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Just before I started my maternity leave, I attended an interesting session on synbiotics and their use for babies and children. We learnt that Synbiotics (a combination of pre and probiotics that work synergistically) are now being used (though not routinely!) to help with allergies in children and can help to restore a healthy gut composition following use of antibiotics. I suppose to a certain degree this was a pharma company showing off their products, so they were keen to emphasize the positives, but it did get me thinking about the role of our gut in our key development years. The slide below was from a virtual talk I attended recently. It highlights the stages of development of our gut bacteria which starts pre-birth stabilising in adulthood. The pharma company were suggesting that babies delivered by c-section would benefit from some kind of pre/probiotic intervention as they would not have been exposed to their mother’s bacteria in the same way as a vaginal delivery. There is ongoing research in this area so it will be interesting to see whether this emerges as official guidance for mothers having c-sections.  So, this leads me onto my question from Part I - how can we be kind to our gut? If you’ve read my published article Gut Health you will know it’s partly to do with gut diversity; fibre, pre and probiotics! Poor fibre intake reduces our gut diversity which in turn affects our immunity (read the article for more detail!). But where do we get fibre from? Well I’m sure you know that we get a range of different fibres from vegetables, fruit, wholegrains, etc. etc! Therefore, we can be kind to our guts by feeding them a range of different fibre in the form of whole fruits and veg. And when better to start than when our babies are being weaned from milk to solids...yes you can see the link now, and why I’m enjoying this weaning stage so much with Max! 
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The gut microbiome is a fascinating topic and thankfully more and more research is being completed within this area. Back in 2014 I attended a Nutrition conference in Glasgow and first heard about some interesting research regarding the role of our gut microbiome in influencing our health and immunity. The chap talking at this conference said that 'Our gut bacteria have their own circadian rhythm' (a mechanism that times daily events like our sleep-wake cycle, temperature, hormone secretion etc.) which at the time I thought was amazing! How incredible they could even know that!?
Our little gut bacteria have particular functions which occur during the day and night, and get busy with them based on environmental cues (light /dark etc). But what I found interesting was that if we alter our rhythm due to lack of sleep for example (something I know a lot about!) it can influence our health, immune system and metabolism. >> if we are altering our sleep patterns...(shift work/feeding babies etc,) it often means we are altering our eating patterns>>which means that the gut microbiota are receiving food at times which don’t correspond to their own schedule >> which can affect the breakdown and absorption of nutrients by the gut bacteria>>possibly then having an adverse effect on our health and immunity….(type 2 diabetes as one example) with 70% of our immune system residing in our gut….it certainly pays to be kind to our gut microbiota! But how can we be kind to our gut?...I reflect on that in part II. It's incredible to think that irritable bowel syndrome (IBS) effects 10-20% of the population worldwide. To be honest, I can believe this as we have seen a year on year increase of referrals to our gastro dietetic clinic for patients newly diagnosed with this debilitating condition.
