teaching hospital described me as the most inept medical student he had ever taught.
The medical establishment did not warm to me, but to be honest, there was no love lost here. I was never comfortable with what I saw as the rather autocratic and egocentric approach of many of the doctors responsible for my education. I had major reservations about the largely symptom-suppressive approach orthodox medicine takes. And while conventional medicine clearly has its place, it did seem to me that much of it was pretty ineffective and sometimes downright dangerous. The thought of practising conventional medicine for the rest of my working life turned me cold. Now almost six years into my training, I decided I didn't want to be a medic after all.
Through a concerted effort in the last few months of my training, I gained a degree in medicine. By some strange and rather ironic twist of fate, I managed to scoop a couple of academic prizes, too. In an odd way, my last-gasp academic success rather than causing me to question my decision to leave medicine, just cemented it. I served my one-year apprenticeship in hospital medicine as a junior doctor, and started to do locums, while I contemplated my next move. The medical school also recognised my efforts on the stage (I was a keen actor in those days) and in the bar by awarding me the prize for contributions to extra-curricular activities.
On one such posting, I admitted an elderly man who had come in for a hernia repair. Although he was in his seventies, he didn't look older than 60. He was fit and robust, and, unusually for his age, had never been in hospital before. The icing on the cake for me was when he told me he and his wife were still 'getting plenty'. I was agog and fascinated with how this man had managed to keep himself in such good health. When I asked him about this, he told me that he'd always eaten a simple, healthy diet, which now included organic vegetables which he grew on an allotment. He cycled several miles each day, and also confessed to taking nutritional supplements.
Intrigued by this man's approach to life, I began to buy books about diet and nutrition, initially with a personal interest in shedding about a stone in excess baggage and transforming the rather grey sense of wellbeing that had plagued me for years. For some months, I read voraciously about nutrition and natural health. On the strength of this new-found knowledge, I decided to experiment, using my own body as the guinea pig. I made a few basic dietary and lifestyle changes, and quite quickly came down to my fighting weight. Not only that, but I also felt healthier than I had done in ages. Propelled by this early success, I resolved to make nutritional medicine my career.
Naive and somewhat blinkered by my experience of life, I did not know that a sizeable natural-health industry was in full swing in the UK. I started work in a diet clinic, imagining this was where nutritionally oriented doctors plied their trade. As it happened, prescribing a high-protein diet and doling out appetite suppressants was not to be my destiny. I ended up starting a practice in nutritional medicine in the City of London, and about three years ago migrated to rooms and a private hospital in north London.
I love my work. I thrive on variety and freedom in my life, and being self-employed suits me down to the ground. My work is split pretty much equally between clinical practice, researching and writing and lecturing. In my practices, I see a wide range of health issues, both physical and emotional. My writing encompasses books, newspapers and magazines. Speaking engagements take me to some far-flung places, and my audience might be practitioners, the general public or corporations. Boredom rarely features in my life, but it's not all plain sailing, either. Fortunately, I am blessed with a fabulous personal assistant who is terribly organised and efficient and whose irreverent wit makes me laugh out loud every time we speak.
Most of my patients suffer from long-standing symptoms or conditions that have yet to be explained, or the treatment for which has proved ineffective. Usually, a fair proportion of my approach is geared to finding the right diet for the individual. For me, using the diet to heal illness makes sense because so many symptoms or conditions are nutritionally related. Headaches and migraine, for example, are often related to factors such as dehydration, caffeine withdrawal, sensitivity to specific foods, magnesium deficiency and blood-sugar instability.
By working nutritionally, we at least have the potential to identify and correct the true underlying cause of an individual's headaches, or whatever else happens to be ailing them. Conventional medicine, on the other hand, rarely treats illness at its root. Headaches, after all, are not caused by a paracetamol deficiency.
I often use food supplements and medicinal herbs as an adjunct to dietary change or manipulation. There is now a wealth of research which shows taking nutrients or medicinal herbs in supplement form can be effective in preventing or treating medical conditions. For instance, overwhelming evidence supports the use of glucosamine sulphate in the treatment of osteoarthritis, and the herb St John's wort has been proven to be effective for depression. I like to keep abreast of the research in natural health and medicine, and will sometimes draw on this in my column.
