The golden toolbox of recovery

What’s in your toolbox?! I was recently at a meeting and friend turned to me and said “I have a strange picture that I’ve seen, it’s you with a golden toolbox. It’s like you have everything you need in that toolbox to deal with life”.

This spoke volumes to me as a person and as a health care professional. Having worked in a team which was predominantly psychological I was immersed in the language of the therapists and the word toolbox often came up. I sat in on plenty of group therapy sessions and got to experience a whole range of different therapies.  Also, in our team meetings we used these skills on ourselves as part of the debrief process. It showed me how important it is to look after not just your patients, but yourself. If you have a life with some stress in it (let’s face it that is probably everyone) then you need to have some skills to hand that help you deal with that stress. Stress and anxiety can be a huge factor in an eating disorder, in mental health conditions and also to physical digestive issues such as IBS. When you have a stressful event how do you respond? What does it trigger in you? When you know how you respond you can start to work on a more effective and helpful mechanism. 

 I will never forget my interview for my eating disorder post. I was asked such an eclectic mix of questions that I had no idea how I had done on leaving the room. When I received the call to say I had the job, I asked why I was chosen. The response “we could see you are robust and able to cope with the strains of this work”.  In the eating disorder field this robustness is certainly needed. I continually need to keep on top of my own anxiety and practise what I preach. 

I want to  highlight some skills or tools that we all, health professionals, patients, people, could include in our golden toolbox. Tools you can use regularly for moments of anxiety, tools you can pull out for those emergency moments.

I remember being on a train that got stuck in a tunnel and suddenly feeling trapped and my anxiety levels rising. It was not an experience I was prepared for and suddenly I knew I needed to use one of my tools. At that point visualisation of a calm beach with lapping waves and some square breathing helped immensley. I know if I had not practised these skills  previously, I wouldn’t have been able to use them there and then. So practise really is the key. 

Here are some of my favourite toolbox tools that I use myself and recommend. 

Journaling –

I’m a seasoned journalling fan. This is something I have always done since my teenage years, I now have a lot of full notebooks with a collection of my teen angst, my working life, my spiritual life and my family life in them. Looking back it shows me how I have evolved and where my stress triggers are. I can see the patterns that I fall into and work on improving my reactions. I dig out my journal when I have a moment I need to work through, when my mind feels cluttered or when something erupts! I also love to journal the good and positive, so any life events or just when I get the urge.

If you are on a recovery journey then I recommend that you journal daily  or at least 4 times a week. It needs to become a discipline and a part of your coping mechanism. A good way to start is to write down 3 things that went no so well in your day and how you could have dealt with these better. Then always finish on a positive, so 3 things that have gone well or that you coped with well. You can also take a single scenario and write out alternative endings. Using an eating disorder example: You had an argument with a friend, this increased your stress and you responded by missing your snack. Thinking through why this was not a useful response – restriction of food does not help your emotional well being, it is a quite fix but not a long term cure. Now you have missed out on some nutrition for the day and your body is hungry. Your body needs regular food right now as you work towards recovery. So take a think through how you could have responded instead…. maybe you could have gone for a walk, taken a bath or done some mindfulness to help you reduce your anxiety after the argument instead of turning to food.

Mindfulness and Breathing –

Such a buzz word at the moment, but this is not a fad. I’ve been using mindfulness with eating disorder clients for over 10 years and I’m sure it has been used for far, far longer than this. Just 10 minutes before a meal or after a meal can make a huge difference. It is all about calming your thoughts and body. I personally love just deep breathing, there are so many variations on this so try a few out. For me, the breathing  is something that spills over from Pilates practise and so I get a double benefit from Pilates of exercise and mindfulness. There are some great free resources to help here. 

Exercise –

This is something to decide upon according to your recovery stage. Exercise can be amazing as a mood booster and a de-stresser. However if you are working on weight gain then it will also have an affect on this. If your BMI is less than 17.5 then you will want to modify your exercise so that it is physically safe. 

