The development of BALM as a clinical framework, method, strategy, and programme that integrates traditional baking techniques with principles of lifestyle medicine.
Traditional approaches to social prescribing often rely on the role of a Social Prescribing Link Worker, to whom a GP or other health professional refers patients for help with their health and well-being needs. This is not the case when it comes to the BALM clinical social prescribing licence. It might surprise you to know that BALM was specifically developed to help support GPs.
To understand why clinicians should prescribe BALM, it is important to understand some of the context in which the framework was developed. You will see how BALM was designed to fully integrate the values and principles of baking to nourish the gut microbiome in a way which empowers GPs to prescribe BALM. So why was this protocol specifically developed to empower GPs and clinicians to socially prescribe BALM?
The Nutrition and Digestibility of Bread Diploma was one of the first official lifestyle medicine courses and was first called this in 2011. It was a popular cause with many healthcare professionals attending.
In 2015/16, I met Tim Spector and, as part of his research, his programme identified that I had extremely low levels of gut microbial diversity. A year later Veronique Bataille, who is a Dermatology consultant, and Tim’s wife, attended the Nutrition and Digestibility of Bread Courses. She suggested as Dr Amrita Vijay had begun working with me on the research library, that we accredit the course with the Royal College of General Practitioners (RCGP) as the syllabus was so relevant. You can thank Veronique for the development of BALM and a year later and we had almost a 2-year waiting list.
The course had been taught for many years but once it was accredited by the RCGP in 2018/19 it was attended by many healthcare professionals. Certainly, the GPs and clinicians who attended enjoyed the class. The course was a combination of academic and practical lessons and we taught about the many students whose health had improved significantly.
GPs under strain
As time went on we noticed that the GPs attending were highlighting that they were dealing with an ever-increasing number of issues on a daily basis that they were simply not equipped to deal with. Many attendees would share that they were under pressure every day. Their resources were stretched and they were ill-equipped to deal with medical issues that were socioeconomic issues. The more healthcare providers that we taught the clearer the picture become. The NHS was struggling, GPs and healthcare providers themselves were being pushed to the limit in general practice and in almost every section of the NHS.
Despite recognising their own challenges almost all spoke of a reluctance to come forward and seek help. The ‘just get on with it’ approach that was once considered a sign of resilience was not proving beneficial as the role of the GP was significantly changed from what it once was. As the course covered many of the medical conditions exacerbated by poor bread, ultra-processed foods, and lack of fibre, so too did the understanding that when people baked in the way we taught, they saw significant changes to health outcomes.
For over a decade, all our recipes had been baked according to the 7 core principles and we’d applied meticulous research and development which underpinned the recipes to our best-selling books, and the Sourdough Club recipes. The foundational values of Baking as Lifestyle Medicine (BALM) were deeply rooted in the principles of social justice and environmentalism, from a defining moment when Vanessa learned Sourdough was the only bread she could digest in 1997, and replied other people were also able to eat bread in the way she made it. When she founded The Sourdough School, the cornerstone was BALM and it was grounded in the concept of ‘eudaimonia’ – a term that signifies a state of happiness, fulfilment, and wellbeing. Eudaimonia necessitates virtue, and virtue, in turn, requires knowledge.
Clinicians and their role of empowering others and addressing social inequality.
It was in recognising that the GPs had two specific abilities which would deliver on the values that underpinned all the teaching at The Sourdough School that resulted in 5 more years of research and development.
GPs and clinicians are specifically able to address the social determinants of health in addition to the physical symptoms and empower patients with the ability to take proactive steps to support their own health. The defining moment of the creation of the Sourdough School was when she had, aged 27 asked her GP when she could digest Sourdough but not other bread. Likewise, it was understanding that the GPs are uniquely placed and needed a social prescription that the system change programme was created and in linking the botanical blend flour, the patients bake and support environmental sustainability, as well as invoke their physical and mental health.
We Needed to Provide Robust Clinical Evidence
It was easy to teach to a room full of medical professionals at the School, and although we had anecdotal evidence coming out of our ears and hundreds of research papers to explain the theory, we lacked the proof that the protocol improves health and a formally recognised way that healthcare professionals socially prescribe.
We also knew that the prescribers needed to be able to use use our protocol themselves. I’d been using the term “Lifestyle Medicine'” informally on course material for many years; the term was first used as the title of a symposium in 1989. The American College of Lifestyle Medicine developed a trail showing the efficacy of intensive lifestyle interventions in treating and reversing disease, and since 2010 I had been following Professor Felice Jacka as she pioneered research on diet quality as a modifiable risk factor for mental illness. The UK caught up and in 2016 the British Society Of Lifestyle Medicine was formed. To empower GPs, we needed to provide a familiar and medically recognised structure through which they could effectively incorporate BALM into their therapeutic repertoire. This and BALM emerged as an empowerment model allowing GPs to address the social determinants of health in addition to the physical symptoms. To provide a comprehensive and holistic approach to patient care, and enhance patient-doctor relationships, we underpinned it by testing BALM as a 12-week dietary intervention study, examining the impact of BALM on the gut microbiome and mental health.
Financing, designing, developing, and implementing an intervention study as a baker, rather than an academic, was no easy task. The work was supported by some of the most eminent academics in their fields, and by volunteers and medical professionals who supplied resources, time and expertise and provided independent validation of the studies – and the results? They did indeed show significant positive changes. The participants’ gut microbial balances improved increasing the short-chain fatty acid (SCFA) producers and key beneficial microbes, and we saw significant improvement in mental health scores. We were not surprised, though. We had been seeing first-hand for many years the tangible improvements in mood, blood sugar balance, sleep patterns, weight management and gut transit time
Building the Diploma in BALM – a social prescribing course that helps the prescribers.
CPD points: We built the online BALM Diploma to support the well-being and health of the healthcare providers that study it. It combines clinical evidence and theory with practical baking. We are currently preparing the diploma to register for 100 hours of CPD points for each year and we believe that this will count as part of their revalidation with the General Medical Council (GMC), so please watch this space (June 2023).
Practical and accessible: Our clinician tick sheet gives the prescriber the ability to prescribe BALM within a ten-minute consultation, this approach maximises the use of a clinician’s time while also making an impactful intervention.
Protecting privacy: A strategic decision was made to separate The Sourdough Club and The Sourdough School. In separating the two companies we ensure privacy, GDPR compliance, and patient confidentiality. Likewise, we decided, to safeguard our medical professionals and ensure patient confidentiality, BALM prescriptions would be hand-stamped and handwritten old-fashioned invitations that the GP writes a code on and gives to the patient there and then.
Personalised care: A clinician can personalise the BALM approach for each patient, considering their specific medical history and needs, something a non-clinician might not be able to do effectively.
Baking is a low-cost activity: The use of simple ingredients—flour, water, salt—means that BALM is a low-cost intervention that can have a high impact on a patient’s health.