Gut and Allergy Dietitian

03/10/2024

About last night. Meeting some of the inspirational women working in allergy in person in Harrogate was amazing. And pizza was a great choice! Please tag yourself! Tori, Penny, Kate, Katie, Nishti, Heidi, Aimee 🫶🏻

12/10/2023

Great couple of days brushing up on PEI and pancreatic disease management, organised by Royal Surrey HPB dietitian Mary Phillips. Highly recommend the course. Mary is available in Twitter as MaryHPBRD for information about the masterclass

03/08/2023

✔️August is Gastroparesis awareness month ✔️

Gastroparesis is a condition that affects the stomach’s ability to empty properly, leading to delayed emptying and uncomfortable symptoms of nausea, bloating, vomiting, and feeling full quickly, even after small meals.

Causes can vary, from diabetes to neurological disorders, but the impact on daily life is significant. People with Ehlers Danlos syndrome can also have gastroparesis.

Diagnosing Gastroparesis may involve gastric emptying studies or other tests to understand its severity.

Though there is no cure, treatments like dietary changes, medications, and lifestyle adjustments can help manage symptoms and improve quality of life.

💡Tip 1: Opt for smaller, more frequent meals to aid digestion and prevent discomfort.

💡Tip 2: Stick to easily digestible foods like cooked vegetables, lean proteins, and well-cooked grains.

💡Tip 3: Avoid high-fat and greasy foods, as they can slow down digestion and worsen symptoms.

💡Tip 4: Stay hydrated and consider drinking fluids separately from meals to avoid feeling too full.

💡Tip 5: Collaborate with a dietitian to create a personalized meal plan that fits your needs.

Work with me to get a more personalised guidance on your gastroparesis management!

02/05/2023

May is EDS awareness month.

Ehlers-Danlos Syndromes (EDS) is the umbrella term for a group of genetic disorders of connective tissue, which affects the structure or function of collagen and other connective tissue proteins that act as a ‘scaffold’ to support structures in skin, muscles, ligaments and the gastrointestinal tract. This affects these structures in a way that makes them more fragile, flexible and ‘stretchy’.

There are 13 types of EDS but the hypermobile type of EDS (hEDS) is the most common type that seems to present with gut symptoms. Some research indicates that chronic gastrointestinal discomfort can be found in around 86% of patients with hEDS.

Other types of EDS can also affect the gut anywhere from the upper digestive tract (oesophagus, stomach and duodenum) to the lower digestive tract (small intestine, large intestine and re**um). Issues with the function of the autonomic nervous system that regulates involuntary physiological processes such as digestion is thought to also be common in EDS and may cause additional gut symptoms. A general lack of understanding of EDS can lead to patient suffering for many years and EDS can be very debilitating.

Currently there is no cure for EDS so management strategies are based on supportive treatment of symptoms and the prevention of secondary complications. Based on the dietetic assessment, lifestyle changes along with the therapeutic diet low in fermentable carbohydrates (low FODMAP) to reduce bloating, gas, discomfort and diarrhoea may be recommended for a certain period of time. I always recommend the low FODMAP diet is best done under supervision from a registered dietitian like myself as there is a lot to consider in terms of nutritional adequacy and the effect on gut microbiota, especially in the long term.
The Ehles-Danlos Society is doing an amazing job raising awareness about EDS &HDS.

27/04/2023

It is always fantastic to catch up with your colleagues . We should do it more often🤓

26/01/2023

One of the quick and east allergy tests an allergy dietitian can do in their clinic is a skin prick test (SPT)

SPT is used to measure levels of IgE antibodies to a specific food allergen by detecting the presence of IgE antibodies in the skin.

Today we had a practical on SPTs and I tested myself for dust mite, grass, cat dander and birch.. as you can see all negative as no wheals are visible ( you also have to do a negative - saline solution and a positive control- histamine).