This functional gastrointestinal disorder is characterised by symptoms of altered bowel habits (for example, constipation and/or diarrhoea), abdominal pain, and bloating without evidence of organic disease. I often see patients in clinic at the end of their tether after years of presenting to their GP with these symptoms over and over without any understanding or answers to all of their questions. These symptoms have often taken over their life, dominating social activities which are driven by locating the nearest toilet, or having painkillers to hand 'just in case'. A thorough GP should be taking a detailed symptom history, listening out for any red flags, and may refer to a consultant for investigations to rule out conditions such as coeliac disease, inflammatory bowel disease to name a few. Often a long way down the road with investigations all proving 'normal' patients are dismissed, or the 'It's just IBS' diagnosis is rolled out. I am lucky at Arrowe Park Hospital that my team have a great relationship with the gastro consultants, working closely with them to help patients who are newly diagnosed. They will often refer to us for the detailed elimination diet therapy called 'The Low FODMAP' diet. This diet removes the highly fermentable oligo-, di- and monosaccharides and polyols (FODMAP)-containing foods which can cause symptoms within this IBS spectrum. The elimination period can be for 4-8 weeks depending upon symptom relief, before reintroducing them systematically to identify any trigger foods. Research into the efficacy of such a dietary approach has shown positive results with patients experiencing improvement in symptom control and quality of life. The combination of working with a healthcare professional and accessing the relevant smartphone app, improves the likelihood of success of completing this elimination diet to identify whether food is in fact the trigger. However, before we even get to that stage there are a lot of basics to cover to ensure that the patient has at least the foundations right. Pharmacological therapies can be effective, but often patients are keen to explore dietary manipulation either first, or alongside medications such as Mebeverine and peppermint capsules. I find it rewarding to analyse, discuss and work with patients to improve their dietary approach to help reduce symptoms. Both the basic 'first line' advice, and the more involved dietary therapies such as the Low FODMAP diet are effective, and patient's have experienced success to varying levels depending upon their own medical situation, environment and other aspects. You can never underestimate the joy from hearing a patient say 'I've got control of my life again'. I undertook the training to become certified in providing the Low FODMAP diet therapy and found the process detailed and fascinating. I am looking forward to using it in my private practice having found it very useful in my clinic at Arrowe Park.  Does it really matter what, how and when we eat and drink? Does it effect my health? It would seem that I am not the only one asking these questions. Gastroenterology as a specialism is a fascinating area. It is fast becoming the focus of scientists around the world as they seek to understand more about the impact of nutrition by investigating the gut and the microbiome; whether pre and pro-biotics have a role in our health; the complexities of the gut-brain axis i.e. the impact of the mind on our gut, to name but a few. What is surprising about organs such as the gut, the pancreas and the liver, are the integral roles they play throughout our lifetime to help us function, perform and live day-to-day. On a more fundamental level though, you may not think twice about what you eat, choosing foods blindly from a buffet, or attending a friends wedding or even just eating out at a local cafe. You may feel full and sluggish after a large meal or ‘tender’ from over-indulging on alcohol but get over it after a day. We can choose to include the next ‘superfood’ shake or feast on fibrous fruit and vegetables to meet that elusive 30g target per day. We take those choices and our health for granted. Sadly, for some people, this is not the case. Nutrition is far from nourishment and has become more of a nightmare.  I have met countless patients over the years who mourn for their old relationship with food and drink; navigating through food choices to avoid experiencing terrible symptoms. Choice, this somewhat simple process dominates their lives. The impact of this can take its toll on their health both physically and mentally, even in the short-term. Indeed, some people restrict their diets to the extent which makes their health worse, without much improvement. Whether people remove food groups, add in ‘interesting’ herbal supplements or simply live off toast, our food choices when we have a medical condition that impacts on our gut, pancreas or liver, are not so simple. This may resonate with you?
Foods which may not be the best for our health, but are part of our culture taunt you! Conversely, foods we may deem as ‘healthy’ may have a completely different effect on you because of your medical condition. This is why I find the area of gastroenterology dietetics so fascinating and rewarding at the same time. Nutrition, (alongside any required medication) can play a huge role. So many of my patients have been amazed at the impact of a nutritional assessment to help them improve their understanding of how their nutritional (solid and liquid!) choices impact their health, and their quality of life. It is very rewarding to work with patients at all different stages in their lives, managing their condition. Sometimes they just need reassurance that they are doing everything they can, sometimes it’s starting from scratch as they have become lost. This is my aim with Wholefoods1st nutrition consultancy. Spending quality time navigating these ‘choices’ together and understanding what they mean to you. What, how and when we eat and drink can effect our health and particularly if we have a medical condition that complicates the picture. Sometimes making dietary changes just takes a bit of patience and trial and error, but nutrition can mean nourishment again.
