B12 and Folate Deficiency can be mis-diagnosed or missed altogether as the symptoms are so varied and similar to other conditions such as depression, IBS, eczema, menopause, CFS.  A B12 blood test is a clear means of assessing whether deficiency actually exists.  There can be false negatives however, it's never simple it is.  So even if you have a negative result, there still could be underlying conditions related to B12 deficiency.

Limited eating such as vegan, fasting, smoothies, fussy eaters can all potentially develop B12 deficiency. 

Treatment is very effective and patients described feeling incredible.  How many of the boxes do you tick?

#B12 #deficiency #folate #crohns #blood #test #FODMAP #fatigue #menopause #feeling #tired #energy #dip #diarrhoea #itch #skin #faversham #nutritionist #kent #apotheca #herbalist #whitstable #canterbury #london #clinic #dietician #weight #loss #PCOS #bloodtesting #phlebotomist #clinic folkestone #slimmingworld #weightwatchers #chatham #rochester #fasting #weightlossinjections #weight #loss #injections #mournjaro #ozempic #fertility #bloodtester #faversham #kent #whitstable #hernebay #carnivore diet #ketosisrisks #ketosiseating

​Foods that should be avoided:

• Deep fried foods
• Eggs (cause symptoms in up to 95% of patients)
• Pork
• Turkey
• Chicken
• Beef
• Nuts
• Legumes
• Dairy (milk, butter, cheese, cream, ice cream)
• Gluten grains (wheat, barley, spelt, rye, kamut)
• Corn
• Coffee (can decrease the risk of developing gallstones, but can aggravate existing gallstones)
• Black tea
• Oranges, grapefruit
• Margarine
• Chocolate
• Alcohol
• Cabbage
• Cauliflower
• Carbonated beverages
• Food allergens

#gallstones #gallbladder #fatfree #lowfat #nutritionist #kent #oxford #dietician #faversham #swale #coeliac #longcovid #clinic #covid #virus #support #chronicfatigue #bile #fattyliver #weightloss

The pancreas is part of the endocrine system and its role is very important for digestion. When we eat the pancreas is stimulated to produce digestive enzymes needed to break down food and absorb the resulting nutrients. Most of the enzymes are produced in the part of the small intestine called the duodenum.  
EPI means the pancreas does not produce enough enzymes which can cause various symptoms and nutritional deficiencies. To help boost up enzyme’s PERT can be introduced (pancreatic enzyme replacement therapy). The treatment is in tablet form and is made up of lipase, protease, and amylase.  

Diet guidance

• eat a healthy varied diet using fresh foods
• avoid packet foods so you avoid hidden fats and sugars
• avoid solid fats and limit fat intake to 30–50g a day
• spread calories out throughout the day, so you have for example six smaller meals rather three
• choose low fat packet foods
• keep hydrated with water throughout the day
• avoid alcohol
• avoid caffeine

Breakfast ideas
Egg-white omelette filled with chopped cherry tomatoes, served on a piece of whole grain toast (no spread).
Bowl of blueberries with four tablespoons of Quark (vanilla flavour).
Whole grain muesli with ‘red’ top milk or alternative.
Cloudy apple juice as a drink.
Weetabix x2 with low fat milk or alternative, blueberries.
Baked apple with sprinkle of coconut sugar. 
Meringue nest with two tablespoons of vanilla Quark and few peach slices in juice (this is a version of Eton Mess and is so great for puddings).

Lunch ideas (use lean proteins around lunch and snacks)Whole grain brown bread two slices, skinless roasted chicken with watercress, drizzle of lemon for flavour, very fine spread of low fat margarine or plain quark.
Home-made chicken kebab with red pepper and cherry tomatoes skewered and cooked. Make up batches so they can be snacks during the day as well.
Small jacket potato, tuna in brine, rocket leaves and baby sweetcorn.
Low fat tomato soup with two slices of wholegrain brown bread (no spread).

Dinner ideas
Cod poached in cup of water with a large squeeze of lemon juice, add chopped French beans and peas, continue to poach, stir in three or four tablespoons of plain quark to thicken, add low fat Thai paste or lemon grass to flavour. Serve with wholegrain brown rice.

