NHD Issue 144 Welcome and news from the Editor

FROM THE EDITOR

WELCOME This month sees two important awareness weeks, which may have great significance in all of our lives, whether it be at work or within our personal time.

Coeliac Awareness Week takes place between 13th and 19th May and I talk a little more about this in our News section on page 6.

The other key awareness event this month also takes place on the same dates: Mental Health Awareness Week, with the theme for 2019 being ‘Body Image’, an issue that can affect all of us at any age. During the week, the Mental Health Foundation will be publishing new research, considering some of the reasons why our body image can impact on the way we feel, campaigning for change and publishing practical tools. More information on this event can be found at www.mentalhealth.org.uk/campaigns/ mental-health-awareness-week With mental health in mind, our Cover Story from Nikki Brierley focuses on the importance of mental health and wellbeing within the workplace and how the NHS is putting staff wellbeing on their agenda. We also welcome back Emma Berry who explores the relationship between food insecurity, nutrition and mental health.

With an ever-increasing ageing and overweight or obese population, the dietitian’s role in primary care will be vital, working towards our profession being a ‘first port of call’ for patients within GP surgeries and clinics. Alice Fletcher outlines her experience of ensuring dietitians are more accessible in the community and looks at the future for dietetics within the community.

Knowledge is shared in NHD from all areas of nutrition and dietetics. This issue is no exception. Our clinical article from Rebecca Gasche, provides us with information on short bowel syndrome and how best to manage this condition nutritionally. The Ketogenic Research Dietitians Network share an overview and update of ketogenics over the past 100 years

and also highlight the recent findings of a survey they completed throughout Emma Coates Editor 2017. Moving onto Paediatrics, Farihah Choudhry delves into the mysterious Emma has been a dietitian world of the gut microbiota and discusses registered for 12 years, with the increasing evidence around the effect experience of adult of probiotics on the immune function in and paediatric dietetics. children. ‘Intuitive eating’ (buzz word of the month), and how it applies to a clinical setting is what Jessica English focuses on in this issue.

And if that’s not enough, NSPKU Dietitian, Suzanna Ford, along with Dr Ben Green, discusses the current landscape with regards to the PKU ‘diet for life’ in IMD Watch and Gill Hooper provides guidance on a practical food-first approach to nourishment in the elderly living in care homes. Evelyn Newman takes a look at a recent project completed in the Highlands were improvements in the consistency in the rationale for prescribing ONS were achieved.

The food-first approach played a major role in this transformation work.

If you have important news or Don’t forget this research updates to share with NHD, or May issue is digital would like to send a letter to the Editor, only, so you can please email us at download it from info@networkhealthgroup.co.uk our website or view it We would love to online at any time: hear from you. www.NHDmag.com Emma www.NHDmag.com May 2019 - Issue 144

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THIS IS HUGE After months of coping with the sleepless worry and heartbreaking cries of her cow’s milk allergy, suddenly, a little moment like this doesn’t seem so little after all.

• PROVEN EFFICACY Hypoallergenic and has been shown to relieve symptoms 1,2 • PROVEN TO BE WELL TOLERATED 96% of infants tolerated Similac Alimentum 3 • APPROVED FROM BIRTH ONWARDS No need to switch formula at 6 months • BEST VALUE Provides cost savings in the prescribing of EH* formulations4 SIMILAC ALIMENTUM. FOR BIG LITTLE MOMENTS.

*Extensively Hydrolysed REFERENCES: 1. Sampson HA et al. J Pediatr 1991;118(4): 520-525. 2. Data on file. Abbott Laboratories Ltd., 2013 (Similac Alimentum case studies). 3. Borschel MW and Baggs GE. T O Nutr J 2015;9:1-4. 4. MIMS, March 2019.

IMPORTANT NOTICE: Breastfeeding is best for babies, and is recommended for as long as possible during infancy.

Similac Alimentum is a Food for Special Medical Purposes and should be used under the supervision of a healthcare professional.

Date of preparation: March 2019 RXANI150142(2)

12 COVER STORY Mental health and staff wellbeing 6

News

Latest industry and product updates

9 F2F INTERVIEW 17 Food insecurity

Impact on mental health 19 Community dietetics

Is the future looking bright?

24 SHORT BOWEL SYNDROME

35 Intuitive eating

Implementation in clinical dietetics 39 IMD watch

Challenge of 'diet for life' in PKU

42 FOOD-FIRST APPROACH 46 Social care

Prescribing ONS in the HIghlands 48 A day in the life of . . .

