Direct Uptake of Nutrition and Caffeine Study (DUNCS): biscuit based comparative study
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RESEARCH
BMJ: first published as 10.1136/bmj-2022-072839 on 19 December 2022. Downloaded from http://www.bmj.com/ on 9 December 2023 by guest. Protected by copyright.
Direct Uptake of Nutrition and Caffeine Study (DUNCS): biscuit
based comparative study
Ceri Jones, John Francis
Noah’s Ark Children’s Hospital, Abstract with a biscuit. Making time for a cup of tea may help
University Hospital of Wales, Objectives healthcare workers avoid their break point.
Cardiff CF14 4XW, UK To identify the time required to achieve optimal
Correspondence to: C Jones palatability of a cup of tea without risk of harm
ceri.jones4@wales.nhs.uk Introduction
(ORCID 0000-0001-8492-649X) (oral scalding) using the resources available in a Over recent years the public sector has faced immense
Additional material is published standard hospital staff room, and to identify the challenges, such as the covid-19 pandemic.1 2 During
online only. To view please visit best accompanying biscuit for nutritional content, difficult times, when morale and motivation have
the journal online. crunchiness, and integrity when dunking. been tested, one quintessentially British refreshment
Cite this as: BMJ 2022;379:e072839
http://dx.doi.org/10.1136/
Design has helped the nation to push through. Although the
bmj‑2022‑072839 Prospective, non-masked, biscuit based, comparative choice of hot drinks now available is extensive, a cup of
Accepted: 21 November 2022
study. tea remains the preferred choice3; when paired with a
Setting biscuit, this combination is rocket fuel for the National
Staff room in the surgery department of a UK hospital. Health Service.
Participants Staff wellbeing is important,4 5 and optimising staff
Four different varieties of round, non-chocolate hydration6 and nutrition can help to improve mood
biscuit: oat, digestive, rich tea, and shortie. A and performance. We have witnessed how NHS staff
standardised cup of tea was determined on the avoid breaks because of constraints on their time,
basis of the investigators’ preference for colour and often grabbing substandard refreshments in a rush. As
palatability and pragmatic tea making methods. scientific evidence is lacking on best snack practice,
most healthcare workers are forced to rely on their
Main outcome measures
The main outcome was time to achieve a safe own experience. Efficient tea making skills and a
temperature for consumption of tea, and the best good quality accompanying biscuit are important for
biscuit to pair with the tea on the basis of nutritional healthcare workers, who deserve to have a brew-tiful
content, absorptive ability, crunchiness, and integrity day.
after dunking. Biscuits were ranked first to last Freshly boiled water is an important part of the
(according to scores 1-4), with penalty points given for tea making process, but this raises concerns about
adverse events such as scalds and breakability. the risk of oral scalding if busy healthcare workers
are tempted to consume a beverage before it reaches
Results
a safe temperature. The choice of accompanying
Baseline data suggested that after adding 240 mL of
biscuit is also important. If staff prefer dunking, will
freshly boiled water to an unwarmed mug containing
their biscuit of choice survive immersion and sustain
a tea bag, the median temperature of a standard cup
of tea was 82°C (range 81-84°C). Optimal palatability crunchiness?
and agreed universal drinking temperature of 61°C We identified the time taken to produce a safe,
was achieved at 400 (range 360-420) seconds with palatable cup of tea. In keeping with the tradition of tea
30 mL of cow’s milk and 370 (330-450) seconds with paired with a biscuit, we assessed four biscuit varieties
40 mL of milk. The investigators considered tea colour for nutritional content and durability after dunking.
preferable with 40 mL of milk.
Conclusion Methods
Healthcare workers can safely consume a cup of Biscuit selection
tea after less than 10 minutes, especially if enjoyed Based on extensive research from years of frequenting
staff rooms in NHS hospitals, we identified four
What is already known on this topic biscuits most commonly found in staff biscuit tins—
oat, digestive, rich tea, and shortie. We describe and
Maintaining adequate nutrition and hydration improves mood and performance
quantify the desirable characteristics (eg, nutritional
Previous studies have reported on the effects of dunking biscuits, such as
content and integrity when being dunked) of these
permeability and breakage
biscuits when paired with a safe, palatable cup of tea.
