To anyone reading leading UK newspapers, Dr John Briffa needs little introduction.  He’s a former columnist for the Daily Mail and the Observer, and former contributing editor for Men’s Health magazine. He has authored for dozens of newspaper and magazine titles internationally, and is a previous recipient of the Health Journalist of the Year award in the UK.

His latest book ‘Escape the Diet Trap – lose weight for good without calorie counting, extensive exercise or hunger’ will be published in January in the UK. Dr Briffa is proud of his heritage and has chosen Malta as the first place in the world to reveal the ground-breaking concepts contained in the book. We’ve an exclusive Dr Briffa article here, based on insights from the book.

In partnership with Bryn Kennard of Body Works in Spinola Bay, he will be revealing the secret to lasting weight loss in the ‘Escape the Diet Trap’ workshop, 12 November, at the Hotel Juliani, St Julians.  (Details & Booking info below.) See the Dr Briffa Bodyworks Workshop Programme (pdf download).

The Insights, the Theories, the Practice

Time and time again the conventional approach to weight loss, ‘eat less, exercise more’, has been shown to be a dismal failure for those looking for long-term sustainable weight loss. It is normally put down to lack of will power or discipline when many fail to control their weight following endless cycles of eating less and exercising more. However, there is good reason to believe that it is not so much that diets don’t work, it’s that they can’t work.

Dr John’s premise is that eating less and exercising more goes against the fundamental design of the body. If calorie intake is cut, it can stall the metabolism as the body seeks to conserve energy. Not only that, when a cycle of eating less ends and normal eating patterns are resumed it can take three months or more for the metabolism to boot up to normal levels.

Studies have also shown that people who tend to eat less also tend to move less making the exercise part of the equation a much harder to sustain. The role of exercise in weight loss has been wildly overstated. In fact, studies clearly show that exercise is quite ineffective when it comes to weight loss. This is not to say that exercise is not important, on the contrary, it still plays a massive role in both aesthetics and health, it just means that it needs to work more intelligently as part of our overall wellness routines.

We asked Dr Briffa to explain a bit more about what’s going on here. 

Q. The logic behind ‘Escape the Diet Trap’ seems so sound and such common sense why has it eluded us for so long? 

Dr Briffa: Some of the misinformation regarding weight loss has come because the calorie principle – the idea that weight loss is an inevitable consequence of ‘eating less and exercising more’ is so persuasive. It makes so much sense. And when it doesn’t work (as is almost always the case in the long term), the tendency is to blame would-be slimmers rather than take another look at the theory and see if it stands up.

On top of this we have a food industry that has been able to peddle ‘slimming’ foods on faulty premises such as ‘low-calorie’, ‘low-fat’ or ‘lite’. This has further reinforced the idea that it’s only calories that count, and further led us down a path to failure.”

Winter, the one time of year it isn't a sauna in Malta, and here we are wishing it were!

It’s January and even in what’s billed as ‘sunny’ Malta, people are feeling chilled to the bone – well, inside our houses anyway as it’s always tricky heating up our limestone igloos. So, it’s time to indulge with a half day somewhere warm and get a fix of wellness treatments to beat the January blues. A 15-minute drive from my home, I’ve a pick of five-star and better four-star hotels with spa and wellness centres.

In fact, Malta has carved a niche as a spa and wellness destination. Hotels recognised that while Malta isn’t a true winter sun destination like the Caribbean, it does have light and a mild enough, if often wet winter climate to entice visitors in the shoulder and low season. And enough attributes to lift spirits and restore energy levels.

Malta is no newcomer to the health and well-being. It has a long and veritable role in caring for people, dating back to the time of the Hospitaller Knights of St John. Their hospital, now the Mediterranean Conference Centre, in Valletta, was renowned throughout Europe in its day for its advanced medical practices. The Knights legacy lived on in the British period when Malta became known as the ‘nurse of the Mediterranean’ for its role in caring for British troops. In its 2011 quality of life index, US-based International Living Magazine ranked Malta’s health care as just above that of the UK and Australia’s. The Islands seem to have the credentials for spa holidays then.

