Eat For You Dietitian

Specialist Dietitian in Eating Disorders and Disordered Eating

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Sophia is a HCPC Specialist Dietitian based in the South East of England. She specialises in eating disorders, disordered eating, IBS and the low FODMAP diet, type 1 and 2 diabetes, and PCOS. Sophia has developed her practice by incorporating a weight-inclusive approach and focusing on finding food freedom. Sophia is registered with the British Dietetic Association.
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  • Navigating the Festive Season During Eating Disorder Recovery

    Navigating the Festive Season During Eating Disorder Recovery

    The festive season is often painted as a joyful, cosy time of year, and can come with more social events as friends and family want to experience everything that the festive season brings. Yet for those in eating disorder recovery, it can bring a very particular set of challenges. Routines shift. Food takes centre stage and can be at different times. People that we haven’t seen in a while can appear. Expectations (both internal and external) can feel heavier.

    If this time of year makes you feel anxious, overwhelmed, or unsure how to navigate recovery, know this: you are not alone. With some planning, support, and self-compassion, it is possible to move through the festive period in a way that protects your recovery and your wellbeing.

    It is important to remember that it is ok to:

    • Set Boundaries

    We can often feel uncomfortable setting boundaries with our nearest and dearest. Setting boundaries can mean asking for a clear plan of what time things are going to happen and if there is no clear time given (which is causing you anxiety and distress), then you can ask for one to support you in being able to participate in the event. Following this, you can agree potential solo time within the day, depending on how long the event will be, it is important to be aware if you need even 5 minutes in the middle to be alone to breathe.

    We can call this time, recharging the social battery. I highly recommend this for my clients and their loved ones.

    Probably the most important boundary is, no food or body talk during the social event. It is not useful unless support has been requested at a particular time. This boundary can be difficult to set as often it can involved family and friends to talk to other people attending beforehand. They may feel uncomfortable to do this but it is necessary. We also live in a society where it is ‘normalised’ to comment on what someone is eating or their body shape and size, but really it shouldn’t be and let’s move the conversation on to something more interesting.

    • Ask ahead of any event what food will be available

    Try to not feel ashamed of asking these questions. You are not doing this to ask for your safe foods to be available, but instead to prepare yourself and potentially to challenge some of these foods beforehand. Challenging these fear foods beforehand can be very helpful for my clients to begin breaking down the strong beliefs around what eating these foods mean, so that when the social event comes, they can try to enjoy the moment. Maybe not for the whole time, that can be too much pressure, but aiming to see of how food can be a part of joyful moments and being with loved ones.

    One step closer towards a better relationship with food.

    Thank you for reading and throughout the month I am going to continue sharing my guidance on how to navigate this festive season and social events when you’re in the depth of your eating disorder recovery.

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  • Managing Nutrition with ADHD

    Managing Nutrition with ADHD

    By Sophia Boothby RD 

    There has been growing awareness around Attention Deficit Hyperactivity Disorder or ADHD in the past few years. Historically this has been seen as a diagnosis for children. However, there is a growing awareness around adult ADHD. Particularly with highly influential individuals speaking more about their diagnosis and the positive impact having a formal diagnosis has had on their lives. There are several theories in how ADHD increases the risk of an individual experiencing disordered eating. Let’s find out. 

    1. What is ADHD?
    2. How does ADHD impact our eating?
    3. How to start eating regularly with ADHD?

    What is ADHD?

    ADHD stands for Attention Deficit Hyperactivity Disorder is characterised by a lasting pattern of inattention with or without hyperactivity, that leads to daily disruption in executive functioning. 

    Symptoms can include restlessness, talkativeness, excess fidgeting, boredom, indecisiveness and procrastination. These can vary from person to person. The cause of ADHD remains unknown, although there is growing research surrounding genetic factors. A 2008 article explains that 75-90% of ADHD is caused by genetics factors.

    Neurotransmitters including serotonin, dopamine and norepinephrine are largely involved in influencing ADHD symptoms such as cognition, memory processing, motor control and endocrine (hormone) regulation. Sex hormones can be known as the key to releasing these happy neurotransmitters. 