  What I like about this product is the simple ingredient list. You add your own eggs, apple and an optional two tbsps of oil. Admittedly, I am not a fan of the label ‘Paleo conforming’ as I find it can put off because it sounds faddy. However, the recipe is simple to follow and fool proof for people like me who tend to mess around with recipes to make them healthier (usually with disastrous consequences!). Whatever your dietary requirement this product covers most of them! A 50g slice is considered a medium-sugared, medium- fat food. However, they are natural sources of sugar and fat, and contain a good amount of protein which helps you to stay fuller for longer. My attempt is shown in the picture above. It smelt and tasted delicious! I had a slice with a cup of green tea at lunch time today.  “Ugg’s Fruit and Seed Loaf makes the perfect start to any day. Delicious toasted and smothered in a little conforming olive oil spread or just nibble when warm from the oven. The Fruit and Seed Loaf mix can also be used to make other recipes including fruit and seed cookies for healthy snacks and a sweet and tasty base to desserts such as Ugg ‘bread’ and ‘butter’ pudding!  Almond meal, raisins (32%), pumpkin seeds (6.4%), sesame seeds (6.4%), sunflower seeds (6.4%), chia seeds (6.4%), xylitol, poppy seeds (1%), flax seeds (1%), spices (cinnamon, coriander, cassia, nutmeg, fennel, cloves). CONTAINS NATURALLY OCCURRING SUGARS * Xylitol is a naturally occurring sugar alcohol. It’s often found in gluten free products and chewing gum. If you have IBS-D it is recommended that you avoid this product. See the BDA IBS guidelines for more information here.  Each 50g serving (one slice) contains: 147Kcals, 12.7g carbs (7.2g sugars), 7.2g fat (1g SF), 6.4g protein, 2.9g fibre. 
 1. Unfortunately the price would put me off purchasing this regularly. However, I recognise that the ingredients are not cheap! 2. You need to spend £40 on the UGG food website before receiving free postage and packaging. So either buy a few bits to try them out or pair up with someone to share the cost! UGG foods have kindly provided readers with a discount code ALLERGY15 for 15% off, valid until March 2015.
 Food Matters Live, held in ExCel London, was a fantastic event to attend. It was great to have the opportunity to listen high profile speakers such as public health specialists, healthcare professionals, academics and representatives from industry, debate wide-ranging topics from ‘Changing eating behaviours’ to ‘Nourishing our next generation’. My musings on this event are currently with an editor of the BDA magazine Dietetics Today for consideration. So I will post the link as soon as it's published. There were a whole host of solutions proposed to improve the health of our nation, from local level, to broad nationwide initiatives that could potentially have an impact. Hopefully there will be some follow up to show where these suggestions are being implemented, and report any success achieved. In addition to the conferences, seminars provided opportunities to hear about new research in heart health, weight management, the exciting future of nutrigenomics, and advances in health technology, to name a few. There was also a variety of interactive talks, innovative cooking demonstrations and interesting exhibition stalls to visit. Over the days I attended, there was so much going on; I wish I could have been in three places at once!
In particular, there were four products that caught my eye whilst wandering around the hall. As samples were available from each of these companies, I was able to try them, and found they all passed my taste test! However, looking into their health claims, nutrition value and costs away from the hype of the exhibition, is a different matter. The following reviews are all my own opinions. I received these items for free at the exhibition and have no benefits from sharing my review.  P.s A rather cool moment for me was having my pic taken with Dr Mosley. I like his energy and passion for investigating health issues. He came across as a decent person with very honest opinions! He was keen to highlight the need for nutrition education for medical students which you would hope will help to improve awareness and patient care.  Wow! Less than a week away until the new Food Matters Live Conference takes place in London at the ExCel centre. Can you tell that I am excited? An event dedicated to food, health and nutrition!? You would not be able to keep me away!!