Spas that spoil you for choice
In the past few years, the Islands have seen the arrival of some 40 or so spa and wellness centres, most based in the top category hotels. Full- and half-day packages and options à la carte mean spa and wellness treatments can form all or just part of a holiday.

You’ll find all the tried and tested as well as popular and pioneering spa treatments available. Malta’s spas tend to specialise in themes of treatments. You’ll find Ayurvedic, Balinese, Thai, Chinese, Indian and Turkish treatments and more to take your pick from.

Many spas offer innovative packages such as ‘mother and daughter’ treatments, and various signature therapies ranging from colour therapy, body toning, and detox or stress-buster programmes to specialist aesthetic interventions. On hand too you’ll often find qualified nutritionists, dieticians, physiotherapists, chiropractors and personal fitness trainers as well as practitioners of Pilates, Yoga and Tai Chi.

Spa Sport
Many hotels offer saunas, Jacuzzis and therapy pools, Turkish baths and hammam to complement general swimming facilities. Spa hotels can often have landscaped spaces, from sun decks to palm-filled gardens that make great backdrops for the indoor therapy and pools and occasionally they house an outdoor sauna. Residents and usually spa day guests too, have access hotel sport and leisure facilities, including gyms and tennis courts.

Check before you book
Check out the hotels’ menu of spa therapies before you book to see which offer the style you’re after. In Malta, spas are nearly all about pampering and relaxing and tend not to be clinical or medically-inspired like some you still find in continental Europe. We doubt you’ll come across austere white-tiled bathing facilities here. But several spas here do offer unique, pioneering treatments that are designed, for example, to help people recuperate after operations, or work on specific clinical complaints. With one or two of the larger spas advertising in British Vogue magazine, you can see just how big a business the whole wellness sector has become in Malta. With 40 or more on offer, shop around especially in the shoulder months as some will have bargain priced all-inclusive weeks with a good number of treatments thrown in.

The edible thistle, the globe artichoke, in season aplenty in Malta right now

I have just seen Jamie Oliver’s TED talk video. Love or hate his style, Jamie is just about the only celeb voice consistently banging on about the junk that’s in a lot of kids’ diets these days, whether they’re eating at home, school or on the street. His crusade to get us to feed our kids healthily has now extended to America. His TED talk showed a clip of what looks like five-year olds in class unable to name correctly, or recognise at all, basic fruit and veg like potatoes and tomatoes (let alone an artichoke). Scary stuff. They looked as if they’d never seen a raw ingredient.

A few weeks ago, my son started receiving a portion of fruit or vegetables in a small plastic container, once a week, at school break. The initiative is part sponsored by the European Union. Malta has high child obesity rates ranking pretty much alongside the US rates. The veg in schools initiative is therefore laudable, but has its problems. I saw one of the offerings as he brought it home, part eaten. It was watery lettuce, cucumber and a bland, anaemic tomato. Kids can like salad, but usually it has to appeal to them. This was rabbit food at its worst and I could barely eat it.

The art of veggie shopping in Malta
Having Jamie’s TED talk and my family’s health at the forefront of my mind, I ended up scrutinising more carefully than usual my shopping basket of goods in the supermarket today. I don’t mean I paused over the low-fat, but high-sugar yoghurt (health-con) products, but I made a point of taking a long hard look at the labeling of the fruit and veg. A recipe on my menu plan for the weekend required ‘snow peas’ – not in season right now, if ever, in Malta. There were some on display though, cellophane wrapped, and stating that they were from Guatemala.

Far too many food miles to contemplate that purchase. Similarly, though I love pineapple and mango, I gave them a miss too and opted for what’s local, in season, plentiful and therefore cheap. At present, that means strawberries! I usually reckon on strawberry season in March, but with growing under plastic and our exceptionally mild winter, they are in the shops now – and they are huge, sweet and just five, reasonably sized ones can provide a child’s Vitamin C quota for the day (according to nutritionist Natalie Savona. See below).

Pick ‘n’ Mix, Squash ‘n’ Squeeze those veggies
In Malta, a good deal of our fruit and veg comes loose, definitely on the veggie carts, and even in supermarkets. That’s a good start to cooking from scratch with raw ingredients. The loose goods are generally local if they are common fruit and veg – or from Sicily.

