AMA with Sophie Medlin, consultant dietitian and founder of founder of CityDietitians

[NicolaDMumsnet]

Hi all,

We’re really pleased to announce an AMA with dietitian Sophie Medlin, who has a wealth of expertise focusing on gastrointestinal and colorectal health. The thread is open now for questions and Sophie will be returning to answer questions throughout the week.

''Sophie Medlin is a well-recognised consultant dietitian, founder of CityDietitians and is the Chair for the British Dietetic Association for London. Sophie has expertise in gastrointestinal and colorectal health. She worked in acute hospitals specialising in gastrointestinal diseases before moving into academia, where she worked as a lecturer at King’s College London.

Sophie is a go-to spokesperson for media when it comes to evidence-based nutrition, recently leading the clinical team in Channel 4’s flagship gut health programme, Know Your Sh**. Sophie works hard to myth busy and share evidence based nutrition information via her social media channels @sophiedietitian.''

Please ask your questions from now - though the thread will be open until Sophie has finished answering questions.

As always, please remember our guidelines - one question per user, follow-ups only if there’s time and most questions have been answered, and please keep it civil. Also if one topic is dominating a thread, mods might request that people don't continue to post what's effectively the same question or point. 

Thanks,
MNHQ.

[SophieMedlin]

Thank you. I am sensitive to some foods.
For example, gluten products make me bloated and constipated but I have tested negative for coeliac disease. Am I damaging my gut by eating foods that make me bloated? And what about vegetables that bloat? I often have anaemia and rosacea too, with anaemia being treated with ferritin.

Hello! Sorry for the delay in getting back to you.
You won't be causing your gut any harm with you not being a coeliac so that's good news. You might want to try some enzymes that help to break down the structure of the sugars in the foods that can cause bloating. They're called FODZYMES. Of course if you want to see us in clinic in regards to all of the above, we're always available.

[SophieMedlin]

@potas

Hi. I am a vegetarian. But am struggling to eat a diet that doesn't cause me to bloat/pass gas/have diarrhoea
I try to eat a variety of veg, eggs, dairy, nuts and seeds. But I'm hungry! If i eat more I get upset guts and if I try adding in soya or "fake meat" products I get really upset guts.
Is there a magic protein source that I am missing out on? Or are there supplements that would help.
Thanks

Hi. I am a vegetarian. But am struggling to eat a diet that doesn't cause me to bloat/pass gas/have diarrhoea
I try to eat a variety of veg, eggs, dairy, nuts and seeds. But I'm hungry! If i eat more I get upset guts and if I try adding in soya or "fake meat" products I get really upset guts.
Is there a magic protein source that I am missing out on? Or are there supplements that would help.
Thanks

Hello @potas, sorry for the delay in getting back to you.

That sounds really tricky. It sounds like you might be sensitive to FODMAPs which are complex carbohydrates found in many foods. You could start by adding FODZYMEs to your foods to see if this helps to break things down better for you. Tofu is usually a good source of protein and shouldn't cause trouble for you. We can get this sorted in clinic for you via citydietitians.co.uk.

[SophieMedlin]

@switswooo

Thank you. I am sensitive to some foods.
For example, gluten products make me bloated and constipated but I have tested negative for coeliac disease. Am I damaging my gut by eating foods that make me bloated? And what about vegetables that bloat? I often have anaemia and rosacea too, with anaemia being treated with ferritin.

Hi @switswoo, sorry for the delay in getting back to you. 
You won't be causing your gut any harm with you not being a coeliac so that's good news. You might want to try some enzymes that help to break down the structure of the sugars in the foods that can cause bloating. They're called FODZYMES. Of course if you want to see us in clinic in regards to all of the above, we're always available.

[SophieMedlin]

@Itmustbenaptime

Can you recommend a probiotic or diet strategy to combat constipation? I’m already drinking plenty of water and eating a fair amount of fruit, veg and whole grains (mostly brown rice and oats.) I can’t tolerate some of the recommended foods like prunes and bananas as they make my headaches worse so am a bit stuck for what to try next!

Hi @Itmustbenaptime , sorry you're struggling! My magic formula for constipation is kiwi fruits (2 per day), chia pudding - here is a recipe - and two teaspoons of psyllium husk. Make sure you keep up the water intake. A great probiotic strain for constipation is Bifidobacterium Longum which we have in the Heights Smart probiotic along with other excellent strains. I hope this helps!

