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Weight loss kingston


Don’t arrive famished


A common mistake people make is trying to eat less during the day leading up to going out for a meal…


Unfortunately, this results in your blood sugar levels dropping and increased hunger. The body’s “survival mode” kicks in and tells you that you need high calorie food to survive…


As a result, when you finally eat, you are most likely to choose high calorie options, refined carbohydrates and eat very quickly…


The consequence of this, is that you will probably consume more calories for that day than you would have done if you had just eaten your usual regular meals.


Eat mindfully


Mindful eating is about paying attention to your food and physical cues when you are eating. Those who eat mindfully are more likely to eat slower and experience a greater level of satisfaction from eating…


This often results in greater recognition of hunger and satiety, eating fewer calories and a reduced tendency to over-eat or binge eat.


Try the following:


1) Put your knife and fork down between mouthfuls.

2) Chew your food well.

3) Savour the first few mouthfuls as this is when your taste buds are heightened.

4) Check in with yourself after each course and ask yourself, am I hungry?

5) Reflect on how you feel after over-eating. Did you feel more satisfied? Did you feel comfortable? What will you do differently next time?





Get the balance right


Try to make sure that your meal includes a source of protein, a portion of starch and some vegetables or salad. This will help you to feel satisfied after your meal and to meet your body’s nutritional needs.


If your meal doesn’t come with vegetables or salad, then ask for some on the side. Commonly when we eat out, we are given 2 portions of carbohydrate for example, a burger bun and chips or naan bread and rice. Think about swapping one of these starch portions for some vegetables or salad.

If you only eat out occasionally:


Make satisfaction your goal


If you only eat out once a month or less, then 1 meal out is not going to make much difference to your weight loss journey, so you don’t need to worry so much about your choices. You can still however, try and apply the above suggestions.


Choose something from the menu you know you will really enjoy and give yourself full permission to eat it without feeling guilty.


If you eat out frequently:


When we eat out, we typically consume more calories than we normally would. This is because the food tends to contain extra fat and the portion sizes are often large…


If you eat out every week or more often, then you are going to have to have a think about your choices to keep you on track with your weight loss journey. The following suggestions may help…


Plan ahead


The good news is that many restaurants these days put their menus on their website so you can decide what you’re having in advance. Many will offer lighter options on the menu or even better will list the calorie content to help you with making an informed decision.


Don’t have the bread

Some restaurants will give the option to have bread or other “nibbles” before your starter or main course. A couple of slices of bread with butter before your meal is likely to add an additional 300 calories, which is a small meal on its own. As long as you don’t arrive feeling famished, then it should be easy enough to decline this. You will probably find that if you don’t have the bread, you will enjoy your main meal more because your taste buds are heightened in the first few mouthfuls of any meal.





Choose low calorie or no calorie drinks


If you were to have a couple of soft drinks such as coke or lemonade with your meal this would add approximately 250 calories to your meal. A pint of lager or large glass of wine would add about 200 calories…


Try and stick to low calorie soft drinks such as coke zero, diet lemonade or water. If you want to have alcohol, then try lower calorie options such as a single spirit with diet/slimline mixer or a glass of prosecco.


You don’t have to eat everything on your plate


Society tells us that we should always try and finish everything on our plate. Many of us were told growing up that leaving food on our plate is wasteful and should never be done…


In truth, if we eat something when we are not hungry then that food is wasted regardless of whether we eat it, or if it goes in the bin because it was more than our body needed. You can probably reflect on times when you may have eaten too much in one sitting, not wanting to waste food and you may have ended up feeling quite uncomfortable.


If you are presented with a large portion of food, then start by only eating half of what’s on your plate. After doing this, decide if you are still hungry. The chances are you will feel satisfied by eating only half, if this is the case ask the waiter to take your plate away as soon as possible. You can take the leftovers home with you to have the next day if you like.


Divide dessert


If you have had your main course and still feel hungry, then try sharing a dessert with someone else. If you don’t feel hungry but other people are ordering a dessert, then order a hot drink such as coffee or tea instead. You will save a lot of extra calories, whilst still feeling like you are having something enjoyable.





Plan to say no


You may find that the minute you tell others you are trying to lose weight, people feel the need to try and persuade you that it’s not necessary. They might say things like “it’s only this once” or “go on enjoy a dessert with me” …


Yes, their intentions are probably in the right place, they want you to enjoy yourself, but this is not particularly helpful when you are trying to lose weight. You might even find yourself eating or drinking things you didn’t really want or enjoy.


If you think that your friends, family, or work colleagues are likely to try and persuade you to have that extra glass of wine or tuck into a dessert then be prepared…


It helps to have a couple of phrases in mind that you will say in response. For example, you might say “that was delicious, but I am so full I couldn’t eat another thing” or “I had a big lunch earlier so I will stick to one course”.


Ask for sauce on the side


Sauces such as salad dressings, peppercorn sauce and mayonnaise are often very high in fat. Fat contains twice as many calories as carbohydrate and protein. Without doing much to the volume of your food you could be taking in a lot more calories than you realise…


By asking for your sauce on the side you can be in control of how much fat you are having.