A diabetes dietitian

29 Ketogenic diets

For epilepsy, past,

present and future

NHS Ayrshire and Arran

32 PROBIOTICS & PAEDIATRIC HEALTH

50 Events & courses

Dates for your diary 51 Dietitian's life

Craving for chocolate

Copyright 2019. All rights reserved. NH Publishing Ltd. Errors and omissions are not the responsibility of the publishers or the editorial staff. Opinions expressed are not necessarily those of the publisher or the editorial staff. Unless specifically stated, goods and/or services are not formally endorsed by NH Publishing Ltd which does not guarantee or endorse or accept any liability for any goods, services and/or job roles featured in this publication. Contributions and letters are welcome. Please email only to info@networkhealthgroup.co.uk and include daytime contact phone number for verification purposes. Unless previously agreed all unsolicited contributions will not receive payment if published. All paid and unpaid submissions may be edited for space, taste and style reasons.

Editor Emma Coates RD

Advertising Richard Mair Tel 01342 824073

Publishing Director Julieanne Murray

richard@networkhealthgroup.co.uk

Publishing Editor Lisa Jackson Publishing Assistant Katie Dennis Columnist Ursula Arens Design Heather Dewhurst

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Phone 01342 825349 Fax 0844 774 7514 Email info@networkhealthgroup.co.uk www.NHDmag.com www.dieteticJOBS.co.uk Address Suite 1 Freshfield Hall, The Square, Lewes Road, Forest Row, East Sussex RH18 5ES

www.NHDmag.com May 2019 - Issue 144

@NHDmagazine ISSN 2398-8754

Neocate Syneo Help rebalance gut microbiota dysbiosis in infants with CMA with new

NEOCATE SYNEO

1,2,5

THE ONLY AAF WITH PRE- AND PROBIOTICS* clinically proven to bring the gut microbiota closer to that of healthy breastfed infants1,5

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This information is intended for Healthcare Professionals only.

Neocate Syneo is a Food for Special Medical Purposes for the dietary management of Cow’s Milk Allergy, multiple food protein allergies and other conditions requiring an Amino Acid-based Formula, and must be used under medical supervision after full consideration of all feeding options, including breastfeeding. *Accurate at time of publication, May 2019 Probiotic Bifidobacterium breve M-16V and prebiotic scFOS/lcFOS blend CMA: Cow’s Milk Allergy AAF: Amino Acid-based Formula References: 1. Candy et al. Pediatr Research. 2018;83(3):677-686 2. Burks W. et al. Pediatr Allergy Immunol 2015;26:316-322 3. De Boissieu D. et al. J Pediatr 1997; 131(5):744-747 4. Vanderhoof JA. et al. J Pediatr 1997; 131 (5):741-744 5. Fox et al. Clin Tranl Allergy. 2019;9:5 Nutricia Advanced Medical Nutrition, White Horse Business Park, Trowbridge, Wiltshire, BA14 0XQ

www.neocate.co.uk If you would like to order a product sample to be delivered directly to a patient, please visit www.nutriciaproducts.com/samples

NEWS CLINICAL COELIAC AWARENESS WEEK 13TH-19TH MAY 2019 Coeliac UK’s annual awareness campaign returns this month. This year the theme focuses on diagnosis awareness, highlighting the need for more people to ask themselves the question: “Is it coeliac disease?” From 13th-19th May 2019, Coeliac UK are asking everyone to share this message and reach out to people who may not be aware that their symptoms could be undiagnosed coeliac disease.

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

To book your company's

product news for the next issue of

NHD call

01342 824073

How can we all support the campaign Coeliac UK have lots of ways in which you can support this campaign. Here are just a couple of ideas to get you started: • Create a Coeliac UK Awareness Week space, or information point at your workplace. It’s an ideal way to meet and speak to people about coeliac disease, helping to raise awareness and get more people diagnosed.

• We all love a bit of cake, so throwing a gluten-free tea party in your local area, department, or hospital is a great way to raise awareness. Coeliac UK have various leaflets and posters available to use at an event like this. You can register for packs on their website: www.coeliac.org.uk/get-involved/coeliac-uk-awarenessweek-2019. Don’t forget to take photos and share them on social media.

Raising awareness on social media Over the course of the week, Coeliac UK will have plenty of social media posts. They are calling for everyone to share these posts across Facebook, Instagram and Twitter to reach as many people as possible and highlight the symptoms of coeliac disease. If you blog, or write on social media, why not share something this month about coeliac disease? If you are doing anything at all to support the campaign, share with the hashtag #IsItCoeliacDisease Help get people diagnosed Coeliac UK have an online assessment that people can complete to tell them whether they should be tested for coeliac disease. This can be shared on social media (#IsItCoeliacDisease) and you can share the resource by word of mouth too!

Whatever you can do to join in this month’s campaign, you will be helping to reach more people who need to know that their symptoms could be undiagnosed coeliac disease.

