Coeliac disease – how a dietitian can help
COELIAC DISEASE How can a specialist dietitian help optimise people diagnosed with coeliac disease? This is a great question and one that is asked every day by enquiring patients. Here at 121 Dietitian we have helped thousands of people, many diagnosed with coeliac disease. It can be overwhelming to learn of such a diagnosis and it can be difficult to know who to turn to. Thankfully we are the experts in optimizing health for all conditions and we have a dedicated programme that takes all the worry and stress away! WHAT IS COELIAC DISEASE? Coeliac disease is an autoimmune disease triggered in those people who are genetically at risk. This trigger causes your immune system to attack your own tissues when you eat gluten. The gastrointestinal tract is the targeted organ for this attack and the consequences are many. Interestingly 35-40% of the general population have the genes that predispose a person to celiac disease, but only around 1% of the general population develop the autoimmune disorder. SYMPTOMS There are several classical symptoms and a few more not so common, so if you feel you have an issue with Gluten you may find this helpful in getting a diagnosis. The most well-known symptoms of coeliac disease include diarrhoea (pale foul smelling fatty stools) fatigue bloating weight loss stomach ache Other not so well know coeliac disease symptoms include: indigestion constipation itchy rash nerve damage (B vitamin deficiencies) malnutrition – not getting enough nutrients from food, infertility problems – women with coeliac disease can have difficulty becoming pregnant disorders that affect coordination, speech, and balance (B vitamin deficiencies) Children with coeliac disease: have all the above symptoms along with nausea and vomiting may not grow at the expected rate and may have delayed puberty. And some people do not have any notable symptoms and this diagnosis comes as a complete surprise. IMPORTANT COELIAC STATISTICS 1 in 100 -people worldwide are affected by coeliac disease In Europe: Germany, The Scandinavian countries, Ireland, and the United Kingdom population have a higher prevalence of coeliac disease ~ 1000 to 1500 per 100,000 individuals Women to men ratio 3:1 Of patients diagnosed with Coeliac disease 50% still report symptoms while following a gluten-free diet (this is where 121 Dietitian can help) Family members 1 in 10 also have coeliac disease If you are diagnosed with coeliac disease you have a x 2 increased risk of coronary artery disease You have an increased risk of small bowel cancers x 4. COELIAC DISEASE TESTING Coeliac disease diagnosis can be made by your GP. They will take a history of your symptoms and arrange a blood test to check for antibodies that are present in the blood of people with coeliac disease. You need to keep eating gluten foods otherwise you may have an inaccurate blood test result. If this is +ve you will then be referred to a gastroenterologist to confirm this with an endoscopy and a biopsy. They will also be looking for blunt villi. Villi are finger-like projections in the gastrointestinal tract required for nutrient absorption, and when flattened do not have enough surface area to absorb sufficient nutrients. COELIAC DISEASE TREATMENT As this is an autoimmune disease – Gluten a protein found in grains is the trigger, coeliac disease is treated with a gluten-free diet. If you have been experiencing symptoms for a while with malabsorption you may need vitamins and minerals to be replaced. A specialist Dietitian who is trained in gastrointestinal diseases is the best person to assist you with optimising your diet and health for the long term. COELIAC MEDICAL TREATMENTS Coeliac disease unfortunately does not have a cure. So a strict gluten-free diet will help control symptoms and prevent long-term complications. What can often be a problem is when people have none to mild symptoms, or their symptoms go away within a few weeks of the diet, they can continue to eat or sneak some gluten and over time if not addressed serious complications can occur. Many years ago my patients often presented as very underweight, anaemic, exhausted, and having multiple nutrient deficiencies. Today this is not always the case. Many people are now being diagnosed who come to see me eating an unhealthy poor quality diet. Some carry excess weight and are nutrient deficient from this and less so from malabsorption. The worst for these people is that, if not educated in the right choices, they replace their poor gluten diet with gluten-free processed unhealthy choices. Unhealthy choices lead to the consumption of insufficient nutrients causing the patient to feel poorly and gain further weight. It is really important to therefore ensure that your gluten-free diet is designed to suit you and is wide in variety, healthy and balanced. Overall it has been fantastic that there has been an increase in the range of available gluten-free foods in the past 10 years. But the negative to this is that it is now possible to eat a diet full of unhealthy choices instead of focusing on a healthy and varied gluten-free diet. WHAT FOODS TRIGGER COELIAC DISEASE? Foods and fluids that contain Gluten include: Wheat and derivatives of wheat such as: Durum Emmer Couscous Semolina Spelt Farina Farro Kamut Einkorn wheat Rye Barley Triticale Malt including, malted milk, milkshakes, malt extract, malt syrup, malt flavouring, malted barley flour, malt vinegar Brewer’s Yeast Wheat Starch that has not been processed to remove gluten to below 20ppm Oats are contaminated in processing and packaging so are not allowed even though they do not naturally contain gluten. GLUTEN FOOD EXAMPLES The following are examples of popular foods containing gluten -so these are no longer suitable to eat – lifelong. bread pasta cereals cakes and pastries biscuits or crackers pies gravies, stocks and sauces beer WHAT HAPPENS IF SOMEONE WITH COELIAC DISEASE EATS GLUTEN? I advise and treat hundreds of newly diagnosed and refractory Coeliac patients. It is a common fear that when not in control of the cooking they are going to