    These neurotransmitters are produced by the gut microbiota and influence the gut-brain axis (AKA the ‘second brain’). It describes the bidirectional relationship between the gut and the brain, and is responsible for cognitive functions such as mood. Often individuals with ADHD can also experience gut issues. 

    How does ADHD impact our eating?

    A 2017 systematic review has suggested that ADHD is associated with disordered eating behaviours. More often seen with a person diagnosed with ‘Predominantly hyperactive-impulsive ADHD’ as with this type of ADHD people often struggle with impulsivity. 

    More specifically binge eating or overeating are common behaviours associated with this type of ADHD. This could also be explained from another key symptom of ADHD pf emotional dysregulation leading to addictive-like eating behaviour. Further studies are needed to determine how sleep deprivation can exacerbate emotional dysregulation and in turn, related to ADHD and disordered eating behaviours. 

    During a ‘binge’, these foods are usually high in fat and/or sugar, resulting in a satisfied feeling due to the activation of dopamine neurons in the reward system in the brain. This contributes to the cycle, as this increases insulin levels, which can interfere with sex hormones regulation, stimulating cortisol (stress) hormones. All of which can disrupt normal appetite signaling, followed by the perception that you need to restrict eating again and the cycle continues. 

    How to start eating regularly with ADHD?

    1. It’s time to be honest and be confronted with your current eating patterns

    Start by writing down a diary of what you are eating and drinking. Try to include as much detail as you can such as time of day, how you’re feeling and amounts. Especially if you are thinking that you are ‘binge eating’, writing it down can help to clear things up as sometimes this can be subjective. 

    1. Start with clear and specific goals for you. Don’t aim for changing everything at once. 

    The impulsivity within your ADHD may want you to go in all or nothing. This may be something that you’ve done before and it may work for a short while, but then something breaks it so you stop and do nothing. So let’s try something different. Choose 2 areas you would like to focus on, such as drinking more hydrating fluids or eating a new fruit or vegetable each week. 

    1. Remember that because these are actively new things you are trying to implement into your life, each day will be a challenge to put in place. 

    Be patient and with consistency, it will become easier. Sometimes, you may not tick off what you have wanted to do. That’s ok and it does not mean you have failed, you can start again later on in the day or tomorrow. 

    If any of these tips have helped you let me know in the comments or email me at hello@eatforyoudietitian.co.uk 

    If you need tailored specialist support then take a look at my services. Stay tuned as I continue writing in this Managing Nutrition with ADHD series. 

  • Nutrition and Supplements for Menopausal Health

    Nutrition and Supplements for Menopausal Health

    By Sophia Boothby RD 

    There has been an influx of supplements targeting individuals who are experiencing perimenopause and menopause. This isn’t just for the individual who is going through perimenopause or menopause, but if you want to understand what your loved ones are going through, read on here. 

    Contents

    1. What is menopause? 
    2. What is peri-menopause? 
    3. Menopausal symptoms (these are some examples but not limited to) 
    4. Nutrition Guidance for Menopause
    5. Supplements for Menopause 

    What is menopause? 

    Menopause is the point in a woman’s life when her menstrual periods have stopped for 12 months. It will be defined as occurring 12 months after the last menstrual period. This is usually experienced between ages 45 to 55.  However, some women may experience menopause much earlier in life, which is known as premature ovarian insufficiency. 

    The British Menopause Society findings state that up to 90% of women will have some symptoms related to menopause, with 25% describing the symptoms as severely impacting their life. 

    The reasons menstrual periods stop is due to the ovaries no longer produce oestrogen, progesterone and testosterone. These hormonal changes impact the body in different ways as they have important roles in maintaining bone and heart health and supporting brain function. Oestrogen has a vital function in supporting bone mineral density and without this hormone the risk of osteoporosis (weak bone density) increases for women post menopausal. 

    What is peri-menopause? 

    This can be split into early and late peri-menopause. Early peri-menopause is the initial stage when women can start experiencing changed in their menstrual cycle pattern so that periods can become infrequent and further apart. An average menstrual cycle can be between 28 to 35 days. 

    Late peri-menopause is when worsening of menopausal symptoms occurs and the menstrual cycle can become even less frequent, which can be difficult to predict for women. It can be as infrequent as a few months apart. 

