I'm a Dietitian - ask me anything

[doesthisseemright]

This one may be a bit dull but ask away.

Sorry bit late, but thank you for answering my ibs/weight loss question earlier in the thread doesthisseemright. 😊

Emmageddon, yes definitely. This would mean large amounts of fructose, although not that harmful when in the whole fruit. More the case of any "too much" of a food will just increase calories. Punnets sound a lot.
I'd keep to 2 fruit a day.

Urbanbeetler, yes potentially this may be worse with a quick weight loss although I have no evidence to back this up. The thing to do is gradual weight loss with retaining lean muscle and adding exercise which tones while you lose. (weight training and swimming for example). You have to let your skin have enough time to cope with the changes.

In saying that, Im pretty sure there was a recent paper out showing that fast weight loss wasn't detrimental but I domt know if they looked at the skin. I will check that out sometime!

One fun question and one serious please:

If you were stuck on a desert island what 3 foods would you like to live on ( not survival purposes, just what you would choose)

If I've been dieting for nearly 40 years ( i was an obese child, I'm now age 50 with BMI 25.1) £100s spent on this book, that book, this club that club etc. Should I just call it a day on calorie counting as it's no way to spend the rest of my life endlessly trying over and over.

I'm a bit lost about where I was, so forgive me if I lose anyone. (Please ask again).

Dramaticmuch, reactive hypoglycaemia is best treated with fairly regular, low GI carbohydrates and a good balance at each meal making sure you have enough protein and healthy/good fats to slow the carbs down even further. One of the few times I recommend snacks - just small, low GI. Also, watch alcohol and caffeine and avoid high GI, sugary foods.

Thanks @doesthisseemright. I have already given up drinking alcohol and caffeine as they both make me feel awful! Is there any way to successfully lose weight whilst managing the hypoglycemia?

Petronius16, as you have mentioned, the low residue diet is only temporary. I wouldn't worry too much about it for now and would love to recommend a multivitamin but you just need to double check with your Doctor (re colours, vitamin E etc). Depending on your instruction, you could have strained or clear vegetable juices. Make sure to have plenty of protein and low res carbs . I shouldn't worry too much, did you get a diet sheet from the Hospital?

If your weight is fine, I wouldn't worry about the fruit in its whole form. I usually say 2-3 pieces/portions a day (different types and colours). Honey is high in fructose and around, maybe 6g sugar per tsp (rough guess). I'd say no more than 2 or so added per day but this is just the blanket recommendation and if you are not overweight and have a generally healthy diet and are active then you don't need to restrict unless you are having enormous amounts.

amigababy, with your first question:
If you were stuck on a desert island what 3 foods would you like to live on ( not survival purposes, just what you would choose)

I think my first response would be salmon, watermelon, and rocket

Another question partly prompted by another thread. It reminded me of papers I'd looked at years ago.

Why isn't measuring body fat percentage as an indicator of health risk more of a thing among the general public (apart from the dedicated gym-goers and amateur athletes who do tend to) and among GPs?

I would assume some specialists do it, but from what I saw recently on TV on Hugh's Fat Fight, where a new script was being taught to GPs, weighing people at GPs was the standard practice but not fat measurement although the results in some studies were striking (e.g. 48% of women with normal BMIs had an unhealthily high fat %). People generally talk about weight and BMI but not fat % even though things to measure it are very easy and cheap to get these days.

(to clarify, that study was not mentioned in the Hugh's Fat Fight show - could have worded that sentence more clearly)

Hi if you are not already quivering in a corner due to do many questions ( and thanks for doing so - I've found it very interesting )
My question is people blame their metabolism for weight gain. Is their any proof to that. I'll hold my hands up and say I'm guilty of that one. I am a yoyo dieter ( and talking stones on/off and repeat ) nearly all my adult life and was also a chubby child as well. Can you mess your metabolism up ?

What's your thoughts on caffeine? I don't smoke or drink but can easily drink 3 cold coffees a day and would have more but would make me feel ill. Every now and then I go a few days without and feel like I've been hit by a train. It's a guilt pleasure, grand scheme of things is it really that bad? Are there any health benefits?

Also to add along with my coffee consumption I still manage 2litres of water a day

I’m a dietetic assistant practitioner. What do you think of the pilot scheme for apprentice dietitians?

doesthisseemright if it’s okay here’s mine again.... :)

My 4 year old dd is very fussy about food, seemingly texture based, and eats almost no vegetables. She will eat leek in risotto, the odd tinned carrot and nibble broccoli under duress but that's it. She likes some fruits (is off skin again though) and drinks milk/loves dairy. She loves anything salty so olives, capers, cheese. Do we need to worry? She does seem to be increasingly narrowing her repertoire and prefers easy to eat food like cottage/fish pie (but will pick out any veg in it) so summer is proving to be a challenge!

2nd, I've had various dx of lactose intolerance, ibs over the years. Coeliac test was negative but I do seem affected by gluten - but also by commercial gluten substitutes with lots of starch (especially cake sad ) and sugary/fatty foods. I'm on a waiting list for NHS dietician but I'm so fed up with not knowing how what I put in my mouth will affect me next! Any ideas? I'm thinking going private might be the best thing.

Thanks!

Misty9 thanks so much for reposting, I did get lost!

