Dietetics or Nutritional therapy – what’s right for me?

So, from a digestive point of view, it's really important to have good gut health on a number of different levels. Number one, you know, how well do you digest your foods, the main macronutrients or food groups? What's the balance in the gut flora? What's your microbiome doing? Is it healthy? Is it not healthy? That is absolutely key. You're then looking at the metabolic function of the gut and how well that is doing, for example, in the production of vitamins and minerals and then also the body's ability, or the gut's ability, to manage inflammation, to manage pathogens coming in, including parasites. So there's many things that go on in the gut itself.

And then when it comes to the rest of the body, I mean, we know now that the health of the gut has an impact on the health of the mind as well. We now know that a number of mental health issues are also associated with poor gut health. Good gut health also impacts on inflammation generally within the body. You can even associate it to joint health, to cardiovascular health and more.

A patient might wish to visit a Nutritional Therapist or a Dietician at any point along their health journey. I mean, sometimes they will be given a diagnosis of an inflammatory bowel condition by their gastroenterologist. And the gastroenterologist has recommended that they go and see someone to discuss what kind of diet would be relevant to them. And I think that's the key, it's personalised to them. And that would be a good time to speak to someone like me, to make a plan moving forward to support them on their health journey.

Other people might not have a diagnosed condition. For example, it could be something like IBS, which is quite an umbrella term and it's not part of the inflammatory bowel diseases, but it's an irritable bowel syndrome which encompass a number of different symptoms. And the patient might have tried a number of different dietary interventions themselves and found some useful, but then getting a little bogged down in the weeds and not quite knowing where to go next. And that would be a good time to come to see a practitioner like myself. And there might be some people that just want to prevent gut issues because they have someone in their family that has issues with it, and they want to make sure that they are doing the best for themselves. So that would be another good time to come and speak to a Nutritional Therapist.

That's a really good question because there are a number of different ways to support your gut. Number one through your diet, and number two through some carefully selected probiotic and prebiotic supplements. Thing about a diet that's more wholesome, is that it will contain a lot more vegetables, a lot more nuts and seeds and grains, lower glycaemic index, grains and all of those foods kind of form what we know as the prebiotic foods for the gut flora to thrive. So you can think of the prebiotic foods as being the food for the probiotics, which is the live gut flora. Now, probiotics is a huge industry and there are lots of probiotic products out there. Some are very helpful for sure. And a number have had a lot of different types of research done on them and we know them to be very helpful in particular conditions in the gut.

I think it really depends on the individual as to which type of probiotic is relevant for them. And that is something that would go through in a consultation. There are a number of different factors that have an impact on the gut microbiome or the gut flora, that is all the bacteria that live in the gut, ideally in a healthy ecosystem. So that can be disrupted by medication. Many different types of medication can affect the gut flora. But one of the ones that we know most about is the antibiotics which, of course, kill bad things and that's why they are necessary, but they can also kill the good. So it's really important to replenish the gut flora after a course of antibiotics.

We also know that a poor diet has a really negative impact on the gut as well. So ultraprocessed foods really do have a negative impact. I mean, in part, they create inflammatory markers in the gut. But also many of these foods are devoid of fibre. And it's the very fibre that would be devoid in a diet that's highly processed. We also know that some environmental pollutants that come into the food chain as well can have a negative impact on the gut. And so it's important to look at that. And then also stress and poor sleep - and poor sleep is a form of stress in a way - that creates a whole cascade of reactions in the body that can have an impact on the gut.

And so it's really important to look at not just what's going in, but also the factors around your lifestyle that might be also having an impact on your gut. And I always urge people to take a look, like an inventory, of their life and see what they're doing every day that might be having a good or not so good impact on their gut.

During a nutrition appointment, I would ask the patient what they'd like to achieve. First of all from the appointment, and we put that into goals and those goals form the basis of the nutrition program that I would then email the patient afterwards. And so, during the consultation, we base it around all the health goals they want to achieve. And I will take a full case history, asking them questions about their background, about any illnesses, about medication, nutritional supplements and of course their diet. We then talk through the specific symptoms that they have, and I'll try and give explanations around that. I then also make recommendations on what they can do based on their lifestyle as well. It's got to be doable. It's all very well having an ideal plan, but if someone can't stick to it, then it's not going to work. So it's based on their life, and what they feel that they can achieve.

And then after the consultation, I email the program to them with any relevant documents. Sometimes there are carefully selected nutritional supplements like the probiotics we talked about, maybe some other things like vitamin D, some of the basic things that I would also recommend. Sometimes recipes and diet sheets as well. Just to help them along their way.

I do have patients that come to see me wanting to follow specific diets that they've either been asked to follow by their gastroenterologist or they've read about. For example, if someone has a coeliac diagnosis, they'll be wanting to follow a gluten free diet and I absolutely give advice on how they can do that in a way that is also a nourishing diet. So I certainly give advice on that. You might have a patient that has been diagnosed with irritable bowel syndrome or IBS and they've been asked to follow a low FODMAP diet, as an example. And I will help them follow that as well. So I can give advice on all these diets which do have their benefits. I should also say that everyone is individual, and so apart from the coeliac, which really is 100% gluten free, I try and personalise the diets as well to make it relevant for that particular individual.

To access nutritional therapy consultations through Benenden Hospital, we encourage you to ring Private Patients to book your appointment.