A cup of tea is important in UK popular culture To minimise the risk from heterogeneity, we limited our
What this study adds selection to single layer, non-coated, non-filled biscuit
varieties.
A cup of tea with biscuits can be enjoyed within just 10 minutes
Of four biscuits studied (oat, digestive, rich tea, and shortie) the oat biscuit
Preparing a standard cup of tea
maintained its integrity better when being dunked in a standard cup of tea
We performed a pilot experiment to determine the best
The pragmatic dunk break point of the oat biscuit was 29 seconds compared with volumes of water and cow’s milk (this being to our
Christmas 2022: R-E-S-P-E-C-T
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workers) required for NHS staff to make a standard cup would be the standard and would allow the addition
of tea in a timely manner; this baseline data informed of 30-40 mL of milk.
subsequent tests. We reviewed existing literature to The mutually agreed tea making process involved
identify a standardised methodology; however, the pouring 240 mL of freshly boiled water over a single
findings were inconsistent or had historical reasoning tea bag in an unwarmed mug. JF stirred the tea bag
not in keeping with the contemporary workplace. gently with a metal spoon for 60 seconds (checked by
One of us (JF) prepared all cups of tea throughout the CJ), before giving it a gentle squeeze and extracting
study, and the other (CJ) monitored relevant times with it from the cup. The milk was taken straight from the
a stopwatch and recorded data. As the tests involved fridge (temperature set to 4ºC) and as soon as it was
risks, health and safety was taken into consideration added to the tea, the stopwatch was started (time zero).
and we refreshed our good cuppa preparation (GCP) The temperature of the tea was measured at 30 second
training before the study. Equipment was checked intervals using a thermometer (fig 1). We both slurped
thoroughly, syringes were designated for enteral use the tea to assess palatability and the potential for oral
only, and emergency equipment, including cold water, scalding. Testing for palatability was repeated every
kitchen roll, a mop, and a food waste bin were readily 30 seconds. Data were collected on the rate the tea
available. temperature dropped and the overall time required for
Throughout the study, tea was prepared in a comfortable, and therefore potentially safe, drinking
standardised, newly purchased, unchipped porcelain temperature to be achieved. Two volumes of milk
mugs, each with a liquid holding capacity of 310 (30 mL and 40 mL) were initially investigated, and
mL. Taking into account the non-filled void for safe we both reviewed the tea’s colour, palatability, and
carriage and a comfortable slurp rim, we determined cooling time—or time to drinkable tea (TTDT). Based
that the total fluid volume (water plus milk) could not on our pilot experiment findings, we used 40 mL of
exceed 280 mL. We then agreed that 240 mL of water semi-skimmed cow’s milk to prepare standard cups of
tea for all six tests.