    Menopausal symptoms (these are some examples but not limited to) 

    • Hot flushes 
    • Night sweats 
    • Disturbed sleep or insomnia 
    • Low energy levels 
    • Low mood 
    • Anxiety 
    • Low libido and sex drive 
    • Impaired memory and concentration 
    • Feeling a ‘brain fog’ 
    • Joint aches 
    • Headaches 
    • Palpitations (or feeling like her heart is racing) 
    • Vaginal dryness 
    • Urinary symptoms 

    Nutrition Guidance for Menopause

    I would aim a food-first approach and to get all your key nutrients from a a varied and balanced diet. There is no cure for menopause. There are pharmacological treatment options that you should discuss with your GP or Consultant. Hormone Replacement Therapy (HRT) remains the gold standard and first line treatment for managing symptoms. Non-hormonal treatments are available for those who cannot or choose not to take HRT, please discuss with your doctor. 

    Supplements for Menopause 

    Let’s not let pretty and fancy packaging make our decision when it comes to deciding on supplements to take on a daily basis. There is limited quality evidence on black cohosh, red clover, lion’s mane and ashwagandha. Although there is has been increasing amount of marketing around these supplements, approach with caution. 

    Vitamin D 

    Your skeletal muscle function is under the direct influence of vitamin as the active form of vitamin D, calcitriol is produced and present in skeletal muscle. Therefore vitamin D deficiency can impact muscle strength, however we do need further studies in this area according to 2020 study. 

    Vitamin D is a fat-soluble vitamin created within our bodies from direct sunlight on the skin. Whilst some foods contain a small amount, throughout autumn and winter in the UK it is recommended we all need a vitamin D supplement. The recommended daily intake in the UK is 10mcg supplement of vitamin D daily.

    Omega 3 Fats 

    Omega-3s are a family of essential fatty acids. Omega-3 has many benefits for PCOS including being anti-inflammatory, improving mood, and lowering cholesterol and triglycerides. These essential fatty acids also support the production of neurotransmitters, which can impact the thermal centre of the hypothalamus that controls our body temperature. A recent 2020 study found that omega-3 supplements were able to improve menopausal symptoms in a safe and effective way. 

    Soy Isoflavones 

    Soy Isoflavones are a type of phytoestrogen that has a similar structure to human oestrogen (sex hormone that is no longer produced in menopause). Isoflavones are found in plant foods such as soybeans, tofu, miso, and soya products. 

    The 2021 overview study has summarised that soy isoflavones or soya foods have been associated with reduced risks of endometrial and bladder cancer, alleviate hot flushes and night sweats symptoms, and reduce bone loss in the spine. 

    If eaten regularly or taken in sufficient amounts they can help relieve menopausal symptoms. It’s important to remember these won’t be immediate and it can take 2 to 3 months for the benefits to be seen. 

    Magnesium 

    Magnesium is a mineral found in a wide variety of foods, including spinach, nuts and wholemeal bread. As with all minerals, it helps the body to function optimally. This includes helping to turn the food we eat into energy and ensuring our parathyroid glands (which produce hormones and support bone health) function normally. 

    There is limited evidence to support increasing magnesium-rich foods or supplements specifically to menopause. There are interesting findings around the mood-improving potential of magnesium and the inclusion of supplements within depression treatment. However, this remains in the early stages. 

    According to the NHS guidelines it is recommended to have no more than 400mg/day of magnesium. Common side effects of exceeding this amount in the short-term includes diarrhoea, nausea and abdominal pains. 

    Key takeaways 

    The appeal of adding supplements to support you with menopause is understandable.  Ensure that you are prioritising your nutrition and lifestyle factors firstly prior to trialling anything additional and consult a doctor to check about any interactions with prescribed medications. 

  • ADHD and Disordered Eating – What’s the link? 

    ADHD and Disordered Eating – What’s the link? 

    Written by Sophia Boothby RD 

    There has been growing awareness around Attention Deficit Hyperactivity Disorder or ADHD in the past few years. Historically this has been seen as a diagnosis for children. However, there is a growing awareness around adult ADHD. Particularly with highly influential individuals speaking more about their diagnosis and the positive impact having a formal diagnosis has had on their lives. There are several theories in how ADHD increases the risk of an individual experiencing disordered eating. Let’s find out. 

