Category Archives: Dietitian Advice

Many thanks to Naomi Leppitt, dietitian, for this blog post. You can find her blog here.

☕️ What is caffeine and what does it do?

Caffeine is a natural stimulant, meaning it temporarily activates your brain and central nervous system. The effects of caffeine depend on how much you have, how sensitive you are, what medications you take and even time of day. For example, someone might be kept up all night with one cup of decaf coffee, whereas someone else might sleep soundly after a double espresso!

☕️ What contains caffeine?

Coffee

Tea (more depending on how long you leave the teabag in!)

Green Tea and Oolong

Cocoa and chocolate 🍫

Caffeine is also added to:

Soft drinks like cola

Energy drinks

Smedicines (read the label!)

Caffeine can:

☕️ make you feel more awake and alert

☕️ improve learning, memory and mood

☕️ increase heart rate and blood pressure

☕️ cause intestinal discomfort

☕️ increase rate of urine production

☕️ be addictive

Feeling more awake sounds great, but some of those other effects might outweigh the positive effects for you. You don’t have to quit your morning coffee entirely, but you may find it helps to switch to decaf coffee.

☕️ How is coffee decaffeinated?

Either the beans are directly soaked in a solvent (methylene chloride or ethyl acetate), which keeps the flavour in, while removing most of the caffeine. (Don’t worry: they rinse the beans so none of the chemical remains in what you’re drinking!) Or the beans are soaked first, and that water is treated with the solvent to take out the caffeine, so the solvent never touches the beans. Sometimes solvent isn’t used at all, just water or carbon dioxide. Whichever way is chosen, there’s no evidence to say one method is safer than the other.

☕️ What about tea?

Both green and black tea come from the plant Camellia sinensis 🌿, and the difference is that black tea is fermented. Black tea contains more caffeine than green tea, unless you’re more of an Earl Grey drinker. Matcha tea contains more caffeine than regular green tea (because it’s ground, so you consume the whole leaf). Overall tea has less caffeine than coffee, so it won’t stimulate your heart as much.

Green teas contain a substance (L-theanine) that has been shown to reduce anxiety and have a relaxing effect without any drowsiness, so people often find they get the benefit of the pick-me-up without the jitters. Not only that, but green tea contains anti-inflammatory catechins, which are being shown in research to have anti-cancer properties.

Tea can be decaffeinated with carbon dioxide or just hot water (for green tea), and these processes keep in most of the catechins, so you won’t lose out on the positive effects. Tea also can be decaffeinated with solvents, but again, there won’t be any solvents in what you’re drinking.

☕️ Are decaffeinated drinks caffeine-free?

Even after decaffeination small amounts of caffeine remain (usually 1-2%, but sometimes up to 20%!). Even though it’s a small amount, it’s still enough that some people may still feel the effects.

And, even if you’re having decaffeinated drinks, be mindful that over the day, those small amounts of caffeine add up to the equivalent of a caffeinated drink.

☕️ So should I switch to decaf?

You may benefit from switching if you suffer with IBS, incontinence or anxiety. And if you’re pregnant, 🤰🏼 you should limit caffeinated drinks to 2-3 cups per day (as lots of caffeine has health risks to the baby or could result in miscarriage), so switching to decaf means you get the flavour without the risk!

Note that if you tend to drink a lot of coffee or tea, and decide to switch to decaf, you may feel withdrawal symptoms such as headaches 🤕, feeling drowsy 😴 or not being able to concentrate as well 🧠.

If you have an anxiety disorder, high blood pressure, an irregular heartbeat, or kidney disease, you may have been advised to cut out caffeine, but, be aware that switching to decaf drinks won’t mean you’re entirely caffeine-free! Alternatively, you could substitute with a non-caffeinated drink such as herbal or fruit tea, hot sugar-free squash or malted drinks.

References:

Butt, M. S. et al. (2015) ‘Green Tea and Anticancer Perspectives: Updates from Last Decade’, Critical Reviews in Food Science and Nutrition, 55(6), pp. 792–805. doi: 10.1080/10408398.2012.680205.

Decaffeination 101: Four Ways to Decaffeinate Coffee. Available at: http://coffeeconfidential.org/health/decaffeination/.

Green Tea vs. Black Tea: Which One is Healthier? Available at: https://www.cupandleaf.com/blog/green-tea-vs-black-tea (Accessed: 20 June 2019).

Kimura, K. et al. (2007) ‘l-Theanine reduces psychological and physiological stress responses’, Biological Psychology. Elsevier, 74(1), pp. 39–45. doi: 10.1016/J.BIOPSYCHO.2006.06.006.

Liang, H. et al. (2007) ‘Decaffeination of fresh green tea leaf (Camellia sinensis) by hot water treatment’, Food Chemistry. Elsevier, 101(4), pp. 1451–1456. doi: 10.1016/J.FOODCHEM.2006.03.054.

Lieberman, H. R. et al. (2002) ‘Effects of caffeine, sleep loss, and stress on cognitive performance and mood during U.S. Navy SEAL training’, Psychopharmacology, 164(3), pp. 250–261. doi: 10.1007/s00213-002-1217-9.

McCusker, R. R. et al. (2006) ‘Caffeine content of decaffeinated coffee’, Journal of Analytical Toxicology, 30(8), pp. 611–613. doi: 10.1093/jat/30.8.611.

NHS. Water, drinks and your health. Available at: https://www.nhs.uk/live-well/eat-well/water-drinks-nutrition/.

Ohishi, T. et al. (2016) ‘Anti-inflammatory Action of Green Tea’, Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry, 15(2), pp. 74–90. doi: 10.2174/1871523015666160915154443.

Ramalakshmi, K. and Raghavan, B. (2005) ‘Caffeine in Coffee: Its Removal. Why and How?’, Critical Reviews in Food Science and Nutrition, 39(5), pp. 441–456. doi: 10.1080/10408699991279231.