Visual summary The DUNC Study Biscuit tests
Direct Uptake of Nutrition
utrition and Caffeine
Time to drinkable tea; the impact of dunking
Optimising staff hydration and nutrition is key The first biscuit test was used to determine TTDT. JF
for a successful health service. We identified Preparing a “standard brew”
the time required for the safe preparation and prepared a standard cup of tea, and the temperature
Preparing a standard “NHS-style” brew involved pouring 240 mL
consumption of a cup of tea and the best
accompanying biscuit to provide the most
freshly boiled water over a single tea bag placed inside an unwarmedd was monitored throughout the test. CJ started the
nd
mug. It was stirred gently for 60 seconds before a gentle squeeze and
effective and refreshing uptake of caffeine, extraction. 40 mL semi-skimmed cow’s milk, taken straight from the e stopwatch at time zero (addition of 40 mL of milk); at
hydration, and nutrition, without the adverse ents
fridge (4°C), was added. Milk addition was time zero for the experiments
events of spillage, scalds, or biscuit breakage this point JF selected two biscuits from a packet and
Biscuit tests dunked each into the tea—one at 30 seconds and one
Oat Digestive Shortie
horrtie
ho Rich tea
tea
The investigators identified 4 biscuits making regular appearances in NHS at 60 seconds; these intervals representing natural
biscuit tins. Each of these biscuits was subjected to rigorous experiments,
designed to qualify and quantify desirable biscuit characteristics. first and second biscuit dunks during a tea break
Experiments were repeated 3 times per biscuit
and determined over many years of the authors’ time
1 Time to drinkable tea (TTDT) working in the NHS. We recorded tea cooling and
2 biscuits, selected at random from the packet, were
Median TTDT 270 240 300 300
dunked into the tea, one at the 30 second interval, one
(seconds) (270-300) (210-240) (270-300) (300-330)
TTDT data for each biscuit variety and repeated the
at 60 seconds. Making tea more palatable quicker is
preferable and the biscuit reducing the TTDT the most
TTDT reduction 100 130 70 70 tests three times with freshly prepared cups of tea. The
(seconds) (70-100) (130-160) (70-100) (40-70)
was seen as the winner
biscuit with the shortest TTDT was ranked first (score
2 1 3 4
2 Nutritional content
3 biscuits from each packet were chosen at random for Weight, g 15 15 11 10
1) and the biscuit with the longest TTDT was ranked
weighing, and energy content (calories) recorded from
the packets. The biscuit with the highest calorie per kcal / biscuit 70 67 65 43
last (score 4).
biscuit value was deemed the best in test 1 2 3 4
3 Saturation volume
Saturation
Nutritional content
Tea was syringed onto the centre of each biscuit in 1mL
increments. The winner was the biscuit that absorbed the
volume
(median, mL)
5 5 4 9 To assess the nutritional content of each biscuit and to
highest volume before permeation onto a doily below 2 3 4 1
corroborate the findings with the information provided
4 Crunch reduction
Crunch scores were recorded using a decibel Crunch reduction (dB) 16.3 9.6 19.3 18 by the manufacturers, we weighed three randomly
meter before and aer adding 2 mL of tea. The
winner was the biscuit with the smallest Crunch reduction (%) 22 15 32 23 chosen biscuits from each of the four packets. We then
compared the recorded weights with those shown on
reduction in crunch volume 2 1 4 3
5 Dunk break point the relevant packet and reviewed the energy content
Mean,
Biscuits were held between thumb and index finger, dunked into 34.3 28.3 31.7 21.3
a fresh brew, and gently moved back and forth until they fell into seconds
1 3 2 4 (kcal). The biscuit with the highest energy content
the tea. The biscuit enduring the longest dunk was the winner
3 penalty points applied was ranked first (1 point) and the one with the lowest
6 Pragmatic dunk break point for biscuit breakage
Biscuits were dunked for 2 seconds into a fresh standard brew,
Mean,
seconds 29 8.5 17.5
RESEARCH
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biscuit variety) and the percentage reduction in crunch
volumes were calculated. The biscuit with the smallest
reduction in crunch volume was ranked first (score 1).
Dunk break point
The dunk break point test was used to identify the
biscuit that would be best for dunking. One of each
biscuit variety was held firmly between thumb and
index finger (the universal dunking grip) before
being dunked into a standard cup of tea as far as the
fingertips. The biscuit was gently moved back and
forth until the dunked portion broke away and sank
(the dunk break point). JF dunked the biscuits while
CJ recorded the dunk break point. The biscuit that took
the longest to reach the dunk break point was ranked
first (score 1).
Fig 1 | Standardised equipment for tea making, temperature control, and colour of tea
Pragmatic dunk break point
onto the centre of each biscuit in 1 mL increments. We The test for pragmatic dunk break point imitates the
then inspected the doilies for signs of tea (fig 2) and real world of tea and biscuit pairing more closely. JF
recorded the volume of tea required before permeation selected a biscuit from each packet in turn and dunked
to the doily. The biscuit that absorbed the largest it (using the universal dunking grip) for two seconds
volume of tea before signs of permeation was ranked into a cup of freshly brewed tea. The biscuit was then
first (score 1). held away from the cup and the time recorded until
the biscuit fell apart. The biscuit that maintained its
Crunch reduction integrity for the longest after being dunked was ranked
To test for crunchiness after a biscuit had been dunked, first (score 1). Biscuits were given penalty points if they
JF first selected three biscuits at random from each broke apart before being moved away from the cup (the
packet and then determined the baseline crunch score floater effect).
