Is Ireland putting too much faith into 'clean-eating' gurus?
Leading cancer specialists came out this week warning people not to put their faith in diets and regimes that promise to transform lives. Do we put too much store in fads and gurus?
Domini Kemp wants to make something very clear. The cookbook that the restaurateur and food writer has just co-authored with nutritionist Patricia Daly is designed to help those suffering from cancer, or in remission, to make sensible food choices and support conventional treatment. The Ketogenic Kitchen is not, she stresses, an alternative to the standard cancer therapies - the surgery, chemotherapy and radiation treatments espoused by oncologists today.
Both she and Daly have experienced cancer themselves and underwent conventional treatments, including, in Kemp's case, a double-mastectomy, to help them recover.
But both sought to ensure that they followed, as they saw it, the best possible diet to help restore them to optimum health. That diet is rich in proteins and fats, but low in carbohydrates - the principles of ketogenic eating, a food philosophy that dates back to the 1920s when physicians sought to help children suffering from epilepsy.
"We are not suggesting that anyone with cancer abandons the treatment their oncologist suggests," she says, "far from it, but like many people who have had cancer, we found that dietary advice was difficult to come by and, in some cases, simply followed the old food pyramid, which is badly out of date at this stage."
The Ketogenic Kitchen has captured the imaginations of many since it was published at the end of April and is already a hardback bestseller. It will be published in the US this autumn and will enter an already crowded market for ketogenic books. But, for Ireland, the concept which became popular again in the US in the 1990s after decades of neglect, is comparatively new.
Kemp and Daly's book has not been without its critics, however.
This week, Dr Robert O'Connor, head of research at the Irish Cancer Society, advised patients not to go on the ketogenic diet.
"Cancer patients of any age with dietary, nutrition or food concerns should always seek the advice of their medical team," Dr O'Connor says.
"Diet, nutrition and weight issues are extremely common in cancer treatment and can require individual specialist guidance. Therefore, the Irish Cancer Society does not recommend embarking on any particular diet or supplement unless undertaken with the patient's medical team.
"There is no evidence," he adds, "that juicing, wheatgrass, spirulina, the vegan diet, the Gerson diet, superfood diets, aloe vera or the ketogenic diet can help prevent cancer, improve symptoms or outcome in the many forms of common cancer."
A number of oncologists, including Dr John Kennedy, quoted earlier in the week also argued that there was no evidence that the ketogenic diet works.
Both Kemp and Daly say they have been hurt by any suggestion that their book is harmful, but say they don't wish to engage in a game of settling scores. "I have seen patients have wonderful results by following the diet," Daly says.
"These are not vulnerable people, they're people who are trying to do their best to recover and they have been frustrated by the lack of dietary advice from doctors. Only 5pc of cancer patients see a dietician. It's as if what we put into our bodies isn't important at all."
"I know there's an awful lot of conflicting information about diet out there," Kemp says, "but it's not a fad and nor is it a silver bullet."
And yet, some consumers might be forgiven for assuming that The Ketogenic Kitchen is yet another cookbook that has come along to offer succour in a wellness and self-help market that thrives on serving up the next big sensation.
The debate about Kemp and Daly's book comes in a week where it emerged that an Australian wellness blogger's claims of having cured her own brain cancer through diet and lifestyle changes were entirely bogus.
Belle Gibson, author of app and lifestyle blog The Whole Pantry, as well as a book of recipes, has admitted that she lied about ever being ill.
As an Australian consumer affairs group launched a legal action against the young blogger, her publisher Penguin said the book had been "published in good faith" and that Gibson's claims had not been fact-checked.
Gibson's is just one of hundreds of diet books that hit the shelves each year and it's been hard to keep up: recent years have thrown up the 5:2 diet, the Dukan diet and the alkaline diet, as well as food fads like kale, quinoa, bone broth and pu-erh tea. All have had their celebrity endorsements, all promised life-changing results, all came in for criticism from medical professionals.
A cursory look at the cookbooks and foodie TV shows of 2016 suggests that 'clean eating' is the diet du jour. Seven of the top 20 bestselling books on Amazon are cookbooks that champion such diets.