Roast dinner with skinless chicken or turkey, broccoli, carrots, mashed swede and sweet potato. Use cornflour to make the gravy the old fashioned way with the vegetable water. Remember leftover chicken or turkey can be used in sandwiches.  Avoid packaged meats as these can contain hidden fats.

Tuna fish cakes (cook a couple of extra for snacks) serve with small roasted sweet potato or white potato and courgette.

Chicken mince cottage pie. Avoid packet flavourings as these often contain powdered garlic and onion.

Lean beef mince spaghetti bolognese served with wholemeal pasta. Omit any cheese toppings. Omit onion and garlic. Use chopped fennel for flavour, this is very subtle and not overpowering at all. It also helps with digestion.

Grilled salmon steak with boiled new potatoes and steamed broccoli, carrots.

Snack ideas - Snacks should be low sugar and low fat.
Low fat yoghurt (natural yoghurts are less likely to be sweetened) with a dash of orange or vanilla extract and chopped banana.
X2 Ryvita with crushed tinned mackerel (in brine).
X2 Corn thins with low fat cottage cheese.
Pear.
Apple.
Small orange (try not to eat too many oranges as they can cause loose bowels with their high vit. C content).

Fat soluble vitamins
Vitamins A, D, E, and K need fats in the diet to help with their digestion. Individuals who have EPI will therefore have difficulty absorbing enough of these vitamins. Some doctors recommend that a vitamin and mineral supplement is added to help boost these. If you do take a multivitamin it is advisable to take it in the morning.

Food to avoid
Keep saturated fats to a minimum.  Foods which are high in these fats are:

• butters
• cream
• cuts of meat which have the fatty marbled look when raw such as beef and lamb
• offal/organ meats
• skins such as chicken skin
• pastries 
• biscuits
• cakes
• cheese
• oily dressing
• onion and Garlic

Don’t mix on the same day:

• cabbage
• broccolli
• kale
• sprouts
• spinach
• cauliflower
• aubergine
• mushroom
• suggest space tomatoes out as well so not eaten every day

Useful flavours:

• fennel
• cumin
• turmeric
• lemon grass
• black pepper
• watercress
• rosemary
• marjoram
• sage
• basil
• lemon juice

#pancreas#EPI#creon#pancreatic#cancer#dietforcancer#pancreatitis#lipase#amylase#nutritionist#herbalist#changes#lowfar#lowsugar#FODMAP#long#covid#virus#help#brain#fog#healthy#eating#advice#faversham#kent#dover#deal#canterbury#herne#bay#swale#folkestone#gravesend#london#harley#street#private#clinic#open#pancreaus#bloodsugardiet#​#weightlossinjections #weight #loss #injections #mournjaro #ozempic #fertility #bloodtester #faversham #kent #whitstable #hernebay

long
Abdominal pain can often be associated with IBS (irritable bowel syndrome) and this can worsen as women's bodies change through the peri-menopause through to the menopause.

For some, the worsening of IBS can be very stressful and even debilitating. Symptoms overlap so it can be difficult to ascertain what is causing them. This is itself can be stressful, as you will read below,  stress (cortisol) can heighten the symptoms. Lifestyle changes and de-stressing is a good place to start when trying to reduce abdominal pain during menopause.
Cause and symptoms of abdominal pain in menopauseAs women’s oestrogen and progesterone levels reduce, some body processes are affected, including the digestion. Hyperplasia means an unusual increase in cellular growth, and with endometrial hyperplasia (the uterine lining) can overgrow, leading to abdominal pain and spotting.

When women supplement oestrogen and not progesterone, or they have a hormonal condition which means their oestrogen is unusually high, endometrial hyperplasia can develop. Other symptoms can include leg pain, increase in urination, constipation and backache. The use of phytoestrogens as supplements for oestrogen, for example soya, can be misplaced, as if there is a pre-existing endometrial hyperplasia, the phytoestrogens can worsen the condition.
Stress and abdominal pain - Cortisol is a hormone released by the adrenal glands. As cortisol levels fluctuate in line with life’s stresses and strains, oestrogen levels fluctuate as well. If too much cortisol is released, the digestive system can be affected, causing abdominal pain, discomfort and even diarrhoea. This is why some women experience digestive changes during their menstrual cycle, and this can worsen as they progress through peri-menopause through to the menopause.

What steps can you take to help alleviate the discomfort?