Distraction – 

I often suggest that people put together a list of distraction techniques that they can use. For example, after a meal,  or when a the urge to binge strikes, at times when anxiety levels are rising it can be useful to have an activity planned. Things like craft, having a friend to call, painting your nails, reading a book, cleaning out a cupboard – something that immerses your mind and changes your thoughts. Puzzles, crosswords, knitting, collage are all great things to have on your list.

Positive thoughts –

Those anxious, negative thoughts are something that we all get. It is how we deal with them that is key. I love the thought of noticing the thought, and finding the opposite reaction. So turn that negative into a positive. If you practise this regularly it can turn into a habit that you hardly notice you are doing. I’m now working on this one with my children too, teaching then that there is always a positive side to things. It is a great skill to learn at a young age but one that you can learn at any age.

I’d love to know what tools you find useful. 

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IBS and the Microbiome

Priya regularly writes for Network Health Digest (NHD Magazine), here is her latest article.  The microbiome is such an up and coming area with so much we are still to research and find out.

Click the link below for the article.

Issue 126 fermented foods IBS and microbiome

A healthier cake – Courgette and sultana (wheat and lactose free).

Each year my love of growing vegetables, well grows. I had a dad who had very green fingers and grew a lot of the vegetables for the small hotel my parents ran. In the summer months our bath water was often emptied by buckets into the vegetable patch! My Sri-lankan grandmother has the greenest fingers in the family. Her windowsills were often covered in seedlings and she would disappear into the garden at mealtime to pick “greens” to make into a family favourite dish. A meal of rice and curry is not right without “greens”. 

One of my first successes was courgettes. Most years I get a good crop, apart from last hear but I blame the baby for that 😉

This year however I have 2 plants that are exploding with monster courgettes and a bountiful supply is on its way.  Follow my instagram stories for pics of the garden and how I cook them.

Personally I love courgettes. Roasted, in a stir fry, ratatouille, on pizza…. only issue is that Miss K and the J boy are not so keen. So it’s been a season of finding ways to encourage them to eat them. I don’t like to hide vegetables so I do tell them it’s in there, once they have tried some. Here are my top ways that they like and eat:

  1. Courgette cake. This has gone down so well. I’ve been making it and freezing it. Recipe below. 
  2. Courgetti. Not because we want to be on trend but because it works. Spiralising courgette, cooking with garlic and lemon juice is a winner. 
  3. Grated courgette in bolognaise, risotto or pretty much any dish!
  4. Roasted and blended with tinned tomatoes for a pasta sauce. 

Hubby and I love a courgette curry so that’s also on the menu but I have to make the children something different on those nights! 

So here is a lovely courgette cake recipe. You really won’t taste the courgette and I’ve lowered the sugar content for you too, it works out at 3g sugar per slice but some of this is the yoghurt and courgette.  Per 100g it is 3.6g sugar so a much healthier alternative to many other cakes. 

I made this for a family party recently and it went down really well! 

Courgette and Sultana Cake (Wheat and Lactose Free)
Serves 12
Easy to make, reduced sugar recipe and includes plenty of yummy courgette.
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Prep Time
15 min
Prep Time
15 min
177 calories
22 g
31 g
8 g
4 g
1 g
82 g
68 g
3 g
0 g
6 g
Nutrition Facts
Serving Size
82g
Servings
12
Amount Per Serving
Calories 177
Calories from Fat 70
% Daily Value *
Total Fat 8g
12%
Saturated Fat 1g
4%
Trans Fat 0g
Polyunsaturated Fat 1g
Monounsaturated Fat 5g
Cholesterol 31mg
10%
Sodium 68mg
3%
Total Carbohydrates 22g
7%
Dietary Fiber 1g
5%
Sugars 3g
Protein 4g
Vitamin A
2%
Vitamin C
9%
Calcium
3%
Iron
3%
* Percent Daily Values are based on a 2,000 calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.
Wet ingredients
  1. 350g courgette
  2. 2 eggs
  3. 85ml rapeseed oil
  4. 2 tbsp natural yoghurt
  5. 1 tsp vanilla extract
Dry Ingredients
  1. 300g plain wheat free flour (I used Aldi's own brand)
  2. 1 tsp cinnamon
  3. 1 tsp mixed spice
  4. 1/4 tsp nutmeg
  5. 1/2 tsp bicarbonate of soda
  6. 1/2 tsp baking powder
  7. 140g sultanas
Instructions
  1. Grate the courgette.
  2. Preheat the oven to gas mark 4. Grease and line a loaf tin.
  3. Mix together all the wet ingredients.
  4. Add the flour and carefully mix in.
  5. Now add the remaining dry ingredients and mix.
  6. Pour into the loaf tin and put in the oven.
  7. Bake for 20 minutes uncovered and then cover the top with foil to prevent it burning.
  8. This cake takes 30-40 minutes in my oven, I recommend checking it by inserting a skewer and seeing if the bottom is cooked. You don't want to have the bottom too soft (I've made that mistake for you!).
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calories
177
fat
8g
protein
4g
carbs
22g
more
Dietitian UK http://www.dietitianuk.co.uk/