Dietitian Advice, Eating Disorders

What recovery looks like – Part 2: food and exercise

15 June, 2019 Priya Leave a comment

Huge thanks to Sophie Richmond (find her on instagram @balancing_bambi) for this amazing series of posts on Recovery from an Eating Disorder. Sophie is not currently a nutritional professsional or therapist but is going to be studying an MSc in Clinical Nutrition and Eating Disorders at UCL from September. I am sharing these posts as inspiration and because I think it is important to show that recovery is possible and happens.

Check out the first RECOVERY STORY POST.

FOOD

There is the common (and incorrect) assumption that people with anorexia ‘don’t get hungry’ or ‘don’t like food.’ In my case neither were true; of course I got hungry and I had, until I became ill with anorexia, really enjoyed food. In ‘recovery’ it is always important to be aware of who is in control of your preferences in relation to food. When you say you don’t ‘like’ a dish – is that true or does your eating disorder dislike it. For me, I had always detested butter and creme fraiche so it was normal for me not to want those foods. However, from a very young age I had always loved really good quality cheeses such as ‘Stinking Bishop’ and ‘Epoisses’. When I told people ‘I don’t like cheese’ it was actually my eating disorder.

You may find it helpful to delve into your childhood memories of food and consider what you enjoyed before your eating disorder – before you knew about calories or diet culture. I always loved fruits and vegetables but anorexia made me obsessive about weighing quantities and avoiding fruits (and some vegetables) that were deemed too high in carbs. I grew up in the countryside and had idyllic memories of eating countless apples, pears and plums in the orchards with my Grandpa with a freedom I could only dream of in the midst of anorexia. Our fingers would be stained with purple juices as we picked blackberries for jam whilst devouring our fair share – not thinking of snacks or allocated portions (I don’t think much jam ever got made!). Was I happy during these times? Yes. Did I want that enjoyment and pleasure back? Yes. I had to make that choice and challenge the rules I had made for myself in order to recapture that freedom. These countless happy food memories would all be impossible to revisit whilst I clung to my ‘comfort blanket.’

I remember sharing ‘Dip Dip Eggs’ with so much pleasure with my Grandpa, loving the molten yolk oozing out over the ‘soldiers’. Anorexia made me hard boil the egg in order to carve out the yolk and only eat the white. During my recovery I found topping my meals with poached eggs (like a shakshuka) helped me capture that happiness and love from someone who cared about be so deeply – someone who bought every colour of Joules bed socks to keep my feet warm when my starved body could not warm itself, someone who wanted me to be happy and healthy, not sad and starving.

Anorexia makes you associate food with calories, diets and weight; confining it purely to ‘fuel’. But it is so much more than that. You WILL need to eat more too nourish and repair your body – but you are allowed to like food and enjoy tasting and cooking as you slowly overcome your fears. I love Moroccan and Indian cuisine for the bursts of flavour in the spiced sauces. I love tomato dishes, vegetables, fish, quinoa, lentils – all foods deemed ‘healthy’ – equally I love baked Camembert with red onion chutney or a homemade apple crumble with custard (although I cannot stand bread and butter pudding). The key is I am in charge of these choices.

I cannot stress the importance of articulating how you feel about food. Externalising and discussing your thoughts allows you to ‘rationalise’ your fears (a registered nutritionist or dietitian is ideal). My mother sat through every meal with me, listening to my worries and showing me that a potato was nothing to fear. She, like my Grandpa, helped me see that food would help repair my thinning hair, my chipped nails, keep me warm and let me think clearly. She wanted me to live, she needed me in her life. The only way I would still be here for her is if I ate.

EXERCISE

Many people will find that their eating disorder spiralled into obsessive exercising and therefore, in recovery, it can be daunting to learn how to enjoy exercise and value the movement of your body – rather than seeing it as a punishment for what you have eaten. I would suggest that you get rid of all trackers and calorie counters (this is really difficult but I promise that you will feel better) and look to gentle activities that you do not do on your own.

Yoga is a relaxing, calming form of movement which encourages you to develop a healthy, respectful relationship with your body. I also found walking my dog with my mother (or a friend) was a good way of getting outside, connecting with nature and doing an activity that was focused on helping my boxer not burning calories.

For me, spending time outside in the garden really helped with the mental challenges of recovery. Planting and nurturing our flowerbeds, watching them regrow with enough care and nourishment, was like an analogy of my journey to recovery. Sometimes the roses took a battering from too much rain, or withered slightly with too much sun, but with with a bit of love they would always bloom again.

Be aware of the amount of exercise you are doing – and the reason you are doing it. If you find yourself making excuses to walk a bit further or do a bit more try to find the strength to be honest with yourself and see that your eating disorder is slowly taking over again. Speak to someone you trust about your concerns. Your eating disorder will convince you that you are being ‘healthy’ and that there is nothing to worry about but I cannot stress enough that battling an eating disorder requires support – in the short term giving into the urges to over exercise or restrict your food intake will seem like an ‘easy’ solution. I promise you, the more you listen to the eating disorder, the more trapped you become.

No one will be angry if you ask for help. If you have started exercising on your own then ask someone to come with you. If this is not possible, try to set a time limit (perhaps listen to a podcast and promise you will stop when it finishes) or make an unmovable arrangement afterwards. Gentle exercise should be a pleasure not a punishment. If you do feel the ‘voice’ of the eating disorder becomes too overwhelming, try to find activities to absorb your attention. We set up a 1,000 piece jigsaw which I could go and do when I need to completely to distract myself and become absorbed in a stimulating activity that would silence my eating disorder. Equally you could play music, read a book, go outside, do some mindful colouring or drawing. These may seem simplistic, but it is about altering your focus and not slipping into the vortex of self-loathing created by your eating disorder.

Dietitian Advice, IBS

Irritable bowel syndrome…what, why and treatments.