of each biscuit variety by breaking the biscuits in half
next to a decibel meter (app on smartphone). Three Statistical analysis
more biscuits were then selected from each packet. For all six tests, each biscuit variety was ranked based
Using another syringe, 2 mL of freshly brewed tea was on median and mean scores, with a score of 1 (ranked
then dripped onto the centre of each biscuit. Each first) assigned to the biscuit with the best result and
treated biscuit was immediately broken in half next a score of 4 (ranked last) assigned to the biscuit with
to the decibel meter and the crunch score recorded. the worst result. We added the scores for each test
For comparative purposes, both dry and wet crunch together, with each test given equal weighting in the
volumes were recorded (three sets of data for each scoring process. The biscuit with the lowest overall
score was thus considered the best biscuit.
Patient and public involvement
Members of the public were not involved in the design
of the study. The manuscript, however, has been
received with interest.
Results
Preparing a standard cup of tea
Baseline data suggested that the initial median
temperature of a standard brewed cup of tea was
82ºC (range 81-84ºC) after adding 240 mL of freshly
boiled water to a single teabag in an unwarmed mug.
After gently stirring for 60 seconds, removing the tea
bag, and adding the milk we observed temperature
drops of 10ºC (range 9-10ºC) with the addition of 30
mL milk and 11ºC with the addition of 40 mL milk.
The tea further cooled by 1ºC every 30 seconds.
Optimal palatability and agreed universal drinking
temperature was 61ºC, which was achieved at 400
(360-420) seconds with 30 mL of milk and 370 (330-
450) seconds with 40 mL of milk. We preferred the
Fig 2 | Saturation volume test for each biscuit colour of tea with 40 mL of milk.
the bmj | BMJ 2022;379:e072839 | doi: 10.1136/bmj-2022-072839 3Christmas 2022: R-E-S-P-E-C-T
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Table 1 | Baseline time to drinkable tea (TTDT) and dunking by biscuit variety in a freshly 8-9) mL of tea before permeating to the doily. The results
brewed standard cup of tea for the oat biscuit and digestive were comparable. The
Median (range) TTDT (sec) TTDT reduction (sec) Score shortie was ranked fourth (4 points), absorbing a
Milk volume (mL) median of 4 (3-4) mL of tea during the three tests.
30 400 (360-420) - -
40 370 (330-450) - - Crunch reduction
Biscuit dunked
The digestive was ranked first (1 point) for crunch
Oat 270 (270-300) 100 (70-100) 2
Digestive 240 (210-240) 130 (130-160) 1 reduction (table 2), with a 15% reduction in crunch
Rich tea 300 (300-330) 70 (40-70) 4 volume. The results for the oat biscuit and rich tea
Shortie 300 (270-300) 70 (70-100) 3 were comparable, and the shortie was ranked fourth (4
points), with a 32% reduction in crunch volume.
Time to drinkable tea: impact of dunking
The TTDT for all four biscuits decreased during dunking Dunk break point
at 30 and 60 second intervals (table 1). The digestive The oat biscuit ranked first in the dunk break point
showed the most significant reduction (median TTDT test, with a mean dunk time of 34.3 seconds to dunk
240 (range 210-240) seconds) and was ranked first break point (table 3). The shortie was ranked second,
(1 point), with the rich tea showing the least reduction with a mean 31.7 seconds to dunk break point,
(median 300 (300-330) seconds) and ranked fourth followed by the digestive (ranked third) and rich tea
(4 points). (ranked fourth), with 28.3 seconds and 21.3 seconds,
respectively.