What are your favourite courgette recipes?

Eating Disorders: Why can’t I recover?

Working in eating disorders as a dietitian is the very hardest part of my job. As a freelancer I cover a huge variety of roles. In my other world as a Pilates teacher and studio owner I have an altogether more energetic and flowing role. Yet it is working with eating disorder clients that uses the most of me, pushes me hardest, and pulls on my mind, spirit and emotions. 

 Some of my hardest work is with the “stuck” clients. Those who really want to change, really want to break free, really want help…. and yet they just can’t do it. It is so very hard for them as you can see they do want to get better. Imagine this – knowing how you are living is ultimately going to shorten your life, make your life difficult and lead to you not being able to do a lot of things and yet not being able to change it. Life with an eating disorder is a very hard life.

Often there is a specific weight that they cannot push past. 

Sometimes there are behaviours such as exercising or purging that they cannot give up.

Change can be made, but only to a point.

 

So what causes this “stuckness”?

An association with a certain weight.  

It is not uncommon for me to being working with someone who 100% agrees that they need to get their weight to xx kg. We put a plan in place, they are working towards it really well, everything seems to be on target and then the “stuckness” hits just before our weight goal. Why? It could be that when they were last at this weight they didn’t like their bodies/themselves, someone said something negative about them or that something traumatic happened at this weight. It could be they have never been that weight before, it is the highest weight they will have reached.

I like to work this through with people. 

“What will it be like being this weight”

“How will it change your relationships and how you see yourself”

“What will be better and what will be worse?”

I also remind them that you really cannot predict how it will feel and be until you get there. Using the analogy of a night in a hotel. You can guess how it will be, you can imagine how you may spend the time with your partner, you can predict the layout of the room, the hotel and the menu. However you cannot really be sure what it will be like until you get there. Even if you have stayed there before, things change, things feel different at different stages of life.

2. Not wanting to move on.

Having an eating disorder can for some be a way of escaping. Escaping growing up, escaping emotions, escaping reality. So getting better means that you have to deal with all those tricky issues. You cannot run away any longer. You have to put on those big pants and be a grown up. It isn’t necessarily going to be fun, but in the long term it will be worth it. 

I find using some motivational work can be beneficial here. Looking at the pros/cons of change. Planning out a vision board of where they want to be in 1 year, 5 years time. Talking through the real reasons they need to get better. For most people there is something driving the desire to make change. Examples are wanting to have a certain career that you can’t do at a low weight (nursing, law), wanting to have children, wanting to be able to go travelling.

3. Invested in the Eating Disorder.

This may seem like a strange one. If you have had an eating disorder for a long time it can be hard to imagine not have one. It becomes part of who you are. It becomes part of the way that other people see you, relate to you and care for you. If you no longer have an eating disorder there is an uncertainty, how will others see you, will they still care for you, will they still take time over you? If you no longer have an eating disorder who will you be? A huge part of this is all around knowing your identity. Spending time journalling can help with this. Thinking about who you used to be, who you would like to be. What are the things that make you come alive inside? Spend time doing those. What are your dreams and aspirations? What things are you good at? Asking someone close to you the question “What are my giftings or what are I good at?” can be very revealing and helpful.  Once you have an idea of who you could be outside of your eating disorder you can push yourself to move past it.