[SophieMedlin]

@coronafiona

HOw do I stop overeating sugar?! I eat good healthy meals but far far too much sugar and now have 3 stone to lose

Hi @coronafiona, we find that the worst thing we can do when trying to lose weight is worry too much about any particular food or food group as this makes us think about it more. Make sure you eat plenty of fruits and vegetables, drink plenty of water and find ways to move your body that work best for you. If you're struggling, it's likely that you need to work on your relationship with food more which we can do in clinic via citydietitians.co.uk
We all know WHAT to eat, it's all about looking for the underlying reasons why it's harder for you to make food choices that would better serve your health goals.
Sophie

[SophieMedlin]

@TyneFilth

I've just been diagnosed with diverticulitis and I'm in a bit of a spin about it. I was just about to go plant-based (whole family in fact) but it seems that kidney beans might be my trigger food. I'm nearly out of this latest episode with the help of antibiotics and prescribed laxatives (oh the glamour).

Please could you outline how to get to a high fibre (ideally plant based) diet that allows me still to enjoy the spontaneity of going for meals at friends houses without being a picky micromanaging killjoy? I feel like I am staring into a lifetime of kale and oatmeal. I haven't dared yet to research whether I should/n't drink gin.

Hi @TyneFilth , sorry for the delay in getting back to you. We've got a great blog on diverticular disease on our website - here is the link - it's all about trying to have lots of soluble fibre while being careful with insoluble fibre. Don't worry about gin, that's safe 😉just be careful about how much.
Sophie

[SophieMedlin]

@MyFaceIsAnAONB

Aw I’ve been a client of Sophie!! 👋🏻👋🏻👋🏻 such helpful, calm insights, really really helpful sessions, thank you Sophie.

I have been diagnosed recently with a couple of autoimmune diseases and my question now is is leaky gut a real thing and if so should I take l-lysine to heal it?? Or l-glutamate or something?
My current regime involves probiotics, fermented foods, mushroom coffee (worth a shot!?), no gluten, no sugar (tricky one!). Not sure where else to go.

Hello @MyFaceIsAnAONB ! Sorry for the delay in getting back to you!
Leaky gut research is ongoing so we don't have any clear answers yet. There is no harm in adding l-glutamine but I wouldn't expect it to be a magic bullet for you. Hope all is well otherwise!

Sophie x

[SophieMedlin]

@Havehope21

I don't drink tea or coffee, but enjoy hot squash instead (around 4 cups a day) - these are 'zero calorie' as they are made with artificial sugars. Is this bad for me? Aside from these drinks, I eat a well balanced diet including 30 plant based foods a week, all meals cooked from scratch etc.

Hello @Havehope21 ! Sorry for the delay in getting back to you!
Artificial sweeteners have hit the headlines again with some new research. I would generally advise that we are all a bit careful with how much of them we consume. Why don't you try hot water with fruits added or herbal teas to see if you can reduce your intake. It's certainly not something I would worry about once-in-a-while but regular intake is something I would avoid.

[SophieMedlin]

@dancinginthesky

If you have IBS, Fibromyalgia, PCOS, endometriosis and are far too obese... what's left that you can eat without triggering anything off?

Hi @dancinginthesky , sorry for the delay in getting back to you. That sounds really tough. It sort of depends what your IBS and endo triggers are. We can help you to find this out in clinic if you're struggling. In terms of the other two, the advice is much the same - a plant based mediterranean diet with plenty of oily fish and limiting processed foods. When you have a few different conditions, it's really difficult so it's always best to get support from a dietitian.

[SophieMedlin]

@Appleshapedmum

Any suggestions to improve excessive flatulence? Very windy but not smelly.

Hello @Appleshapedmum ! We can help you find the cause of flatulence in clinic but it is usually due to fermentable carbohydrates in the diet such as onions, garlic, cruciferous vegetables and beans and pulses. It's worth keeping a food diary to see if any of those foods come up on the days when you are most windy. Try not to limit your diet without seeing a dietitian first as gas that isn't smelly is a great sign that your microbiome is working well so we don't want to cause any harm to that by restricting your diet.
Sophie

[SophieMedlin]

@WordInYourShellLike

Hi Sophie, I've had IBS-D and gluten intolerance for most of my life so for the last year I've completely avoided gluten. Now I've developed a lactose intolerance so I'm having to avoid that as well and it's hard to plan family meals and when eating out.

A year ago I started intermittent fasting (mainly around 10/14) and it really helped but then last winter I read that studies had shown it can be bad for you. I decided to stop over the winter but have now started again, concluding that the positives outweighed the negatives. I take Optibac Every Day probiotics, but I really don't like fermented foods.