Despite the rather intensive approach to build anticipation before the doors open on Tuesday morning, I have welcomed the event planner guides and seminar information. With speakers from around the UK from some of the most prestigious health and nutrition related research centres and universities, high profile food companies, and media and Governmental representatives, the excitement for me was already there! With such a jam packed schedule on offer, it still is a difficult process to narrow down the seminars I would like to attend. Not to mention the hundreds of exhibitors on show as well! There are several key themes relating to the marketing and reformulation of products showcased at this event. In particular, exploring ways to enhance their attractiveness and health functions to consumers. These themes do not really draw me to the event. I appreciate that there are many ways to maximise health potential. I also appreciate that product re-formulation is deemed as another step towards improving the nutrition value of staple food products. However, I am not sure it addresses broader issues in the future health of our nation... Reassuringly, there are several other strong themes. Indeed, I am looking forward to hearing and learning more about how our environment and psychology shapes our food choices, how individualised nutrition linked to our genes will progress in the future, and learning more about how to make our food systems more nutritious and sustainable. I will also be interested to hear from some of the thought leaders in Public Health specifically regarding, who's responsibility it is to drive health improvements in our population. One of the quotes used to advertise this particular talk regarding our nation's health was somewhat alarming; "By 2015, the total cost of poor diet to UK society is estimated to reach £27 billion". So will we get an insight from Food Matters Live as to how our health can be improved and these costs reduced...? Tune in next week to find out. You can also follow me at @AmyG_Dietetics The Allergy and Free From Show took place again this year in Liverpool and London, with exhibitors from around the UK sharing their latest advances in products for people with allergies and intolerances. The show also included cooking demos and a few talks on related subjects such as asthma and coeliac disease. They market themselves on their website as follows,
The Allergy & Free From Shows are weekend events full of products (food, drink, skin / hair care, household items and more), cooking classes, talks, expert advice, kids activities – the list goes on – all ‘free from’ and all dedicated to helping you to improve your life. All though this free to attend, 'Free-from', exhibition could be mistaken for a 'free-for-all', due to the amount of tasters available for visitors, it was still an interesting exhibition to attend. I am hoping in the future this exhibition will lessen the dominance of the big supermarkets with their endless goodies. Instead, it would be better to give opportunities for smaller companies to have an impact, without having to bleed their stocks dry! I went on a busy Saturday morning back in October and had limited time unfortunately. I just whizzed round the stalls on this occasion, so my review is largely product based... The exhibition itself showcased some really innovative companies trying to promote awareness of allergies, and products which are naturally gluten free, and allergy friendly. Some of my favourites were the following companies (both big and small!) but remember these companies are not sponsors, and all my comments are my own opinions! The Honest Carrot - a company who offers really tasty, homemade vegetarian food Allergy Buddies - a fab company which offers 'custom made products to alert everyone of a child’s allergy or intolerance'. Lavida Food, for their bean pasta range- which is super tasty! Conscious chocolate - raw, organic handmade chocolate. You only need a small piece to enjoy this! And was intrigued by Trimbake mainly because the product is made out of a blend of natural fruits, vegetables and legumes which provides a more natural approach to fat and sugar replacement in a recipe. I am also waiting to hear about a new baby shampoo product, currently being trialed by a relative on their child who has reacted badly to a range of mainstream shampoos to-date. The product is from an international brand, who offer a 'mild and tear-free' baby wash product which appears to backed up by a appropriate testing and research . So I will await her verdict! In addition, some really worthwhile and effective organisations such as, Coeliac UK, IBS Network and the National Excema Society who were on hand to explain what their societies offer to the public and to health practitioners. Their websites offer a range of resources available to the public for free, and not just for paying members. Overall, the varieties of starchy foods such as breads, pastas and snacks such as crackers, I can imagine is very appealing to those who are denied such products from the gluten filled aisles in a supermarket. However, there was an almost overwhelmingly large amount of biscuits, cakes and other unhealthy snacks on offer in the free-from sections of the exhibit. This worryingly, matches the misplaced trend in thinking everything gluten free is healthy. Apart from having their gluten removed, gluten-free foods like cakes and biscuits are not so very different from their regular counterparts. You may find that these alternative products are just as high in sugar, salt and trans fats…all of the ingredients we should be watching out for! But I digress. As the event remains free to attend, and I enjoy finding out how some of the smaller companies are progressing, I will probably be there again next year...  