Although SPTs are very common and easy to do, they should always be done by an allergy specialist as the accuracy of testing may be reduced in children under two years of age and you can also be sensitised to a food allergen and not have the allergy.

SPT involves having drops of a skin prick test solution specific to the food, or the actual food itself, for example, a banana (this is called a prick to prick test). A small hand held lancet (sharp prick like device) is applied directly to the forearm and introduces the food allergen. Skin prick test results are quick and can be read after 10-15 minutes.The advice given based on the results of SPT is dependent on the allergy focused history.

31/12/2022

Wishing you all a very Happy New Year! May 2023 be the best year of you life! Im so hopeful it will bring more positivity, peace, happiness, health and wellness into everyone’s lives. See you in 2023. If you struggling with any gut issues or struggling with fertility issues or maybe going through peri or menopause and need some evidence based practical advice, DM me! 🎄❤️☃️

19/12/2022

My recent article in the BDA Dietetics today.
Raising awareness of the Ehlers Danlos syndromes. Link to online version https://www.bda.uk.com/resource/gut-health-raising-the-awareness-of-ehlers-danlos-syndromes.html

30/10/2022

Spot me there in the centre of the table like it was my party 😂 lovely catch up with team today. So nice to see everyone and meet new members of the team. Looking forward to the next meet already 💯

05/09/2022

How do you know if you have food intolerance, also called non-allergic food hypersensitivity?

⛔️Unfortunately I still see a lot of IgG tests in my clinic. You can not confirm food intolerances by blood test, only true allergies. The IgG tests have no diagnostic value and are very expensive and can lead to very restrictive diets for no reason.

Rather than than these expensive tests, food intolerance in clinical setting can be diagnosed using the ‘3R Method’. This is something I discuss with my clients who want to confirm food intolerances. It consists of 3 steps:

‼️Record - keep a 2 week food and symptom diary, in which you write down everything you eat and drink, record any symptoms and record other events, such as exercise, sleep and stress levels ( as these can also affect your symptoms).

‼️Restrict - after you identify the trigger food, cut it out from your diet for at least 2 weeks. Actually some need to testify for longer, depending on your symptoms’ severity.

‼️Reintroduce - bring the food back into you diet to confirm it was causing your symptoms.

This way, there is no crazy restrictions of 100 types of foods.

☝🏻Also, food intolerances can be transient and can improve over time. During the consultation, I discuss strategies with my clients on how this can be archives in the long term.

Have you ever suspected you have a food intolerance and did you fall into the trap if doing IgG tests?

03/09/2022

Ever wondered what happens during a classic IgE mediated allergenic response?

There are a few immune cells involved in the allergic reaction.
Food proteins or antigens enter the body through the gastrointestinal mucosa when we eat the food. Cells of the immune system ‘scan’ everything that gets there. Antigen-presenting cells, also called dendritic cells named for their probing, 'tree-like' shape encapsulate the antigens and present them to another type of immune cells called T- helper cells. In people with allergies, this process stimulates the production of Th2 cells, which in turn stimulate B cells, to produce IgE food-specific antibodies to the protein encountered. Those IgE antibodies then bind to mast cells in tissues via a special receptor in the cells.

The antibodies in blood actually have a very short life but once bound to mast cells they can stay in the tissues for many months waiting to come into contact with the allergen. This process is called sensitisation.

Once the person is exposed to the same allergen again, the specific IgE antibodies recognise unique area on the food protein called epitope which allows the proteins to bid with the antibody, leading to degradation of these cells and the release of histamine, prostaglandins and other factors leading to many symptoms of the allergic reactions.