    Contents

    1. What is ADHD?
    2. ADHD Medications 
    3. How does ADHD impact our eating?
    4. Key Takeaways

    What is ADHD?

    ADHD stands for Attention Deficit Hyperactivity Disorder is characterised by a lasting pattern of inattention with or without hyperactivity, that leads to daily disruption in executive functioning. 

    Symptoms can include restlessness, talkativeness, excess fidgeting, boredom, indecisiveness and procrastination. These can vary from person to person. The cause of ADHD remains unknown, although there is growing research surrounding genetic factors. A 2008 article explains that 75-90% of ADHD is caused by genetics factors.

    Neurotransmitters including serotonin, dopamine and norepinephrine are largely involved in influencing ADHD symptoms such as cognition, memory processing, motor control and endocrine (hormone) regulation. Sex hormones can be known as the key to releasing these happy neurotransmitters. 

    These neurotransmitters are produced by the gut microbiota and influence the gut-brain axis (AKA the ‘second brain’). It describes the bidirectional relationship between the gut and the brain, and is responsible for cognitive functions such as mood. Often individuals with ADHD can also experience gut issues. 

    ADHD Medications 

    As per NHS guidelines there are 5 types of licensed medication for the treatment of ADHD split into stimulants and non-stimulants. Stimulants work by increasing levels of dopamine and norepinephrine in the brain, which can help with focus and concentration. 

    These are primary medications to help manage the symptoms associated with ADHD and are not intended to cure ADHD. 

    1. Methylphenidate 
    2. Lisdexamfetamine 
    3. Dexamfetamine 
    4. Atomoxetine
    5. Guanfacine 

    Common side effects of all the medications can impact mood negatively and decrease appetite. There are different versions of these medications from short acting medications or extended release medications. Usually it may take time to find your best dose for your symptoms and any side effects experienced. 

    How does ADHD impact our eating?

    Often individuals considered to be in a ‘higher BMI’ can be advised as stated in NHS guidelines to lose 5-10% of weight as the primary treatment.  This could be for clinical conditions such as PCOS and type 2 diabetes. Often individuals are given this blanket advice without guidance on implementing positive and sustainable lifestyle changes. 

    This can result in pursuing online sources for clearer guidance and finding unreliable sources that advise dietary restrictions that ‘promise’ symptom improvement. 

    A 2017 systematic review has suggested that ADHD is associated with disordered eating behaviours. More often seen with a person diagnosed with ‘Predominantly hyperactive-impulsive ADHD’ as with this type of ADHD people often struggle with impulsivity. 

    More specifically binge eating or overeating are common behaviours associated with this type of ADHD. This could also be explained from another key symptom of ADHD pf emotional dysregulation leading to addictive-like eating behaviour. Further studies are needed to determine how sleep deprivation can exacerbate emotional dysregulation and in turn, related to ADHD and disordered eating behaviours. 

    During a ‘binge’, these foods are usually high in fat and/or sugar, resulting in a satisfied feeling due to the activation of dopamine neurons in the reward system in the brain. This contributes to the cycle, as this increases insulin levels, which can interfere with sex hormones regulation, stimulating cortisol (stress) hormones. All of which can disrupt normal appetite signaling, followed by the perception that you need to restrict eating again and the cycle continues. 

    Key Takeaways

    ADHD is a neurodevelopmental disorder and it can impact all areas of life. Often individuals will require to work on one area at a time as to not overwhelm their mind. There has been research focused on nutrition for our brains and we are aware of key food groups we need daily. With ADHD it may be a set weekly meal plan reminders are needed, safe spaces to eat regularly with minimal distractions, regular exercises for fun and tools to desensitise when needed. 

  • What is Irritable Bowel Syndrome (IBS)?

    What is Irritable Bowel Syndrome (IBS)?

    Written by Sophia Boothby RD

    Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal or gut disorder characterised by changes in bowel habits (e.g diarrhoea, constipation or both) and symptoms such as abdominal pain and bloating that can severely impact daily activities. 

    The term ‘functional disorder’ is a term used for, in this case a disorder on how the gastrointestinal (GI) tract is functioning, without pathological abnormalities, as common medical investigations will often show normal results. IBS is a multifactorial functional disorder which includes the brain-gut axis communication and it is now considered a disorder of the gut-brain interaction. 

