Webchat with Jane Clarke

 

Jane ClarkeNutritionist and dietitian Jane Clarke was our webchat guest in February 2011. She says her mission is to change people's lives through the power of nourishment. Jane runs two dietetic practices (her specialist practice assists patients who have cancer and their families) and advises some of Britain's leading sportspeople.

Her latest book, Nourish, explains nutritional needs at every stage of life - children, teens, adulthood, pregnancy, middle age and over-60s.

She talked to us about the best diet for those with different medical conditions, the best foods to keep energy levels up and how to deal with children's fussy eating habits.

Dietary help with specific medical conditions | General dietary issues | Being a dietitian | Children's diets

 

Dietary help with specific medical conditions

Letter Qangelcake99: I am quite a few stone overweight and have polycystic ovary syndrome. I have been prescribed slow release Metformin for this. I am vegetarian and have struggled to control my cravings for sweet foods and high carbs. Please could you advise what foods could help with my weight and help me feel satisfied for longer?

Letter AJane Clarke: PCOS is a tough condition to manage, as the body can be cruel, making you crave the foods which, unfortunately, not only don't make you feel great, but actually because of their effect on blood sugar and insulin levels make the symptoms of PCOS worse.

Generally with PCOS, the thing we try to achieve is a steady blood sugar level, as this helps to keep the hormone insulin levels steady too. As a vegetarian, lentils and beans are great satisfying foods, which contain a combination of carb and protein, helping you feel satiated but not too heavy. So, delicious dishes like lentil soup, full of vegetables, can be a wonderful lunch, or little chickpea rissoles go well with a big green leafy salad for a comforting supper. You may also like to try using more nuts and seeds as these say toasted on top of a salad or steamed curly Kale with a dollop of hummus can help make it all taste great and above all keep you satisfied for longer, ultimately helping you to control your weight.

Finally, there is a traditional remedy for helping ease sugar cravings which seems to work well with a lot of my patients with PCOS, and that is to sniff something vanilla-based, such as vanilla essence or a perfume based around vanilla, as vanilla really helps to kick sweet cravings - strange but it seems to work!

Letter QJammygal: I know quite a few of us on here have hypothyroidism. I have anaemia too. Any tips on diet that may help us to get our metabolism back on track? I know lots of us feel the same way: tired, fat and old before our time!

Letter AJane Clarke: What a combination - as you say, being deficient in thyroxine and anaemic is bound to make you feel exhausted. I just wonder what you're doing to correct your anaemia. Although it takes a few weeks for iron-deficiency (which is the most common form and therefore I'm assuming it is the type you're referring to) anaemia to correct, if you can get your iron levels up in your diet, along with your vitamin C intake up, you should soon start to feel much stronger.

The iron-rich foods are really meat-based, so this means lean steak, eggs, dark green leafy vegetables such as spinach, curly kale and soya - which could be soya milk or soya proteins. If you can boost the amount of these in your diet, then slowly but surely your anaemia should correct itself.

"Vitamin C helps your body to absorb iron - squeeze fresh lemon on to a salad or use finely grated orange rind in vinaigrette dressing made with walnut oil."

I mentioned vitamin C, as this vitamin helps your body to absorb the iron - so this could practically mean simply squeezing some fresh lemon on to a spinach salad, or using a little finely grated orange rind in a vinaigrette dressing made with a walnut oil before you toss it into a rocket salad to serve with some thinly sliced roast beef.

I tend to prefer the herbal iron supplements such as Gentle Iron and Floradix, rather than the harder prescribed supplements, as these tend to be gentler on the gut. 

On the thyroid side, you may have read that some people find that having a diet rich in iodine can help improve symptoms, which would mean eating more seaweed and seafood, but I would just caution against taking iodine supplements unless you've had specific advice from a clinical dietitian, as they can have adverse effects on your thyroid gland, so it's just worth a little caution.

Letter QItsGraceAgain: I've got CFS/ME and want to get better. I eat a lot of meat, fruit and veg and I take a multivitamin plus mineral supplement, plus Omega3 and vitamin C. Do you know of anything else (affordable) that could help support my poor, tired system?

