The relationship between the classes was strictly hierarchical, with the nobility and clergy claiming worldly and spiritual overlordship over commoners. Microbial modification was also encouraged, however, by a number of methods; grains, fruit and grapes were turned into alcoholic drinks thus killing any pathogens, and milk was fermented and curdled into a multitude of cheeses or buttermilk. Stockfish , cod that was split down the middle, fixed to a pole and dried, was very common, though preparation could be time-consuming, and meant beating the dried fish with a mallet before soaking it in water. Quality protein uptake is defined as the ratio of essential amino acids to daily dietary protein. Each monk would be regularly sent either to the misericord or to the refectory. The lack of recipes for many basic vegetable dishes, such as potages , has been interpreted not to mean that they were absent from the meals of the nobility, but rather that they were considered so basic that they did not require recording.
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The effect of abdominal adiposity occurs not just in those who are obese, but also affects people who are non-obese and it also contributes to insulin sensitivity.
Recent validation has concluded that total and regional body volume estimates correlate positively and significantly with biomarkers of cardiovascular risk and BVI calculations correlate significantly with all biomarkers of cardio-vascular risk. There are numerous theories as to the exact cause and mechanism in Type 2 Diabetes. Central obesity is known to predispose individuals for insulin resistance.
Abdominal fat is especially active hormonally, secreting a group of hormones called adipokines that may possibly impair glucose tolerance. But adiponectin which is found in lower concentration in obese and diabetic individuals has shown to be beneficial and protective in Type 2 diabetes mellitus.
Developing asthma due to abdominal obesity is also a main concern. As a result of breathing at low lung volume, the muscles are tighter and the airway is narrower.
It is commonly seen that people who are obese breathe quickly and often, while inhaling small volumes of air. Based on studies, it is evident that obesity has a strong association with vascular and metabolic disease which could potentially be linked to Alzheimer's disease. Recent studies have also shown an association between mid-life obesity and dementia, but the relationship between later life obesity and dementia is less clear. Based on logistic regression analyses, it was found that obesity was associated with an almost fold increase risk of Alzheimer's disease.
The currently prevalent belief is that the immediate cause of obesity is net energy imbalance—the organism consumes more usable calories than it expends, wastes, or discards through elimination. Some studies indicate that visceral adiposity, together with lipid dysregulation and decreased insulin sensitivity ,  is related to the excessive consumption of fructose. Quality protein uptake is defined as the ratio of essential amino acids to daily dietary protein.
Visceral fat cells will release their metabolic by-products in the portal circulation, where the blood leads straight to the liver. Thus, the excess of triglycerides and fatty acids created by the visceral fat cells will go into the liver and accumulate there.
In the liver, most of it will be stored as fat. This concept is known as 'lipotoxicity'. Hypercortisolism, such as in Cushing's syndrome , also leads to central obesity. Many prescription drugs, such as dexamethasone and other steroids, can also have side effects resulting in central obesity,  especially in the presence of elevated insulin levels.
The prevalence of abdominal obesity is increasing in western populations, possibly due to a combination of low physical activity and high-calorie diets, and also in developing countries, where it is associated with the urbanization of populations.
It is recommended to use both standards. BMI will illustrate the best estimate of your total body fatness, while waist measurement gives an estimate of visceral fat and risk of obesity-related disease. A study has shown that alcohol consumption is directly associated with waist circumference and with a higher risk of abdominal obesity in men, but not in women.
Excluding energy under-reporters slightly attenuated these associations. After controlling for energy under-reporting, it was observed that increasing alcohol consumption significantly increased the risk of exceeding recommended energy intakes in male participants — but not in the small number of female participants 2.
Further study is needed to determine whether a significant relationship between alcohol consumption and abdominal obesity exists among women who consume higher amounts of alcohol. In those with a BMI under 35, intra-abdominal body fat is related to negative health outcomes independent of total body fat. BMI and waist measurements are well recognized ways to characterize obesity. However, waist measurements are not as accurate as BMI measurements. For this reason, it is recommended to use both methods of measurements.