I don't want to spend the rest of my life not being able to eat or drink so many things that trigger bloating and diarrhoea - is there a way to heal these intolerances completely? Thank you.

Hi @WordInYourShellLike , sorry things are tricky! I'd say to try a probiotic that can help you to tolerate lactose better. The Heights Smart Probiotic would be a good choice. After you've been on that for about 6 weeks, I'd start reintroducing lactose as per the milk ladder to allow your gut microbiome to readjust. Sometimes these things take a bit of time but it's worth investing in your microbiome first then trying to reintroduce.

[SophieMedlin]

@turquoisediamond

I've always had bad skin, a bit spotty, red areas, also have eczema and a sensitive tummy. Am allergic to nuts. Never really tried cutting any foods out as it seems too much hassle. What would you suggest I try first (ie should I try no gluten to see if it makes a difference and if so how long for?)

Hi @turquoisediamond ! Have a look at information on histamine intolerance and see if you think that's in keeping with your symptoms. That might be a good place to start. Happy to help in clinic too!
Sophie

[SophieMedlin]

@Saunaandsteam

Does the gut microbiome change during the menopause and, if so, how can it be supported?

Hi @Saunaandsteam ! Yes it does! The best way to support it is to continue to eat a varied diet and take a good quality probiotic. The Heights Smart Probiotic is a good choice.
After the menopause, women's microbiomes look more like a man's with a higher propensity for cardiovascular problems and diabetes so it's really worth investing in your gut throughout and after the menopause.

[SophieMedlin]

@Cheesewinelover

Hi. Do you recommend probiotics and if so which one or what should I look for if you can't recommend a specific one. I suffer regular bloating and occasional flare ups of painful high up stomach cramps and loose stools. Have for many years. I used to use a probiotic in Australia (not sold here) years ago and really found it helped.

Hello @Cheesewinelover ! The Heights Smart Probiotic is a good choice for overall gut health. Hopefully you've had your symptoms checked by your doctor and/or seen a dietitian :)

[SophieMedlin]

@Rummikub

I e been seeing more about guy health and mental health being linked. What probiotics or pre biotics would you recommend to support brain health?

Hi @Rummikub , I had the pleasure of designing the Heights Smart Probiotic which is designed just for that purpose!

[SophieMedlin]

@Daisypain

Is Symprove actually any good?

Id read the vast majority of the pro/pre biotics just get digested and are rendered useless and the only way to truly improve your biome is eat widely fruit and veg wise, reduce chemicals including sweeteners and up fibre.
But Symprove makes some very big claims and is heavily ‘celebrity’ (read Instagram influencer) endorsed. Any truth in their claims?

Hi @Daisypain , we recently did some testing on a leading liquid probiotic (👀) and unfortunately none of it got to the gut alive. All of the lifestyle factors are great and definitely worth investing in. Ideally you need a probiotic with a delayed release capsule. We did that with Heights and the data on reaching the gut alive was great! Heights Smart Probiotic

[SophieMedlin]

@VeryLittleOwl

Any advice for eating after acute pancreatitis? Cause was high trigylcerides which have now been sorted, no gallstones seen on an MRI, no permanent damage to the pancreas and I have no pain 99% of the time. Hospital told me I can eat whatever I want, just experiment and avoid any foods that cause pain, GP was horrified at that and told me even though I don't have gallstones I have to eat a very low fat diet for the rest of my life. What's the most up-to-date advice?

Hi @VeryLittleOwl ! I would say if the cause was high triglycerides and that is sorted now, you should be fine. After anything like that we always advise 'fat to tolerance' meaning to keep an eye on how you feel after higher fat meals and if you have any discomfort or stool changes, you'll need to reduce your fat intake. Make sure your blood lipids are regularly monitored but I don't see any reason why you need to be on a very low fat diet, just normal healthy eating advice!

[SophieMedlin]

@MsGrahamCheese

Hi Sophie, thank you for this opportunity.

Can you please give me some tips for including a little gentle fibre in my diet?
I have to keep to a long term low-residue diet due to a stricture following a total colectomy but having so little fibre seems to be impacting my energy & ability to keep hydrated. I can't tolerate wholemeal/wholewheat (indigestion).

I'm also pending a diagnosis for CFS so any tips on healthy, energy-supporting foods (especially ones that don't require too much preparation) would make a real difference! I'm finding I'm relying too much on sugar-heavy and highly processed foods, which don't feel so good and I'm putting on a fair amount of weight!

Any advice would be hugely appreciated.