31 May, 2019 Priya Leave a comment

Big thanks to Georgia Berry for her help with blog post. Georgia is a nutrition student and can be found on instagram as @berry_nutrition

Did you know it is estimated that 17% of the UK suffer from Irritable Bowel Syndrome?

What is Irritable Bowel Syndrome?

IBS is a condition affecting the digestive system (NHS). The exact cause is unknow despite it leaving millions of people feeling embarrassed due to their unpredictable bowel movements. Symptoms differ from person to person; however, the most common symptoms include:

-bloating

-constipation

-diarrhoea

-abdominal cramps

Often sufferers learn what food triggers a bout of symptoms, however IBS is a complex disorder.

What causes IBS

Although the cause of IBS is not fully understood, there are a few theories behind how the condition develops. IBS is a mostly ‘western’ issue, meaning that populations that don’t live a typical western lifestyle have almost no instances of the condition. This has led researchers to believe that it may be due to lifestyle factors.

Many believe that IBS develops after the gut experiences stress, such as from antibiotics or food poisoning. This then causes the gut to be overly sensitive and causes the symptoms of IBS.

Another interesting theory behind the development of IBS is one based on the natural bacteria in the human gut. The human gut is filled with an incredibly diverse range of bacteria, however when the composition of these bacteria becomes unfavourable, it may lead to adverse side effects.

Scientists also believe that there is a huge link between mental health and IBS, with stress often being a huge trigger. In fact, there has been shown to be a placebo rate of 50% in IBS patients, showing the important of mental health in maintaining gut function. This doesn’t mean you are making things up however it just shows the massive link between your gut brain and your brain.

Treatments

A common strategy to combat flare ups is to create a food diary to assess links between food and symptoms. This is a great place to start and good to do before seeing a dietitian for advice as you can take this to talk through.

Currently, many people are being sent straight to the low FODMAP diet and it is being suggested they start on this diet by themselves. As a dietitian Priya does not agree with this. There are simpler strategies to try first as the low FODMAP diet is very restrictive, can alter your gut flora and really needs 1-1 dietitian support to do it well.

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. This essentially creates a diet low in allergens and common triggers, with foods being introduced back to the diet slowly to assess their role in triggering a flare up. People often report these foods as common triggers:

Dairy
Onion
Garlic
Caffeine
Fatty foods
Certain fruit and vegetables
Lentils, beans and pulses

So cutting out all these foods leaves you with large gaps in your nutrition and the need to really have support planning your meals.

Simpler treatments can be used to manage IBS and these should be tried before the FODMAP diet. Here are 10 ideas for you to try.

Eating smaller, more frequent meals throughout the day may be beneficial as it may be that the process of eating sets off symptoms as eating can stimulate the digestive tract.
Increasing chewing time can ease digestive symptoms. This is because as the mouth breaks down the food more thoroughly it prepares the stomach more for digestion.
Leading on from a theory mentioned above is the reduction of stress to reduce flare ups. Sufferers that report a big increase in symptoms when stressed or suffering with depression may benefit from therapy or relaxation techniques. In more severe cases anti-anxiety drugs may be appropriate.
Another treatment for IBS is based on the theory that a poor gut bacteria composition can lead to symptoms. Giving sufferers both a prebiotic and a probiotic has the ability to affect the gut’s microflora, potentially leading to less flare ups.
Linseeds can be a useful tool for some people suffering from constipation, try 1tbsp a day with plenty of fluid.
Reduce gas producing veggies if you suffer from bloating (cauliflower, cabbage, brussel sprouts).
Fibre rich foods can help constipation but do increase these slowly and drink more fluid too.
Reduce caffeine, alcohol and fizzy drinks.
Cook more meals from scratch as ultra processed foods can cause some of the symptoms.
Be active daily – walking is great exercise and can help with your stress levels too.

Conclusion

IBS is a complex condition which is poorly understood, with symptoms differing hugely between patients. Therefore, successful treatments will vary patient to patient. It is key to get some support to help you work through things. A balanced diet is really important so when you make dietary changes do take care to replace nutrients to stop any deficiencies. It is also important to work with your medical team to test for other diseases such as inflammatory bowel disease or coeliac disease to prevent further issues if undiagnosed. Most importantly, always consult a registered dietitian if you think you may be suffering from IBS. You can ask to be referred on the NHS or seek a freelance dietitian like Priya.

Check out this great fact sheet from the British Dietetic Association.

https://www.bda.uk.com/foodfacts/IBSfoodfacts.pdf

Dietitian Advice

Diet and Mental Health – Part 2

17 May, 2019 Priya Leave a comment

Huge thanks for this guest blog post by Bethany Francois. MSc Eating Disorders and Clinical Nutrition. Find her on Instagram: bethany_laura_

As mentioned in Part 1 of this blog post, health is not just a physical concept but involves mental and social wellbeing too. Therefore, by definition it is impossible achieve a healthy status if one of these aspects is jeopardised for the other i.e. regardless of what you are eating, if your dietary choices are negatively affecting your mental wellbeing you cannot reach state of health.

The mass of dietary information available from unreliable and unqualified individuals has made food choices complicated and confusing. We know that social media use is associated with an over-fixation on eating ‘the correct way’, which can have a profound impact on our mental health (2). It is unsurprising that what we eat can often have a psychological impact when words and phrases such as ‘bad’, ‘guilty pleasure’, ‘naughty’ and ‘clean’ are used to describe the food we eat. An overemphasis on our dietary choices as a measure of our self-worth is dangerous and likely to result in low self-esteem and can lead to eating disorders and other mental health conditions.

In a society where disordered eating behaviours have become normalised e.g. removal of food groups, calorie counting and earning the right to eat via exercise, it can be difficult to recognise (in ourselves or others) when our dietary habits may be having a detrimental effect on our mental health. Here are some signs to look out for:

Preoccupation with food
Anxiety at the thought of straying from your meal plan or last-minute changes to eating plans
Avoidance of social eating and self-isolation
Feelings of guilt or shame associated with food
Compensating by restricting/skipping meals
Justification of eating with exercise
Basing self-worth on dietary choice
Chronic under-eating

Take Home Messages

Diet is an important part of our overall wellbeing and a poor diet can both be a contributing factor and consequence of mental illness. However, it’s important to recognise that mental illnesses have complex aetiologies and require multicomponent treatment strategies. Whilst diet may be a tool to improve symptoms, it is not a cure (note that in the SMILES study (1), all participants remained on their current treatment plan throughout).

