Anorexia – written by my patient Eli

 

Eli is 19 and came to me in September desperately seeking help with her anorexia. Despite years of hospital stays and outpatient treatment Eli has struggled to recover. I am working with Eli, her psychologist and her family to slowly her move towards a more normal and contented life. Thank you Eli for your hard work, courage and determination.

By Eli………….
Eating disorders are sadly on the rise and are a very complicated mental illness to help cure or manage. I’m writing this blog post to raise awareness about eating disorders but particularly Anorexia Nervosa; something that anyone at all can suffer from. I find it a bit strange because eating disorders aren’t actually about food – instead food is used as a means of coping with something much deeper that is causing emotional trauma that needs controlled and for some reason and in my case that’s avoiding or restricting my dietry intake.
Eating disorders don’t just appear one day and don’t just dissapear either – they also aren’t caused by one event or situation but many that have collated together and caused your body to need to develop this vile illness. Eating disorders have many disadvantages and also some advantages for people which makes it so hard to let go, they are controlling, manipulating, a bully but they also provide a sense of security and power.
Eating disorders are so hard to fight against and we all need a little support along the way both from a therapist and a dietician. Sometimes these people are suddenly some of the most valuable and most trusting in your life – certainly for me.
This blog post is a bit random! But i did it as a means of giving a brief summary of eating disorders from my view and hopfully I will write more and share more about different aspects within living, coping and recovering from Anorexia.
Thanks ūüėÄ

Trans Fats – what do I need to know?

I’m always being asked about fats…….”which fats are good” or “which fats are bad”.¬†While it is clear that we all need to include some fat in our¬†diets to remain healthy, not all fats are equal.

What are trans fats?

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Trans fats are the baddies, the grizzly little gremlins of the food world. They are:

  • Artificially produced as an ingredient for biscuits, pies, cakes and fried food
  • Produced when vegetable fats are subjected to a very high temperature e.g. takeaway foods
  • Naturally occurring in small amounts in dairy e.g. cheese and cream

Health concerns about these fats has recently led to many UK manufacturers reducing the amounts of trans fats in foods. In 2006 United Biscuits, who produce McVities, KP and Jacobs ranges, removed trans fats from their products. Marks & Spencer, as well as many other supermarket chains, also banned the use of trans fats in own brand products.

Why are trans fats bad for me?

Trans fats raise levels of ‚Äėbad‚Äô LDL cholesterol and reduce the ‚Äėgood‚Äô HDL cholesterol. Trans fats also increase levels of another form of blood fat called triglycerides. All of these effects of trans fats can raise your risk of coronary heart disease (CHD).

Trans fats appear to increase risk of CHD more than saturated fats, and so are potentially worse for our health.

How do I know if a food is high in trans fats?

ConfusedYou need to check ingredients lists for partially hydrogenated fats.

A ‚Äėhydrogenated fat‚Äô does not contain trans fat, only ‚Äėpartially hydrogenated fats‚Äô contain¬†trans fats. If a food product contains partially hydrogenated fats or oils, it will almost certainly contain trans fats too, and the higher¬†up the list the fat or oil appears, the more trans fats the product is likely to contain.

Many manufacturers now avoid using hydrogenated fats or have reduced the amount of trans fats in their products to very low levels.

 Unfortunately for takeaway food in can be harder to tell as nutrition labelling may not exist. Big takeaway companies like McDonalds have removed artificial trans fats from their menus, however, small takeaway outlets may still use trans fats for cooking.

Take home message……

The good news is that in the UK intakes of trans fats are on average lower than the guidelines. In the last 20 years, levels of trans fat in food have reduced considerably.

However as part of a healthy diet, you should aim to keep the amount of trans fats to a minimum. In general trans fats may be found in takeaways, cakes, biscuits, hard margarines, pastry, pies and fried foods, all of which are the types of foods to limit when choosing a healthy, balanced diet.

