Minas Gerais. My hero this month and at many other times also, is Caroline Walker. She and I (in that order, and quite right too) wrote the The Food Scandal. This got us into all sorts of trouble with a giant manufacturer of drugs, hair-cream, toothpaste and some ultra-processed food products, one of which we mentioned in a list of products containing sugar, whereas it contained caramel, and – well, there was a court case, and they won.

Co-authoring is a bit like the experience of marriage, somebody else said to me once, and Caroline and I did get married. She died over 20 years ago, and I wrote a little book (2) about her life and her work as a campaigning public health nutritionist. It was Caroline who inspired me to believe and have faith in the vital importance of food, nutrition and public health. She was very popular. Her death in her 30s from colon cancer, as well as being a great shock, reminded many people that eating well does not guarantee good health. A number of us created the Trust in her name, which still flourishes – although I wish it would, as Caroline did, take more interest in the world outside the UK. It's a special experience to be midwife to somebody's immortality.

This month, I start to write about what's special for me as a citizen of the global North, to be living and working in the global South. This month, as the first of a new series in these columns, I celebrate Brazilian food and cooking, to be enjoyed by all our senses.

References

1. Walker C, Cannon G. The Food Scandal. What's Wrong with the British Diet, and How to Put it Right. Enlarged and updated paperback edition. London: Century, 1985.
2. Cannon G. The Good Fight. The Life and Work of Caroline Walker. London: Ebury, 1989. Obtainable from www.cwt.org.uk

Brazilian cuisine

Delights from earth and water

Scrumptious crisp yet chewy pão de queijo, is made with manioc flour (left); and (right) moqueca, the even more wonderful equivalent of bouillabaisse

Well naturally, being as this is a column about food, nourishment and well-being, I start my new series with some Brazilian favourite dishes and snacks, that in other countries you will find only in cookery books and specialist restaurants. Whereas here…

The joy of mandioca

My Brazilian friend Maria who I knew in London, told me that the first thing she always did after getting through customs and immigration at Guarulhos airport in São Paulo on her way home, was to head straight for the Casa do Pão de Queijo, now the biggest snack franchise chain in Brazil, founded in 1967, and currently heading for 1,000 outlets. No, I am not an absolutist about fast food and drink outlets. Not in Brazil, anyway. Every town has lanchonetes (roughly, snack bars) that serve juices made of fruits from the Amazon, pulped, frozen and trucked south. Heaven! Plenty of these outlets, and also per quilo restaurants (with arrays of dishes and salads buffet-style, paid for by weight) serve dishes that may be prepared and cooked on the spot, or maybe off-site but close by. In my opinion, there's not a lot of difference between places like this and your own kitchen.

'Pão de queijo' translates into 'cheese bread', which is misleading. As you can see from the picture above (left) it is well, a sort of 'puff'. There are three reasons why Brazilians abroad long for it. One is that it's rare to find it outside Brazil, because the main ingredient is mandioca (cassava) flour. For me it is a treat in itself to enjoy foods whose main ingredient is mandioca or corn. No, I do not miss wheat and its products. And as for fat chips (French fries) made from mandioca – well, just for the occasional treat… So this makes me think about where food comes from, and all the more so when I see great choppings of brown mandioca root in the shops, or being sold from stalls on the side of the highway to and from my home and Rio de Janeiro.

Parenthetically, something else I like about Brazilian food, is that in all food shops, apart from just a few chic outlets in big cities, hypermarkets, supermarkets and greengrocers do not sell fruits and vegetables that are all the same size, shape and condition. The produce is piled up for customers to poke over and pick. Any pile is liable to have items that are bruised, broken or somewhat rotten. Hooray! It doesn't all come from local sources, and not all comes from Brazil, but it hasn't been made cosmetic. Plus there is no inhibition about selling piles of fruits that by their nature often look manky but are delicious inside, like passion fruit. Yes, there's a real chance of finding that your apple is inhabited. Good news, for bugs and grubs are sensible little creatures, they know what's good for them, and they are a sign that biocides have at least not been overused.

Back to pão de queijo. Another reason that Brazilians abroad dream about it, is that it reminds them of the tastes of their childhood. The third reason is that like quite a lot of other apparently simple dishes and snacks, really good pão de queijo is quite hard to find. 'It's not like mother made' people say, and they are probably right.

Those made for Casa do Pão de Queijo are prepared and baked off-site, frozen, and trucked to the shops, where they are reheated. The recipe is said to be that of Dona Arthêmia, mother of Mário Carneiro, founder of the firm. Here comes the twist. The family sold the business in 2009 for around $US 35 million to the South African-based Standard Bank Private Equity. So that's why the prices in my local Casa in Galeão, Rio's international airport, have rocketed, along with their price of fresh orange juice, which is now the same as in London and more than in New York City

Hm. Bah! The owners will deny this I'm sure, but I reckon the products have lost their savour and exquisite crisp chewiness. Dona Arthêmia's face decorates every store, like a beaming matronly version of 'Colonel' Sanders. Has her recipe been changed?