One of the bestselling cookbooks in Ireland this year, Natural Born Feeder, written by the model Roz Purcell, espouses a low-sugar, anti-processed and whole-foods diet, while two of Britain's most-talked-about chefs this year, sisters Jasmine and Melissa Hemsley, will be bringing their clean-eating philosophy to the mainstream when their first TV series debuts on Channel 4 next week.
But the sisters, whose beautifully arranged dishes have made them a hit with the Instagram generation, have come in for criticism for pushing a so-called 'bad science' diet.
Last week, another celebrity chef and former Great British Bake Off contestant, Ruby Tandoh, attacked the "wellness evangelism" of chefs such as the Hemsleys and accused them of giving "false hope" to vulnerable people.
Her words were echoed by the celebrity chef Gizzi Erskine, who said: "Spiralized courgette with pesto made from whizzed-up avocado? That's not my idea of dinner. It's a salad. Nourishing your body doesn't just mean raw 'health' foods; it's about understanding balance and why we break up our plate into proteins, carbs, vegetables, fats, and the right volumes of these things.''
Dublin-based psychotherapist Joanna Fortune says such books appeal to people because they purport to offer so much more than just a way of eating.
"They present a lifestyle that's idealised, this notion of a quick fix towards being super-healthy and happy and where, by making certain dietary changes, your entire life can be transformed."
She is especially troubled by the growth of 'clean eating'.
"It's a term I really dislike because it implies that if you're not following this diet to the letter you're 'dirty eating'. In the course of my work, I'm seeing people who are showing symptoms of orthorexia [an eating disorder common to those fixated on eating the right foods]. They may have really good intentions, but become enslaved by what they're eating and yet don't get the correct nutrients."
Fortune says the growth of the self-help industry - reputed to be worth $12bn in the US alone per annum - appeals to our desire for a quick fix.
"So many people are time-poor and something that comes along and promises to transform their lives is often putting a band-aid over a more serious problem, one that might require counselling."
The self-help industry - featuring books, DVDs, seminars, retreats and so on - appears to expand with every passing year and publishers in particular place more and more stock on finding the next big thing.
"It's not an exact science," says a senior executive at a leading Irish publisher, "and while all the houses might publish a lot of health, fitness, dietary and lifestyle books, only some of them will connect with an audience."
When one considers that an estimated 45,000 self-help titles are in print, not all can define their times like Dale Carnegie's mould-breaking How to Win Friends and Influence People from 1936 and Rhonda Byrne's positive thinking manual, The Secret. The latter, published in 2006, has grossed $300m to date.
The publisher says they are always on the lookout for the next big thing in the self-help genre.
"To be honest, self-help is a genre that does nothing for me on a personal level, but no mainstream publisher can ignore it today so we're always on the lookout for something that will connect with people, and to do that you need to keep an eye on trends - such as what's happening in food and health and so on. And by 'people' we're talking 90pc women here. Women buy fiction in greater numbers than men, and when it comes to self-help they're the dominant market by far. I've yet to meet a man who said, 'I've just read this great book: it's called The Secret'."
The publisher believes the trend for clean eating and body-beautiful books will continue for "at least a couple more years" but says it's sometimes impossible to second-guess just what will excite the great self-help book-buying public.
"If you were to tell me a year ago that a book about tidying up would become a worldwide bestseller, I would have thought you were mad, but that's exactly what happened."
The book in question, The Life-Changing Magic of Tidying Up, by Japanese author Marie Kondo, evangelises decluttering and bigs up the unusual pleasures of folding clothes.
She has amassed an enormous social-media following who like to tag her into pictures of their spotless homes and perfectly arranged wardrobes.
For Fortune, such books appeal to those people attempting to juggle busy lives.
"You've got people with families, working long hours, commuting, you name it. There's a sense of chaos in their lives and what books like this offer is hope that if they can order their living spaces, they can put order on everything else that's going on, too, but it doesn't work like that. It's just not that simple."
Fortune argues that it's people who are already in a good place, psychologically, who could find such books useful as they may reinforce views they already hold, but they are of limited value to those who are vulnerable or are struggling to cope.
"The one-size-fits-all approach just doesn't work," she says, "so, for instance, something that espouses certain diets or fitness regimes will not have the same impact on everyone. A couple of years ago when all the talk was about high intensity interval training [HIIT, as popularised by BBC journalist Michael Mosley, who is also accredited with bringing the 5:2 fasting diet in vogue], some busy people might have been tempted to make that part of their lives, especially time-poor people, but in fact, what would have been more suitable for them was making the time a mediative approach, such as yoga."