While central obesity can be obvious just by looking at the naked body see the picture , the severity of central obesity is determined by taking waist and hip measurements.
A differential diagnosis includes distinguishing central obesity from ascites and intestinal bloating. In the cohort of 15, people participating in the National Health and Nutrition Examination Survey NHANES III , waist circumference explained obesity-related health risk better than the body mass index or BMI when metabolic syndrome was taken as an outcome measure and this difference was statistically significant.
In other words, excessive waist circumference appears to be more of a risk factor for metabolic syndrome than BMI. The increased amount of fat in this region relates to the higher levels of plasma lipid and lipoproteins as per studies mentioned by Eric Poehlman review. This parameter has been used in the study of metabolic syndrome   and cardiovascular disease.
When comparing the body fat of men and women it is seen that men have close to twice the visceral fat as that of pre-menopausal women. Central obesity is positively associated with coronary heart disease risk in women and men.
It has been hypothesized that the sex differences in fat distribution may explain the sex difference in coronary heart disease risk.
There are sex-dependent differences in regional fat distribution. In women, estrogen is believed to cause fat to be stored in the buttocks , thighs , and hips. Males are more susceptible to upper-body fat accumulation, most likely in the belly, due to sex hormone differences.
Even with the differences, at any given level of central obesity measured as waist circumference or waist to hip ratio, coronary artery disease rates are identical in men and women. A permanent routine of exercise, eating healthily, and, during periods of being overweight, consuming the same number or fewer calories than used will prevent and help fight obesity. Adjunctive therapies which may be prescribed by a physician are orlistat or sibutramine , although the latter has been associated with increased cardiovascular events and strokes and has been withdrawn from the market in the United States ,  the UK ,  the EU ,  Australia ,  Canada ,  Hong Kong ,  Thailand ,  Egypt and Mexico.
A study published in the International Journal of Sport Nutrition and Exercise Metabolism ,  suggests that combining cardiovascular aerobic exercise with resistance training is more effective than cardiovascular training alone in getting rid of abdominal fat. An additional benefit to exercising is that it reduces stress and insulin levels, which reduce the presence of cortisol , a hormone that leads to more belly fat deposits.
Self-motivation by understanding the risks associated with abdominal obesity is widely regarded as being far more important than worries about cosmetics.
In addition, understanding the health issues linked with abdominal obesity can help in the self-motivation process of losing the abdominal fat. As mentioned above, abdominal fat is linked with cardiovascular disease, diabetes, and cancer.
Specifically it's the deepest layer of belly fat the fat you cannot see or grab that poses health risks, as these "visceral" fat cells produce hormones that can affect health e. The risk increases considering the fact that they are located in the proximity or in between organs in the abdominal cavity. Various legumes , like chickpeas , fava beans and field peas were also common and important sources of protein , especially among the lower classes.
With the exception of peas, legumes were often viewed with some suspicion by the dietitians advising the upper class, partly because of their tendency to cause flatulence but also because they were associated with the coarse food of peasants.
The importance of vegetables to the common people is illustrated by accounts from 16th-century Germany stating that many peasants ate sauerkraut from three to four times a day. Fruit was popular and could be served fresh, dried, or preserved, and was a common ingredient in many cooked dishes.
The fruits of choice in the south were lemons , citrons , bitter oranges the sweet type was not introduced until several hundred years later , pomegranates , quinces , and, of course, grapes.
Farther north, apples , pears , plums , and strawberries were more common. Figs and dates were eaten all over Europe, but remained rather expensive imports in the north. Common and often basic ingredients in many modern European cuisines like potatoes , kidney beans , cacao , vanilla , tomatoes , chili peppers and maize were not available to Europeans until after , after European contact with the Americas, and even then it often took considerable time, sometimes several centuries, for the new foodstuffs to be accepted by society at large.