1.  Adjusting your diet and lifestyle can make a huge difference.

Try following a low-fat diet that contains plenty of high fibre vegetables and avoid saturated fats (solid at room temperature.) It's important to maintain a heathy balanced weight, avoid smoking and include at least three sessions of exercise in your week. 

2.  Hormones and supplements can help.

Remember to only introduce one at a time, and allow time for them to take effect. There is a tendency for people to saturate their body’s with multiple remedies, in the hope of help. The problem here is that they cannot tell which is effective. Individual introduction means you don't spend money unnecessarily, and you can also tell what works by monitoring changes in how you feel.

3. Hydration is extremely important for digestion.

Sip throughout the day and avoid too much caffeine. Two cups of coffee or tea is sufficient. Swap to water and herbal teas for the rest of day, or just plain water. If you struggle with water,  add sliced lemon, cucumber or mint leaves to add some flavour.

4.  Be happy.
Embrace the menopause as an opportunity to eat healthily,  exercise regularly and work towards a fit and healthy ageing process. Try relaxation using yoga, Tai Chi, massage, even quiet times at home. The menopause doesn't mean 'the end', it is simply a subtle change and a new sense of freedom.


#nutritionist#nutrition#weight#loss#probramme#virtual#appointments#lockdown#coronovirus#thevirtualnutritionist#dietician#kent#sussex#faversham#canterbury#dover#deal#sheppey#lincolnshire#Scotland#aberdeen#shepway#folkestone#hythe#eatwell#live#well#menopause#hot#flushes#abdominal#pain#why#bloating#diets#gluten#free#help#belly#fat#ketosis#ibs#ibs#crohns#gallbladder#london#dartford#gillingham#sittingbourne#long#covid#oxford#london#supportgroups#

A little history
Gout has been associated for centuries with overindulgence in meats, seafood and alcohol. The condition was, in fact, considered a disease of the wealthiest people — those who could afford such eating habits. And long before the cause of gout was understood, doctors had observed some benefit of a restricted diet on gout management.
For many years, treatment for gout focused on eliminating all foods that had moderate to high amounts of purine. The list of foods to avoid was long, which made the diet difficult to follow.

Current understanding
More recent research on gout has created a clearer picture of the role of diet in disease management. Some foods should be avoided, but not all foods with purines should be eliminated. And some foods should be included in your diet to control uric acid levels.

The purpose of a gout diet today is to address all factors related to disease risk and management. Above all, the goals are a healthy weight and healthy eating — a message that applies to lowering the risk of many diseases.

Diet details - Before you make significant changes to your diet always consult a health professional to check they are safe and suitable.

The general principles of a gout diet are essentially the same as recommendations for a balanced, healthy diet:

• Weight loss. Being overweight increases the risk of developing gout, and losing weight lowers the risk of gout. Research suggests that reducing the number of calories and losing weight — even without a purine-restricted diet — lowers uric acid levels and reduces the number of gout attacks. Losing weight also lessens the overall stress on joints.
• Complex carbs. Eat more vegetables and whole grains, which provide complex carbohydrates. Avoid foods such as white bread, cakes, candy, sugar-sweetened beverages and products with high-fructose corn syrup.
• Water. Keep yourself hydrated by drinking water. An increase in water consumption has been linked to fewer gout attacks. Aim for eight to 16 glasses of fluids a day with at least half of that as water. A glass is 8 ounces (237 millilitres). Talk to your doctor about appropriate fluid intake goals for you.
• Fats. Cut back on saturated fats from red meats, fatty poultry and high-fat dairy products.
• Proteins. Limit daily proteins from lean meat, fish and poultry to 4 to 6 ounces (113 to 170 grams). Add protein to your diet with low-fat or fat-free dairy products, such as low-fat yogurt or skim milk, which are associated with reduced uric acid levels.