5 Ways to NOT look haggard

When a lady gets to a certain age, we start to sit up and take notice of tubs of expensive face creams. The word anti-ageing is banded about the beauty industry with aplomb, and the pseudo science convinces us of the latest miracle product will make us look ten years younger.

Don’t get me wrong, there is some good stuff out there. According to London skin guru¬†Caroline Hirons¬†there are only a few ingredients that have scientific backing for effectiveness (in true dietitian style, scientific evidence is everything). Specific ingredients to look out for include sun protection (SPF), vitamin A/retinol, and glycolic/lactic/salicylic acid.

As a teenager, I would devour hand me down magazines from my Auntie Ann.¬†images.jpegMagazines are mostly full of nonsense, but I did pick up one tip: using sun screen everyday. I’ve been doing this since I was 16, I think it’s made a difference……..although recently there are times when I catch a reflection of myself in a shop window and think “s***¬†I could give Iggy Pop a run for his money”.¬†¬†We all know stress, sleep deprivation and smoking are bad for our skin, and I¬†can tick a box for all three (my ‘social’ smoking habit as a student was hopefully so short lived that no long term image was done)

Here are 4 ways to look after your skin…….

    1. Smoking – if you do this, and you don’t want to have skin like an old bag. Stop. Simple as.
    2. Sun – don’t stick your face in the sun everyday to get a tan (or a ‘tawn’ as we say here in Northern Ireland). Be sensible. A little sun is important for vitamin D, but you can get this from exposing arms and legs for 20 minutes without sun cream. For your face, protect it from the sun. Apparently you don’t necessarily need to use a separate suncream everyday as a lot of moisturisers and foundations have an SPF.
    3. Sugar and refined carbohydrates – there had to be a dietary contribution to this post! If you want to reduce the wrinkles, step away from the sugar. In a nutshell, skin¬†damage from the inside may be¬†caused by a reaction called ‘glycation’. This is a process in which collagen fibres (the scaffolding of your face) are reduced in elasticity by losing the cross links between the fibres, leading to wrinkles and lines. Sugar and reined carbohydrates also promotes inflammation in the body, which is not good for the skin.
    4. Healthy fats – Essential Fatty Acids are important for a multitude of functions in your body. If you’re not getting enough EFAs in your diet, your skin may be dry, red and¬†more prone to spots. EFAs can improve skin conditions such as psoriasis and eczema. Fats are also needed for your body to absorb vitamins A, C, D and K.
    5. Sleep – this seems like kind of an obvious one, but fundamental to the cause! In a study published in 2015,¬†chronic poor sleep quality is associated with increased signs of ageing, diminished skin barrier function and lower satisfaction with appearance. I have a number of clients who have reported that one¬†of the happy ‘side effects’ of improving their¬†diet has been better sleep: a very unscientific and anecdotal statement for me to make, but worth mentioning.

Anti ageing diet:

AVOID:

  • sugars – I’m not saying ‘never’, but keep in check¬†sugar, brown sugar, coconut sugar, ¬†honey, agave syrup, glucose, sucrose, dextrose, fructose, corn syrup etc. Yes, unfortunately even the trendy sugars are ‘sugar’.
  • high glycaemic index foods –¬†These are refined carbohydrates which are digested quickly – white breads, white rice, cakes, biscuits, fruit juice, sweet fizzy drinks, energy drinks etc.

DO EAT:

    • healthy fats¬†– these are anti inflammatory and help to keep blood sugar levels lower – salmon, mackerel, sardines, flaxseed, walnuts, cashews, olive oil, avocado, pumpkin seeds, sunflower seeds. Here’s a guide to¬†healthy fats. Healthy fats in sensible amounts are good. If¬†you are overweight then go easy on these – have a handful of nuts rather than the bag, one mackerel fillet not three.
    • whole grains –¬†replace refined carbs (generally anything made with white flour or sugar) with wholesome alternatives as these have a lower glycaemic index so keeping blood sugar levels down. Beans, lentils and oats are particularly good.
    • antioxidants –¬†sunlight and smoking¬†cause oxidative damage by generating ‘reactive oxygen
      Eat it, don't lie in it

      Eat it, don’t lie in it!!

      species’. So lots of vegetables, the more variety in colour the better…..red cabbage, broccoli, asparagus, avocado, beetroot, kale, carrots, peppers, and spinach. Fruit is good too with top marks for deeply coloured strawberries, blackberries, blueberries, raspberries, plums, apples. Green tea and black tea (builder’s tea).