Campaign packs are available and you can register for one at www.coeliac.org. uk/get-involved/coeliac-uk-awareness-week-2019

UPDATE ON ADVERTISING RESTRICTIONS FOR PRODUCTS HIGH IN FAT, SALT AND SUGAR (HFSS) Further to our News report in the February issue on the government’s open consultation on restricting the promotion of HFSS foods in a bid to reduce childhood obesity, they are now asking for views on two documents: the consultation document outlining their proposals and the impact assessment considering what the costs to businesses and health benefits would be.

Have your say by visiting: www.gov.uk/ government/consultations/further-advertisingrestrictions-for-products-high-in-fat-salt-and-sugar The consultation is open until 10th June 2019.

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www.NHDmag.com May 2019 - Issue 144

NEWS INTERNATIONAL SURVEY ON CARE RECEIVED BY OBESE PATIENTS A new international survey, the largest of its kind, shows that 8 in 10 people with obesity believe it is their sole responsibility to lose weight. The study also found that people wait six years after initial weight loss struggles before speaking to their healthcare professional (HCP).

ACTION IO (Awareness, Care, and Treatment In Obesity MaNagement – an International Observation), surveyed over 14,500 people with obesity and nearly 2800 HCPs from 11 countries in five continents.

The objectives of the ACTION IO survey were to identify perceptions, attitudes, behaviours and potential barriers to effective obesity care. Results from the survey highlight that: • 71% of HCPs in the survey believe that obese patients are not interested in losing weight, while only 7% of those who are obese said they are not interested, illustrating a clear gap in perception regarding interest to lose weight; • 81% of people surveyed had made at least one serious weight-loss effort in the past, while HCPs believe only 35% of their patients had done so.

ACTION IO has been published in Diabetes, Obesity and Metabolism Today, Monday 29 April. www.onlinelibrary.wiley. com/doi/10.1111/dom.13752

COCHRANE REVIEW - THE EFFECT OF A HEALTHY LIFESTYLE

By Manu5 - www.scientificanimations.com FOR WOMEN WITH POLYCYSTIC OVARY SYNDROME Polycystic ovary syndrome (PCOS) is a very common condition affecting 8%-13% of women.

Being overweight worsens all clinical features of PCOS. The condition affects quality of life and can worsen anxiety and depression either due to its symptoms or due to the diagnosis of a chronic disease.

The Cochrane review considered evidence from a variety of studies on the effects of lifestyle interventions on reproductive, anthropometric (body measurement), metabolic and quality of life outcomes in women with PCOS. The review concludes that lifestyle interventions may improve the free androgen index (FAI), weight and BMI in women with PCOS, but the effect of lifestyle intervention on glucose tolerance in uncertain. The benefits of diet and exercise for weight loss have been demonstrated in women with PCOS in low-quality studies, but this remains to be confirmed in higher-quality studies. The review recommends that the effect of various intervention characteristics, including intervention type, duration, intensity and other aspects of implementation on various outcomes should be considered in future trials.

Read the full review here: www.cochranelibrary.com/cdsr/ doi/10.1002/14651858.CD007506.pub4/full

The Ketogenic Dietitians Research Network is a group of paediatric and adult ketogenic dietitians and researchers. The aims of the group are to: • provide a support network for dietitians to undertake ketogenic diet (KD)-related research; • share practice and research ideas between ketogenic centres; • seek funded research time for dietetic-led projects; • promote evidence-based practice by publishing results from our projects, and through sharing and review of relevant journal articles.

If you are a dietitian or dietetic support worker working in ketogenic-related clinical practice, academia or industry and are interested in joining the group, or collaborating with us, we would love to hear from you! We also offer Associate Membership for dietitians not currently practicing in ketogenics and for other healthcare professionals.

Please contact Dr Natasha Schoeler: n.schoeler@ucl.ac.uk. www.NHDmag.com May 2019 - Issue 144

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Call for Research Reviews from NHD and British Lion eggs Network Health Digest (NHD) and British Lion eggs surveyed readers earlier this year about eggs and found that there’s still much about this nutrient-packed food that healthcare professionals are unclear about.

To help educate your peers, we would like your original research reviews on the role of eggs in the diet. We are looking for fully referenced articles discussing two key themes: 1. Understanding the fat content and calories in eggs, as well as additional nutritional benefits they offer.

2. Egg safety, especially in relation to babies and older people, and allergy.

The best article will be published in NHD later this year and the winning author will

WIN £500 WORTH OF SHOPPING VOUCHERS.

Emma

Entries will be judged

by NHD Editor Emma Coates RD and Dietitian and Health Writer, Dr Carrie Ruxton.

Carrie

Please email NHD here . . . for a ‘Contributor template’ and further guidance on submissions.

We look forward to receiving your entries.

For more information on eggs please visit www.egginfo.co.uk For the terms and conditions click here . . .

Deadline for submission Monday 1st July 2019