You can of course get most things, like those snow peas, from anywhere in the world, but why bother? Only around three per cent of Malta’s population is in agriculture, but they work hard and eke out a fairly good spread of raw ingredients. Broccoli, spinach and artichokes are some tempting veg that is in season at the moment. I know that the impoverished soil here might mean that some farmers spray a lot of chemicals around, but who knows what is on most of the imported fruit and veg, unless is says ‘organic’, which itself has been in dispute as the manna from heaven. Wash, scrub and peel things, I say, when in doubt.

Like most canny shoppers in continental Europe, the Maltese housewife (and I use that term because many women do describe themselves here as that) touches and squeezes the produce and digs deep the in plastic tray to find the best of the tomatoes or whatever. There’s a lot of pecking and picking over goods, and the barging aside of other shoppers (as I witness on my local veggie cart days). The economical shoppers go out of their way to ask for any veg that’s almost past its best. I often see people buy a load of wilting this or that to pop in a ‘brodo’ or stew. These are people who use every last sad veg from the bottom of the fridge, and why not? In these times, we have a thing or two to learn from them.

Maltese-descent Celeb Nutritionists
As an afterword, it’s worth noting that the Islands have two Maltese-descent UK celebrity nutrionists to their name. Natalie Savona, an academic and practitioner who has written for and broadcasted extensively in national UK media; and Dr John Briffa who had a long-running column in the UK Observer and has an active blog.

Now, I’m off to work out how to dissect those massive globe artichokes I bought on whim, and see if I can learn what to do with them! They were going like hot cakes on the veg cart yesterday. Damn, I should have called upon the collective wisdom of my fellow ‘housewife’ shoppers to ask their advice…

Related Posts
Cost of Living: Food shopping in Malta
How to shop at the village veggie store
Pumpkin: not just for Halloween
Strawberry Fair

Photo: James

The signs are that Gozo is the place to head for dental treatment these days!

Malta has quietly been establishing itself as a medical tourism destination in recent years. The islands can claim a long and veritable history in medicine from the time of the Knights of St John to their role as ‘nurse of the Mediterranean’ in World War II.

Despite the Sterling-Euro exchange rate of the past year or so, Malta still seems to be attracting medical tourists. Its pull is not only its value-for-money, professional medical and dental treatment but also its climate, culture, English-speaking medical staff and relative ease of access from European cities.

For Britons, facing a lack of NHS dentists and exorbitant rates for ‘going private’, a trip here makes sense. For some, it’s almost a home from home. At the tail end of last year, journalist Jennifer Pulling joined them, taking the dental tourism trail to Gozo, Malta’s small sister island.

Here, she describes her ‘dental Odyssey’ on Calypso’s Isle.

It actually all began the Christmas before last. I wanted to escape the frantic shopping fest and plumped for Gozo. I basked in warm sunshine, sat in deserted village squares and discovered the mix of sacred and pagan in the island’s folk lore and myth. But even here I couldn’t escape the nagging anxiety about my teeth. As I walked across the salt pans on Christmas Day, I told myself I would not let another year pass without resolving it. I wasn’t sure how as I knew that I could never afford the verging on £20,000 my UK dentist was asking.

The answer came out of the blue. One evening, I opened the local Yellow Pages and looked up dentists. The following day I stood in a telephone box in Victoria making a call to a dental clinic. A few days later I flew home with all the literature.

Never one to make decisions swiftly, it took me almost a year to find the courage to go for it. In the meantime, the enormity of the problem and the lengths Brits go to solve it surprised me.

Some 70,000 Britons went outside the country for health care in 2007, a figure which was expected to rise to 200,000 by 2010. Out of a sample of 650 UK health tourists, savings on treatment cost accounted for 92% of the reasons for having treatment done abroad. 97% of medical tourists said they would ‘definitely go abroad for medical treatment again’. The ex-UK medical tourism market is currently worth £375 million. Dentistry is a particularly good example, due to the UK’s shortage of National Health dentists.

I’m a journalist who goes for research in a big way. The Google machine was both a blessing and a curse, taking up hours of my time as I ploughed through websites on dentistry abroad. The British Dental Association made gloomy reading as it only pointed out the pitfalls: number of visits required, qualifications and experience to check, and darkest of all, what does one do if things go wrong.