So in a nutshell (excuse the pun!!), here’s yet another reason fill your boots with loads of colourful veg, some fruit, oily fish, nuts, lentils, beans, and other whole grains. If you need recipe ideas, here you go:¬†recipes.

 

 

IBS? Heard of FODMAPs?

New low FODMAP diet for IBS: 75% see significant improvement

If you were to tell me 15 years ago, when I was a newly qualified dietitian at St George’s Hospital in London, that I would specialise in treating IBS, I would have thought you wereshutterstock_52604065 crazy. Back then we just didn’t have good answers for people suffering with Irritable Bowel Syndrome.

Irritable Bowel Syndrome is a disorder where the bowel looks normal, but it doesn’t function properly. It is incredibly common, affecting about 1 in 5 people in the UK. The diagnosis of IBS is usually made when other conditions such as coeliac disease, Crohn’s Disease, colitis, have been ruled out. Symptoms include bloating, wind, diarrhoea, constipation, acid reflux, nausea and abdominal pain.

UnknownThe Low FODMAP Diet has been published in international medical journals and is now accepted and recommended as one of the most effective dietary therapies for IBS and other digestive conditions. In February 2015 it was added to the National Institute of Clinical Excellence’s IBS treatment guidelines.
Elimination phase: high FODMAP foods eliminated for 2-4 weeks
Reintroduction phase: high FODMAP foods systematically reintroduced to identify your problem foods (not everyone reacts to the same FODMAPs)
It is important to have the advice of an experienced dietitian to help guide you along your low FODMAP journey

Here some great information all about the low FODMAP Diet: FODMAPs

And here is what some of my patients say:

Miss VG, IBS, marathon training (April 2016) The low FODMAPs is going very well, it has helped a lot with my symptoms. I was quite surprised how well it has worked!

Mr RD, IBS (March, 2016): Hi Sarah. Hope you‚Äôre well; I came to see you a year ago to help with IBS issues which have improved dramatically. I very rarely suffer any of the symptoms I used to ‚Äď brain fog, stomach cramps etc and find I‚Äôve been able to reintroduce a lot of foods that did give me problems previously, so thanks again!

Miss J, IBS (February, 2016): This week is my 4th week on the FODMAP diet and so far so good. I’m actually really enjoying it and have discovered some lovely new recipes. It’s made a very noticeable difference in terms of bloating, cramping and wind which is fantastic. My skin has also improved too.

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IBS: Are you the 1 in 5?

An astonishing 1 in 5 people suffer with digestion issues such as bloating, abdominal pain,shutterstock_52604065 constipation or diarrhoea, excessive wind, heartburn and nausea. Usually the diagnosis is irritable bowel syndrome (IBS).

When a doctor or gastroenterologist has diagnosed IBS (you should not diagnose yourself) this is good news, as it means your symptoms are not due to anything more serious, such as Coeliac Disease or bowel cancer. However, coping with and managing the symptoms can be challenging. Unfortunately there is no pill or supplement that is a magic fix.

The good news? IBS CAN BE TREATED EFFECTIVELY with a low FODMAP diet. It has been so successful and popular with my clients that it has become my speciality. I have been inundated with requests for help, and even see clients via Skype if they can’t travel in person to the clinic. The vast majority have a major improvement, which make me a very, very happy dietitian!

The low FODMAP diet is¬†relatively¬†new. It is a¬†rigourously¬†scientifically tested¬†dietary treatment that produces a significant Unknownreduction in symptoms for 75-80% of people. The FODMAP Diet was originally developed at Monash University, Australia; and recently more ¬†research has been carried out at King’s College, London. The low FODMAP diet is increasingly being used by gastroenterologists and dieticians to successfully manage the tummy problems.

