Book Review: Health and the Food-chain
Authors: David Luyt
Journal: Journal of the Royal Society of Medicine (2001)

The food we eat and its risk to health is now high on the national agenda. Reasons are multiple. Chief amongst them is anxiety over the real risks of BSE, together with the potential risks of genetically modified foods. Others are the outbreaks of Escherichia coli food poisoning and the rising prevalence of serious food allergies, particularly to nuts. Healthcare professionals face increasingly probing questions from their patients, the consumers, who have been primed by information in the press and on the Internet. Questions may concern not only these well-publicized food-related illnesses but also less common food-borne conditions such as parasitosis. The planning committee for a British Medical Bulletin on Health and the Food Chain assembled contributors from a wide range of scientific backgrounds to provide answers to many of these questions. The nineteen chapters cover three principal themes—mechanisms that keep food and water `healthy', diseases from foods, and economic and social issues around food hygiene.

On the theme of mechanisms to prevent food contamination or deterioration, the first chapter is an historical review of food processing over the past 100 years. It describes developments such as drying, heat processing, freezing, chilling and radiation; changes in the processing of two staples, bread and milk; and finally the health implications of these changes. Food spoilage is largely preventable through the wide range of current and future mechanisms described; but, where animal products are concerned, an important principle is to limit or eliminate bacteria at the `on the farm' stage. The chapter on the microbiological safety of water again offers an historical perspective before proceeding to indicators of contamination, drinking water standards and waterborne diseases. Finally there are chapters of more specific medical interest, on vegetative microorganisms, bacterial spores, food-borne viruses, toxigenic fungi and mycotoxins, parasites, food-borne protozoa and marine toxins. Each details the organisms and the diseases, the control strategies now in place, and future challenges.

There is a natural overlap between themes because the chapters on control of food-borne infections also address the diseases acquired. Some of these will be well known to clinicians practising in Britain; however, international travel and vacations in distant and exotic locations are now commonplace and even the food on our local supermarket shelves may come from countries with less rigorous controls than ours. A series of chapters conveniently summarize for the reader the conditions, causative organisms, control mechanisms and treatment. But adverse reactions to foods do not arise only through infections; in developed countries, allergic reactions and food intolerance are far more troublesome. This matter is comprehensively addressed with clear distinctions between food allergy, food aversion and food intolerance, along with accounts of mechanisms, clinical features, diagnosis, treatment and prognosis. This chapter also describes presentations of food intolerance including reactions resulting from enzyme defects (e.g. lactase deficiency), pharmacological mechanisms (e.g. caffeine, tyramine) and specific drug—food reactions (e.g. tyramine-containing foods and monoamine oxidase inhibitors). Modifications of foods through their genes, whether we approve or not, will be part of our future. Genetically modified crops are already successfully established in large areas of the world. The relevant chapter is titled `Genetically modified crops: methodology, benefits, regulation and public concerns', clearly the main issues in the debate; but risks are tackled as well as benefits.

Amongst the social and economic issues dealt with are consumer perceptions and understanding of the risk of food, risk communication, life-style and food use and the economic impact of food-borne outbreaks and their control.

This British Medical Bulletin covers a wide range of topics in a manner that will amply equip the busy practitioner to counsel a concerned patient. Its broad range will make it appeal to a readership including nurses and dietitians as well as doctors. I found it a most enjoyable read.