Recommendations for specific foods or supplements include the following:

• High-purine vegetables. Studies have shown that vegetables high in purines do not increase the risk of gout or recurring gout attacks. A healthy diet based on lots of fruits and vegetables can include high-purine vegetables, such as asparagus, spinach, peas, cauliflower or mushrooms. You can also eat beans or lentils, which are moderately high in purines but are also a good source of protein.
• Organ and glandular meats. Avoid meats such as liver, kidney and sweetbreads, which have high purine levels and contribute to high blood levels of uric acid.
• Selected seafood. Avoid the following types of seafood, which are higher in purines than others: anchovies, herring, sardines, mussels, scallops, trout, haddock, mackerel and tuna.
• Alcohol. The metabolism of alcohol in your body is thought to increase uric acid production, and alcohol contributes to dehydration. Beer is associated with an increased risk of gout and recurring attacks, as are distilled liquors to some extent. The effect of wine is not as well-understood. If you drink alcohol, talk to your doctor about what is appropriate for you.
• Vitamin C. Vitamin C may help lower uric acid levels. Talk to your doctor about whether a 500-milligram vitamin C supplement fits into your diet and medication plan.
• Cherries. There is some evidence that eating cherries is associated with a reduced risk of gout attacks.

A sample menu
Here's a look at what you might eat during a typical day on a gout diet:
Breakfast

• Whole-grain, unsweetened cereal with skim or low-fat milk
• 1 apple
• X 1 Decaff Coffee
• Water

Lunch

• Roasted chicken breast slices (2 ounces) on a whole-grain roll with mustard
• Mixed green salad with balsamic vinegar and olive oil dressing
• Skim or low-fat milk
• Water

Afternoon snack

• 1 cup fresh cherries
• Water

Dinner

• Roasted salmon (3-4 ounces)
• Roasted or steamed green beans
• 1/2 cup whole-grain pasta with olive oil and lemon pepper
• Water
• Low-fat yogurt
• 1 cup fresh melon
• Caffeine-free beverage, such as herbal tea

Sip fluids inbetween meals also.

(sourced and full credit to the Mayo Clinic.)

#gout#diet#joint#pain#arthritis#uric#acid#purine#low#Nutritionist#Faversham#Canterbury#Dartford#Kent#

I recently had too prepare fat free foods for my partner, as he was planning for a cholescystectomy (gallbladder removal). He had experienced three very severe episodes of pancreatitis as well, so we decided to remove as much sugar as possible, other than sugars found naturally in food.   I decided to do the new eating style with him, to make it easier and too support him.

At first, even as a Nutritionist, I wondered what on earth I was going to do to keep up with variety and flavour.  The Gallbladder has a function where it helps assimilate and store bile to help digest fats.  By eating low to no fat we were hoping too rest the organ and also shrink the liver, so key hole surgery would be easier.  We store fat in the liver, so if it is engorged, it is harder for the instruments for gall bladder surgery to be used.

I decided to get some food items in which would boost flavour, act as digestive support, and rotate my main meals around these.  I also cooked extra so that lunch was generally a smaller version of dinner so I was certain my partner didnt stray away from the plan (he doesn't cook).

I bought a good quality non stick frying pan and roasting tin, so I could still do a 'fried egg' without the oil, and I could roast chicken or fish etc, by adding cherry tomatoes to the roasting tin, which would burst to add liquid to the tray and flavour too any sauces.  

Some great products which replaced fatty foods were:

Lemon Juice used instead of olive oil.
Fat Free Quark to replace cream, cream cheese and act as a sauce base.
Lemon Grass, Fennel Seeds, Ginger and Turmeric to add flavour and introduce their gallbladder supporting qualities.
Lime Zest and Black Pepper for flavour.
Chillies
Coriandar

One meal which I cooked was Thai Curry using Quark gently heated with 0% milk, Lemon Grass and Coriandar for the sauce and you really couldn't taste the difference from this version and a fatty version.

We often associate fat and oils with flavour, crispiness and colour, but by using other ingrediants I managed too adjust existing recipes by tweaking the ingrediants.

As a Nutritionist I do feel that this eating style has reinforced how easy it can be making changes.  You can still cook lovely tasty meals.  My only concern was the lack of essential fatty acids in this style of eating.  We added 1000 mg capsule of Omega 3,6,9 to his regimen as this meant we could monitor his gallbladder activity.  Gallbladder dumping can mean very severe urgent bowels, so by removing the oils from the food and adding them in a controlled way we could control and avoid this as much as possible.

I hope this article gives a little inspiration to readers who have gallbladder problems, may be pre operative and worried about the changes.  I will be writing up some of the recipes and posting them, so watch this space.

#Gallbladder#Diet#FatFree#Faversham