Milk was an important source of animal protein for those who could not afford meat. It would mostly come from cows, but milk from goats and sheep was also common. Plain fresh milk was not consumed by adults except the poor or sick, and was usually reserved for the very young or elderly.
Poor adults would sometimes drink buttermilk or whey or milk that was soured or watered down. On occasion it was used in upper-class kitchens in stews, but it was difficult to keep fresh in bulk and almond milk was generally used in its stead. Cheese was far more important as a foodstuff, especially for common people, and it has been suggested that it was, during many periods, the chief supplier of animal protein among the lower classes.
There were also whey cheeses , like ricotta , made from by-products of the production of harder cheeses. Cheese was used in cooking for pies and soups, the latter being common fare in German-speaking areas. Butter , another important dairy product, was in popular use in the regions of Northern Europe that specialized in cattle production in the latter half of the Middle Ages, the Low Countries and Southern Scandinavia.
While most other regions used oil or lard as cooking fats, butter was the dominant cooking medium in these areas. Its production also allowed for a lucrative butter export from the 12th century onward.
While all forms of wild game were popular among those who could obtain it, most meat came from domestic animals. Domestic working animals that were no longer able to work were slaughtered but not particularly appetizing and therefore were less valued as meat. Beef was not as common as today because raising cattle was labor-intensive, requiring pastures and feed, and oxen and cows were much more valuable as draught animals and for producing milk.
Mutton and lamb were fairly common, especially in areas with a sizeable wool industry, as was veal. Domestic pigs often ran freely even in towns and could be fed on just about any organic waste, and suckling pig was a sought-after delicacy.
Just about every part of the pig was eaten, including ears, snout, tail, tongue , and womb. Intestines, bladder and stomach could be used as casings for sausage or even illusion food such as giant eggs. Among the meats that today are rare or even considered inappropriate for human consumption are the hedgehog and porcupine , occasionally mentioned in late medieval recipe collections. In England, they were deliberately introduced by the 13th century and their colonies were carefully protected.
They were of particular value for monasteries, because newborn rabbits were allegedly declared fish or, at least, not-meat by the church and therefore they could be eaten during Lent. A wide range of birds were eaten, including swans , peafowl , quail , partridge , storks , cranes , larks , linnets and other songbirds that could be trapped in nets, and just about any other wild bird that could be hunted. Swans and peafowl were domesticated to some extent, but were only eaten by the social elite, and more praised for their fine appearance as stunning entertainment dishes, entremets , than for their meat.
As today, geese and ducks had been domesticated but were not as popular as the chicken , the fowl equivalent of the pig. But at the Fourth Council of the Lateran , Pope Innocent III explicitly prohibited the eating of barnacle geese during Lent, arguing that they lived and fed like ducks and so were of the same nature as other birds.
Meats were more expensive than plant foods. Though rich in protein , the calorie -to-weight ratio of meat was less than that of plant food. Meat could be up to four times as expensive as bread. Fish was up to 16 times as costly, and was expensive even for coastal populations. This meant that fasts could mean an especially meager diet for those who could not afford alternatives to meat and animal products like milk and eggs.
It was only after the Black Death had eradicated up to half of the European population that meat became more common even for poorer people. The drastic reduction in many populated areas resulted in a labor shortage, meaning that wages dramatically increased. It also left vast areas of farmland untended, making them available for pasture and putting more meat on the market.
Although less prestigious than other animal meats, and often seen as merely an alternative to meat on fast days, seafood was the mainstay of many coastal populations. Also included were the beaver , due to its scaly tail and considerable time spent in water, and barnacle geese , due to the belief that they developed underwater in the form of barnacles. The Holy Roman Emperor Frederick II examined barnacles and noted no evidence of any bird-like embryo in them, and the secretary of Leo of Rozmital wrote a very skeptical account of his reaction to being served barnacle goose at a fish-day dinner in Especially important was the fishing and trade in herring and cod in the Atlantic and the Baltic Sea.