Nutritional content
No discrepancies were found between the recorded Pragmatic dunk break point
weights of biscuits and the weights given on the The oat biscuit ranked first in the mean pragmatic
packets for all four biscuit varieties (table 2). The oat dunk break point test, with 29 seconds compared with
biscuit had the highest energy content (70 kcal/biscuit; 17.5 seconds for the shortie (ranked second) and 8.5
1 kcal=4.18 kJ) and was ranked first (1 point), and the seconds for the digestive (ranked third). The rich tea
rich tea had the lowest energy content (43 kcal/biscuit) was ranked fourth; it was also given three additional
and was ranked fourth (4 points). penalty points for having the lowest dunk break point
in all three repeat tests.
Saturation volume
The rich tea was ranked first (1 point) in the saturation Overall biscuit scores and best performing biscuit
volume test (table 2), absorbing a median of 9 (range The oat biscuit ranked first after all six tests (table 4).
The digestive ranked second—it crumbled in three
tests of absorptive capability and structural integrity
Table 2 | Nutritional content, saturation volume, crunch reduction, and dunk break point
(saturation volume, dunk break point, and pragmatic
by biscuit variety
dunk break point). The shortie was ranked third,
Biscuit variety
whereas the rich tea (the only biscuit given penalty
Oat Digestive Rich tea Shortie
points) was ranked fourth; the penalty points did not
Nutritional content
Weight (g) 15 15 10 11 directly influence the rich tea’s ranking.
Energy content:
kcal 70 67 43 65 Discussion
Score 1 2 4 3 Good hydration and nutrition are fundamental,
Saturation volume (mL)
whether in the context of protocols for enhanced
1 5 5 9 4
recovery after surgery,7 trace element replacement
2 6 5 8 4
3 5 5 9 3 on the intensive care unit, or simply avoiding
Median (mL) 5 5 9 4 “hangriness.”8 Optimising fluid and energy intake is
Score 2 3 1 4 essential for peak performance. As with elite athletes
Crunch volume (decibels) who require expert diet management to optimise
Dry test No: performance,9 healthcare workers also need to perform
1 75 62 78 62
at their best. Tea and biscuits are part of British culture,
2 70 67 81 64
3 77 61 80 55 and it would be beneficial to harness the rejuvenation
Mean 74 63.3 79.7 60.3 provided by the pairing of these two and to deliver
Wet (2 mL tea) test No: them to healthcare workers directly.
1 60 54 59 39 Although the study results varied, important
2 56 52 66 42 findings were that it takes around 400 seconds for a
3 57 55 60 42
cup of tea to reach optimal palatability (61ºC) with 30
Mean 57.7 53.7 61.7 41
Crunch volume:
mL of milk, and just 370 seconds with 40 mL of milk.
Decibels 16.3 9.6 18 19.3 A healthcare worker can expect to enjoy a cup of tea
Percentage reduction 22 15 23 32 in less than 10 minutes and paired with an oat biscuit
Score 2 1 3 4 (ranked first overall in all six tests) can help towards
1 kcal=4.18 kJ=0.00418 MJ. improved sustenance.
4 doi: 10.1136/bmj-2022-072839 | BMJ 2022;379:e072839 | the bmjRESEARCH
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Table 3 | Dunk break point by biscuit variety The British public will have many anecdotal views
Biscuit variety on how to brew and enjoy a cup of tea—the late
Oat Digestive Rich tea Shortie Queen Elizabeth II and Paddington Bear included.11
Dunk break point (sec) Although tea making facilities are accessible to most
1 35 29 21 33 NHS workers, constraints on time mean that certain
2 31 30 21 28 compromises must be made when preparing a cup of
3 37 26 22 34 tea. One debatable and popular culture point that was
Mean (sec) 34.3 28.3 21.3 31.7
addressed was when to add milk.10 The investigators
Score 1 3 4 2
of the current study can confirm that although it may
be reasonable when using fine bone china cups to add
Strengths and limitations of this study milk first to protect the cup from hot tea, this is not
Leafing through the literature and steeping ourselves relevant to NHS workers, who often have a wide choice
in the evidence, we were unable to identify a of mugs available. Such mugs have stood the test of
pragmatic recipe for brewing a standard cup of tea. time, and often just finding milk is a triumph.