Working on your relationship can also be helpful. If these are strong then you know that people will care for you always, with an eating disorder or not. Being in a sick role means you are seen in a very different way. Being recovered and healthy can expand and move your friendships and relationships to new levels. 

Being stuck in your eating disorder recovery can be a very natural part of the recovery process. If you are in this place do seek some help. Do spend time journalling, talking, being creative and finding who YOU are. To look for a good therapist and dietitian near you in the UK the B-eat website is a good starting place. Or drop me an email as I work with people around the UK by video call.

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Salmon and Spinach Fishcakes

It’s been a hot week, needing summer food. These salmon and spinach fishcakes hit the spot. Yes you have to put the oven on to cook them but they can be prepared ahead of time and then served hot or cold. They also freeze well, I always mean to make extra for this purpose but then the kids eat them all!

I must admit to my brain needing a kick start to come up with ideas for summer food. My family aren’t huge salad lovers, so all those beautiful salads that my mind fancies have to take a step back. It is like digging up buried treasure, deep in the recesses of my dusty brain were recipes I haven’t made for well over a year. This was one of them. The hardest part about these is getting the breadcrumbs on them, which really even my toddler can do. In fact, maybe next time I should get the kids to cook these and sit down with a cuppa. 

The salmon provides a great source of omega 3’s needed for brain development and cognitive function, heart health and reduction of inflammation. They can be beneficial in rheumatoid arthritis and depression. It is recommended that we eat 2 portions of fish a week of which one should be healthy. I try to ensure my family get 1 portion a week in their evening meal and it is usually salmon that we favour. I’ve used tinned salmon for ease in these, to save extra faff and cooking.

Spinach is a great source of Vitamin K, Vitamin A (in the form of carotenoids), manganese, folate, magnesium, iron, vitamin B2, vitamin B6, vitamin E, calcium, potassium and vitamin C. It is a source of dietary fibre, phosphorus, vitamin B1, zinc. Using frozen spinach again saved cooking and I find it easier in dishes like this. Frozen spinach is such a versatile and great ingredient to have on standby. If you don’t have frozen spinach in your life, go and get some. 

So the iron and omega 3 content also make this recipe a great one for pregnant ladies and for toddlers. A great family meal, one where you can cook just the one meal for all. I served ours with courgetti cooked in the wok with lemon juice and garlic, plus homemade coleslaw. 

 

Salmon and Spinach Fishcakes
Serves 4
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Prep Time
10 min
Prep Time
10 min
389 calories
23 g
105 g
13 g
42 g
3 g
293 g
232 g
1 g
0 g
5 g
Nutrition Facts
Serving Size
293g
Servings
4
Amount Per Serving
Calories 389
Calories from Fat 120
% Daily Value *
Total Fat 13g
21%
Saturated Fat 3g
16%
Trans Fat 0g
Polyunsaturated Fat 2g
Monounsaturated Fat 3g
Cholesterol 105mg
35%
Sodium 232mg
10%
Total Carbohydrates 23g
8%
Dietary Fiber 2g
7%
Sugars 1g
Protein 42g
Vitamin A
16%
Vitamin C
17%
Calcium
4%
Iron
11%
* Percent Daily Values are based on a 2,000 calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.
Ingredients
  1. 500g potatoes, skin on for extra fibre and for speed
  2. handful of frozen spinach (I used 4 lumps)
  3. 1 tbsp butter
  4. 2 tins salmon
  5. 1 tsp Dijon mustard
  6. 1 tbsp lemon juice
  7. 1 tbsp fresh parsley
  8. 1 tbsp fresh chives
  9. seasoning
  10. Breadcrumbs or polenta (see below)
Instructions
  1. Wash the potatoes, cut into small chunk and boil. Add the frozen spinach for the last few minutes.
  2. When soft mash the potato and spinach, leave to cool.
  3. Mix in the salmon, mustard and lemon juice, parsley, chives and seasoning.
  4. Now comes the fun part, shape into patties with your hands.
  5. Roll in the breadcrumbs.
  6. Now you can leave these to chill until you want to cook, freeze them or cook straight away.
  7. Cook at Gas Mark 6 for 10-15 minutes.
Notes
  1. I used bought breadcrumbs for the family, as they were in the cupboard and then I used cornmeal for my own fishcakes to make them wheat free. The picture above is of my wheat free fishcake with the polenta crumb.
beta
calories
389
fat
13g
protein
42g
carbs
23g
more
Dietitian UK http://www.dietitianuk.co.uk/