Nourishing yourself properly and eating regular meals are likely to have a positive impact on your mental health. Research suggests that the Mediterranean diet may be associated with a decreased risk of depressive symptoms. However, eating well when struggling mentally can be extremely difficult. Feeling guilt or shame due to being unable to prepare meals will only make things worse. It is so important to be kind and compassionate towards yourself-you are doing the best you can.

Our relationship with food should always allow us to be able to fully engage with other aspects of our lives. Being too anxious to attend a friend’s birthday meal will always be worse for your health than any food you would have eaten.

Please remember you can have poor health as a result of your relationship with food without experiencing weight changes. Health is not just physical and weight should never be solely used as measure of our health. Feelings of anxiety, shame and guilt are never healthy, no matter what your weight and you deserve the support to overcome these feelings.

People often roll their eyes at the word ‘balanced’. It may sound boring and it’s not as eye-catching as celebrity endorsed dietary products but it’s the truth. Regular and healthy meals are likely to have a positive impact on our mental health. But equally, an obsessive and restrictive approach to our dietary choices will never result in happiness.

Resources and Support

Mind: https://www.mind.org.uk/

Young Minds: https://youngminds.org.uk/

Mental Health Foundation: https://www.mentalhealth.org.uk/

Rethink Mental Illness: https://www.rethink.org/

Samaritans: https://www.samaritans.org

Beat: www.b-eat.co.uk

References

1. Jacka, F., O’Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., Castle, D., Dash, S., Mihalopoulos, C., Chatterton, M., Brazionis, L., Dean, O., Hodge, A. and Berk, M. (2017). A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Medicine, 15(1).

2. Turner, P. and Lefevre, C. (2017). Instagram use is linked to increased symptoms of orthorexia nervosa. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 22(2), pp.277-284.

Dietitian Advice

Diet and Mental Health PART 1.

15 May, 2019 Priya Leave a comment

Huge thanks for this guest blog post by Bethany Francois. MSc Eating Disorders and Clinical Nutrition. Find her on Instagram: bethany_laura_

The 13^th-19^th May 2019 is Mental Health Awareness Week. In the UK, mental health problems affect 1 in 4 adults and 1 in 10 children and up to 18% of NHS expenditure on treating and managing long-term conditions is associated with poor mental health and wellbeing¹. Furthermore, depression is a major contributor to global overall disease burden and is the leading cause of disability worldwide².

In the media, the term ‘health’ is often represented by an image of a thin person, with a low body fat percentage and visible muscles, but this definition couldn’t be further from the truth. Health is far more complicated than aesthetics and although often not visible, mental illness can have a serious impact on the overall health of an individual. The true definition of health is a state of physical, mental and social wellbeing-all of which can be impacted by our dietary choices.

We’ve probably all heard the term ‘food and mood’, but what does this really mean? This article will take a look at current research and what we know about how our diet can impact our mental state.

What we Know about Food and Mood

The best evidence we have currently, in terms of diet and mental health, is the impact of the Mediterranean Diet (MD). This diet is generally high in fruit and vegetables, legumes, beans, nuts, cereals, grains, fish and unsaturated fat sources such as olive oil and lower in meat, saturated fats and added sugar. The first causal data showing improvements in depression whilst following the MD were seen with the publication of the SMILES trial³. This was a 12-week randomised control trial, where individuals with depression either implemented the MD or received social support (control) alongside their normal treatment programme (such as psychotherapy or medication). Results showed a significantly greater improvement in depressive symptoms in the dietary group compared to the control, with 1/3 reaching remission at 12 weeks. The specific mechanisms by which dietary patterns may impact depressive symptoms is unknown, however, hypotheses include via inflammatory and oxidative stress pathways as well as the gut microbiota and the gut-brain axis. What I think is important to note is, the improvements seen in the study were independent of weight change. Often weight is overly relied on as a measure of health and I think it’s worth making clear that improvements in mood were not a result of weight loss.

Eating Well with Mental Illness

Severe mental illness is associated with poorer health outcomes and a significantly reduced life expectancy⁴. Reasons for this may include decreased income due to an inability to work, self-neglect, poor diet, the effect of some psychotropic medications and the effect of stress and trauma on the immune system. As well as exclusion and stigma within healthcare services and a reduced likelihood of seeking medical help⁵. In other words, those suffering with mental illness face significant health inequalities.

Research into diets that may improve mental health is incredibly important. However, for somebody in the depths of mental illness, being able to eat an adequate diet and look after themselves in general can feel impossible. Social media is inundated with art-worthy bowls of oats, influencers spending hours making the perfect ‘Buddha bowl’ and green smoothies containing 10+ ingredients. For individuals struggling with their mental health, getting out of bed and showered can be a difficult task, let alone recreating these meals. To be bombarded with images like this and the message that this is what it takes to be ‘healthy’ (not true by the way), can exacerbate feelings of low self-worth and inadequacy. Please know that if all you can manage to do is reach for a sachet of instant porridge or put a piece of toast in the toaster, then you are doing great. Do not let social media or the wellness movement make you feel guilty for this.

Tips for Eating Well when Struggling

Don’t complicate things

Meals do not need to be complicated and require lots of ingredients. Try to aim for a portion of carbohydrates (wholemeal if possible) e.g. bread, pasta, rice or potatoes, a portion of protein e.g. meat, fish or veggie sources (beans, tofu, soy, eggs), a portion of fruit or vegetables and a source of fat e.g. cheese, olive oil or nuts at each meal. It can also be a good idea to freeze meals so that on difficult days they can simply be re-heated.