In my capacity as a journalist, I got the chance to check out a Bulgarian clinic, but the young age of the dentist there, and the clinic’s rather austere atmosphere despite its professional manner somewhat dissuaded me from taking that route. So I returned to Malta to combine a holiday with a trip to that Gozitan clinic. It was incredibly hot and the long bus journeys coupled with ferry crossings were exhausting. But from the moment I stepped into the practice I felt I had come home.

[eds. note: Jennifer was mid-way in her treatment writing this but was impressed with the care, attention to detail, time and professionalism she has received at the Gozitan clinic she chose.]

The confidence in knowing I am now on the road to correcting my teeth has over spilled into other areas. I have no qualms about returning to begin on the next phase, the implant procedure I need. In fact I can’t wait.

Perhaps I won’t have absolutely perfect teeth. There have been far too many years of my own and some UK dentists insouciance…..but I’ll be able to talk, laugh and eat with confidence. I have taken the step in time. I dipped into my savings and had the initiative to take myself to Gozo. What of those who can do neither and must suffer broken, painful and missing teeth for the rest of their lives?

I look back on that call I made from a Gozitan telephone box; it was one of the best things I’ve ever done.

Jennifer was treated at the Savina Dental Clinic, Gozo.

Photo: Therese Debono

Hung out to dry, but how clean will they be later?

“Oh, pollution, well, it all blows away thankfully, since it’s nearly always windy in Malta.” This was how one friend answered my query about air pollution when I arrived in Malta years back. We’d been walking up Bisazza Street in Sliema, shrouded in diesel smoke belching from the passing buses. Today, it’s pretty much the same, although some buses are a bit newer.

Back then too, in the early ’90s, the location of the then new power station was still a hot topic. While its site was chosen, apparently, to mitigate the power station’s environmental impact, the landmark chimney just happened to rear up a few metres from former Labour prime minster Dom Mintoff’s villa.

Since Malta’s EU membership, environmental issues are taking centre stage more frequently and are less likely to be dismissed in a partisan or jokey fashion. A topic never far from the media is the high incidence of asthma in Malta and its linkage to air pollution and particle inhalation.

Several NGOs – Flimkien għal Ambjent Aħjar, Friends of the Earth, Birdlife Malta, Din l-Art Ħelwa, Greenhouse, NatureTrust Malta, and the Ramblers’ Association of Malta - have joined forces in recent weeks to petition the Malta Transport Authority (ADT) to do more (or at least use their current powers more effectively) to curb illegally high vehicle emission levels. The belching buses are a visible reminder that however many years pass, plus ça change…!

When it comes to the effects of particle emissions on the health of the nation, Malta has more sinister visible signs. Benchmarking Malta’s asthma rates internationally, we find that the islands have among the highest incidence of asthma in the Mediterranean, and place around third in European league tables. Our heavy reliance on fossil fuels for transport, energy and industry is taking its toll. For example, St Anne’s Street (the main thoroughfare in Floriana) is likely the most toxic street in Malta, according to statistics compiled by the planning authority. The street harbours three nasties – particulate matter; benzene; and nitrogen dioxide – in levels which far exceed those the EU deems acceptable.

Flimkien għal Ambjent Aħjar, the new kid on the block in Malta’s environmental lobby, has the energy of youth to not let the authorites off the hook. It has the bit between its teeth now on the air pollution/particle issue and is hounding the government over its decision to seek exemption from EU rules on air quality and PM10 particulate traffic pollution until mid-2011. Whether you’re an active environmentalist or not, it’s clear that Malta, despite its wind-swept location, has serious air quality problems. And, unlike our winter storms giving way to summer again, these toxic clouds won’t be going away easily.

Photo: Gege Gatt

Although not a native of the Malta, or the Mediterreanean (its origins lie in South America), the Opuntia ficus-indica (Indian fig) certainly thrives here. Were it not for farmers lopping off bits from time to time it might well take over. Farmers of old would use it as a boundary between fields; it’s definitely a good deterrent to intruders or straying livestock and is cheaper for villa owners to install than a security system!