 

Eating out with young children.

Eating out is meant to be a relaxing, delicious event, yes? Well, when you have young children it isn’t always the case. My husband loves to eat out, I find that I need to be in the right mood. Eating out with my tribe of kids (Miss K age 6.5, J-boy aged 3 and Etty just 1 yr) requires a military operation of packing bags, finding shoes, brushing hair, finding toys and by the time everyone is in the car I’m ready for a nap. I am the one that has the noisy kids that will not sit still and talk politely, the one everyone looks at, I like to think they are looking over and thinking how adorable my children are, but I’m probably deluded!

So here are my top tips for eating out with small people:

    •  

    • Leave them behind! I’m only half joking. If you want a calm, relaxing meal where you can hold an adult conversation then having a child-free meal could be the answer.
    • Choose somewhere that is family friendly. Somewhere that it is ok to make noise, to make a mess and to get down from the table. My kids do not sit still and they need something to look at, somewhere they can talk noisily and somewhere they can walk/jump/dance around. For us Sainsburys cafe, community cafe’s and Wagamama’s are a hit.

 

    •  

    • Check the menu before you go. Is there food suitable for the whole family? This doesn’t have to mean a children’s menu as such, just a balanced meal option your child will enjoy. There is no satisfaction over ordering a meal and your child refusing to eat it. A starter, a selection of side dishes or sharing an adults meal between a couple of children can work well. In fact, my children are not fans of the standard nugget and chips children’s fare. When the adult meal arrives and looks yummier they are not impressed and just eat mine. There go my prawns. 
    • Set the expectations. I tend to explain before we set out where we are going, how I expect them to behave and what type of food we will be ordering. I then repeat it when we get there.
       
       

 

  • Pack a bag. Toys that you can play with at the table, colouring bits, stickers, a book and snacks. I always have something to tide them over until the meal
    arrives in case it is a long time. You know you don’t want a grouchy, tired child on your hands.
  • Do not expect them to be perfectly behaved. They are children, they are meant to be noisy, they are meant to be active, they are meant to have fun. If you are ready for them to be this way then it is a nice surprise if they do sit quietly!
  • Breath and remember they are only young for a short, short time. Enjoy the moment and relish not having to wash up and leaving the mess behind. 

“This too will pass, so enjoy the moment”

 

 

Messy Home, but Top Nutrition Tips.

When the BBC ask if they can come and film you in your home what do you do? 

Firstly –  Say Yes.

Secondly  – Flap about in panic at the state of your house and kitchen. People who know me well will know that my kitchen is rarely tidy and usually full of our home life. Pictures from the kids, plates ready to go in the dishwasher, toys on the floor. ARGH. 

Thirdly – Wonder what on earth they are going to ask your to talk about. Oh well, that can wait, I have a house to tidy.

So, when the crew turned up, their first statement was “Wow lovely kitchen, it’s very lived in” which I read as “It’s certainly not pristine and clean”. SIGH. I did tidy, I promise. 

Then when they ask to look in your freezer…. OH MY GOODNESS. Really? I can’t say No, but I didn’t see that coming. My freezer is outside the house and definitely NOT TIDY or video viewing. 

So you have been warned, this is a “lived in”, mum with 3 kids, messy life video. Or maybe I should say it is REAL LIFE.