For example, a simple and balanced meal could be wholemeal pasta with tuna mayonnaise, sweetcorn and grated cheese.

Fresh isn’t always best

Convenience is often seen as a negative connotation when it comes to diet. However, contrary to what we are often told by wellness influencers, convenience doesn’t automatically mean food is unhealthy. For example, it can be really useful to use frozen or tinned vegetables rather than fresh. These are not only cheaper but require less preparation and also means you don’t have to worry about not managing to use something before it’s use by date. Jarred or packet sauces can also help to enhance a meals flavour without considerably adding to preparation time.

Food, family and friends

Often the thought of socialising can be difficult when struggling with mental illness, resulting in isolation and further adding to feelings of low mood. Although it can be difficult to reach out to those around us, food can be a useful way to interact with others, whether that is seeing a friend for lunch or preparing and eating dinner with family members. Social eating is also a key concept of the MD discussed earlier.

Comfort

When we hear the term ‘comfort food’, we automatically associate this with an unhealthy habit. We are told that comfort eating is bad for us, that emotional eating is something that should be avoided. Using food as our only way of coping with our emotions is not ideal, however, eating or cooking your favourite meal in an attempt to boost your mood is not something that should be frowned upon. Nourishment is an act of self-care, something some people with mental health problems struggle with. Often individuals feel underserving of things that make them feel good. Spending time preparing a meal you enjoy or perhaps used to have as a child can be an important way to show yourself some compassion and kindness.

Resources and Support

Mind: https://www.mind.org.uk/

Young Minds: https://youngminds.org.uk/

Mental Health Foundation: https://www.mentalhealth.org.uk/

Rethink Mental Illness: https://www.rethink.org/

Samaritans: https://www.samaritans.org

Beat: www.b-eat.co.uk

References

1. The King’s Fund and Centre for Mental Health (2012). Long-Term Conditions and Mental Health. The Cost of Co-morbidities. London.

2. Who.int. (2018). Depression. [online] Available at: https://www.who.int/news-room/fact-sheets/detail/depression [Accessed 12 May 2019].

3. Jacka, F., O’Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., Castle, D., Dash, S., Mihalopoulos, C., Chatterton, M., Brazionis, L., Dean, O., Hodge, A. and Berk, M. (2017). A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Medicine, 15(1).

4. Chang, C., Hayes, R., Perera, G., Broadbent, M., Fernandes, A., Lee, W., Hotopf, M. and Stewart, R. (2011). Life Expectancy at Birth for People with Serious Mental Illness and Other Major Disorders from a Secondary Mental Health Care Case Register in London. PLoS ONE, 6(5), p.e19590.

5. Makurah, L. (2019). Health Matters: Reducing health inequalities in mental illness – Public health matters. [online] Publichealthmatters.blog.gov.uk. Available at: https://publichealthmatters.blog.gov.uk/2018/12/18/health-matters-reducing-health-inequalities-in-mental-illness/ [Accessed 12 May 2019].

6. Turner, P. and Lefevre, C. (2017). Instagram use is linked to increased symptoms of orthorexia nervosa. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 22(2), pp.277-284.

Dietitian Advice, Nutrition Education, Vegetarian

Nutrition Tips for a Plant based Diet

10 May, 2019 Priya Leave a comment

Eating a more plant based diet or switching to a vegan diet is definitely on trend right now and whilst normally I’d not be recommending you jump onto the lastest fad in terms of nutrition, this is one I do agree with. I spoke about this at Womens Health Live so thought it was time I blogged on it too.

We all need to be doing our bit to help our planet. Eating more plants, preferably those grown locally and not wrapped in lots of plastic, is one step in the right direction towards a more sustainable diet.

But are there any nutrition concerns with eating a vegan, vegetarian or plant based diet? Whilst it is well known there are health benefits there are also some health risks if you are not consciously eating certain nutrients.

CALCIUM

If you are reducing your dairy intake then you are also reducing your calcium. To help with this check that the milk you use is fortified and focus on non-dairy calcium rich foods being in your diet. The higher calcium content foods are chia seeds, fortified plant based milks, yoghurts and tofu.

An adult needs 700mg calcium per day, the requirements are higher if you are breastfeeding.

Non dairy calcium foods	Calcium mg
30g chia seeds	178
1/2 pint Calcium enrich plant milk (rice, oat, soya)	330-370
100g tofu	350
1 pot Soya yoghurt	150
1 tbsp tahini	130
150g baked beans	80
2 slices wholemeal bread	75
23 almonds	75
1 large orange	70
2 tbsp cooked greens	70
30g cashews	28
3 dried apricots	20
3 tbsp cooked lentils	25
1 tbsp kidney beans	25
1 tbsp hummus	12

IODINE

The body needs iodine to make thyroid hormones which play a key role in metabolism. Iodine is also needed in pregnancy for proper bone and brain development. There is an rise in iodine deficiency in the UK so it’s a nutrient to be mindful of.

Iodine deficiency is a potential concern if you do not eat meat, fish or dairy, so it’s important to be aware of other sources of iodine. Symptoms of iodine deficiency can include a swelling in the neck where the thyroid hormones are struggling to be made so the thyroid gland is on overdrive, fatigue and weakness, inability to concentrate/recall information, hair loss and dry flaky skin.

All is not lost, you can get your iodine in. Firstly, check your plant based milk as some are now fortified with iodine. Iodised salt is a good option (but not too much salt of course 6g max a day), seaweed limited to once a week and dried prunes are other options.

See this great food fact sheet on Iodine.

IRON

A nutrient that comes up a lot in terms of vegan and vegetarian diets. Can you meet all your iron needs on a plant based diet? Yes, totally but you need to plan things and be on the ball.

The iron you get in plant based foods is less readily absorbed by the body so you need more of it (1.8x). If you focus on eating iron rich foods daily and utilise some top tips you should be fine.