The fruit can be red, deep wine-red, green or yellow-orange and is perfectly edible (fussiness over seeds aside). It is sweet and moist with a flavour similar to sub-tropical fruits like watermelon, honeydew melon, strawberries and figs. And is a fraction of the price of these, or free if you pick your own.

I would leave picking, and removing the peel to the experts though; rural folk with hands like leather, who wield a knife skilfully and are impervious to the nasty spines. On my first trip to Malta 20 years ago, I was offered a half-heartedly peeled prickly pear and ended up, very uncomfortably, with very fine, hair-like spines swelling my lips for days.

Prickly Pear culinary delights
Malta doesn’t really make much use of its abundant prickly pear supply. Our Sicilian neighbours treat it far more adventurously making candies, granita (slushy ices), ice creams, and jellies from it, as well as serving it up as dessert in restaurants ranging from casual trattorie to those listed in the esteemed Michelin Guides.

The prickly pear is however on the increase on menus in Malta as we are beginning to see chefs value this humble, poor-man’s food. Its presence on the menu can add local flair to what is often a bland list of internationally available desserts. The prickly pear is also versatile, and equally at home in savoury dishes.

Most people I know simply eat it unadulterated; or they juice it. It can make a refreshing drink, and it certainly makes an interesting, pink-coloured Maltese liqueur under the Zeppi brand, called Bajtra. You’ll find it in most grocers and at the airport, alongside Maltese honey and biscuits, being sold as a souvenir.

Health benefits
It has an impressive list of healthly properties: it is rich in anti-oxidents and contains a good dose of vitamin C. Some say its juice can help cure a hangover. The ficus indica is being looked at closely for its health benefits: A Maltese company, along with a French partner, has been researching prickly pear properties since 1996. It has has found its extracts can help alleviate symptoms of extreme fatigue experienced after performing strenuous exercise – we’re talking about scuba divers and racing drivers here.

So, it seems that the humble prickly pear, much maligned and often viewed as an invasive weed, has a lot to offer Malta after all.

Practise Safe Sun in Malta this summer.

I landed back in Malta around midnight last night, when the temperature was close to 30 degrees. This morning, even my 200 year-old farmhouse with metre-thick limestone walls was running a sweat. The humidity factor was around 80 per cent and stiffling.

People who visit Malta in peak summer often end up with heat-stroke, bad sun-burn and worse. Here are some quick tips on how to survive a heatwave in Malta:

1. Ideally, don’t get direct sun exposure between 11.00 and 15.30hrs. Remember the silly ditty about ‘Mad dogs and Englishmen’? Well, there’s still a large element of truth. If you can, stay indoors and catch a siesta when the sun is at its hottest.

2. Use sunblock factor 30. Anything else is useless. We’ve all read about how too much sun accelerates the ageing process. It’s time to put all this into practice.

3. Wear a hat with a brim. A large one. Baseball caps do nothing for the ears and neck.

4. Drink plenty of water. Stay away from any alcohol if you are in the sun. If you want something flavoured, try Kinnie. It’s an acquired taste, but part of our heritage and might give you a bit of an energy boost, and has a bitter-sweet kick.

5. Be careful of staying in front of an air-conditioner for a long period. You can get an ice-cream headache when you get away from it. And they do circulate germs.

6. Keep young children covered. We repeatedly see young, fair-skinned children playing on a beach and going salmon-pink. Consider getting some UV protective swim wear. Local children often have just bathers on, but don’t do as they do if you’re a short-stay visitor with young kids here on holiday.

7. If you are on an open-top tourist bus, or on a boat, you may not be too hot as there’ll always be a nice breeze whizzing by. But while you’re staying cooler, your skin is far more exposed and in practice, you’re dehydrating as quickly as if you were standing still in the middle of Republic Street. Take the same precautions!

8. Wear loose-fitting cotton or linen clothing – go for natural fibres. Save the lycra for other places.

9. Sometimes, soaking a bandana in water gives some respite.

10. If you want to spend a whole day on beach, rent an umbrella. Most beaches have these in abundance for a relatively modest charge. It can certainly get you to enjoy a painless stay. But remember that harmful UV rays bounce off the sand and under your umbrella too! So don’t forget the suncream.