Love to know your thoughts. 

 

 

Reduce your risk of breast cancer.

Today, a report entitled “Diet, nutrition, physical activity and breast cancer” came out from the World Cancer Research Fund. When you are a dietitian, this kind of thing excites you – why? Well it included a good review and analysis of the research on breast cancer. Looking at 119 studies worldwide and over 250,000 women, the evidence has been categorised into strong and limited evidence. 

Here is a little summary and a vlog I did as a Facebook Live.

 

Diet:

There is strong evidence for alcohol increasing the risk of breast cancer. The report states that a glass of wine or small beer a day (equivalent to 10g alcohol content) is linked to a 5% increase in breast cancer risk in pre-menopausal ladies and a 9% increase in post-menopausal ladies. We all know alcohol is a toxin for the body, I’m not sure I’m ready to give it up entirely though. Other evidence from the Mediterranean diet tells us that red wine can be good for heart health. So I think the take home message here is to stick to small amounts and to have plenty of alcohol free days too.

Limited evidence was found for

  1. Eating non starchy vegetables (broccoli, mushrooms, peppers, beans, green leafy veg etc).
  2. Eating catotenoids – orange and red fruit  (orange peppers, sweet potatoes, tomatoes, carrots) and veggies plus dark leafy greens.
  3. Having a high  intake of dairy foods. Increasing these by 200g led to a 5% decreased risk. 

Exercise:

We all know we should be getting active. The research supports this showing exercise that increases your heart rate was helpful in reducing the risk of breast cancer. Swimming, running, fast walking, cycling – anything that gets you a bit out of breath.

A strong link was found with weight. Being a healthy weight could prevent 16% of cases in the UK. 

Having Children:

Pre-conception and pregnancy are key times for getting on top of your eating as what you eat will help lay the foundation for baby. Your diet at this point can influence your baby as an adult, Birthweight was found to be a predictor or later growth and being a healthy weight is linked to reducing the risk of so many chronic diseases including breast cancer.

Having children reduces your risk as does having a pregnancy before you are aged 30 yrs. 

Finally breastfeeding was found to reduce the risk for you as a mummy.

Lots of great take home tips that centre around eating well and being active. We already knew that waa a good idea, now there is more proof. 

Vegetarian Moussaka and going meat free for a week.

This week we went Vegetarian for National Vegetarian Week. As a family we always have at least 3 meat free meals a week, so this was a good chance to unleash some new recipe ideas. To be honest I don’t think the family really noticed the lack of meat, though they would do if carried this on for a few weeks. I love vegetarian meals and would probably be one if I wasn’t cooking for the whole family. Eating more plant based meals is better for the environment, a more sustainable way of eating and has some fabulous health benefits too.

Our week of vegetarian meals:

Vegetarian Moussaka, Leek and Stilton Risotto, Courgette and Lentil Lasagne, Vegetable egg Stir fry rice, Quorn Bolognaise and Roasted Veggie Pasta.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The moussaka is something I’d seen a variation on in a gluten free recipe book that I’ve had hanging around for ages. I used soya milk to make it lactose free for my boy – omit the cheese to make it dairy free. A few adaptations made this a super simple meal that is going to stay on our meal list.

 