Iron Rich Foods	Iron/mg
Baked beans	1.4
Butter beans	1.5
Chickpeas	2
Kidney beans	2
Tofu	1.2
Dried Figs	3.9
Dried Apricots	3.4
Almonds	3
Brazil Nuts	2.5
Smooth peanut butter	2.1
Hazelnuts	3.2
Sesame seeds	10.4
Sunflower seeds	6.4
Broccoli	1
Spinach	1.6

Including vitamin C with a meal helps with absorption. So having a glass of fruit juice or a smoothie with an iron rich meal will help. Keep your tea and coffee away from meal times as these contain phytates which prevent the iron absorption. Cooking, soaking and sprouting your nuts, seeds and beans can help with absorption too.

For more on iron check out the British Dietetic Association Factsheet.

VITAMIN B12

Mainly found in animal products with a few exceptions of fortified foods (fortified milks, nutritional yeast and breakfast cereals) this is one that you are going to need to take a supplement of if you stop eating animal products.

B12 is needed for nerves, for DNA production and for brain function as well as healthy red blood cell production. A pretty key nutrient. If you aren’t eating many fortified foods then you likely need a supplement which you can buy as part of a multivitamin and mineral over the counter. Chat to your medical team if you have any further concerns as there are also B12 injections.

So can you meet your nutritional requirements on a plant based diet? Yes with some careful planning and a couple of supplements. Remember you do not have to go fully vegan, eating a few days a week in this way has benefits.

Dietitian Advice, Nutrition Education

The misconception of sugar.

26 April, 2019 Priya Leave a comment

By Rosie Jasper, student dietitian.

Many thanks to Rosie for this blog post. Carbs are a huge topic that I myth bust on and talk to clients about every week… so I know you will find this helpful.

I don’t know about you but I’m sick and tired of seeing celebrities, Instagram influencers and articles in the media encouraging us to cut out key components of our diets, for example carbohydrates!
Apparently cutting out sugar and therefore carbohydrate sources is the key to losing weight according to some top celebrity influencers such as Jennifer Lopez, who was promoting a 10 day no sugar, no carbohydrate challenge!

Sugars are carbohydrates; when we consume foods containing carbohydrates (such as those previously mentioned), our bodies break these down into simple sugars called glucose. Glucose is an essential part of our diet as it provides our body, including our brain with the energy it requires to function on a daily basis.

Carbohydrate containing foods also contain essential vitamins and minerals that are required to keep our bodies working as effectively as it should; a lack of nutrients could cause lead to a decrease in energy, mood and brain function. A decrease in mood may mean that we’re more likely to opt for ‘comfort foods’, that are often high in fat, salt and refined sugar, which defeats the object of the aimed weight loss and the vicious cycle begins. Therefore, by cutting out all carbohydrates in the diet, it’s subsequently removing important nutrients our bodies need.

As suggested by the Eatwell Guide, a third of the food we consume should be starchy foods and carbohydrates should form 50% of our energy intake daily. It is recommended that when choosing starchy foods, we should opt for wholegrain varieties where possible instead of their white/refined varieties.

Examples of wholegrains:

Wholegrain bread
Wholegrain pasta
Brown rice
Quinoa
Bulgur
Wheat based cereals e.g. – Wheat biscuits, Bran Flakes, muesli (opt for the no added sugar or salt variety)

White/refined products have been processed and includes foods like white bread, white pasta and white rice. During processing many of their nutrients including B vitamins, vitamin E, fibre and minerals are removed; however, we need all of these nutrients as they provide many health benefits such as providing energy, having antioxidant effects, keeping our digestive system healthy and for maintenance of bone, teeth, nerves, hair etc. Wholegrain carbohydrates include the whole grain and therefore maintain its nutrients.

Carbohydrates do not naturally lead to weight gain if eaten in moderation, however it is true that eating carbohydrates excessively can lead to an increase in weight. Carbohydrates have many important roles in the body and shouldn’t be avoided due to the fear of weight gain.

The important role of carbohydrates in the body:

Our main source of energy – starchy foods are broken down more slowly than free sugar products and therefore provides us with a steady release of energy during the day
Brain function – the brain requires a steady glucose supply in order to function properly
Wholegrain starchy products contain B vitamins, vitamin E, fibre and minerals
Fruits and vegetables contain naturally occurring sugar and are packed with essential vitamins and minerals to help keep our bodies healthy
Fibre is a type of carbohydrate and helps to keep our digestive system healthy, reduce likelihood of constipation, reduce cholesterol and a diet high in fibre has also been associated with a lower risk of bowel cancer
A diet low in carbohydrates is associated with low energy levels, a decreased brain function and low mood

It is recommended that we aim for 5 portions of starchy foods per day (260g). To put it in to perspective this is what 1 portion of a starchy carbohydrate looks like. An easy portion guide is for your cooked carb to fill your cupped hand. There is no need to weigh foods out each time you cook then, just weigh it once and find something it fits in like a tea cup to use as a household measure.

50 dry oats/ ½ cup
2 wheat biscuits
1 slice of bread
1 bagel
1 naan bread
100g dry cous cous/ ¾ cup/approximately 2 hands full
75g dry pasta/ ¾ cup/approximately 2 hands full
75g spaghetti (when bunched together should be the same width as a £1 coin)

The portions of pasta, cous cous and oats may look small when uncooked but when water is added to them and they are cooked, they increase in size and weight. Then when vegetables and/or lean meat is added the portions will bulk out more to create a balanced dish. Meals should be based around starchy foods and adding extra ingredients will contribute to a healthy, balanced diet and increase the nutrient content.

Fibre is also a type of carbohydrate that is found in plant-based foods, however it’s not absorbed or digested and therefore doesn’t impact our blood sugar levels, so doesn’t need to be classed as part of your daily CHO.