Avoid fried options and creamy sauces


Instead of choosing fried foods which are high in fat, try to have grilled, steamed, or baked options where possible.


Choose tomato or other vegetable-based sauces rather than creamy of cheesy sauces. Not only will this help to reduce your intake of fat, but it will also add an extra healthy vegetable portion to your day.

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Updated: Oct 3, 2021

The low FODMAP diet provides symptom relief for 75% of people with IBS. But unfortunately, that means that 25% of people don’t get the results they were hoping for and are left wondering what to do next.


If you are one of these people, read on to find out what your next steps may be…



IBS dietitian Kingston

Check you followed the low FODMAP diet correctly


The truth is that the low FODMAP diet is a pretty complicated one to follow and most people find that even with the proper guidance, they are likely to make mistakes, particularly in the beginning.


There are often FODMAPs hidden in foods which we may not have considered and unfortunately even small amounts of FODMAP can trigger symptoms in some people.


The low FODMAP diet should only be attempted with the support of a registered dietitian who can support you with following it correctly and ensure that you achieve a well-balanced diet whilst doing so.


Did you get a confirmed IBS diagnosis?


IBS can be a complicated condition to diagnose as there is no specific test to confirm it.


A diagnosis of IBS should be considered only if there is abdominal pain or discomfort that is either relieved by defaecation or associated with a change in bowel habit. This should be accompanied by at least two of the following four symptoms:

· altered stool passage (straining, urgency, incomplete evacuation)

· abdominal bloating (more common in women than men), distension, tension or hardness

· symptoms made worse by eating

· passage of mucus.


All people presenting with IBS symptoms should be clinically assessed for ‘red flags’ including signs and symptoms of cancer, inflammatory bowel disease (crohns and ulcerative colitis) and coeliac disease. A blood test and stool sample are usually required to exclude these diagnoses. Although best practice guidelines state that further testing is usually not required, some practitioners will arrange further testing such as a colonoscopy or endoscopy if they consider it appropriate.


If your GP or consultant has given you a diagnosis of IBS and you have trialled dietary modification including the low FODMAP diet with no improvement, then your GP may refer you to a gastroenterologist to explore other causes. Other possible causes include small intestinal bacterial overgrowth (SIBO), gastroparesis and diverticular disease.


Tip: If you are not sure about your diagnosis go back to your GP.


Consider Taking Probiotics


A Probiotic is defined as a micro-organism that when introduced into the host (human body) it should have beneficial qualities.


The use of probiotics in people with IBS may help to change the gut microbiota and improve the number of beneficial bacteria in the gut and reduce the number of unfavourable strains. Although probiotics have been researched considerably for their role in the treatment of IBS, there remains enough strong evidence to confirm which specific strains of bacteria or doses may be the most beneficial. This may in part be because everyone’s gut bacteria are different and therefore the required strain and dose of probiotic may vary between individuals.


It may be worth trying a probiotic, ideally one with multiple strains of different bacteria. You should take it for at least 4 weeks before deciding whether it has worked or not. If you see no improvement in symptoms after 12 weeks, then you should stop taking it.

Most people who see an improvement in their symptoms find that they must take the probiotic continuously or their symptoms return.


Although the elimination phase of the low FODMAP diet should not usually be followed for longer than 8 weeks, I often see people who haven’t had any guidance and may have been following it for much longer. Unfortunately, studies in recent years have shown that this can lead to unfavourable changes to the gut microbiota which can cause increased gut sensitivity. Researchers at Kings College in London found that taking a probiotic may help to offset these changes.


Tip: Trial a probiotic for at least 4 weeks before deciding if it has worked. If you notice no improvement after 12 weeks, then stop taking it.



IBS dietitian Kingston

Balance Your Fibre Intake


Fibre is an important component of the diet, it helps to keep our guts healthy and promotes regular bowel movements. Foods high in fibre include fruits and vegetables, beans, pulses, nuts, seeds and wholegrains.


Fibre can be a complicated topic when it comes to the management of IBS. A common mistake is to try introducing fibre into your diet too quickly. In practice I often see clients who set out to improve their diet to optimise their health or transition on to a plant-based diet and as a result their fibre intake doubles or even triples overnight.


As a starting point, if your symptoms are diarrhoea predominant then try reducing your fibre intake and then gradually increasing it again. If your symptoms are constipation predominant try gradually increasing your intake of fibre.


Tip: Increasing your fibre intake should always be done gradually to give your gut time to adjust.



IBS dietitian Kingston


Limit your intake of caffeine, alcohol, spicy and fatty foods


The above are potential gut irritants and are likely to contribute towards IBS symptoms. If you are currently consuming caffeinated drinks such as tea and coffee regularly, try and limit them to a maximum of 2-3 caffeinated drinks per day.