What are FODMAPs?

FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. Quite a mouthful (excuse the pun)! These foods have one thing in common: they are all carbohydrates that the gut poorly absorbs and are quickly fermented by the bacteria  causing the bloating, wind, diarrhoea or constipation and pain. There is quite a long list of foods that are high in FODMAPs, and not everyone with IBS reacts to the same foods.

What foods are high FODMAP?

You may be surprised that many foods considered good for digestion are high FODMAP, and therefore can aggravate IBS. These include wheat, onions, garlic, apples and pears, lactose found in dairy products, beans and lentils.

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Sourced from Monash University (2015)

The FODMAP Diet

The¬†FODMAP diet is not a diet for life. It is a ‘learning diet’, where all high FODMAP foods are removed for approximately 2-4 weeks. Many people see improvements within a few days. After this elimination phase, foods are reintroduced in a systematic way to identify which foods you react to. This stage is extremely important so that you are not excluding foods unnecessarily.

IBS and FODMAPs can be confusing, with a lot of conflicting advice on the internet. WhenConfused
done well, the low FODMAP diet can be very effective. If you want to try see if it helps you, it is advised¬†that you seek guidance from a Registered Dietitian with experience in the Low FODMAP Diet. Your GP can refer you within the NHS, or a list of private dietitians in your area can be found on the¬†Freelance Dietitian’s website.

I hold clinics at Kingston Health Centre and also offer Skype appointments.

Here’s what my patients say:

Miss J, IBS (February, 2016): This week is my 4th week on the FODMAP diet and so far so good. I’m actually really enjoying it and have discovered some lovely new recipes. It’s made a very noticeable difference in terms of bloating, cramping and wind which is fantastic. My skin has also improved too.

Miss R, France, diarrhoea predominant Irritable Bowel Syndrome (December, 2015) Hope you’re well I just thought I would drop you an email to let you know how I am doing. I have been on fodmap for a week now. After three days I could see a big difference to the way my tum felt and my digestive symptoms I feel great!

Mrs H, ulcerative colitis. (November, 2105): Your advice has given me some hope that I can manage my health much better and, who knows, hopefully avoid an operation. I think my gut is already beginning to improve, less gurgling, bloating and twinges, so I’m very pleased so far. (January 2016): I am so happy that you have helped me to help myself, I just wish that I had done something like this before, still better late as they say.

Good sources of information on FODMAPs:

A great article all about FOMDAPs

Monash University FAQs

A great (and reliable!) FODMAP blog with recipes

 

 

8 Cures for Constipation

Constipation is something that most people suffer from time to time, or for the unlucky, everyday. It’s also something that most people don’t like to talk about, even to their doctor. It¬†can make you feel horrible, lethargic and bloated.¬†images-2

Not everyone has a bowel movement daily, but you may have constipation if you pass fewer than three stools a week, if you pass hard stools, strain more than usual or if you feel that you haven’t completely emptied your bowel. Get¬†a check-up from your doctor just to make sure a medical condition isn’t causing the problem, especially if you’ve never been constipated before now, you have stomach pain, you’ve noticed blood in your stools or you’re losing weight without trying.

Here are the most common causes of constipation:

  • Diet: not enough fruit/veg/wholegrain food, (common with people adopting a high protein diet for weight loss/muscle gain) or eating too many refined foods e.g. white bread, pastries, pasta, biscuits, cake etc.
  • pregnancy hormones slow the contractions of the bowel, possibly to allow for more nutrient absorption from food.
  • iron supplements
  • IBS – an imbalance of gut bacteria results in an over production of methane gas when fermentable carbohydrate foods are eaten. Methane is thought to reduce bowel muscle contraction.
  • hypothyroidism – a common condition when the thyroid gland in the brain doesn’t produce enough thyroid hormone. This causes the body’s systems to slow down, including the digestion
  • diabetes – uncontrolled diabetes with high blood sugar levels can cause damage to the nerve endings in the bowel
  • possible intolerance to some foods e.g. dairy or nuts
  • medical conditions e.g. where the bowel¬†has an extra loop, or the nerve endings in the rectum become desensitised