Hi @MsGrahamCheese ! When we do low residue diets in clinic, we always recommend lots of soluble fibre from root vegetables and fruits like melon and tinned peaches. It's also a good idea to add smooth soups and fruit smoothies to keep your fruit and vegetable intake high. That should also help with your energy levels. We have great resources on low residue diets in the clinic which would help!
Sophie

[SophieMedlin]

@Cinderellasfeatherduster

Hi, Sophie and thank you for the chance to ask a question.

I had appendicitis earlier in the year which was complicated with an appendicular mass, peritonitis and sepsis. I didn’t eat for three weeks and could initially only eat fruit, smoothies, simple proteins eg chicken and fish and lightly steamed green vegetables. I’m gradually returning to normal but I still have a serious abscess on the appendix which has meant they’ve as yet been unable to operate to remove the appendix. My digestion is still very delicate and I have to eat small amounts several times a day. What can I do to support my gut health as I recover, pre and post surgery?

Thanks so much, it’s been a very worrying time and it’s great to be able to ask your advice.

Hi @Cinderellasfeatherduster , sorry you've had such a difficult time! I'd recommend you go on a low residue diet and try to get lots of smooth soups and smoothies in to keep your large bowel happy. We'd be really happy to help you in clinic. It's CityDietitians.co.uk

Sophie

[SophieMedlin]

@MumofCrohnie

As my username suggests, I am the parent of a child with Crohn's. This was diagnosed when she was 10 but I think she had it from age 7 or so.

I have been investigating the impact of the modern diet on the likelihood of Crohn's susceptible individuals getting "triggered" into symptomatic disease. It seems like there is a fair amount of evidence of the impact of certain emulsifiers, gums, and artificial sweeteners in IBD. This is ironic since the emulsifiers and gums proliferate in "healthy" alternatives such as gluten free or vegan meat alternative foods that many with IBD try out in an attempt to control their symptoms.

Do you think this will ever become common knowledge and will the industry offer (harmful) emulsifier-free alternatives, or food labelling for ibd- friendly foods?

Hi @MumofCrohnie ! Yes, I think this is coming more into the forefront of our management of IBD and certainly in our clinic, we're recommending people be careful with emulsifiers and other additives when they live with IBD. Unfortunately the food industry and the NHS will take a while to catch up!
We definitely need more convenient, non ultra-processed foods on the market. Especially children friendly ones!

[MsGrahamCheese]

@SophieMedlin

Hi @MsGrahamCheese ! When we do low residue diets in clinic, we always recommend lots of soluble fibre from root vegetables and fruits like melon and tinned peaches. It's also a good idea to add smooth soups and fruit smoothies to keep your fruit and vegetable intake high. That should also help with your energy levels. We have great resources on low residue diets in the clinic which would help!
Sophie

@SophieMedlin

Thank you, that's actually some of the most helpful advice I've had since starting the diet several years ago!

[Polkadotpjs]

My son was diagnosed with coeliac two weeks ago. He's finding it tough. What would be your tips for making him feel well again and what supplements could help ?

[MsGrahamCheese]

@SophieMedlin if you're taking a couple of extra questions (and because I can't afford to come to your clinic atm!), can you mention a 2 or 3 foods which are high in soluble fibre but low in insoluble fibre please?

When I try and research those good for soluble fibre, many seek to be high in insoluble fibre too!

Thank you so much

[VeryLittleOwl]

@SophieMedlin

Hi @VeryLittleOwl ! I would say if the cause was high triglycerides and that is sorted now, you should be fine. After anything like that we always advise 'fat to tolerance' meaning to keep an eye on how you feel after higher fat meals and if you have any discomfort or stool changes, you'll need to reduce your fat intake. Make sure your blood lipids are regularly monitored but I don't see any reason why you need to be on a very low fat diet, just normal healthy eating advice!

Thank you very much - got told yesterday that I can start to come off some of the meds they put me on, so will be having blood tests every three months for a bit to make sure nothing shoots back up.

[SophieMedlin]

@Polkadotpjs

My son was diagnosed with coeliac two weeks ago. He's finding it tough. What would be your tips for making him feel well again and what supplements could help ?

Hi @Polkadotpjs , it can take a bit of time to start feeling well but it's great that he has his diagnosis and is getting back on track. We have a great children's and adult coeliac dietitians in clinic who are extremely experienced. Our children's dietitian Nat has coeliac disease herself and her daughter does too. It's citydietitians.co.uk. The most common nutrient deficiency with coeliac disease is iron so make sure his GP has done an iron studies blood test so any anaemia can be corrected. That will make him feel better very quickly.
Sophie