The herring was of unprecedented significance to the economy of much of Northern Europe, and it was one of the most common commodities traded by the Hanseatic League , a powerful north German alliance of trading guilds. Kippers made from herring caught in the North Sea could be found in markets as far away as Constantinople. Stockfish , cod that was split down the middle, fixed to a pole and dried, was very common, though preparation could be time-consuming, and meant beating the dried fish with a mallet before soaking it in water.
A wide range of mollusks including oysters , mussels and scallops were eaten by coastal and river-dwelling populations, and freshwater crayfish were seen as a desirable alternative to meat during fish days. Compared to meat, fish was much more expensive for inland populations, especially in Central Europe, and therefore not an option for most.
Freshwater fish such as pike , carp , bream , perch , lamprey and trout were common. While in modern times, water is often drunk with a meal, in the Middle Ages, however, concerns over purity, medical recommendations and its low prestige value made it less favored, and alcoholic beverages were preferred.
They were seen as more nutritious and beneficial to digestion than water, with the invaluable bonus of being less prone to putrefaction due to the alcohol content. Wine was consumed on a daily basis in most of France and all over the Western Mediterranean wherever grapes were cultivated.
Further north it remained the preferred drink of the bourgeoisie and the nobility who could afford it, and far less common among peasants and workers. The drink of commoners in the northern parts of the continent was primarily beer or ale.
Juices , as well as wines, of a multitude of fruits and berries had been known at least since Roman antiquity and were still consumed in the Middle Ages: Medieval drinks that have survived to this day include prunellé from wild plums modern-day slivovitz , mulberry gin and blackberry wine.
Many variants of mead have been found in medieval recipes, with or without alcoholic content. However, the honey -based drink became less common as a table beverage towards the end of the period and was eventually relegated to medicinal use.
This is partially true since mead bore great symbolic value at important occasions. When agreeing on treaties and other important affairs of state, mead was often presented as a ceremonial gift. It was also common at weddings and baptismal parties, though in limited quantity due to its high price. In medieval Poland , mead had a status equivalent to that of imported luxuries, such as spices and wines.
Plain milk was not consumed by adults except the poor or sick, being reserved for the very young or elderly, and then usually as buttermilk or whey. Fresh milk was overall less common than other dairy products because of the lack of technology to keep it from spoiling. However, neither of these non-alcoholic social drinks were consumed in Europe before the late 16th and early 17th century.
Wine was commonly drunk and was also regarded as the most prestigious and healthy choice. According to Galen 's dietetics it was considered hot and dry but these qualities were moderated when wine was watered down.
Unlike water or beer, which were considered cold and moist, consumption of wine in moderation especially red wine was, among other things, believed to aid digestion, generate good blood and brighten the mood. The first pressing was made into the finest and most expensive wines which were reserved for the upper classes.
The second and third pressings were subsequently of lower quality and alcohol content. Common folk usually had to settle for a cheap white or rosé from a second or even third pressing, meaning that it could be consumed in quite generous amounts without leading to heavy intoxication. For the poorest or the most pious , watered-down vinegar similar to Ancient Roman posca would often be the only available choice.
The aging of high quality red wine required specialized knowledge as well as expensive storage and equipment, and resulted in an even more expensive end product. Judging from the advice given in many medieval documents on how to salvage wine that bore signs of going bad, preservation must have been a widespread problem.
Even if vinegar was a common ingredient, there was only so much of it that could be used. In the 14th century cookbook Le Viandier there are several methods for salvaging spoiling wine; making sure that the wine barrels are always topped up or adding a mixture of dried and boiled white grape seeds with the ash of dried and burnt lees of white wine were both effective bactericides , even if the chemical processes were not understood at the time. Wine was believed to act as a kind of vaporizer and conduit of other foodstuffs to every part of the body, and the addition of fragrant and exotic spices would make it even more wholesome.
Spiced wines were usually made by mixing an ordinary red wine with an assortment of spices such as ginger , cardamom , pepper , grains of paradise , nutmeg , cloves and sugar. These would be contained in small bags which were either steeped in wine or had liquid poured over them to produce hypocras and claré. By the 14th century, bagged spice mixes could be bought ready-made from spice merchants.