16/02/2022

One thing that is mega useful in constipation or hard stools especially if someone suffers from a lot of wind is a fibre called Psyllium Husk. It is a water soluble fibre and gel forming and it’s poorly fermented meaning it will not cause much gas when ingested compared to some of fibres.
I often recommend Psyllium as a bulk laxative as it has a gentle laxative effects due to increasing faecal size. This bulk happens due to water and gas absorption in the small intestine and colon to give faeces more size and moisture, so the most common characteristics of stool following supplementation of psyllium are 'soft, and easy to pass’. ✅Dose: for the f***l forming properties, a daily dose of 15g (dividing into 3 daily dosing of 5g) is a good starting point as we titrate the dose up or down depending on its effects on faeces. ‼️It is very important to have at least 200 ml of water with each dose of Psyllium Husk to allow it to its job properly.

14/02/2022

‘Adverse reactions to food’ is an umbrella term referring to any unexpected and unwanted reaction after the ingestion of a food or a food additive. These type of reactions have been proposed to be referred to as Food Hypersensitivity (FH) by A European Academy of Allergy and Clinical Immunology (EAACI) task force. ✅Food intolerance is non-allergic food hypersensitivity; the reactions are mostly delayed occurring hours or even days after, whereas ✅true food allergy actually involves immune response and symptoms are very quick to manifest, within minutes to a couple of hours.
Symptoms of FH usually involve gut, skin and respiratory system. ‼️If food hypersensitivity is suspected it is worth working with an allergy specialist doctor and a dietitian to identify which category it falls into to optimise the management. I see a lot of people in clinic who have had their symptoms for years and suspect food hypersensitivity but unable to establish exactly what kind of reactions the are having and the triggers. Together we are able to work on this. I always signpost to other registered health professionals if needed, for example for specific IgE blood tests or skin prick tests if needed and where appropriate. More on FH to come! Like, share and save if this post is useful 🙌

11/02/2022

A low FODMAP diet is usually recommended after the first line advice in IBS has failed to produce symptoms resolution. This particular therapeutic diet consists of 3 stages and 1st stage involves the reduction of FODMAPs. It should be followed for 4-6 weeks but even a few weeks is long enough to identify if symptoms will respond to reduced FODMAP. Remember is it’s a low FODMAP diet, not a no FODMAP diet, so some fermentable carbohydrates are still present.
After the initial 4-6 weeks if and when the symptoms are controlled, it is important to work with your dietitian to progress to stage 2- reintroduction of the FODMAPs to identify which particular groups of carbohydrate cause you symptoms. You may be surprised at this stage to learn that you can tolerate a lot more foods without symptoms as sensitivity to FODMAPs varies between people. The reintroduction is therefore essential to establish how much of that particular FODMAP containing food is well tolerated. Although a low FODMAP diet can be nutritionally balanced, working out what you are most sensitive to helps to increase food choices in your diet and diversifying the diet in stage 3 where personalisation is important for the long term management. Following a Low FODMAP diet for too long can result in negative changes to gut bacteria and it’s functions, so take home message is … always reintroduce! Even in small amounts higher FODMAP foods feed that beneficial bacteria and contribute to a more balanced microbiota

11/02/2022

It is important to look after your mental as well as physical health by doing things you enjoy more like spending time with friends, going for walks and being outdoors and physically active as well as eating a good balanced nutritious diet. Mental health in gut conditions is often overlooked.

10/02/2022

10/02/2022

FODMAPs are Fermentable Oligo-, Di-, Mono-saccharides, and Polyols. All fermentable carbohydrates🙌. FODMAPs are “osmotically-active”, meaning they will draw a lot of water when they reach the large intestine, especially in large quantities which can cause a lot of bloating, digestive discomfort and loose stools in IBS. During the fermentation copious amounts of gas can be produced which can also affect and ‘stretch’ the large intestine casing abdominal pain and more bloating.
The low FODMAP diet remains the most effective method of IBS treatment and should be done under the guidance of a registered dietitian to ensure nutritional adequacy and unnecessary restrictions for longer than needed as doing it long term can negatively impact on gut microbes. I often use a modified FODMAP diet where only trigger FODMAPS are reduced or avoided making the diet less restrictive.

31/01/2022