Thought for food

Rasleen Kahai
By Rasleen Kahai     06/06/2023

“Don’t judge me!” a colleague says, looking guiltily at her pink iced doughnut.

It’s a common reaction. As a dietitian, I’m often thought of as the ‘food police’ (I prefer Diet-Titans myself). But I give my colleague some reassurance - dietitians are not just there to tell people off.

We dietitians are qualified healthcare professionals who bridge the gap between scientific research on food, health and disease, and who provide individualised and practical advice to patients.

So, this week, being Dietitian's Week, is a good time to recognise and celebrate the important role dietitians play. In our modern world, where nutrition-related illness is on the rise, the importance of the role is ever increasing.

Surprisingly in the NHS in England, dietitians make up a modest workforce of 4,400, compared to an estimated 164,000 doctors and 360,000 nurses. At Royal Brompton Hospital and Harefield Hospital, dietitians specialise in treating nutritional problems associated with heart and lung disease.

I deal with one of these areas – lung disease – as a specialist respiratory dietitian. You might think it’s a narrow role if I’m only concerned with lungs and only concerned with diet. And yet nearly a third of patients coming into hospital are at risk of malnutrition. Often associated with images of famine in developing countries, in the hospital setting, this translates as patients with low body weight or unintentional weight loss.

So how does a dietitian prevent malnutrition? It depends on the condition. Let me take you through a typical day.

My first patient on this day has plastic bronchitis, a condition characterised by the accumulation of white fatty fluid in the airways. This patient needs dietary advice around a life-long low-fat diet – which is comparable to the fat content found in one packet of crisps per day. So, I help them understand the vital link between their diet and their condition and I also introduce them to low-fat cooking methods and recipes that align with their lifestyle to fit around their busy job.

A low-fat diet can mean deficiencies in fat soluble vitamins and essential fatty acids – which are supplemented through a vitamin tablet & daily walnut oil. It’s not just about how the patient consumes food, but also how they think about it. I provide psychological support to address the impact of dietary changes on their overall lifestyle – including social & cultural aspects.

Next, I see a patient who has been unable to enjoy their favourite pastime, gardening, due to bronchiectasis which involves widened airways and excessive mucus production. An infection has given them shortness of breath and weight loss. They also have nausea. We initially discuss the impact on their sense of identity, including the upset caused by friends joking about their skeletal appearance.

We discuss strategies around optimising energy and protein, crucial nutrients for respiratory patients. Since their lungs are working hard and burning calories, energy becomes essential. Protein is vital for rebuilding lost muscle mass. We look at changing this firstly through food fortification which involves enhancing the nutritional content of meals without increasing their portion size, and secondly through oral nutritional supplements, which are small milk-based drinks packed with extra energy, protein, vitamins, and minerals.

But of course, all of this is pointless if they are still feeling nauseous. So I provide holistic advice such as suggesting dry foods, ginger, and peppermint, and I speak to my medical colleagues for potential anti-sickness medication. Finally, I suggest checking their vitamin D levels in the blood, as sunlight is the primary source of this essential nutrient.

Lastly, I meet a patient with a neurodegenerative disorder causing their muscles to deteriorate, including crucially the swallowing muscles. This leads to an increased risk of chest infections when eating and drinking. Today therefore our discussion revolves around the consideration of artificial feeding, specifically a gastrostomy. A gastrostomy is a tube placed into the stomach to deliver nutrition, fluids, and medications.

Dealing with such a device can be challenging and involve complex decisions. We cover the advantages and disadvantages, discuss the procedure itself, explain the necessary care and maintenance, and consider different feeding methods with the gastrostomy. Using this device piles on more emotional pressure for the patient and their loved ones. To ensure the patient has sufficient information to make an informed choice, we provide written and video materials. We also schedule a follow-up in a few days to address any further questions or concerns.

So that’s what I do in a typical day. As healthcare continues to evolve and innovate, nutrition plays a key role in this. It is fundamental to maintaining our health – it affects physical, mental and emotional aspects of our lives. It keeps our body functioning, keeps us strong, boosts our immune function, influences our mental health, and keeps us interconnected with social and cultural aspects of our lifestyle, relationships, and quality of life. Food is paramount. Whether your colleague is eating a pink iced doughnut, or not.