The bliss of moqueca

The Brazilian dish I have no mixed feelings about is the entirely wonderful moqueca. This is the Brazilian equivalent or Provencal bouillabaisse – fish (or also seafood) stew, gives you a rough idea. To explain moqueca I am now going to lift an item from the most recent column written by my colleague and friend Fabio Gomes (1). For me he says it all: childhood, family life, local custom, engagement with earth for the cooking pots and water (ocean, sea, river) for the fish that are the main ingredient. Here he writes just about the type of moqueca he grew up with. And he also moves into the world of all the senses, finding an ode written by Renata Bomfim, the beautiful young poet from his State, which evokes the aromas and all they may mean.

Once again I ask you my readers. Find me an ode to a burger! The first one to reach me gets a prize! Here is Fabio, whose columns on this site are much missed. But soon he will have finished his PhD…

'I was born in Rio de Janeiro, but spent a great part of my childhood and adolescence living in Vila Velha. This, once a little town, became the centre of what is today the state of Espírito Santo, located in the Southeast region of Brazil, surrounded by the states of Minas Gerais, Rio de Janeiro, Bahia and the great Atlantic Ocean. You can imagine the great mixture that has emerged from this combination. Although Espírito Santo is known for innumerable beauties and delights, such as its coffee, its greatest treat is the Moqueca Capixaba which you see in the picture above (right) served accompanied with rice, and with pirão, the sauce made with the fish juices and manioc (cassava) flour.

' Moqueca Capixaba ('capixaba' simply means 'from Espírito Santo') is more than a culinary delight. With its preparation, it is part of the culture of these parts. The authentic dish is prepared in a special mud pot, designed by the potters of Goiabeiras. By mixing their sweat, their joy, the mud, and pigments from the red mangrove tree, these women create unique, resistant and long lasting pots. The work of the Goiabeiras potters is recognised as 'an intangible cultural heritage' of Brazil (2) Yes, it is possible to make a Moqueca Capixaba in any earthenware pot, but cooked in a Goiabeiras mud pot it tastes intangibly better!

The ingredients

'In the North-Eastern states of Brazil there are also fish stews that are called moqueca. But the Moqueca Capixaba is special. Besides its mud pot, its secret is its simplicity. You just need (very) fresh fish, coriander (shown in the picture above), chives, tomatoes, onions, garlic, salt, limes, and olive oil. The North-Eastern fish stews are 'richer' – they include pepper, eggs, potatoes, carrots, palm oil and/or coconut milk. They are good, but they are not the Moqueca I love. Try and judge for yourself.

'So many Brazilian poets mingle the sensuality of food and the sexuality of love. Here, above and below, is the young brilliant Capixaba writer Renata Bomfim:

Moqueca Capixaba

She becomes hot so slowly,
(Ela vai sendo aquecida, lenta e)
gently, on a low flame,
(delicadamente, em fogo brando.)
At the table, the loved one,
(Sobre a mesa, o namorado,)
warmed and amorous, awaits.
(temperado com amor, espera.)

Daughter of black native earth,
(Pretinha de barro, filha de indio)
In your lap, the fruit of the sea
(seu colo acolhe o fruto do mar)
is bubbling now, heavy with aroma.
(fervilhante, emana seu odor.)
And all of us wait, eager.
(Esperam-na todos, deleitantes.)

Now, a good table wine,
(Um bom vinho, à mesa,)
then a time of silence
(um silêncio respeitoso,)
while mouths moisten
(as bocas anseiam e marejam)
like sails, experiencing the sea.
(como velas errantes ao mar.)

Now it is the loved one that
(E o namorado vai sendo devorado,)
is devoured, transubstantiated.
(transubstanciação)
With Holy Spirit in our mouths,
(Espírito Santo no ceu da boca.)
Moqueca capixaba is divine.
(Divina moqueca capixaba!)

References

1. Gomes F. Mud, sweat and inspiration, and other items. [Column] Website of the World Public Health Nutrition Association, June 2011. Obtainable at www.wphna.org
2. http://portal.iphan.gov.br/portal/montarDetalheConteudo.do?id=12569&sigla=Institucional&retorno=detalheInstitucional

Causation

How deep should we go?

The theme of this item, the first of two to appear this and next month, is causation. Specifically, it's about the significances and consequences of our believing that anything (call this X) is an alterable cause of anything else (call this Y), and that therefore if we want to have an effect on Y we need to affect X. Yes I know this is already sounding abstract, but it's important. If we want to understand why some people say that obesity is caused by an excess of calories, and others say it is caused by energy-dense ultra-processed products, and others say it is caused by poverty (and all seem to have nothing to say to one another), we need to understand what 'cause' means, and may mean.