So what can you do to get things moving? If you don’t want to resort to medication/laxatives, here are 8 cures for constipation:

    1. fluid – having enough fluid in your bowel helps a lot! It doesn’t matter what you drinkbottled-water (contrary to popular belief coffee and tea aren’t dehydrating). Aim for about 2 litres of fluid a day. Water, warm water with lemon, peppermint tea etc.
    2. fruit –¬†particularly¬†kiwis, apples, pears, rhubarb, prunes, figs. Fruit is very effective as it acts as a natural laxative, acting as a softener by drawing water in to the bowel. The gentle fibre encourages the bowel muscles to contract, helping to move things along. If you are prone to bloating and wind, kiwis are the best (try two a day)
    3. glass of fruit juice – fruit juice has an ‘osmotic effect’ meaning that it’s sugar draws water in to the bowel, which is a great thing for people with constipation. This is why for some people prone to IBS with diarrhoea, they are advised to avoid fruit juice as it can make things even worse
    4. coffee – caffeine has a stimulatory effect on the bowel, meaning that it causes the gut muscles to contract. Many people find that a strong cup of coffee has them heading for the toilet within minutes!image
    5. flaxseed Рrich in insoluble fibre, ground flaxseed absorbs water adding bulk to help move things through the digestive tract quickly. Sprinkle a teaspoon in to porridge, a bowl of soup, or try making this easy Bread
    6. yogurt Рif your gut bacteria are out of balance, this can affect how your bowel functions. Yogurts contains good bacteria and when eaten daily can encourage gut microbiome. How to choose a healthy yogurt
    7. exercise – there’s¬†an established relationship between our activity level and our bowel habits and in cases of vigorous exercise (e.g., running) there is evidence of a significant increase in activity helping with constipation.image
    8. magnesium supplement – worth trying, some people find relief within days by taking about 300mg magnesium citrate per day (this is perfectly safe). Magnesium is important for muscle contraction, and draws water into the bowel. If you have kidney or severe heart problems ask your doctor first.

Seriously Healthy 1 minute muffin

UnknownHigh in healthy fats and protein, low carbs.
The main ingredient in these healthy muffins is ground flaxseed. Flaxseed is a source of healthy fat, antioxidants, and fiber; rich source of micronutrients, dietary fiber, as well as manganese, vitamin B1, and the essential fatty acid omega-3.

imageModern research has found evidence to suggest that flaxseed can also help lower the risk of diabetes, cancer, and heart disease. I regularly recommend it to patients especially for constipation.

Flaxseed can be bought in most of the big supermarkets or health food images-3shops (it is the same as ground linseeds – my Mum tells me they used to put linseed oil on horses tails to make them healthy and shiny)

Add a little bit of honey/maple syrup/agave nectar/sweetener/raisins if you like (they can be a little bland without any sweetness!)

Nutrition info: 320 kcal, 1g carbohydrate, 16g protein

  • 1/4 cup flaxseed
  • 1/2 teaspoon baking powder
  • 1 teaspoon cinnamon
  • 1 egg
  • 1 teaspoon light vegetable oil, such as olive oil
  • optional sweetener of choice (1/2 teaspoon sugar/honey etc)
  1. 
In a coffee mug, stir together 1/4 cup of flax meal, 1/2 teaspoon of baking powder, sugar/honey/sweetener if using and 1 teaspoon of cinnamon. Be sure to use a coffee mug, not a cup.
  2. Add 1 egg and 1 tsp. of oil to the dry ingredients and mix well.
  3. Microwave the mug for 45 to 60 seconds.
  4. Pop the muffin out of the mug and enjoy.

Eat on the run, or serve with a high protein yogurt and berries.

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Medical News Today article on Benefits of flaxseed

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