Eosinophilic Oesophagitis: what, why and what now?

Eosinophilic oesophagitis (EoE) is a condition in which the oesophagus (gullet) becomes inflamed as a result of an allergic reaction.

Complications range from mild (i.e. tickling sensation in the throat) to severe (i.e. food bolus blocking the oesophagus or oesophageal tear).

It can only be diagnosed through having an endoscopy with multiple biopsies (tissue samples that are then examined under a microscope). If your oesophageal lining contains lots of eosinophils (eosinophil count above 15 is characteristic to EoE), you will be diagnosed with this disease.

EoE can be treated with topical steroid therapy or diet, but some people may also require their oesophagus to be dilated (if they have permanent narrowings aka strictures).

Your gastro doctor will go through pros and cons of steroid and diet therapy, but it's up to you which one you choose. Different people will prefer different management options and that's OK, the most important thing is to keep in close contact with your team and ensure that you are getting support and monitoring that you need. If you choose to explore dietary management, ensure that your dietitian is liaising with your gastro team- it’s crucial for ensuring appropriate monitoring and management of the condition.

Although the mechanisms are not yet well understood, food allergens such as milk, soya, wheat and egg often trigger this condition. It is classified as a ‘non IgE mediated allergy’ so allergy tests (skin prick tests and specific IgE blood tests) are not always able to identify the foods that trigger the EoE. Currently the most effective dietary treatment for EoE is a six food elimination diet (SFED), but you may be recommend a four food elimination diet (FFED) depending on the results of the initial assessment. Whether it’s a SFED or FFED, the diet will usually need to be followed for 6 weeks. If symptoms have improved, foods are then reintroduced one at a time to identify the trigger allergens.


Is there a link between hunger – fullness hormones and fertility?

Ever wondered why you feel hungry or full? There are a number of systems that work together to tell you when to seek out food, with the key players being Leptin and Ghrelin.

Our fat cells produce leptin, which regulates food intake and energy expenditure. Leptin levels correlate with your fat mass; if your fat mass is lower than your genetics would like it to be, the brain will sense the lower leptin levels and stimulate your hunger. In women, low leptin levels will also mean reduced fertility and/or amenorrhoea (lack of periods). The rationale for this is: if your body is low in energy stores, it’s not safe to start growing a baby!

It doesn’t only matter how much ‘padding’ we have, but also the pattern of our eating. Our gut cells release a hormone called Ghrelin in response to lack of protein in our diets or irregular meals. Ghrelin has a direct impact on the hormones that regulate our menstrual cycles (talking to the ladies here): it suppresses the luteinising and follicle stimulating hormones, which in turn impairs follicle maturation and ovulation..

Being ‘within the healthy BMI’ range does not necessarily mean that your body will be ‘ready’ to have a baby. You need to be at a weight that is genetically set for you as ‘healthy’ and eat regular, and balanced meals. Other factors that are important include exercise (not too much!) and avoidance of too much stress. The latter two increase cortisol levels, which also tends to suppress those all important menstrual cycle hormones...


Should you take a probiotic alongside a low FODMAP diet?

This question comes up in my clinics all the time and I thought I'd share my thoughts on this here...It is not yet known whether it is better to take a probiotic alongside a low FODMAP diet or not. In 2016, Staudacher and colleagues published a randomised controlled trial looking at the effects on IBS symptom improvement and faecal bacteria with a low FODMAP diet and probiotics (VSL#3) versus a low FODMAP diet alone. IBS symptoms improved to the same extent in both groups, suggesting that VSL#3 did not add any further benefit. However, VSL#3 in combination with low a FODMAP prevented the decline in the numbers of bifidobacteria (beneficial bacteria) that is usually seen in those following a low FODMAP diet. We do not yet know whether the beneficial bacteria comes back with the reintroduction of high FODMAP foods at the later stages of the diet or whether this can only be achieved by adding in a probiotic...

 


Widen your focus

With the first days of summer, for some, comes the dread of having to strip off the layers and have their body visible to the world.. so many of us suffer with negative body image or even body image dysmorphia..

We all have the tendency to focus on the things that make us feel shame, or the things that make us feel the most vulnerable. I hear similar sentiments echoed by my clients when they speak to me about having negative body image, or experiencing distress in relation to specific parts of their bodies.. They often describe this sense that they should be doing more/ not feeling stuck in the spot they're in. And they literally stop being able to move beyond whatever they’ve hyper-focused on.This perverse focus on their ‘faults’ disables them from being able to immerse in the things that are truly important.

I help them learn to focus on a broader picture and explore the futility of trying to ‘catch and hold’ happiness by trying to change their physical body. It’s freeing to get rid of this.


Let’s talk about caffeine (& enjoy our morning coffee)

Caffeine is often unfairly criticised by some, but this is not justified when the evidence from research studies on moderate intakes is considered.In fact, moderate caffeine intake has been associated* with a reduced risk of heart disease in adults. Caffeine also has desirable short-term effects, such as improved alertness, concentration, and reduced perception of fatigue and pain.