The concept of cause is fundamental to our work. We need to identify causes, before we can rationally and reliably act so as to treat, control or prevent disease, or protect or enhance good health and well-being. Without this foundation we are on shaky ground. But although we are all the time acting and reacting on the basis of notions about causation, there is not much discussion in our literature or at conferences about the concept and its implications (1).

This is a serious mistake. It can't be because we all agree on what are the causes of the concerns and problems that we are faced with. See above. We don't. Nor can it be because causes don't matter. They do. Further, and as I hope to show, this and then next month, what we believe to be the most important or relevant causes – or types of cause – largely depends on our personal and professional point of view (2).

Here is an illustration of the concept of causation. I sit down and suddenly suffer an acute pain in my backside. I get up and remove a tin-tack. Then I gather up loose tin-tacks scattered on my desk and put them in a box and a drawer. Then I give my young son a stiff lecture.

So what or who was the cause of my pain? The immediate physical cause was a tin-tack, but two other causes were human: my son placing a tin-tack on my chair, and me not keeping the tin-tacks boxed and out of sight. So in this illustration, three causal agents are identified: the tin-tack, my son, and me. As soon as human agency is introduced, the story indicates that it is usual for there to be more than one cause and also more than one type of cause, of any event. Generally, to say that X causes Y is much the same as saying X is responsible for Y. Given this, which of the second two causes above is the most relevant would depend on the age of the boy. If he was ten years old, it would be mainly down to him. If he was two years old, it would be mainly down to me.

How, what, why and who questions

Asked what caused the same event, pathologists will address 'how' and 'what' questions, while lawyers will also address 'why' and 'who' questions

Now apply this to two different points of view of an event: that of the pathologist, and that of the lawyer. In technical terms, their universes of discourse are different and don't much overlap. They think differently.

See the slides above. Asked to examine a recent corpse with a gunshot wound in the face (and no other sign of harm), and having examined an x-ray of the skull showing something like the picture (left), a pathologist would probably say that death was caused by a bullet penetrating the brain. The report might be detailed but it would be focussed and precise, and would answer the questions 'how?' and 'what?'

By contrast, a lawyer would regard a pathological account as relevant only inasmuch as it contributed to broader issues. While not dismissing 'how?' and 'what' questions, a lawyer's account, however concise, would also address the questions 'why?' and 'who?' (3). Examination of different types of organised facts – which is to say, evidence – might warrant a reconstruction such as the picture (right), and the accusation and verdict of murder. But by their nature, 'who?' and 'why?' questions usually do not have rock-solid answers (4). Other evidence could lead to a decision that the death was an accident or suicide. The pathologist's report will be of immediate or 'proximal' causation, in descriptive, objective and neutral terms, with no reference to human agency. By contrast, the judgement of the lawyer will also be of underlying or 'distal' causation, in explanatory, subjective and evaluative terms, involving human agency (5).

Characteristically, physicians (6) take a similar approach to causation as pathologists. A physician who records the cause of a death as say, a 'cerebrovascular event' (a stroke) with or without evidence from a post-mortem, is saying what a pathologist would say. Or, a physician might go one step further, and instead say that the cause of death was hypertension (high blood pressure) which itself caused the haemorrhage.

Asked what caused the same event, biochemists will address 'how' and 'what' questions, while sociologist will also address 'why' and 'who' questions

Now for two more different points of view: that of the biochemist and that of the sociologist. Roughly the same thing applies here, as with the pathologist and the lawyer. The biochemist, whose specialist knowledge is in the biological sciences, will have expert knowledge of human metabolism. Asked what is the cause of obesity, one of the answers that might be given by a biochemist could be the caption to the picture above (left) and, in a presentation, a brainy slide like that shown might be projected. If the biochemist was showing the results of new research, the diagram might have some more pathways or arrows, perhaps animated. Notice again that these are 'how' and 'what' answers, which are independent of time and place.

So what about a sociologist, trained in the social sciences? As with the lawyer, the answers given will respond to the questions 'why?' and 'who?', which are time- and place-dependent. To give an example of what is now a hot topic, advertising of ultra-processed food and drink products to children, the slide might show a picture like that above (right) and the caption to the slide might be like that under the picture.

A key point here is that there is no overlap in thinking, between the cast of mind of the pathologist and that of the sociologist. If – and I have never seen anything like this done, and more's the pity – two experts from the two disciplines debated on the cause of obesity, they might I suppose say polite things about one another's take on obesity, in public. But what they probably would be thinking, and saying afterwards over drinks, would be something like 'that other approach is not the point'.

So what about nutrition, and public health?