Although we appreciate that opinions differ widely
on how to brew a palatable cup of tea,10 waiting Comparison with other studies
3-4 minutes for tea to brew is unrealistic for all but Previous research into biscuit dunking has
the most senior of NHS managers. We are confident predominantly focused on how quickly biscuits break
that our study methods reflect a real world approach as a popular science experiment for schoolchildren
to tea making in NHS staff rooms. Each biscuit was aged 5-7 years. A previous study applied the Washburn
assessed and scrutinised in an open and unbiased equation—a more mathematical approach to the
manner, although both of us acknowledge a personal optimum dunk as it describes capillary flow in porous
preference for the shortie. materials.12
Our study addressed the multifactorial nature of tea
making and biscuit choice to better inform NHS staff Conclusion
when having a tea break. We used the time needed to NHS staff can easily enjoy the pairing of a cup of tea
brew and consume a standard cup of tea as a proxy for with a biscuit in less than 10 minutes. Biscuit dunking
the time needed to have a restorative tea break, and has a beneficial effect on tea cooling and should
we identified the cooling effect of a dunked biscuit be encouraged, and the oat biscuit was the best at
that might help in the consumption of this beverage. achieving this when compared with the digestive, rich
Although we performed six tests, the joy of dunking a tea, and shortie. Making time for a cup of tea is an
biscuit never waned and, at times, actually provided important daily ritual, and it should be encouraged to
hilarity. This joyfulness enhanced the tea break help improve the mood and performance of healthcare
experience and this could have an important place in workers.
teambuilding and connectedness between different Contributors: The authors contributed equally to the design,
hierarchies and disciplines; a powerful influence to be implementation, funding, and drafting of the manuscript. Both
authors are guarantors. The corresponding author attests that all
considered.
listed authors meet authorship criteria and that no others meeting the
We limited our biscuit choice, excluding chocolate and criteria have been omitted.
cream variants with their potential for high desirability Funding: No funding was available for this study. The investigators
as we believed it important to limit the distraction and purchased study materials (mugs, biscuits, tea bags, and milk) out of
potential finger licking that usually occurs when eating pocket.
Competing interests: All authors have completed the ICMJE uniform
biscuits with cream or chocolate fillings. The sticky and
disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no
licked finger scenario is not compatible with a healthcare support from any organisation for the submitted work; no financial
environment and should be reserved for non-work time. relationships with any organisations that might have an interest in the
Future research will include an observation of sandwich submitted work in the previous three years; no other relationships or
activities that could appear to have influenced the submitted work.
style biscuits, such as the classic custard and bourbon
Ethical approval: Despite actual biscuit harm being planned
creams; perhaps studies on the biscuit filled with jam we successfully buttered up the local research and development
could be enlightening. department and were given full approval to dunk, break, and eat the
participant biscuits.
Data sharing: Dataset is available from corresponding author
Table 4 | Overall test scores by test and biscuit variety (ceri.jones4@wales.nhs.uk)
Biscuit variety The manuscript’s guarantors (both authors) affirm that the manuscript
Test Oat Digestive Shortie Rich tea is an honest, accurate, and transparent account of the study being
reported; that no important aspects of the study have been omitted;
TTDT 2 1 3 4 and that any discrepancies from the study as planned (and, if relevant,
Nutritional content 1 2 3 4 registered) have been explained.
Saturation volume 2 3 4 1 Dissemination to participants and related patient and public
Crunch reduction 2 1 4 3 communities: We have not disseminated the information at
Dunk break point 1 3 2 4 present but continue to share the information within our regional
Pragmatic dunk break point 1 3 2 4+3* multidisciplinary team meetings.
Overall score 9 13 18 23 Provenance and peer review: Not commissioned; externally peer
Overall rank 1 2 3 4 reviewed.
TTDT=time to drinkable tea. This is an Open Access article distributed in accordance with the
*Includes penalty points. Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license,
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which permits others to distribute, remix, adapt, build upon this work 6 Stachenfeld NS, Leone CA, Mitchell ES, Freese E, Harkness L.
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