Much of the self-help industry relies on the endorsements of celebrities, including Oscar-winning actress Gwyneth Paltrow, whose lifestyle brand Goop essentially kicked off the craze for clean eating.
Facebook's Sheryl Sandberg popularised the idea of "leaning in" in her book, encouraging women to make a push for senior positions in the workforce. And one of the most talked about celeb books in the US this year is from actress Kate Hudson, daughter of Goldie Hawn: Pretty Happy is subtitled Healthy Ways to Love Your Body.
But psychologists argue that there is a disconnect between the 'life lessons' dispensed by hugely successful, wealthy celebrities and the rest of us.
That was certainly the case in this country last year when model Rosanna Davison was heavily criticised for her book Eat Yourself Beautiful, with organisations such as Arthritis Ireland and Irish Autism Action disputing a number of the health claims she attributed to certain foods.
And, and in the past week, some bloggers writing about depression have questioned what they see as the comparatively simple message of wellness campaigners such as Niall 'Bressie' Breslin, whose book detailing his own mental health journey, Me and My Mate Jeffrey, was an Irish bestseller last year.
Mother-of-three Niamh, who blogs as My Indoor Voice, wrote that while Breslin's positive message has resonated with her, there are aspects around the discourse of mental health, that positive spin, that she and others simply can't relate to.
"For someone like me who's sitting at home thinking 'I'll never be Bressie, there's Bressie, he's successful, there's Olivia O'Leary, she's successful'… I've always felt I've failed in life because of it," she wrote.
"You can feel so much worse when you see those people and you think, 'well feck, none of that works for me, I'm still here, I'm still depressed'."
When it comes to the self-help industry, it appears that very little actually 'works'. The authors of the book Self Help That Works suggest that 95pc of claims made in books, programmes and seminars have never been scientifically evaluated.
By contrast, long-established self-help practices, such as Alcoholics Anonymous' 12-step programme, has been consistently shown to be beneficial in helping addicts stop drinking. One study showed that two thirds of those who stayed with the AA programme for at least 27 weeks were still off drink some 16 years later.
A 2014 report on the effectiveness of self-help programmes in the journal, Scientific American argued that it is important to know how to protect yourself from potentially dangerous self-help rituals by learning to recognise dubious experts and by understanding how peer pressure impairs judgment. It suggested that anything that promised a quick fix was probably best ignored.
Meanwhile, Kemp and Daly say their book is anything but a quick fix and quick buck.
"We put our hearts and soul into it," Kemp says. "We really believe it has helped both of us, when used in conjunction with conventional treatments, and we think it can help others.
"In the early 1970s, some argued that refined sugar could lead to health problems. It wasn't taken seriously then, but it is now. Our knowledge of diet and its effect on our bodies is changing all the time. We keep learning more."
Seven popular regimes
1. The Master Cleanse:
Beyoncé used it to lose over a stone for her role in the film Dreamgirls. Involves drinking six to 12 glasses of a special mixture of water, lemon juice, maple syrup and cayenne pepper each day for up to 45 days.
2. Raw Food Detox:
Involves the consumption of raw fruits and vegetables, wholegrains and seeds. Demi Moore is a devotee.
3. The Clean Programme:
Excludes gluten and other common allergens, with detoxers eating one solid meal a day, drinking two liquid meals and taking supplements. Fans include Gwyneth Paltrow.
4. The Juice Cleanse:
This involves ingesting all of your food in the form of juice. All you need is a juicer and a DIY book. (See panel, right).
5. The Salt Cleanse:
Salt is reputed to help heal the body by removing bacteria from the lungs and it has been shown to improve asthma, allergies and irritations of the skin. Involves pouring Epsom salts into a warm bath and soaking in it three times a week.
6. The Detox Retreat:
Popular as weekend breaks and includes such themes as weight-loss, liver flush, raw food, energy and soul care. cloona.ie
7 The ketogenic diet:
A high-fat, adequate-protein, low-carbohydrate diet which forces the body to burn fats rather than carbohydrates. The ketogenic diet was designed in 1924 by Dr Russell Wilder at the Mayo Clinic.