Tag Archives: Dietitian UK

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.

SaveSave

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
Write a review
Print
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.

Chocolate Granola Baked Apples

Granola is one of those foods that I could easily eat quite a lot of, though I tend to not eat it as a cereal but add it to dishes. I love the crunchiness and the variety it gives to transform your simple fruit and yoghurt into something more exciting. However granola is usually high in sugars and the amount of fruit, nuts and seeds is surprisingly low. If you have the time you could of course make your own, but you have to watch it carefully when it bakes. With my current tribe of small people I would be sure to burn it! 

So I was most delighted to be sent a pack of granola to try out, especially when it was chocolate granola. Such a hard life. 

Lizi’s granola is something I’ve recommended to some clients in the past due to it’s low sugar content and low glycaemic load (GL). The GL is a measure of how much a portion of a food affects your blood sugars. The GL for this granola is 6.6 for a 50g serving. Generally a low GL foods is one under 10 and you want to keep your GL to under 100 per day. So this granola is definitely a good option if you want a not too sweet, crunchy hit with a chocolately taste. It uses dark chocolate (which I love), some may say there is the added benefit of polyphenols and antioxidants but at only 5% dark belgium chocolate you won’t be getting much per 50g serving.

Here is how we enjoyed the granola – baked apples with chocolate granola. Instantly renamed big gruffalo crumble by the toddler boy. He calls any fruit crumble a gruffalo crumble, completely my fault for starting that one. 

“Now my tummy’s beginning to rumble, my favourite food is gruffalo crumble”

Chocolate Granola Baked Apples
Serves 4
A quick, simple dessert that is great to perk up your midweek meals.
Write a review
Print
Prep Time
10 min
Cook Time
20 min
Prep Time
10 min
Cook Time
20 min
166 calories
32 g
8 g
5 g
2 g
2 g
196 g
4 g
22 g
0 g
2 g
Nutrition Facts
Serving Size
196g
Servings
4
Amount Per Serving
Calories 166
Calories from Fat 45
% Daily Value *
Total Fat 5g
8%
Saturated Fat 2g
11%
Trans Fat 0g
Polyunsaturated Fat 1g
Monounsaturated Fat 1g
Cholesterol 8mg
3%
Sodium 4mg
0%
Total Carbohydrates 32g
11%
Dietary Fiber 5g
21%
Sugars 22g
Protein 2g
Vitamin A
4%
Vitamin C
14%
Calcium
2%
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.
Ingredients
  1. 4 apples
  2. 4 tsp raisins
  3. 4 tbsp granola
  4. 1 tbsp butter
Instructions
  1. Preheat the oven to Gas Mark 5
  2. Cut the apples in half and cut out the core, this will leave a hole you can now fill.
  3. Fill the apples with the raisins, dot with a little butter and press the granola over the top.
  4. Bake for 20 minutes.
  5. Serve with Greek yoghurt if wanted.
beta
calories
166
fat
5g
protein
2g
carbs
32g
more
Dietitian UK http://www.dietitianuk.co.uk/
 Disclaimer: This granola was sent to me to review, this is not a dietetic endorsment but simply my own views on it. 

 

 

Carrot and Parsnip Cake

I’ve had a hankering for carrot cake for a few weeks after a conversation on social media about a bumper crop of carrots leading to recipes for carrot cake being posted. So when carrots were on offer and hubby came back with 3 bags of them plus 2 bags of parsnips it was suddenly my opportunity. Seriously, there are only so many things you can do with parsnips, so I thought why not try them in a cake. In that moment it felt like probable madness, however actually, you know what? The parsnips add a real kick to this cake. A warm earthiness and nuttiness that really adds to the sweetness of the carrots.

My main critic will always be my husband. He isn’t fobbed off as easily as the children, he has a sweet tooth and isn’t pulled in by any of the latest health trends or superfoods. So I tried him on one. He gave me the “what is it” quizzical expression which I interpret as “What the heck is the crazy woman now trying to give me”. To be fair, you can’t blame him, I am experimental in my approach and a fair few of these experiments just don’t work out. Upon trying it his response was “Actually that’s not bad”. Now for hubby that is a compliment. He isn’t overflowing with expression and excitement like me, thankfully or our house would be even more crazy! So this “Not bad” really meant “I wasn’t expecting it to taste nice but it is pretty good and I like it”. He agreed it was actually the parsnip that made it.

This cake is moist, light and a little to easy to eat. With 250g vegetables in it, it may feel pretty nutritious but you would have to eat a lot of cake to get a portion of veggie in! Having said that these will contain some vitamin A, some calcium and iron, so as cake goes, it is a good option. 