Benefits of fibre:

Promote regular bowel movements
Prevents constipation
Helps to control blood glucose levels
Reduces cholesterol

Wholegrain varieties of starchy foods, fruit and vegetables especially when eaten with their skin on, e.g. – potatoes, apples and pears are all excellent sources of fibre.

Meal ideas including their carbohydrate and fibre content

Meal	Carbohydrate content (g)	Fibre content (g)
50g oats made and water 80g berries	37	6
2 wheat biscuits 135ml semi skimmed milk Sliced banana	53	5
Wholegrain bagel Low fat spread Salmon Cottage cheese	42	7
2 slices of wholegrain toast Low fat spread Peanut butter	31	7
75g dried pasta ½ tin of chopped tomatoes 80g peas 80g broccoli 20g spinach	64	16
Medium sized jacket potato ½ tin of baked beans 30g cheddar cheese	63	15

Endorsement of faddy diets in the media should be taken with a pinch of salt (or sugar in this case!), remember a lot of these people have personal dietitians, chefs, personal trainers, photoshop and surgery to achieve their ‘dream bodies’ that you see online. Removing main food groups, even for a short period of time is not healthy or sustainable and shouldn’t be encouraged.

Dietitian Advice, Nutrition Education

Eating for a healthy gut

14 April, 2019 Priya Leave a comment

PRE/PROBIOTICS – EATING FOR A HEALTHY GUT

Huge thanks to Melissa Kuman for this guest blog. Melissa is a Registered Associate Nutritionist. She can be found on instagram or check out her blog.

TOP FACT! Can you believe that the bacteria inside us can weigh up to 2kg and around 10% of what we eat feeds them?

In a nutshell, you can improve your gut by eating certain prebiotic foods and/or take probiotics. This is important as a lot of our immunity is dependent upon our gut (70% of the immune cells are located in the gut) and the microbes that live in it. Plus, 90% of serotonin, the happy hormone is produced in the gut. So basically good nutrition = healthy gut= serotonin and immune system= happy mind and body! Now lets get into this in a bit more detail…

What is the difference between pro and prebiotics?

Great question! Well probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host FAO/WHO (2002). Where as prebiotics are certain fibrous foods (like banana, onions and oats) that help feed the bacteria.

What do probiotics do?

Probiotics rarely colonize in the gut, but rather intermingle with microbes there. As they go through the gut, they interact with gut cells, immune cells and food, giving their benefits. There’s so much research talking about the benefits of probiotics! Studies show that probiotics can improve digestive health and our immunity, including: decreasing antibiotic‐linked diarrhoea; improving resilience to infections; and improving digestion of lactose. There is even some early evidence of benefits in weight management and glycaemic control, depression and anxiety (Jacka 2017).

There’s no harm in taking probiotics but they’re quite expensive, so you could go for prebiotic foods that help feed the good bacteria like oats, bananas, onions, greek yoghurt and Kombucha.

It is important that the probiotics you are taking have research on the certain bacteria they include and that a health benefit has been proven.

Prebiotics

Prebiotic foods are fibrous foods but not all fibrous foods are prebiotic, see table below. Overall, we need 30g of fibre a day and on average, in the UK, we are consuming just 18g. Both observational and interventional studies show that fibre influences gut health. As Burkitt, 1972 said ‘Dietary fibre has a role in the prevention of certain large bowel and other diseases present in Western countries’. Prospective studies also show it can decrease the risk of bowel cancer and insulin resistance in type 2 diabetes.

So how can we increase our fibre? Why not try eating more nuts and seeds and whole fruit and vegetables. For example you could add banana onto your morning cereal and make a big pot of vegetable curry with whole grain rice.

Interestingly Tim Spector, Professor of Genetic Epidemiology at King’s College London followed his son’s ‘Fast Food Diet’ to investigate the changes in the microbiota over the 10 day period. Tim ate 2 x Large McDonalds Meal [Big Mac/chicken nuggets, fries & Cola], 1 packet crisps & 2 beers for 10 days. After the 10 days, he lost nearly 40% of bacterial species with the good bacteria diminishing. Tim felt constipated, tired and grumpy. Not surprising really.

Other factors influencing the gut

‘Exposure to stress, both physical and psychological can modify the composition of the microbiota, due to increased permeability of the gut, allowing opportunistic bacteria to grow and potentially cause damage.’ Rhee et al. (2009).

It is important to put a bit of self-care into your day to reduce stress like running a bath and to be mindful when eating. Both these can help you have a happy gut.

Prebiotics	Probiotic
banana	Yakult- Lactobacillus casei shirota
chicory	Codex- Saccharomyces Boulardii
onion	Actimel- Lacobacillus Casei
asparagus	Mutaflor- Escherichia Coil Nissle
garlic	Dicoflor- Lactobacillus rhamnosus
leeks	Tempeh
Cocoa	Kimchi
Flaxseeds	Miso
Artichoke	Kombucha
Barley	Live yoghurt
Oats	Kefir
Apples	Sauerkraut

References

Heiman ML, Greenway FL. A healthy gastrointestinal microbiome is dependent on dietary diversity. Mol. Metab. 2016;5(5):317-320. doi:10.1016/j.molmet.2016.02.005.

Rhee et al. (2009) Nat Rev Gastroenterol Hepatol; 6: 306-314. 14.

Hooper B, Spiro A, Stanner S. 30g of fibre a day: An achievable recommendation? Nutr. Bull. 2015;40(2):118-129. doi:10.1111/nbu.12141.

https://theconversation.com/your-gut-bacteria-dont-like-junk-food-even-if-you-do-41564

Jacka BMC Med 2017 ‘A randomized controlled trial of dietary improvement for adults with major depression’

FAO/WHO (2002) updated Hill et al (2014) Nature Rev Gastro Hepatol

https://theconversation.com/your-gut-bacteria-dont-like-junk-food-even-if-you-do-41564

Dietitian Advice, Eating Disorders, Intuitive Eating

What is Orthorexia Nervosa and what can I do?