    Contents

    1. How is IBS diagnosed?
      1. The Bristol Stool Chart 
    2. When do you seek help? 
    3. Is IBS the same as IBD?
    4. Treatment for IBS
    5. Key Takeaways 

    How is IBS diagnosed?

    The Rome Foundation specifies the Rome IV criteria for diagnosing and treating Disorders of Gut-Brain Interaction (DGBIs). According to IV criteria, the diagnostic criteria for IBS includes recurrent abdominal pain for at least 1 day a week for the past 3 months (symptoms to have started at least 6 months prior), associated with 2 or more of the below:

    1. Associated with bowel motion 
    2. Associated with change in frequency of bowel motions 
    3. Associated with a change in form or appearance of bowel motion (look down the loo to get to know your ‘normal’) 

    In the UK we also have National Institute for Health and Care Excellence (NICE) guidelines that outlines the diagnostic tests that should be performed by your GP including blood tests and stool (or faecal) tests which check for inflammatory markers, antibodies related to coeliac disease, malabsorption and reviewing your risk of colorectal cancer. 

    IBS is categorised by subtypes according to symptoms experienced and using the Bristol Stool Chart which categorises our stools from Type 1 (hard pebble-like) to Type 7 (watery diarrhoea). 

    1. IBS- Constipation predominant (IBS-C) majority type 1 or 2 less than 3 times a week 
    2. IBS- Diarrhoea predominant (IBS-D) – majority type 6 and 7 at least 3 times a day 
    3. IBS- Mixed bowel habits (IBS-M) combination of constipation and diarrhoea stools  
    4. IBS- Unclassified (IBS-U) – bowel motions are neither constipation, diarrhoea or mixed sub-types, however they meet other diagnostic criteria. 

    The Bristol Stool Chart 

    Bristol Stool Chart

    Rome Foundation. 2016. Rome IV Criteria – Rome Foundation. [online] Available at: <https://theromefoundation.org/rome-iv/rome-iv-criteria/>

    When do you seek help? 

    When presenting the above symptoms are impacting on your quality of life and you being able to do your everyday activities is usually the time. There are key red flags that if present you should seek advice and investigations from your doctor. These include unintentional weight loss, rectal bleeding (particularly if over 50 years old), family history of bowel or ovarian cancer, unknown cause of micronutrient deficiencies, over 60 years old with change in bowel habits of type 6 or 7. 

    Is IBS the same as IBD?

    IBS is separate from Inflammatory Bowel Disease (IBD) which can be diagnosed as Crohn’s Disease and Ulcerative Colitis (UC), however the symptoms individuals experience can be similar. IBD is a diagnosed disease which causes chronic inflammation to your GI tract. IBD can be seen in investigative imaging. You should undergo the correct diagnostic tests for IBD as the treatment and management options are different to IBS, therefore it is important to seek medical advice. 

    Treatment for IBS

    Once diagnostic tests have been performed to outrule an organic cause for your presenting symptoms, such as IBD you may then be formally diagnosed with IBS by your Doctor. According to NICE guidelines the first line treatment begins with dietary and lifestyle advice and symptom-targeted medication. 

    Our diet is one of the key modifiable factors that shape our gut microbiota, which plays a crucial role in intestinal homeostasis. 

    First line dietary treatment is focused on general advice such as regular meals during the day and avoiding skipping meals or eating too late at night, and reviewing intake of; alcohol, caffeine, high fat/fried foods, dietary fibre diversity and fluids. 

    The key areas focused on will depend on the subtype of IBS and the primary symptoms of the individual. An important factor to remember is that inclusion is vital to support our gut health and first line treatment is focusing on what we can include in our diet to increase diversity. 

    British Dietetic Association summarises first line treatment including non-dietary approaches such as regular movement,mindfulness and stress-relief advice. This includes gut directed hypnotherapy, and yoga that can often be as effective as dietary modification found in clinical trials. The yoga intervention includes different postures and breathing techniques aimed to relax both body and mind, targeting the gut-brain axis. 

    Key Takeaways 

    Please don’t self-diagnose your symptoms as IBS. Especially over 60 years of age, any changes to your bowel habits or other gut symptoms should be taken seriously and investigated by your GP or Consultant through valid and reliable tests only.

