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NHDmag.com

Dec 2018 / Jan 2019: Issue 140

POLLEN FOOD SYNDROME PANCREATITIS

Emma Coates Editor Emma has been a registered dietitian for 12 years, with experience of adult and paediatric dietetics.

If you have important news or research updates to share with NHD, or would like to send a letter to the Editor, please email us at info@network healthgroup.co.uk We would love to hear from you.

& DIETARY MANAGEMENT FALTERING GROWTH:CARE OF THE NICE guidelines ELDERLY MALNUTRITION CRITICAL CARE & ECMO INSECT PROTEIN EXPLAINED METABOLIC DIETETICS

CARE HOME NUTRITION Autism: diet

CLINICAL RESEARCH nutrition DYSPHAGIA:and CURRENT PRACTICE IMD: PRESCRIBING pagesCHALLENGES 23-26

BILE ACIDNutrition MALABSORPTION &

INFANT WEANING Non-IgE-mediated

ADULT MALNUTRITION MALNUTRITION MAP Hydration Week allergy: home KETOGENIC DIET THERAPY ONS AND OBESITY page 23-25 introduction guides DEMENTIA: CLINICALLY ASSISTED NUTRITION WHOLEGRAINS

FIBRE AND INFLAMMATORYNUTRITION AND MALABSORPTION WEIGHT MANAGEMENT AND MND: A MULTIDISCIPLINARY FOOD ALLERGY EXAMINED: BOWEL DISEASE BONE HEALTH AFTER SURGERY SPORTS NUTRITION APPROACH WHERE WE ARE NOW BREASTFEEDING

FOCUS ON iMAP GUIDELINES ONS PRESCRIBING PKU THE ALKALINE DIET 49-58 pages

GLUTEN-FREE DIET Multidisciplinary CHRONIC RENAL DISEASE VITAMIN D IN team THE UKwork pages 35-37 FOOD-BASED ACTIVITY

Egg competition: SWEETENERS

PAEDIATRIC FOOD ALLERGY winner's article EATING DISORDERS IN OLDER PEOPLE pages 23-25 DYSPHAGIA

GASTROSTOMY PretermFEEDING infant PROBIOTICS & GUT HEALTH feeding HEAD TRAUMA & NUTRITION PLANT-BASED pages DIETS 29-31

TODDLERS & NUTRITION Join the NHD TEENAGERS & HEALTHY EATING community at ELDERLY MALNUTRITION NHDmag.com BOLUS FEEDING EXAMINED

NETWORK HEALTH DIGEST

IBS: A NEW SERVICE Diabetes and FOODBANKS: UK DEMAND carbohydrates CROHN’S AND FODMAPS Pages 41-45 US ANIMAL PRODUCTS

Enhanced recovery after surgery Pages 17-22

Goodbye 2018, Hello 2019! As we move forward into another year, here at NHD we are revelling in the success of the last 12 months. Looking back, we’ve created 10 great issues, which showcase the rich diversity of skills, experience and knowledge that nutrition and dietetics provide to many walks of life.

At the heart of our success are our dedicated and passionate writers, who have provided the wide-ranging content for each issue. We raise a glass to each and every one of you for your excellent contributions. But before we get too carried away with the glasses of fizz and nibbles, we’ll take you through the goodies nestling under the tree in this issue.

Deep into winter now and with the season of goodwill upon us, the difficulties many people face will be all too evident. The growing use of food banks in the UK is being highlighted in the media with frightening figures recently released by The Trussell Trust, one of the UK’s largest food bank providers. Emma Berry takes a timely look at the impact of food insecurity and the limitations of emergency food provision.

We welcome Lucy Williams with this month’s Cover Story, exploring the nutritional management of motor neurone disease (MND) and the timely placement of gastrostomy. She stresses the importance of the multidisciplinary team (MDT), which more often than not is essential in the successful treatment of illness and disease.

ERAS (Enhanced Recovery After Surgery) is another important MDT area and here, Rebecca Gasche focuses on the current guidelines and evidence to support its use. Rebecca also provides an overview of her experience in setting up a dietetic-led IBS service and pathway, highlighting group sessions on the low-FODMAP solution. The lowFODMAP diet has been seen to help in

the management of Crohn’s disease too, and Priya Tew shares current research in this area. In her second article, Priya talks us through the little-big world of pre- and probiotics and the microbiome.

Where did you complete your dietetic placements as a student?

Would you have considered a social care placement at the time? Highlands based Evelyn Newman discusses the development of innovative social care dietetic placements and how they may potentially benefit the future profile of the profession.

With Brexit in mind, Maeve Hanan reports on animal products from the US, notably the use of chlorine and antibiotics in meat production. Lucy Aphramor analyses healthism and how public health messages simplify the complex issues surrounding overweight and obesity. And in our Student Zone this month, Erin Kelly, takes a look at the difficulty in meeting nutritional requirements during cancer treatment.

We also have our regular features including Face to Face, which sees Ursula meeting up with Nutrition Consultant, Margaret Ashwell; and A Day in the Life . . . provided by Vanessa Bara, Specialist Dietitian in Adult Cystic Fibrosis, who shares some case examples from her busy schedule.