 

Carrot and Parsnip Cake
Yields 24
Write a review
Print
121 calories
13 g
23 g
7 g
2 g
1 g
38 g
173 g
3 g
0 g
6 g
Nutrition Facts
Serving Size
38g
Yields
24
Amount Per Serving
Calories 121
Calories from Fat 59
% Daily Value *
Total Fat 7g
10%
Saturated Fat 1g
3%
Trans Fat 0g
Polyunsaturated Fat 1g
Monounsaturated Fat 5g
Cholesterol 23mg
8%
Sodium 173mg
7%
Total Carbohydrates 13g
4%
Dietary Fiber 1g
3%
Sugars 3g
Protein 2g
Vitamin A
22%
Vitamin C
2%
Calcium
5%
Iron
4%
* 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. 150ml Rapeseed Oil
  2. 60g Brown Sugar
  3. 3 Eggs
  4. 150g Carrots (2 large)
  5. 100g Parsnips (1 large)
  6. 300g Doves Farm Self Raising Flour
  7. 1 tsp Mixed Spice
  8. 1 tsp Cinnamon
Instructions
  1. Peel and grate the carrots and parsnip.
  2. Mix the oil and sugar together. Add the eggs and mix.
  3. Next add the grated vegetables and slowly add the flour and spices in.
  4. Pour into a greased and lined loaf tin.
  5. Bake at Gas Mark 5 for 30-40 minutes.
beta
calories
121
fat
7g
protein
2g
carbs
13g
more
Dietitian UK http://www.dietitianuk.co.uk/

Is having a cuppa soon to be history?

Britain has historically had a love affair with tea. In fact it was the British who introduced it to India in order to compete with the Chinese production of it.  According to the recent Cost of Tomorrow report, people between the age of 50 and 64 spend £31.20 on tea annually, but for millennials this drops to £10.40. So are we drinking less tea? If so what are we drinking instead?

© Tatjana Grinberg | Dreamstime Stock Photos
© Tatjana Grinberg | Dreamstime Stock Photos

Currently, the average household spends £1,475 on tea over a lifetime and  £2,585 on coffee over the course of their lives, so coffee has definitely overtake in the hot drink department. Soft drinks have definitely increased with smoothies, fruit juices, fizzy drinks and milk shakes being more popular now. All of these contain more calories and sugar than your average cuppa. 

Sadly, coffee shop culture means we spend a lot on the treats that go with that cuppa. The Cost of Tomorrow report suggested we spend £11,520 on cakes, buns and biscuits to complement our favourite hot drinks; 4.2% more than we spend on fresh fruit (£11,034) over a lifetime. 

So the take home message on National Tea Day 2017? 

  1. It is perfectly safe to drink 2-3 standard caffeinated cups (400mg) of tea or coffee a day. If you are concerned about the caffeine then try herbal/fruit tea or decaff versions.
  2. Tea contains polyphenols and there are health benefits stated for dental health, diabetes, heart disease and cognitive function. 
  3. Tea is a natural sources of fluoride so has benefits for dental health.
  4. The polyphenols in black tea are thought to be responsible for the links between tea and reduced risk of cardivascular disease. 
  5. Soem studies show a reduced risk of diabetes with 2-3 cups of tea a day (presumably tea without sugar).
  6. With less calories and sugar (if you don’t add it by the spoonful) tea is a good option to be drinking, better than a fizzy drink. 
  7. Tea does hydrate you. Studies have shown it to be equivalent to water!
  8. Tea provides calcium (from the milk), manganese and potassium as well as flavanoids which are potent antioxidants. 

Now who is for a cuppa?

Eating Mediterranean to beat the bills

One thing I love about nutrition and dietetics is the conundrum that is complex science that usually translates down to simple health messages. The Mediterranean diet is a great example. The science behind how it all works on the body is long winded actions of  polyphenols and antioxidants. However you don’t really need to worry about all of that. What we really want to know is:

  1. What does the summary of the research say about the health benefits.
  2. How can I translate that into my everyday life.
  3. What do I need to eat and how often. 

A team from Ghent University analysed the research on the Med diet, looking at 8 meta analysis and 10 cohort studies, they founds some pretty huge results.  If we convinced 2% of the UK to eat a more Mediterranean diet it could lead to a saving of £1 billion. Increase this to 10% of the population eating more plant foods, olive oil, soya, nuts and seed would potentially save £5 billion.  Reductions through a decrease in hospital admissions, doctors bills and keeping people healthy to work more days a year. Isn’t it amazing that such simple changes can lead to such huge savings.

A summary of the research showed that a Med diet can:

  • Reduce diabetes risk by 26% 
  • Lead to a 42% reduction in CHD in men and 25% in women
  • 37% reduction in stroke
  • 33% reduction in breast cancer
Med diet reduces disease risk Women Men
Colon cancer

40%

44%

Stomach cancer

42%

29%

Lung cancer

25%

23%

Diabetes

28%

28%

Stroke

36%

9%

Prostrate cancer  

30%

Postmenopausal breast cancer

36%

 
coronary heart disease

4%

4%

Soya beans, soy products and tofu contain phyto-oestrogens. These are bioactive substances in plant foods that have naturally occurring oestrogen activity. Photo oestrogens have been widely studied and there is evidence they can help with menopausal symptoms such as hot flushes and night sweats. Some bone sparing effects in osteoporosis and they may reduce the risk of certain cancers. They can reduce the risk of heart disease due to their cholesterol lowering effects. Eating more soy can displace the saturated fat intake from meat. 

 

 So the plan from this for you? 

Eat more fruit and vegetables – aim for over 5 portions a day if you can and include soy products in your eating (25g a day = 1 portion).