Vegetarian Moussaka
Serves 4
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Prep Time
30 min
Cook Time
30 min
Prep Time
30 min
Cook Time
30 min
494 calories
81 g
19 g
12 g
15 g
4 g
509 g
124 g
13 g
0 g
7 g
Nutrition Facts
Serving Size
509g
Servings
4
Amount Per Serving
Calories 494
Calories from Fat 108
% Daily Value *
Total Fat 12g
19%
Saturated Fat 4g
21%
Trans Fat 0g
Polyunsaturated Fat 1g
Monounsaturated Fat 6g
Cholesterol 19mg
6%
Sodium 124mg
5%
Total Carbohydrates 81g
27%
Dietary Fiber 7g
29%
Sugars 13g
Protein 15g
Vitamin A
30%
Vitamin C
35%
Calcium
24%
Iron
10%
* Percent Daily Values are based on a 2,000 calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.
Ingredients
  1. 2 tsp olive oil
  2. 1 large aubergine
  3. 2 cloves garlic, crushed
  4. 1 medium onion, chopped
  5. 2 tbsp white wine
  6. 150g mushrooms, chopped
  7. 1 x 400g tin chopped tomatoes
  8. 1 tbsp tomato puree
  9. 1 tbsp chopped chives
  10. 1 tsp paprika
  11. 1 1/2 cups of uncooked rice
Sauce
  1. 1 tbsp rapeseed oil
  2. 1 tbsp cornflour
  3. 400ml soya milk
  4. 40g grated cheese
Instructions
  1. Slice the aubergine, onion and garlic.
  2. Saute onion and garlic in the olive oil on a medium heat.
  3. Add 2 tbsp white wine and the mushrooms, cook for a few minutes to soften.
  4. Add the chopped tomatoes, puree, chives, paprika and rice.
  5. Stir and simmer for 10 minutes whilst you make the sauce.
  6. Heat the oil, add cornflour and turn the heat low.
  7. Add 1/3 soya milk and stir well, add the rest of the milk and increase the heat to medium, carry on stirring as the sauce thickens.
  8. Layer the rice mix with the aubergine, then the rice and the aubergine.
  9. Top with the sauce and sprinkle the cheese.
  10. Cook in the oven at Gas Mark 5 for 30 minutes.
beta
calories
494
fat
12g
protein
15g
carbs
81g
more
Dietitian UK http://www.dietitianuk.co.uk/

Coeliac Disease: The Facts and Frustrations.

Coeliac Disease is often referred to as a gluten intolerance or allergy. Which makes sense as the treament for it is to follow a strict gluten free diet. However it is actually an autoimmune disease, which means it is a disease in which the body produces antibodies and  attacks it own tissues. In the case of coeliac disease there are 3 antibodies produced in response to gluten and these can be tested for: 

  • anti-tissue transglutaminase (tTG) antibodies
  • endomysial antibodies (EMA)
  • deamidated gliadin peptide (DGP) antibodies

The immune response leads to damage to the villi in the intestinal linings. The villi are where nutrient absorption occurs, they produce enzymes that help digest carbohydrates and proteins, they absorb nutrients into the capillaries around them so the nutrients can then go to the blood stream. Destruction of the villi means that there is firstly less surface area available, so less absorption of nutrients occurs. Secondly the enzymes are not there to digest the food. This may mean that you eat food but just don’t absorb it, instead you excrete it, leaving you lacking nutrients and suffering with digestive symptoms such as abdominal pain and diarhoea. Over time this can have a major impact on your body and be very confusing. If you know you are eating a well balanced diet but you are showing symptoms of nutritional deficiencies or digestive problems this is definitely the moment to see your GP and get advice.  

 

The treament for Coeliac disease is a lifelong strict gluten free diet. This is not a fad diet, or a “choose to be gluten free for a while diet” but a gluten free diet that has to be followed to the letter. I’m not a coeliac but I can’t eat wheat, it won’t harm my villi but it can cause me to be unwell for a few days and is linked to a some digestive issues I have. When I eat out I have to double check and often I find things on my plate than I can’t eat! This can be very dangerous for a coeliac. Even a few crumbs of gluten can cause problems. When on a gluten free diet the villi should recover and nutrients should start be be better absorbed. 

What can be frustrating is that Coeliac disease is under-diagnosed and so there are people with it who have no idea. The rise in gluten free diets also means that there are more gluten free options around, but sometimes it can take aware from the severity and the need for a strict gluten free diet. I’ve seen quite a few places advertising gluten free foods with statement such as “we cannot guarantee these foods are made in  an area free from gluten”. So gluten free food that is not suitable for a coeliac! 

Coeliac Awareness Week is a great time to spread the word and to get people knowing more about these issues so please share and get talking.

Freelance Dietitian specialising in helping those with Eating Disorders and a Media Spokesperson for the profession.