11. And, to really go native, go early morning or very late afternoon to the beach. Dive off into a beach bar or back to your hotel for lunch and a siesta.

During the June heatwave in the UK this year, many a newspaper asked why the British were so ill-equipped to cope when continentals and Mediterranean folk live though temperatures 30 degree C and upward every year. The answer: well, we don’t pack in all our sunbathing in a few short days, so there’s far less pressure to ‘be out in the sun’ come what may; and we hibernate as much as we can around the midday to mid-noon hours.

Our watchwords: Heat can bring harm, not just happiness.

Professor Nigel Lightfoot, CBE, UK Chief Advisor on Pandemic Influenza, giving of his expertise while holidaying in Malta this month.

The Chief Advisor on emergency preparedness and pandemic influenza at the UK’s Health Protection Agency, Professor Nigel Lightfoot, CBE, said in an interview with Malta Inside Out that the islands were preparing well for any swine flu pandemic and that visitors and locals could be rest assured and enjoy the summer season as usual.

Professor Lightfoot, who is currently holidaying in Malta, held a lecture for around 300 health professionals at Malta’s main state hospital, Mater Dei, earlier this week. His visit is timely and his expertise invaluable to Malta as the country has only recently experienced its first cases of swine flu and is seeing increasing local media coverage of the virus’ spread on the islands.

The Professor, who has long-standing Malta links since his time here as a doctor with the British Navy in the ’60s and through Maltese relatives, has forged informal dialogue with the Maltese health ministry and the islands’ leading virologists over the years. Professor Lightfoot frequently attends the UK Cabinet’s emergency council, known as Cobra, which meets to discuss and plan UK government responses in times of emergency. He therefore has expert insight into the mechanisms Malta needs in place to deal with pandemics.

Professor Lightfoot’s comments come after the vociferous media and public debate on whether events, like Isle of MTV last week, should be cancelled. “There is no need for public events to be cancelled. It is inevitable that swine flu will spread and the incidence of the flu in Malta will most likely take the same pattern as in the UK. At this stage in the UK, we are talking not about containment but about treatment – to the extent that even people in contact with swine flu patients, but who have not shown signs of any symptoms themselves, can and should still go about their regular daily lives,” Professor Lightfoot said.

“Swine flu is a new strain of flu and for that reason we can’t say precisely how it will develop in the wider population over time or whether it will remain the relatively mild flu it has been for the vast majority of people infected,” said Professor Lightfoot. He said that any country new to facing swine flu should put out the level-headed message that people should take a calm approach and sensible hygiene measures and remain at home and off work for seven days if they have flu. He added that at present, young people, aged from three to around 19, appeared to be more susceptible to the virus. His overriding message was that while vigilance was needed, there was no need for public alarm.

Professor Lightfoot pointed out four differences in the way the public and public agencies were reacting to this latest flu in comparision to past pandemics and spikes in seasonal flu: “The avian flu strain H5N1 in the East heightened our ability to plan, but it also brought far greater public awareness of pandemics; we are now seeing a public that wants, impossibly, a ‘no risk’ society; the media tend to take the line that a country is not prepared enough, thereby overlooking the solid foundation of behind-the-scenes work that is putting appropriate national and international responses in place; and, for the first time with any flu, anti-virals are being made available on a wide scale – covering around 70 per cent of the UK population and probably around 35 per cent of the population in Malta.”

Professor Lightfoot has had a distinguished career in UK public health, and received a C.B.E. in the New Year’s Honours list this year for his outstanding work on preparedness for pandemics and on Polonium 210 (investigating its use in the death of Russian UK resident, Alexander Litvinenko). His career has seen him lead national responses to some of the most well-reported threats to UK public health over the past decade, such as anthrax, polonium and pandemics, as well as draw up top-level, sensitive policies to counter chemical and biological warfare and terrorism attacks.

Malta Swine Flu helpline:

Anyone who is currently feeling any flu-like symptoms is urged not to go to hospital emergency departments or clinics; instead they are asked to stay at home and contact a doctor, or contact the swine flu helpline on 21324086.