And now, the next question is: what does the nutritionist have to say about the cause of obesity? And what does the public health specialist have to say on the same subject? Here I am addressing public health nutritionists, so this is a pertinent question, which I will answer next month. And the other question to address, is which answer is right – and without wishing again to get too abstract, what does 'right' mean, here?

Until October!

Notes and references

1. Notice the tendency to evade 'cause' and instead to write about 'aetiological factors', or 'risk factors' or 'statistically significant correlations', sometimes followed by the view that more research is needed.
2. A point made by Alexis Carrel: 'Every specialist... believes that he understands the entire human being, while in reality he only grasps a tiny part of him'. (Carrel A. Man, the Unknown. New York: Harper, 1935). An alternative is 'Maslow's Law of the Hammer': 'If all you have is a hammer, everything looks like a nail' (Maslow A. The Psychology of Science. A Reconnaissance. New York: Harper and Row, 1966.
3. Hart HLA, Honoré A. Causation and common sense; Causation and responsibility. [Chapters 2 and 3]. In: Causation in the Law. Oxford: Clarendon Press, 1959.
4. Which is why judgements in a court of law are never absolute. They are made on the basis of the balance of evidence, or else when the case for the judgement is beyond reasonable doubt.
5. For the concept of underlying and also basic causation in food and nutrition science and policy, see Jonsson U. Integrating political and economic factors within nutrition-related policy research: an economic perspective. [Chapter 12]. In: Pinstrup-Andersen P (ed). The Political Economy of Food and Nutrition Policies. Baltimore: Johns Hopkins University Press, 1993. Also: United Nations Children's Fund. Strategy for Improved Nutrition of Children and Women in Developing Countries. Policy review no 1. New York: UNICEF, 1990.
6. Meaning, physicians who practice modern conventional allopathic medicine, mostly concerned with health in the sense of diagnosis and treatment of disease in individuals, and also more broadly in groups and populations.

Caroline Walker

Nutrition is about food

'Caroline Walker, nutritionist' was how Caroline always announced herself, before making an intervention at a conference or delivering a presentation. When lecturing she usually turned up with a shopping bag full of props. The first thing she would do is pull out an apple, plonk it on top of the lectern, smile, and say 'This is to remind me that nutrition is about food'. It wasn't her she was reminding.

In the work I am now doing with Carlos Monteiro and our colleagues at the University of São Paulo (3), I am always reminded of Caroline's take on cosmetic additives. Most people who worry about additives focus on toxicity, sometimes with good reason. Not Caroline. Here is a typical passage (4).

'Put yourself in the shoes of Sam Sludge, managing director of Sludge International plc, creator and sole purveyor of the Bulldog Brand Boil-in-the-Bag Soyburger, Iron Lady Wonder Whip, and Honey Krunch Rainbow Jelly Toppings… You pay a visit to your top secret Sludge Laboratories where Professor Crackling is putting the finishing touches to his latest creation, a new instant chocolate flavour pudding created with the lovely cheap ingredients found for him by Sludge International Research and Development Division, which constantly scours the globe in search of cheaper and better raw materials to turn into new and profitable foods. 'A complex multiphasic hydrocolloidal system of water, lipids, protein, carbohydrates and air' mutters Professor Crackling, tingling with excitement and doing a little skip as he deftly tips the brown powder into cold milk, does some energetic whisking with the Sludge Whisk-o-Pud (yours for just twenty Sludge Pudding packet tops) and artfully swirls the resulting light and creamy fluff into his best cut-glass test tube for an experimental morning snack. 'Perfect', he proclaims, savouring every last molecule of TFS/P/84/28, his new chocolate pudding flavour. 'Organoleptic bliss! Now I can create twenty other puddings exactly the same, but they will all be different!' For there is no tiresome chocolate in the mixture, to prevent the basic recipe being turned into peach, pear, strawberry, or his newest tropical tutti-frutti fizzy flavour: all the flavour is artificial. A quick shake of reliable artificial yumminess and the mixture can be endlessly transformed'.

You think her satire is off the mark? Well, it's a bit homespun. But have a look at the labels of some of the lead lines of packet cake mixes and such-like products in your local supermarket. Caroline had a phrase for this: legalised consumer fraud.

References

1. Walker C, Cannon G. The Food Scandal. What's Wrong with the British Diet, and How to Put it Right. Enlarged and updated paperback edition. London: Century, 1985
2. Cannon G. The Good Fight. The Life and Work of Caroline Walker. London: Ebury, 1989. Obtainable from www.cwt.org.uk
3. Monteiro CA, Cannon G. The Food System. Ultra-processed products. Product reformulation will not improve public health. [Commentary]. World Nutrition, September 2012, 3,9, 406-434. Obtainable at www.wphna.org.
4. Walker C. Legalised consumer fraud. [Chapter 2]. In: Lawrence F (ed). Additives: Your Complete Survival Guide. London: Ebury, 1986