    If you are struggling with IBS and it is impacting your relationship with food. Sophia Boothby RD offers a 3-month Individualised Dietitian Package, book in your FREE discovery call here.

  • 5 Money Saving Tips for Food Shopping

    5 Money Saving Tips for Food Shopping

    Dietitian Approved

    Written by Sophia Boothby RD

    Have we all asked ourselves and our friends the question, ‘When will prices stop going up?’ One example that I found quite remarkable was the supermarket own brand dog food I used to buy used to be £5 for 12 tins. This went gradually up in price to £9 for 12 tins. This meant quite a steep increase in the amount we were spending on our 2 dogs every month and it doesn’t look like the price will ever go back to what it was so now it’s our new normal. So apart from our family pets, where else can I try to save money on my weekly food shop?

    Contents

    1. Fruit and vegetables
    2. Carbohydrates
    3. Beans, pulses, legumes and other protein sources
    4. Oils and spreads
    5. Fancy Brands and Packaging

    Fruit and vegetables

    Choose frozen and tinned options so you have your cupboard and freezer staples if keeping up with fresh fruit and vegetables is not achievable.

    Often it can be believed that fresh/organic fruits and vegetables are the best source. This isn’t always necessarily true highlighted in this 2017 study. Especially when financially it is difficult to maintain fresh produce in your home then consider what frozen alternatives there could be.

    I have always gone for frozen versions of fruit and vegetables. Keeping a stock of sliced peppers, mixed veg, stir fry mix, green beans, peas and sweetcorn, kale, spinach, raspberries and strawberries is super handy!

    Carbohydrates

    Supermarket own brands of pasta and spaghetti are pennies so why would you pay more for packaging.

    I go for supermarket own brands of bread too, aiming to choose wholegrain or seeded wholegrain bread when I can.

    Cereals are one of my simple breakfast options (bran flakes topped with raisins) and I’ve noticed that branded options of popular choices like cheerios, weetabix and weetos are about twice the amount of supermarket-own brands. My top tip is trialling the supermarket-own brands which are wheat biscuits or honey hoops at least once. You may not always favour these but when considering a total cost perspective, avoiding the colourful branded cereal boxes can save you quite a bit of £££.

    Beans, pulses, legumes and other protein sources

    Tins, tins and more tins of chickpeas, mixed beans, red kidney beans, green lentils, black-eyed beans. These can another cupboard staple to add to bolognese, curries, chilli, stews as a great protein source and a extra dietary fibre goodness. If you are new to adding beans and pulses to your diet, do this gradually as they can cause more wind and can be uncomfortable if too much is eaten too quickly. Chew properly!

    There is no really getting round the cost of meat and poultry. I aim to buy bigger family packs and portion these accordingly for meals. There are frozen options also available.

    Frozen fish fillets – haddock, tuna, salmon are easy to use. I often go for tinned tuna and mackerel in tomato sauce to have available for my lunches.

    Other protein sources do include eggs, cheese, nuts and seeds. With nuts and seeds choose mixed variety bags if you can to gain more diverse plant-based fibres that can benefit your gut health.

    Oils and spreads

    1kcal oil sprays are a popular choice nowadays which can allow you portion control how much oil you’re using in cooking. The good about these is that once you buy one you’re probably using it for ages and ages until it has to be replaced.

    There can be fancy oils around such as coconut oil and I don’t want to be against it but I’d rather people use on their hair and bodies if they must than cook with it.

    Fancy Brands and Packaging

    You may swear by a particular brand of XYZ and the cheaper ones may not compare to it. My question for you, have you tried the other cheaper option?

    I often buy the big tub of supermarket-brand instant coffee and I will decant it in the small jar. For a while I had a Nescafe coffee jar (it must’ve been on offer). One day I made my brother-in-law a coffee and when he saw the Nescafe coffee jar he raved at how good his coffee was. A clear example of being blinded by the big brand names.

    I guess I am fortunate that my parents taught me these effective ways of steering away from branded foods/drinks as a way of keeping the food shop costs down from a young age. I do think it is a useful tip to keep costs down as when you do compare some of these prices are triple.

    Let’s see if you can give it a go this week.