While wine was the most common table beverage in much of Europe, this was not the case in the northern regions where grapes were not cultivated. Those who could afford it drank imported wine, but even for nobility in these areas it was common to drink beer or ale , particularly towards the end of the Middle Ages. In England , the Low Countries , northern Germany , Poland and Scandinavia , beer was consumed on a daily basis by people of all social classes and age groups.
For most medieval Europeans, it was a humble brew compared with common southern drinks and cooking ingredients, such as wine, lemons and olive oil. Even comparatively exotic products like camel 's milk and gazelle meat generally received more positive attention in medical texts. Beer was just an acceptable alternative and was assigned various negative qualities. In , the Sienese physician Aldobrandino described beer in the following way:. But from whichever it is made, whether from oats, barley or wheat, it harms the head and the stomach, it causes bad breath and ruins the teeth , it fills the stomach with bad fumes, and as a result anyone who drinks it along with wine becomes drunk quickly; but it does have the property of facilitating urination and makes one's flesh white and smooth.
The intoxicating effect of beer was believed to last longer than that of wine, but it was also admitted that it did not create the "false thirst" associated with wine. Though less prominent than in the north, beer was consumed in northern France and the Italian mainland. Perhaps as a consequence of the Norman conquest and the travelling of nobles between France and England, one French variant described in the 14th century cookbook Le Menagier de Paris was called godale most likely a direct borrowing from the English "good ale" and was made from barley and spelt , but without hops.
In England there were also the variants poset ale , made from hot milk and cold ale, and brakot or braggot , a spiced ale prepared much like hypocras. That hops could be used for flavoring beer had been known at least since Carolingian times, but was adopted gradually due to difficulties in establishing the appropriate proportions. Before the widespread use of hops, gruit , a mix of various herbs , had been used. Gruit had the same preserving properties as hops, though less reliable depending on what herbs were in it, and the end result was much more variable.
Another flavoring method was to increase the alcohol content, but this was more expensive and lent the beer the undesired characteristic of being a quick and heavy intoxicant. Hops may have been widely used in England in the tenth century; they were grown in Austria by and in Finland by , and possibly much earlier. Before hops became popular as an ingredient, it was difficult to preserve this beverage for any time, and so, it was mostly consumed fresh.
Quantities of beer consumed by medieval residents of Europe, as recorded in contemporary literature, far exceed intakes in the modern world. For example, sailors in 16th century England and Denmark received a ration of 1 imperial gallon 4. Polish peasants consumed up to 3 litres 0. In the Early Middle Ages beer was primarily brewed in monasteries , and on a smaller scale in individual households.
By the High Middle Ages breweries in the fledgling medieval towns of northern Germany began to take over production. Though most of the breweries were small family businesses that employed at most eight to ten people, regular production allowed for investment in better equipment and increased experimentation with new recipes and brewing techniques. These operations later spread to the Netherlands in the 14th century, then to Flanders and Brabant , and reached England by the 15th century.
Hopped beer became very popular in the last decades of the Late Middle Ages. When perfected as an ingredient, hops could make beer keep for six months or more, and facilitated extensive exports.
In turn, ale or beer was classified into "strong" and "small", the latter less intoxicating, regarded as a drink of temperate people, and suitable for consumption by children. As late as , John Locke stated that the only drink he considered suitable for children of all ages was small beer, while criticizing the apparently common practice among Englishmen of the time to give their children wine and strong alcohol.
By modern standards, the brewing process was relatively inefficient, but capable of producing quite strong alcohol when that was desired. One recent attempt to recreate medieval English "strong ale" using recipes and techniques of the era albeit with the use of modern yeast strains yielded a strongly alcoholic brew with original gravity of 1. The ancient Greeks and Romans knew of the technique of distillation , but it was not practiced on a major scale in Europe until some time around the 12th century, when Arabic innovations in the field combined with water-cooled glass alembics were introduced.