Sometimes, I may also present ideas or concepts that have not been formally studied and are therefore not thought to be scientifically validated. However, let us not lose sight of the fact that just because an approach has not been studied, does not necessarily mean it is ineffective. Absence of proof does not mean proof of absence.
Despite my scientific background, I am alive to the fact that science can sometimes be a pretty blunt tool with which to dissect reality. The closer I look at medical and nutritional research, the more I realise it is filled with inconsistencies and anomalies. It is not uncommon for similar studies to show quite contradictory results. And it's amazing what a bit of nifty statistical manipulation can do to the apparent findings of a study. Lies, damned lies and statistics, I think they call it. Opinion is generally based on the 'balance of evidence'. However, much research is never published because it did not yield the expected or desired result. This means that the balance of evidence may not be very balanced at all. Worse still, fraud and misconduct is known to occur in research, which means that even in scientific and medical journals we cannot always believe what we read.
So, while I recognise that science can sometimes provide us with useful pointers about how best to overcome illness and improve health, I'm no slave to it. Many of the concepts and approaches I use in my work are based on common sense and what has been found to work in practice. I will work nutritionally with almost all patients, but I will often want to explore with my patients other physiologically based factors in health, such as breathing, and the function of important organs such as the thyroid and adrenal glands. While getting the physical body going is important, as Barefoot Doctor I suspect will agree, it's not the whole story, either. For this reason, we'll often sneak a peak at the emotions, too, and look at ways to resolve issues here.
I have distilled what I see as the most important and effective approaches to physical and emotional health into a book entitled Ultimate Health - 12 Keys to Abundant Health and Happiness (Penguin). It's due out in May.
While we are often advised to eat a healthy, balanced diet, it's amazing how little agreement there is on what this actually means. There does not even seem to be a consensus on whether foods such as pasta or bread are healthy or not, or if margarine really is better than butter. In the world of nutrition, it seems that confusion reigns.
My belief is that the place specific foods have in the diet needs to be taken in the context of our diet as a whole. For instance, broccoli may be a healthy food, but eating nothing but broccoli does not make for a healthy diet. By the same token, the odd crème brûlée or bottle of merlot is not necessarily a problem, as long as the broad base of the diet is sound. As with most things in life, eating healthily is about balance.
If we are going to look at specific foods, however, my belief is that the diet should be based on the foods we evolved on, because it stands to reason that these are the foods we are best adapted to. The bulk of the evidence suggests that a diet rich in foods such as fruits, vegetables, beans, pulses, nuts, seeds and fish (all as unadulterated as possible) is the best for us. Even moderate amounts of meat and eggs appear to be compatible with a healthy diet: a close look at the evidence reveals that the link between saturated fat and disease is not nearly as clear or as strong as we have been led to believe.
There is emerging evidence that the real dietary spectres for many of us come in the form of foods rich in refined sugars and starches such as many pastas, breads, breakfast cereals, confectionery, soft drinks and snack foods. Other food components that appear to be giving cause for concern are the partially hydrogenated or 'trans' fats that have only been in our diet in appreciable quantities in the last few decades. These fats lace more and more of the foods we eat including most margarines and many processed, baked and take-away foods.
To my mind, many of the health problems we face in the 21st century come, at least in part, from eating a diet that is light years away from the one we evolved on. It's easy to imagine hunter-gatherers subsisting on a diet of fruit, vegetables, nuts, seeds, beans, pulses and eggs, interspersed with the odd meat or fish supper. On the other hand, can you really see early man sitting around the campfire tucking into plates of pasta Neopolitana? I don't think so. Study after study shows that when populations switch from an indigenous diet to a more 'Westernised' style of eating, the risk of problems such as obesity and degenerative conditions rises accordingly. Nutritional thinking, it appears, is coming full circle. There is now a compelling argument for our return to a diet based on basic ingredients that are innate to the human diet. Irish spew, anyone?
· Dr John Briffa is also in Observer Food Monthly today. His regular column in Life starts next week. If you have any issues you would like him to address in this column, please contact him by email on email@example.com. Please note that Dr John Briffa cannot enter into any personal correspondence.