So, we’ve raised a glass to our contributors but what about you guys, the readers? Well here’s an extra special toast to you. Cheers! Merry Christmas and a Happy and Healthy New Year from us all at NHD. Emma

www.NHDmag.com December 2018/January 2019 - Issue 140

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LOW-CARB DIET 'COULD INCREASE LONG-TERM WEIGHT LOSS' A study1 hit the media recently, with headlines such as ‘Low-carb dieters can lose more than 1.5 stone over three years’, being reported by The Daily Telegraph.2 Researchers at the Boston Children's Hospital, Framingham State University, Emma Coates the University of Arkansas and Baylor College of Medicine carried out this Editor randomised controlled study, which included 234 participants, aged 18 to 65, with a BMI of 25 or above.

Emma has been a Initially, over a 10-week period, each participant was expected to follow the same weight registered dietitian for 12 years, with loss diet, with the aim that they’d lose 12% of their body weight. The diet provided around experience of adult 60% of their estimated calorie requirements. After 10 weeks on the diet, 70% of participants and paediatric dietetics. achieved the weight loss goal, with an average weight loss of 9.6kg. For the second part of the study, the 164 successful weight loss participants were randomly allocated one of three weight maintenance diets to follow for 20 weeks. Each diet adjusted the calorie intake with the aim maintain body weight. This produced varying success for the participants, with 120 of the 164 participants remaining within the target of 2kg of their post-weight loss weight (38 in the high-carb group, 39 in the moderate-carb group, 43 in the low-carb group). During this maintenance phase, the average body weight change was less than 1kg. There was no significant difference in body weight change between each diet group.

The average energy expenditure of the participants on the various diets at specific weights was compared via isotopically labelled water. The results were as follows: • High-carb group - energy expenditure fell by 19kcal a day.

• Moderate carb group - energy expenditure rose by 71kcal a day.

• Low carb group - energy expenditure rose by 190kcal.

• Compared with the high-carb group, the low-carb group had a daily energy expenditure of 209kcal a day.

To book your • The hormone ghrelin was lower in people following the low-carb diet. company's It was hypothesised by the researchers that if the alteration in energy expenditure product news were to continue for three years, without any change to the diet and activity levels, it would equate to an estimated 10kg weight loss for a 100kg 1.78m tall 30-year-old for the next male. The researchers concluded that ’dietary composition seems to affect energy expenditure independently of body weight’, and a low-carb diet ‘might facilitate issue of weight loss maintenance beyond the conventional focus on restricting energy NHD call intake and encouraging physical activity’.

01342 824073 The study has a variety of limitations, including that the results are theoretical and so don’t demonstrate any physical evidence of improved weight maintenance or greater weight loss in those who followed a low-carb diet, when compared with those on a high or moderate carb diet. The study only lasted 20 weeks, so we do not have any actual evidence that the weight loss will be maintained and although participants lost a significant amount of weight within the first 10 weeks of the study, during this time, the food they ate was prepared for them and prescriptively calculated for calories and the balance of the fat, protein and carbohydrate. This is unachievable for most people in day-to-day life.

Whilst the study has not provided any long term or realistic outcomes to demonstrate whether or not low carb diets work, or whether there may be any risks associated with such diets, the results provide some interesting information about how the body may metabolise varying combinations of foods within the diet.

1 Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomised trial. BMJ 2018; 363: k4583. Available at www.bmj.com/content/363/bmj.k4583 <accessed 15/11/18> 2 www.telegraph.co.uk/news/0/low-carb-dieters-can-lose-15-stone-three-years-study-claims/ <accessed 15/11/18>

www.NHDmag.com December 2018/January 2019 - Issue 140

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Save the date

MATTHEW’S FRIENDS WILL BE HOSTING THEIR ANNUAL KETOCOLLEGE PROGRAMME 4TH – 6TH JUNE 2019 - CROWNE PLAZA FELBRIDGE HOTEL, EAST GRINSTEAD, WEST SUSSEX, UK AN ADVANCED CPD COURSE FOR NEW AND REFRESHER KETOGENIC THERAPY LEARNING AND NETWORKING. In its 4th year, KetoCollege 2019 offers both scientific background and practical training in all aspects of implementation of the different ketogenic therapies. Led by recognised ketogenic diet experts, it will include presentations, workshops and time for networking and group discussions. Registrations are welcome from allied medical health care professionals currently working with or looking to expand their knowledge of Ketogenic Dietary Therapies.

Scientific Committee Chair Professor J. Helen Cross OBE

For further details please visit www.mfclinics.com/keto-college or to register your interest please email: ketocollege@mfclinics.com RCPCH APPROVAL PENDING | CONVENIENTLY LOCATED ONE HOUR TRAIN FROM LONDON AND 20 MINS TAXI FROM LONDON GATWICK

NETWORK HEALTH DIGEST

www.NHDmag.com A wealth of useful dietetic resources for all dietitians and nutritionists Make the most of your NHD Community!