Safe upper levels for caffeine consumption for healthy adults (report by EFSA**) have been defined as no more than 200mg as a single dose, and no more than 400mg as a daily dose.

Caffeine content of common drinks (per serving):

  •  espresso: 140mg
  •  filter coffee: 90mg
  •  black tea (teabag): 50mg
  •  decaff coffee: 15mg

Based on the above, up to 8 cups of tea or 2 cups of espresso, can be safely consumed as part of a balanced diet. However, what caffeine should not be used for, is to compensate for inadequate food intake or lack or sleep. Although it may feel like it's helping short-term, it may mess up your hunger signals, make you feel anxious and further disrupt your sleep..

*association studies do not suggest cause & effect, but merely a link, therefore, evidence from these studies need to be taken with a pinch of salt.

**(EFSA) European Food Safety Authority


Is exercise always good for you?

Excessive exercise can have significant negative effects on your body, i.e. worsen inflammatory state if you have PCOS or even lead to irregular periods and fertility issues.. It’s important to recognise if you have crossed over the line into an unhealthy pursuit of compulsive exercise, which could also be a sign of an underlying problem, such as body image dysmorphia, an eating disorder or dysfunctional regulation of emotional states.

Some warning signs that your relationship with exercise may be ‘unhealthy’:

  • You decline engaging in social activities in order to exercise
  • You feel restless/ irritable if you take a day off or try to cut down your exercise
  • You increase the amount of your exercise if you think that you are ‘too much’
  • You continue to work out even when you are sick…

What is YOUR relationship with exercise?


Happy Easter

Easter means different things to people and to me it’s about celebrating spring, new life and and embracing family traditions, which revolve around painting eggs, baking cinnamon buns and spending half of the day eating Easter lunch... The egg is a symbol of fertility and of renewed life that goes back to the ancient Egyptians and Persians. It’s thought that they are the ones who started the custom of colouring and gifting eggs during their spring festival... I’ve gone off on a tangent here a little talking things not really diet related...

To get back on track, I will share a ‘fun fact’ on male fertility. Male sperm contains lots of antioxidants, including vitamins E & C, carnitine, carotenoids, zinc, selenium and folate. They protect semen from the damage of reactive oxygen damage, which could otherwise cause fertility issues by damaging sperm and changing the sperm DNA. Dietary intake of antioxidants (both from food and supplements) has been shown to be strongly associated with semen quality (aka fertilisation potential). On the contrary, alcohol and smoking (even being exposed to cigarette smoke) have negative effects on fertilisation potential because these tend to reduce sperm count and slow down its speed... Bottom line is, when it comes to fertility, diet and lifestyle choices matter! Happy Easter everyone!


Can you improve your body image without changing your body?

In the culture that we live in, we are surrounded by images of cisgender, white women in thin bodies. This is not representative of the population and leaves A LOT of people feeling invisible and ‘imperfect’. Research has shown that seeing those images of thin bodies maintain the female ideal and programme the mind to strive for it. Here are some tips on the first steps towards improving your body image: Reduce imagery of very small women from your media feed. Only 2% of the images we see on a regular basis are plus-size women (size 14+). This distorts our perception of body size distribution in our society. Images of smaller women are absolutely fine as plenty of people are naturally thin. Your goal is not to demonise small bodies, but to make your image intake more balanced. Whichever social media platforms you use most frequently, find people to follow that are different to you. Whether it’s their body size, skin colour, ability or sexual orientation. Let your social media represent the world you live in rather the skewed picture that we are being ‘fed’ every day by the mainstream media. Expose yourself to the new images on a regular basis. The more you see, the more normalised different body shapes will become.


International Women's Day

To mark the international women’s day, I’d like to share some thoughts on Sexual Objectification (SO) Theory. It proposes that SO contributes to mental health problems and disproportionately affect women (i.e. Eating Disorders, depression and sexual dysfuntion) via two main paths: SO experiences and self-objectification.

When media presents women in body parts rather than thinking and feeling humans, we, women, learn to turn that gaze upon ourselves. We internalise this outsider view and begin to self-objectify by treating ourselves as an object to be looked at and evaluated on the basis of appearance (Fredrickson & Roberts, 1997). This takes away from everything more important that we could be focusing on, such as good friendships, talents, hobbies and dreams...  To all girls out there, I wish the power to overcome self-objectification and start living your life to the full.


Loving your body - self compassion

Many struggle with the concept of loving their body unconditionally, and allow it to depend on how many calories they’ve eaten/ burnt that day or how many compliments they received.. Years of dieting and being soaked in messages and images of ‘perfect bodies’ can make loving your body feel unachievable. Working on self-compassion and recognising that you are an imperfect human with strengths and weaknesses that don’t define your worthiness is the way forward