Letter AJane Clarke: I'm sorry to hear about ME, as I know from having treated so many people with ME how debilitating it can be. Try as much as you can to have three protein rich meals a day as you'll probably find that this helps maintain a good blood sugar control, which can maintain better energy levels - this could be an omelette, scrambled eggs, a quick tuna fish salad or some cold cut deli hams or smoked salmon, made as an open sandwich on a slice of wholemeal bread.

Letter QRindercella: My husband has advanced prostate cancer (spread to lymph nodes and widespread bone metastases). He has been to the Penny Brohn clinic and we are trying to follow the Bristol Diet to help him as much as we can. Unfortunately, he sometimes struggles to eat due to his illness and treatment. I cook everything from scratch for him, with lots of lentils, vegetables, (little) fish and occasional chicken. He has totally cut out dairy from his diet and has now started to eat gluten-free bread. What other advice would you give? In your experience, is this diet helpful? If so, how can it help? Is there anything else I could be doing to help him? He sometimes (actually, frequently) finds food very difficult to digest. Do you have any advice on how better this could be managed? I know my husband's cancer will not be cured, but what can help to make him more comfortable and his life more bearable?

Letter AJane Clarke: I'm so sorry to hear about your husband. I work a lot with patients with cancer, be this prostate cancer or cancers of all sorts, in my practice in central London, so if you would like to come and see me, I would be delighted to help you put together a strategy to help ease some of your husband's symptoms.

"Food can be a wonderful way to ease a lot of the symptoms of cancer, but there is scaremongering around the links between dairy and cancers."

Food can be a wonderful way to ease a lot of the symptoms of cancer but I have to say that there is so much scaremongering around the links between dairy and cancers, when recent studies show that cancer-rich foods such as yoghurt and milk can actually have a cancer-protecting effect. I don't mention this to confuse you, just to highlight that it's such a complex area, which I would love to be able to support you more through. As a starting point, there is a chapter in my new book Nourish on cancer, so this may give you a few ideas and pointers.

Letter QSameAsYou: I have psoriasis and have been advised to reduce dairy. I don't really have that much dairy other than in tea or coffee. Please can you advise what other foods would be good to eat, or any supplements?

Letter AJane Clarke: I'm not really sure why you've been advised to cut down on dairy as, although too much of anything doesn't do the body any good, I'd be surprised if dairy foods were aggravating your psoriasis. It's a tough skin condition to treat as everyone is slightly different and it doesn't seem to respond in as general way as, say, eczema.

One thing I'd try is to boost your intake of the long chain omega 3 fatty acids, as these can have an anti-inflammatory effect on the skin, which if taken at a level of a couple of portions (a portion we usually define as 140g-ish) of salmon, fresh tuna, sardines, mackerel a week this could give your body a good dose of these beneficial omegas.

One thing to point out as a more general point is that women of childbearing age shouldn't be eating more than a couple of portions of these oily fish a week, as we have concerns over the toxins in oily fish, which could potentially be passed onto an unborn child. This isn't meant to scare anyone, but it's best and perfectly safe and nourishing to have a couple of portions in a week, but don't OD on them. Men and older women can have up to four portions a week. B

"Women of childbearing age shouldn't be eating more than a couple of portions o

But, back to your psoriasis, also see if there are any foods or drinks which are aggravating it, as certain wines can, as can histamine-rich foods, such as strawberries. I talk about how to deal with skin conditions in my new book, so you may just find that useful.

Letter Qcrissyboo: I have an underactive thyroid and currently take 150mg thyroxine a day, however, I am constantly tired and am gaining weight despite going to the gym three times a week and trying to follow Weight Watchers. Are there any foods I can eat or supplements I could take to boost my thyroid level? It is really starting to get me down now, as I also have psoriasis and depression.

Letter AJane Clarke: Have you had your thyroid gland checked recently, as I just wonder what's going on? Also I'd ask for your doctor to refer you to an endocrinologist, which is a hormone doctor, as they can check to see if there is anything else wrong hormonally which could do with tweaking, as you shouldn't be gaining as much weight etc and feeling so low.

The problem with supplements supposedly designed to boost your thyroid function is that either they just don't work or, worse still, they can interfere with the thyroxine's effectiveness and get you into all sorts of messes - I'd really press your doctor to get you to see an endocrinologist. Insist!
 