Distillation was believed by medieval scholars to produce the essence of the liquid being purified, and the term aqua vitae "water of life" was used as a generic term for all kinds of distillates. Alcoholic distillates were also occasionally used to create dazzling, fire-breathing entremets a type of entertainment dish after a course by soaking a piece of cotton in spirits.
It would then be placed in the mouth of the stuffed, cooked and occasionally redressed animals, and lit just before presenting the creation. Aqua vitae in its alcoholic forms was highly praised by medieval physicians. In Arnaldus of Villanova wrote that "[i]t prolongs good health, dissipates superfluous humours, reanimates the heart and maintains youth. By the 13th century, Hausbrand literally "home-burnt" from gebrannter wein, brandwein ; "burnt [distilled] wine" was commonplace, marking the origin of brandy.
Towards the end of the Late Middle Ages, the consumption of spirits became so ingrained even among the general population that restrictions on sales and production began to appear in the late 15th century. In the city of Nuremberg issued restrictions on the selling of aquavit on Sundays and official holidays. Spices were among the most luxurious products available in the Middle Ages, the most common being black pepper , cinnamon and the cheaper alternative cassia , cumin , nutmeg , ginger and cloves.
They all had to be imported from plantations in Asia and Africa , which made them extremely expensive, and gave them social cachet such that pepper for example was hoarded, traded and conspicuously donated in the manner of gold bullion.
The value of these goods was the equivalent of a yearly supply of grain for 1. Sugar , unlike today, was considered to be a type of spice due to its high cost and humoral qualities. Even when a dish was dominated by a single flavor it was usually combined with another to produce a compound taste, for example parsley and cloves or pepper and ginger. Common herbs such as sage , mustard , and parsley were grown and used in cooking all over Europe, as were caraway , mint , dill and fennel.
Many of these plants grew throughout all of Europe or were cultivated in gardens, and were a cheaper alternative to exotic spices. Mustard was particularly popular with meat products and was described by Hildegard of Bingen — as poor man's food.
While locally grown herbs were less prestigious than spices, they were still used in upper-class food, but were then usually less prominent or included merely as coloring. Anise was used to flavor fish and chicken dishes, and its seeds were served as sugar-coated comfits.
Surviving medieval recipes frequently call for flavoring with a number of sour, tart liquids. Wine, verjuice the juice of unripe grapes or fruits vinegar and the juices of various fruits, especially those with tart flavors, were almost universal and a hallmark of late medieval cooking. In combination with sweeteners and spices, it produced a distinctive "pungeant, fruity" flavor.
Equally common, and used to complement the tanginess of these ingredients, were sweet almonds. They were used in a variety of ways: This last type of non-dairy milk product is probably the single most common ingredient in late medieval cooking and blended the aroma of spices and sour liquids with a mild taste and creamy texture.
Salt was ubiquitous and indispensable in medieval cooking. Salting and drying was the most common form of food preservation and meant that fish and meat in particular were often heavily salted. Many medieval recipes specifically warn against oversalting and there were recommendations for soaking certain products in water to get rid of excess salt.
The richer the host, and the more prestigious the guest, the more elaborate would be the container in which it was served and the higher the quality and price of the salt. Wealthy guests were seated " above the salt ", while others sat "below the salt", where salt cellars were made of pewter, precious metals or other fine materials, often intricately decorated. The rank of a diner also decided how finely ground and white the salt was. Symptoms may include stiffness, swelling and tenderness in the large muscles of the legs and back, dark urine, rapid heart rate, fever, nausea and vomiting.
Liver impairment or failure can also result from long-term use or high doses of other medications, including over the counter pain relievers, such as acetaminophen. Toxic effects of these medications can cause jaundice, fatigue, nausea, vomiting, diarrhea and loss of appetite. Video of the Day. What Does High Enzymes Mean? Elevated Liver Enzymes in Babies. Symptoms of Slightly Elevated Liver Enzymes.
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