25 February, 2019 Priya Leave a comment

Orthorexia Nervosa is the newest eating disorder phrase on the block. It was devised by Steven Bratman in 1996, after he noticed a trend in his patients. Ortho means rich or correct.

Orthorexia = an unhealthy obsession with healthy eating. It can have elements of anxiety disorders and OCD with it.

Whilst there is an overlap here with anorexia nervosa and people with orthorexia may end up developing anorexia, there is also a big difference. Orthorexia is taking healthy eating to the extreme, it has an aspirational, wellness culture ideal associated with it. This means it is less about weight and more about purity and an ideal lifestyle. Social media has certainly heightened this and fuelled it. With role models who life perfect pure lifestyles of food, exercise and spirituality, it can seem as if that ideal is achievable and realistic. Striving to achieve it leads to feelings of failure and guilt.

The Bratman Orthorexia Self-Test

This is a test devised by Steven Bratman to help identify if you are at risk of orthorexia. If you answer YES to ANY of these questions you may be at risk. I think it is useful test to read through and think to how much you identify with the statements.

(1) I spend so much of my life thinking about, choosing and preparing healthy food that it interferes with other dimensions of my life, such as love, creativity, family, friendship, work and school.

(2) When I eat any food I regard to be unhealthy, I feel anxious, guilty, impure, unclean and/or defiled; even to be near such foods disturbs me, and I feel judgmental of others who eat such foods.

(3) My personal sense of peace, happiness, joy, safety and self-esteem is excessively dependent on the purity and rightness of what I eat.

(4) Sometimes I would like to relax my self-imposed “good food” rules for a special occasion, such as a wedding or a meal with family or friends, but I find that I cannot. (Note: If you have a medical condition in which it is unsafe for you to make ANY exception to your diet, then this item does not apply.)

(5) Over time, I have steadily eliminated more foods and expanded my list of food rules in an attempt to maintain or enhance health benefits; sometimes, I may take an existing food theory and add to it with beliefs of my own.

(6) Following my theory of healthy eating has caused me to lose more weight than most people would say is good for me, or has caused other signs of malnutrition such as hair loss, loss of menstruation or skin problems.

If you identify with anything in this post then I highly recommend that you reach out to your medical team, GP, a friend, a parent, a dietitian who works in this field like myself. You can also contact B-Eat.

Top tips for Orthorexia:

Here are some steps you can take to help combat Orthorexia, I suggest these are done with the support of a therapist and dietitian.

Unfollow anyone on social media who fuels the thoughts of having to eat a pure diet/lifestyle. Or try a social media detox for a week.
Focus on eating a variety diet. There are no wrong or right foods it is all about the balance and variety that you eat. Nothing is off limits. Nothing is wrong to eat.
Work with someone qualified in this area to redefine healthy for you. This may include food, movement, quiet space, social time, family time.
Develop alternative coping skills. Can you see how food helps you feel in control and also makes you anxious? Using distraction after a meal and journalling your thoughts can be a good initial step.
Write out a list of your food rules/beliefs. These need to be challenged.
Only allow yourself to get your nutrition knowledge from someone with a minimum of a degree in nutrition – a registered nutritionist or dietitian.
Stop tracking your nutrition. This may take time to do so start with doing it at one meal at a time.

Dietitian Advice, Eating Disorders, Intuitive Eating

Should I count calories?

17 February, 2019 Priya Leave a comment

With all these calorie counting apps that are around and the pressure is better on us to look a certain way calorie counting can be an easy trap to fall into. Whilst it can be useful in some clinical instances I don’t think it is helpful for the general purposes of dieting.

Formally, a Calorie is a measure of the amount of energy required to heat one kilogram of water one degree Celsius. It was first used in engineering and physics, but eventually found its way into nutrition, we have Wilbur Atwater to thank for that.

Whilst it may make sense that tracking your calories, macros and nutritional intake will help you with your weight, overall health or dietary intake in fact it can have the opposite affect. It can lead to you becoming obsessed with counting everything you eat and feeling you have to stick within a certain number of calories per day. This will stop you enjoying your food and impact your socialising too. What if you are out with friends in a cafe, a once a week occurance and the cake you is 450kcals plus a coffee 150kcals but you are only allowing yourself to eat 1500kcals a day? That cake is 1/5th of your calorie intake for the day, so is it worth eating it? Do you choose to eat it knowing you will be over your calorie limit for the day but that you have enjoyed your cake and time with friends, do you choose to eat the coffee and cake but then restrict your calories the next day to make up for it or do you decline the cake and feel deprived and as if you cannot join in?

Dietitian UK: Why I don't like calorie counting

I’d suggest that calorie counting can be a useful guide and tool for one off occasions but over the long term it has the potential to become obsessive. Following a calorie restrictive diet does not make it a balanced diet. You could be getting all your calories from just fruit and veggies or be skipping a whole food group out.

There is also the question of is it even accurate? There is no way to accurately know the exact calories of the food apart from using a calorimeter in a laboratory. I don’t know about you but I don’t want to burn my food up each time! Yes this is worked out for us on food labels but that is a guide. A slightly different portion size, a different way of cooking, a slight change to a recipe and it will have a small affect. Does that matter? No not really as the calories are just a guide.

Delving deeper, your body will also not necessarily absorb all the calories that you eat. For some foods such as nuts for example, a proportion of the calories are excreted. So even know you may be eating X amount of calories you are not necessarily going to be absorbing all of those. Other foods can make your metabolism work harder, again showing calorie counting to not be a 100% accurate tool.

Personally I do not think counting calories on a daily basis is helpful and it can be a negative trap that you fall into. Instead look at the balance of your diet. Think about getting a range of nutrients in to your day and a wide variety of foodstuffs. Ensure you cook from scratch as much as possible, eating wholegrains and starchy foods, fruit and veggies, protein and healthy fats regularly. Enjoy what you eat, stop when you are full, eat when you’re hungry and be mindful of the food that you consume but not consumed by it.

Dietitian UK