General diet issues

Letter Qinthequeue:  I have had several miscarriages over the last year (diagnosed with over-active natural killer cells, sub-clinical hypothyroid and Factor V Leiden), and the only time that I successfully carried a pregnancy I was on a very low carb diet. Even when not low-carbing I generally eat a healthy diet, with very few sugary foods or ready meals. I wanted to ask whether you believe that there such thing as an optimal fertility diet?

Letter AJane Clarke: The relationship between specific foods and fertility is a little complex, so I'm sorry if I don't get to cover this completely today. It's interesting that you have found that a low-carb diet has been successful, as I suspect that it may have something to do with the relationship that exists between insulin and the other reproductive hormones. Eating a low-carb diet can help some women, but I would say that one thing worth checking is that your diet is as all-round nourishing as possible, rich in good quality lean proteins and vegetables and fruits, as you're more likely to ensure that you have plentiful amounts of beneficial nutrients such as zinc and vitamin C. 

Letter QByThePowerOfGreyskull: I have a seemingly healthy diet with fruit or veg at every meal, I don't cut out any food groups and try to have a balance of thirds on my plate. However, I am a very windy person (both ends) and I get huge cramps from time always in the same place - just slightly in from my right hipbone. I haven't yet managed to work out what it could be. Any tips?

Letter AJane Clarke: Wind is always an awkward subject to bring up, but it's oh so common, so I'm glad you have. So a few things to try - have you first of all thought about keeping a food and symptom diary for a few days? This could show you if there is any specific food or food type, such as brassicas like cabbage, artichokes, sprouts etc, which could be making things worse or just not suiting you. It's a good place to start as it gives you some pointers, hopefully.

"Have you thought about keeping a food and symptom diary? This could show if any specific food or food type is not suiting you."

It's my experience from treating this problem for many people that it's often down to a combination of sometimes having too much raw foods - try a week of eating cooked vegetables and fruits instead of raw and see if this makes a difference.

Equally, you may find that a couple of remedies could help - my favourite is aloe vera juice, which, as disgusting as it is to drink, can soothe a windy gut. Also try taking a prebiotic and probiotic supplement, containing about 4 billion cultures of probiotics, for a few weeks to see if rebalancing the gut bacteria helps too. Good luck!

Letter QGreatGooglyMoogly: Could the reason I am often tired and need naps be that my diet is lacking in something, or even that I don't drink enough water? I have had blood tests and am neither anaemic nor diabetic.

Letter AJane Clarke: A couple of things to try - first, it could be that you're not drinking enough water. It's amazing, once you hit the 2.5l a day mark that energy levels can just feel more consistent. I know it sounds a lot but if you stagger it throughout the day, this can help you, first, not end up on the loo all the time and, second, keep energy levels and moods up. It could be 2.5l water or a herbal tea - the ones I find most energising are lemon, be this fresh lemon in boiling water, or with mint leaves, or a tea such as lemon verbena or lemon and ginger, or fresh root ginger in hot water - try them.

Second, why don't you see if boosting your protein intake makes a difference, as I tend to find that if my lunch is high in lean proteins - roast chicken, an omelette at home, or something like some cold wafer thin ham (along with the salads, veggies etc) - I feel more energised in the afternoon. This is opposed to having more of a bread-based lunch which, if there is just too much bread, it makes us snooze.

The other option is to try crisp breads - I rather like the Dr Karg style biscuits with seeds on or the Swedish style rye crackers, as they're delicious and don't tend to make our energy levels drop as much as a big bready sandwich. I see so many people who find that too much of the starch at lunchtime doesn't work. I'm not saying you need to avoid the starches all together, but just try tweaking the amount.

Letter QThePosieParker: I've had eating issues since I was in my teens, losing weight by not eating but because my appetite disappears, then ballooning from under 6st to over 12st in pregnancy. What foods can I eat that will inspire me to eat well? 

Letter AJane Clarke: I wish I could wave a magic wand for you! Have you tried to see someone professionally as I'm presuming going down to 6st was far too light for you? You don't say how much you weigh now, but I'm assuming that you're not happy where it is.