With your 4-year-old, it's a bit of a balancing act because you want two things - 1) to increase the range of foods and get her to eat vegetables and 2) to improve nutritional quality, no matter what.
The first thing is to take the stress out of it, for both of you. There is no rush, you can try things very slowly. Start by including foods in different ways - chatting about planning meals together, preparing food together, just smelling the food etc (I do this when buying and putting the fruit and vegetables away). Then try very small amounts of different foods and textures over time. Don't fret about waste. Sometimes it helps to put a few items - fruit and vegetables out on your benchtop and to get the child to choose the ones they will have in the meal. Then you could also try "hiding", which is not everyone's cup of tea but works ok if you are doing it in tandem with trying things.
Start small. Don’t think you have to add a whole lot at once, build a little up over time.
Start with favourite meals and meals you know she will eat. I add green lentils to bolognaise. No-one‘s complained yet.
Hide vegetables in dishes of the same colour. Experiment with what goes with which meals. Squash goes well with macaroni cheese.
Finely grate vegetables (like courgettes or onions) and add to meat when making mince dishes like meatballs or burgers. Use purées. Vegetables can be puréed and made into pasta sauces or added to stews and casseroles. Dice vegetables super small so they blend into soup and casseroles or mix into fried rice dishes. Try blending vegetables and pulses like chickpeas or kidney beans into pasta sauce, bolognaise or chilli dishes. Mix other root vegetables (like carrots, sweet potatoes, parsnips) into mashed potato. Start in small amounts so the colour change isn’t a big issue. Cauliflower can blend nicely with potato. Be careful to avoid lumps. Use finely grated vegetables in baked goods like muffins, cakes or bread. Dice cauliflower very small and add to chicken curry dishes. If cooked well, the cauliflower tends not to get noticed.
The main thing is to keep trying, but relax with it!

doesthisseemright thank you so much for taking the time to reply - this is a brilliant thread.

We didn't get a list from the hospital, no doubt due to diagnosis being partly through A&E etc., things were a bit chaotic at the time.

Apart from things like melon, cut into chunks, all our fruit is whole.

Thanks again.

Misty9, is it the IBS symptoms then? I see you have had your coeliac test so you don't have to avoid gluten-containing foods in order for the test to be valid. That being said, you may find its not gluten but fructans you have an issue with. Often people assume its the gluten as fructans are the fodmaps in wheat, barley etc.
The NICE guidelines suggest that you should think about the first phase for IBS management - look at : Regular Meal Pattern, Fibre & Fluid intake, Caffeine & Alcohol, Fat (amount & type), fruit and vegetables etc and then, if all looks ok we consider the fodmap exclusion and challenges. The fact that you have a lactose issue and have seen the gluten (possibly this is the fructans) is an issue suggests a fodmap problem.
I would hang on for that NHS appointment and see how it goes. Meantime look at information on fodmaps and, back a step - your general diet. If the NHS appointment is not successful, then look at a private Dietitian.

Oh No, Petronius16, I am so upset you didn't get an info sheet!! I wonder if googling an NHS low residue sheet would be a start? I think there are some good ones. Or ask the Hospital to send one (via the Dietetic dept if you can).

amigababy, If you can then yes to acceptance, living a life free of guilt and restriction and counting! Focus on quality.

Pennycarbonara I think its the ease of weighing and accuracies of body fat %. They are never quite right. There has, historically, been a fixation on weight and I think that's here to stay despite our best efforts. :(

namethecat, yes you can influence metabolic rate and I truly believe people can mess it up but it can be "repaired", Metabolic rate depends on a number of things - for example it can be influenced by your body composition.
Muscle tissue needs more energy to function than fatty tissue, so people with more muscle (or ‘lean’) tissue will have a higher metabolism. So, you could change your metabolic rate by exercising more, burning calories, reducing fat and increasing the amount of lean tissue you have. You should include full body strength and light weight training in your workouts. Don't diet without including exercise.
This is particularly important as we get older, when we tend to gain fat and lose muscle. This explains why basal metabolic rate tends to decrease with age.

I really feel sorry for people who diet and don't change body composition as they then sort of get stuck on lower calorie requirements and when they eat "normally" tend to regain.

I'm mid 50s, fit and well with no food issues.

A few months ago, on holiday, I ate lots of salads, veg and fruit and stopped eating bread, porridge and pastries purely because the fresh stuff tasted so much better than the sugary processed stuff.

On return home I continued this way of eating but as it's not all prepared for me in a glorious buffet this has become my way of eating:

am: pear, apple, orange with full fat greek yoghurt, big handful of unsalted nut and seeds.
lunch: the same (fruit varies)
dinner: big plate of assorted roasted veg with melted cheese, sometimes with salmon or eggs (I don't eat meat)

This way of eating has for the first time in my life made me not want to eat cakes etc or drink coffee and it must contain far more goodness in than my previous carb heavy way of eating. I've lost a few pounds without even trying although my nut/seed/cheese heavy meals must be very high calorie.

However it seems very samey although I have a vast array of different fruit, veg, nuts, seeds and I do feel rather tired and lacking in energy sometimes. My aim is to be healthy and energetic, not to lose weight.

My question is:

• what's your view on the way I'm eating?
• can eating lots of seeds be bad for the body - gut? bladder?
• what can I add to give me more energy?

Moominfan. caffeine is one of those sneaky topics that is creeping up with lost of evidence but I have to go back and have a good look as I haven't got around to it yet. You can get withdrawal symptoms even from cutting one cup of coffee down so three will do it for sure. Caffeine can affect bowels and stress levels and sleep. I don't recommend for CFS/ME. Coffee actually has some benefits though, which is great! There were some studies on reducing type 2 diabetes risk, and dementia and mental health recently. I think the trick is to keep to moderate amounts

moomoomonkey, when I first read about the suggested apprenticeships, I hated the idea. I really don't understand them at all and think they have been really poorly explained. Its been radio silence from the BDA since the first mention.
I'm assuming it's like a sandwich course where you can work whilst doing a day or so at Uni? I'm a bit of a traditionalist and would be horrified if Dietitians were out there without having completed robust studies in biochemistry, pharmacology, physiology. microbiology first etc etc