I am increasingly being asked in clinic "Which is the best yoghurt to buy!?". With such an array of options in the supermarket, I can understand why it can become confusing knowing how to decide. Ultimately, we all have our own taste preferences, and budgetary considerations which will drive our purchasing behaviour. However, having a closer look at your staple foods every now and then can be quite insightful, and you may be surprised at the results! There are 3 key things I will suggest you think about in your choices, to make them more healthful or appropriate to your health goals. 1) Choose natural where possible to avoid added sugars (glucose/syrup/barley malt) 2) Look for a short ingredient list – keep it simple! 3) Look for the addition of probiotics/live cultures Whilst not strictly a 'whole food', yoghurts (made by bacterial fermentation of milk), can provide a range of vitamins and minerals, calcium, and some good quality protein (in particular, from Greek style yoghurts). This fermentation process lowers the lactose and galactose content which can lessen the inflammatory effect on the body. Indeed, further research suggests there is an association between fermented milk products and a reduction in the risk of cardiovascular disease. More recently, new research is emerging that higher fat dairy in the form of yoghurt can protect against Type 2 Diabetes, an effect not found in similar low fat foods. Overall, by carefully choosing a more healthful option, yoghurts can be a great choice for breakfast, a snack or a simple dessert. Added sugar During my work as a practitioner, I am always keen to assess food items on an even platform, using the latest guidance to inform my thinking. Helpfully, the guidance provided by the British Dietetic Association on identifying high sugared products, takes the effort out of this process. Nutrient High Low______ Sugar >22.5g per 100g <5g per 100g In recent times, the 0% fat, low fat and diet yoghurts have dominated the supermarket trolley as a shopper's choice. This is in line with standard advice to lower saturated fat (SF) intake for a range of health reasons. However, be mindful not to focus purely on this low fat label, as often reduced fat products have added sugars, in addition to the natural sugars (lactose) that make up yoghurt. Low fat does not automatically equate to a healthy option. For example, standard low fat yoghurt has approximately 13-20g sugar per 100g, (or 20-30g in a 150g standard pot) which would be considered a medium-sugar food. Ingredient list Bearing in mind the Wholefoods1st philosophy of keeping it fresh and simple, I find myself increasingly drawn towards less adulterated options, with short ingredient lists. I can then add my own whole fruit/nuts/seeds, for additional flavour and health benefits. Yes it is important to assess the nutrient values, but what about the overall quality and health value of a product? Ultimately, having a 100-150g serving of whole or low fat natural yoghurt provides a more healthful option with only minimal amounts of sugar and fat when looking at the diet as a whole*, and ultimately should be a more satiating experience. If a client has a large amount of saturated fat in the diet from biscuits, pies, pastries and red meat, I would certainly be addressing these areas as priorities for improvement, rather than the saturated fat obtained from natural yoghurt. Attached are some examples of ingredient lists of yoghurts (taken from a large supermarket brand website). It is interesting to see what you are naturally drawn to without the packaging to entice your purchasing choices. 
Probiotics
If you want the added benefits of live cultures and probiotics choose products that specifically state they contain them. For example, a label may read “Contains the following live cultures: Bifidobacterium, Lactobacillus Bulgaricus, Lactobacillus Rhamnosus….” . Probiotics have been found to improve the digestive and immune system. Specifically, strains of bacteria found in yoghurt can assist our existing gut bacteria to digest common foods more easily, such as fruit, veg and wheat. In addition, live cultures have been linked to the treatment of IBS symptoms, acute diarrhoea and prevent infection due to their complex ability to improve mucosal barrier function in our gastrointestinal tract. However, the effects have only been shown when consumed every day over a period of time. I have completed further analysis on the ranges of natural yoghurt available in the supermarkets which is available to clients I work with. Interestingly, the calorie and protein content of natural yoghurt can vary a fair bit. If natural yoghurt is new to you, try a small pot first. If it is not to your liking, then use the other two principles to guide your choices, combined with the guidance on choosing low sugar products. * Recommendations regarding saturated fat intake should be < 10% of total calories. For example a typical healthy woman requires 2000Kcals a day to meet their energy needs. 10% of 2000Kcals = 200 Kcals. A 150g serving of natural yoghurts contains 1.5-4g of SF. This equates to 14-36 Kcals, 7-18% of this advised 200Kcal limit. Information sources
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