One thing to try straight away would be to try and get into a habit of sticking to three meals a day. I know this sounds so general and boring, but forcing yourself to get into a structured eating pattern rather than picking or snacking, or going for long periods without eating and then overeating, will really help you start to move forward. Ask yourself whether the food which you're about to put in my mouth going to nourish you; if it is, then go ahead, but if not, ditch it!

Letter QMerryMarigold: Which foods are really good at promoting energy and which foods drain your energy levels (yes, yes, biscuits!). Also, are there recipes in your Nourish book?

Letter AJane Clarke: Ah, a biscuit lover! Yes they can give you a boost and be utterly delicious as they do, but so often we feel a crash afterwards. So in the long run you don't feel great.

"If you want something sweet, eat it after a meal which has some protein in it, as this slows the absorption of sugar, which helps cushion against sugar-related energy surges and crashes."

The trick can lie in trying two things - try a sweet treat which is based around something with wholegrain and fruit, such as slice of walnut and fig cake, made with wholemeal flour and apple purée, as this tends to be more gentle on blood sugar and hence energy levels.

Secondly, try, if you're wanting to have something sweet, to eat it after a meal which has some protein in it, such as some meat, fish, eggs etc, or, if you're vegetarian, something lentil or bean-based such as bowl of Tuscan bean soup, as this helps to slow down the absorption of the sugar, which again just helps cushion any sugar-related energy surges and crashes. There are lots of recipes in Nourish, so I hope you enjoy them!
 

Being a dietitian

Letter QFunnysInTheGarden: Always loved your no-nonsense approach to food. So how come they replaced you with John Briffa at the Observer? I followed your columns avidly, but hate The Biffa's rather holier-than-thou take on What's In Your Basket. I mean, will nothing please the man? "Ooooh porridge - you do know that it will raise your blood sugar and then cause it to crash with hideous consequences, don't you?" In the common parlance of MN: FFS. So Jane, when are you coming back? We need you!

Letter AJane Clarke: Oh I do miss the Observer - I loved writing for them! It does feel a long time ago though. I was childless and lived in a minimal factory, which would no way look the same now that I have gorgeous eight-year-old Maya! I made the decision two years ago, when I moved out of London, to step away from writing a twice-weekly column as I just didn't want the pressure, having been a columnist for 10 years. I also wanted to treasure my time with Maya, as it's going so quickly. But I hope you enjoy my articles as I feel inspired to write them and my new book. Having the flexibility to write Nourish without the pressures of a newspaper editor breathing down my neck was lovely.

Letter QAonach: As a dietitian I am so pleased that Mumsnet are using a credible person and not a 'nutritionist'. Nutritionists are entirely unregulated where dietitians have studied between four and six years at university, with clinical placements,and are HPC-regulated to only provide evidence-based advice. Well done Mumsnet and Jane for raising the profile of dietitians. 

Letter AJane Clarke: Whilst I love being a dietitian, the problem with the word is that it still to many creates an image of a holier-than-thou, white-coated professional who hands out diet sheets. I know we're not, but the reason I often refer to myself as a nutritionist is that it helps people to feel that I'm all about nourishment, nutrients and the foods you can eat, rather than putting people on diets. As you say though, there are so many nutritionists out there who have no qualifications and many people thinks that they're professionally qualified. Therefore, I like to use nutritionist and dietitian, but I realise that it's a bit of a mouthful!

Letter QCuppaTeaJanice: Do you think Gillian McKeith's pitiful performance on I'm A Celebrity has had a detrimental effect on the reputation of the nutritionist/dietitian practice? Is the public more likely to now think that good nutrition is of little benefit if one of its more famous champions is looking old and haggard and fainting all over the place?

Letter AJane Clarke: Oh how could I resist this question! It's such a shame that people assume that Gillian is a dietitian and lump us all in the same sack and judge us as such. As so many of you have quite rightly pointed out, there is a huge difference between someone who calls him/herself a nutritionist and a properly qualified dietitian - whilst there are some great accredited nutritionists, at the moment it's hard to tell the difference.

If you see someone who calls him/herself a dietitian, you know that they have to have completed a degree or postgraduate dietetic qualification, so I think it's a much safer place to ask for professional advice. 
 