Alcohol is a potential gut stimulant, if you notice your symptoms are worse when drinking alcohol try and limit your intake to a maximum of 2 units per day. This is equivalent to approx. 1x 175ml glass of wine, a pint of beer or 2 single spirits. You should also try to only consume alcohol with food rather than on an empty stomach.


Although the mechanism is not clear, fatty foods have been shown to exacerbate symptoms in some people with IBS. If you have tried following the low FODMAP diet but your symptoms persist, be aware of whether fatty foods such as takeaways, cakes, pastries, butter, and cooking oils may be making you feel worse.


The ingredient capsaicin in chilli has been shown to worsen symptoms in people with IBS, particularly women. Again, if you notice your symptoms are worse following consumption of spicy foods then try removing spicy foods from your diet.


Tip: Try alternating your tea and coffee with decaffeinated options.


Practice Intuitive Eating


In some cases, IBS symptoms are exacerbated when you are not eating according to what your body needs. You may be swinging between going for long periods without eating, to eating large portions in one sitting. In doing so you may be putting your digestive system under strain.


Eating intuitively means that you are paying attention to your body’s hunger and satiety signals and therefore eating when you are hungry and stopping eating when you are no longer hungry. By eating intuitively, you are more likely to be following a little and often approach to eating which may be better tolerated by your gut.


Tip: Take your time when eating to be able to recognise when you have had enough. It takes approximately 20 minutes for your stomach to signal to your brain to tell you when you are full. If you eat very quickly you could easily eat quite a lot in one sitting before realising you have had enough.



IBS dietitian Kingston


Stress, Anxiety and Mood


Stress, anxiety and low mood have been shown to be significant contributors to IBS symptoms. Research has shown that people who have IBS are more likely to suffer with depression.


We have all heard of the phrase a “nervous tummy” and this may be explained by the “gut-brain axis” which consists of communication between the emotional and cognitive centres of the brain and the intestines.


Managing stress can be a difficult thing to master, particularly when most of us tend to lead busy lifestyles. Taking time out to relax, taking part in regular exercise and cognitive behaviour therapy are all useful tools.


If you suffer from depression and/or anxiety then your GP may recommend a mild dose of anti-depressants which have been shown to improve IBS symptoms in some cases.

More recently, gut hypnotherapy has been studied as a method to help “fix” the miscommunication between the gut and the brain. A study at Monash University in Australia compared the benefits of using gut directed hypnotherapy with the benefits of doing the low FODMAP diet and found it to be equally as beneficial for providing symptom relief. As a starting point I recommend a trial of the gut hypnotherapy app Nerva to my clients. If they start to see signs of improvement, then this suggests they may benefit further from 1:1 gut hypnotherapy.


Tip: Consider exercising regularly, taking time to relax, meditation or gut hypnotherapy.


Eat lots of plant-based foods


An imbalance in gut bacteria may be a contributing factor to your IBS symptoms. Bacteria in the gut are critical for normal gut development and health. A key factor supporting this is that IBS often develops after an episode of gastroenteritis (“stomach upset”) which has been shown to alter the number of bacteria in our gut. Additionally, multiple studies have shown that people with IBS have fewer strains of gut bacteria present compared with healthy controls.


By eating a well-balanced diet and in-particular focussing on consuming a large variety of different plant foods can help to optimise your gut health and repair any imbalance in gut bacteria. It is recommended that we should try to eat 30+ different plant-based food sources per week. This is likely to explain why in practice I often see clients who transition to a plant-based diet see an improvement in their IBS symptoms.

Tip: Aim to include 30+ different plant-based sources in your diet each week.



IBS dietitian Kingston


Summary:


Whilst the low FODMAP diet has high success rates in the management of IBS, 25% of people unfortunately do not see any benefit from following it.


Considering taking probiotics, limiting intake of caffeine, alcohol, spicy and fatty foods, adjusting dietary fibre and managing mood are all suggested methods which may help.


Sources:



Gralnek IM, Hays RD, Kilbourne A, et al. : The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology. 2000;119(3):654–60. 10.1053/gast.2000.16484 [PubMed] [CrossRef] [Google Scholar]


Lovell RM, Ford AC: Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10(7):712–721.e4. 10.1016/j.cgh.2012.02.029 [PubMed] [CrossRef] [Google Scholar]


Mearin F, Lacy BE, Chang L, et al. : Bowel Disorders. Gastroenterology. 2016;150(6):1393–1407.e5, pii: S0016-5085(16)00222-5. 10.1053/j.gastro.2016.02.031 [CrossRef] [Google Scholar]


NICE, 2017., Irritable Bowel Syndrome in Adults: Diagnosis & Management. Accessed 28/09/21., Available at: https://www.nice.org.uk/guidance/cg61/chapter/1-Recommendations


Rhee SH, Pothoulakis C, Mayer EA. Principles and clinical implications of the brain-gut-enteric microbiota axis. Nat Rev Gastroenterol Hepatol. 2009;6:306–314. [PMC free article] [PubMed] [Google Scholar]

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