Children's diets

Letter Qphilmassive: My son is seven and will only eat an extremely limited selection of foods: sausages, pasta, olives, orange juice, steak, chicken, ketchup, bread, tuna, cheese and tomato pizza, and rubbish, like crisps and sweets. He doesn't eat any fruit or vegetables in their proper form and he steadfastly refuses to try new things and even sometimes refuses familiar things if they look different or have a different texture. I do try to buy the best versions of what he will eat, like high meat content sausages and organic ketchup but I know he must be enormously lacking nutritionally and I think he must often be hungry and bored by such a limited diet. He won't eat versions of the foods he does like, for example, he eats pasta and tuna but won't have tuna and pasta bake. He hates 'wet' food. Do you have any tips to encourage him to try new foods and would you recommend a vitamin supplement for him? Also from reading on here other people's experiences I do wonder if he has some sort of disorder. Can you explain how I could go about finding out if this is the case?

Letter AJane Clarke: I wouldn't panic and don't think that he has a disorder. As frustrating as it is, I think it's just one of those phases he will grow out of. It may well take going around to a friend's house where he's served tuna and pasta bake and nothing else is on offer, for him to click out of being so specific over what he will and won't eat.

I know it may feel as if he's lacking in essential nutrients, but the test of this is really if he is thriving, feeling well, enjoying activities, etc, as the body will tend to grab more of an essential nutrient, rather bizarrely if you don't have that much of it. This can be the case with minerals like calcium, which, if you don't have that much in the diet, their intestine absorbs a high proportion of what it's offered. So unless he is flagging, then I would assume that he at the moment is getting enough to keep him healthy.

"It's a tough line to toe, but having lots of children who are fussy eaters, the more clear you can be about just offering that one food and not offering something else if he doesn't eat it, the more likely he is finally to realise he needs to tuck in - albeit after some pretty miserable meals."

It's a tough line to toe, but I have to say, having treated lots of children who are fussy eaters, the more clear you can be about just offering that one food and not then offering something else if he doesn't eat it, the more likely he is to finally, albeit after some tantrums, I'm sure, and some pretty miserable meals, realise that he needs to tuck in.

Incentive charts also work well, even at seven, so he can work his way towards something he'll love, if he tries a few mouthfuls etc. Finally, I know it's not easy but try as much as you can to eat the same food as him and with him, as this can help build up his desire to please you.

I'm going to sneak in a mention about sugar, as I see lots of you have written in worried about the amount of sugar you're giving your children. Sugar is a very divisive and judgmental issue, as some of us much prefer not to give many sweet things, such as sweet drinks and biscuits, whereas other parents think we're being overly strict and risking a backlash.

I so often see that overly sweet foods, such as refined sweets and drinks don't make children feel great, so my feeling is why would I want to give a child something that does this? Every parent has a right to choose what they give their child and yet other parents can be so overly critical if you don't go along with what they do. The only caution I would offer is being too strict when they're at friends parties or houses and everyone else is eating the sweet stuff you'd rather your child wouldn't eat - try to let them have some as they'll rebel if you don't and you also run the risk of them then starting to feel they need to hide the food from you, which is a path best avoided if you can. Limit as much as you can and just see it as a blip as you'll know they'll soon be back on the nourishing stuff at home.

Letter QDolceeBanana: I have three children (4.5, 3.5 and 16 months). My eldest son has always been far pickier than his sisters. He hates fish and will often gag when encouraged to taste it. We eat a fairly healthy, balanced diet of home-cooked food. How would you coax him to eat and enjoy fish?

Letter AJane Clarke: I'd take the pressure off yourself if he's otherwise eating well, as children don't always genuinely like the foods we wish they would eat at certain points in their lives, but the likelihood is that he will click into another phase and especially if he sees his sisters eating fish, to join in too. Have you tried fish soup that is blended so that he won't know it's there?

At the age of 4.5, he's perfect age for incentive chart, so try to pick something he'll love and break this achievement into several stars, so that slowly but surely he can see there is something good to come out of at least trying, and hopefully, enjoying eating fish. Could always try the thing I used to love as a child when we went on holiday to North Wales and to take fish and chips on to the sea wall and to watch the waves whilst we ate them!

Last updated: 04-Mar-2011 at 4:00 PM