Fatty liver how to fix NAFLD
Fatty Liver Did you know Fatty liver affects 1 in 3 of us and if you have diabetes this figure is higher again. Scarily the end result, if not addressed, can be a decompensated liver and even liver failure. So, if you have been thinking about losing weight and getting more active but really don’t feel the need, you may wish to think again. Many of us bury our heads in the sand and believe we are getting along fine. No aches no pains, enjoying our current way of eating, drinking and moving when we have to. So why change? Well, today, the most common cause of chronic liver disease is nonalcoholic fatty liver disease (NAFLD) AND…. 95% of people with NAFLD do not know they have it. I have many patients come to see me for weight loss, diabetes or healthy eating advice, and when we investigate their health further, we uncover blood markers that don’t read well. It is such a common problem and one that I fix daily so I feel it is important for you to be aware. I have been researching some information to help you further, and in this blog I have pulled a few interesting details from medical papers which I have added in below. So let’s dive in. What is non-alcoholic fatty liver disease NAFLD? It is a liver disease that is NOT caused by alcohol use. Characterized by fatty infiltration of the liver. What is the main cause of a fatty liver? Fat builds up in the liver by eating excess calories. This excess energy is too much for the liver to process and too much fat creates insulin resistance and can lead to inflammation. Fatty liver can occur if you have other conditions, such as obesity, diabetes, high triglycerides, and metabolic syndrome. What are the signs of a fatty liver? There are usually NO signs of fatty liver disease in the early stages. But you may feel fatigued and have pain in the right upper quadrant (upper right part of the abdomen)- it’s usually a dull discomfort and you may wish to investigate. How serious is a fatty liver? Early-stage NAFLD, if sorted early enough thankfully can be reversed, and doesn’t usually cause harm. But if not treated it can lead to serious liver damage, including cirrhosis. Having high levels of fat in your liver is also associated with an increased risk of problems such as diabetes, heart attacks, and strokes. What is liver cirrhosis? Cirrhosis is scarring (fibrosis) of the liver caused by long-term liver damage. The scar tissue prevents the liver from working properly. If cirrhosis (the most advanced stage) occurs, you can get more severe symptoms, such as yellowing of the skin and the whites of the eyes (jaundice), swelling in the legs, ankles, feet, or tummy (oedema) and itchy skin. How do you fix a fatty liver? Great news, diet and lifestyle are first and foremost the key to success. 121 Dietitian has years of experience treating fatty liver patients and would love to help you with any of the following: Lose weight Establish a healthy diet for fatty liver Create a personalized fatty liver meal plan Improve blood sugar control Create a personalized weight management programme Support your overall liver health if needing to be medicated Suggest foods, snacks, meals and recipes for optimum liver health Make recommendations for healthier food products and supplements as required In addition, we will recommend exercise and how to be more active Assist if you have diabetes or have been diagnosed with pre-diabetes Lower your cholesterol, triglycerides, LDL, HDL. … The bottom line recommendation: If you’re overweight or obese, the aim is to reduce the number of calories you eat each day and increase your physical activity in order to lose weight. Easier said than done. I know it’s not for the want of trying different diets or strict boot camp style workouts- sadly if they are too tricky they don’t last. So that is where we at 121 Dietitian can help you with no quick fixes. Interestingly, although obesity is described in 50% to 90% of patients diagnosed with NAFLD, the condition can also affect individuals with a normal weight and body mass index so if you are experiencing health issues or have a poor diet do get checked with your Doctor if you are concerned. Can fatty liver disease be cured? The good news is that fatty liver disease can be reversed—and even cured—if patients take action early, including a minimum 10% sustained loss in body weight and/or a change in the foods you eat. How long does it take for fatty liver to go away? An average period of 6 weeks to 2 months is an expected timeframe to recover from fatty liver disease. However, lifelong adherence to particular diet and lifestyle changes may be necessary to prevent relapse. What foods are good for fatty liver? Foods That Help Fatty Liver Disease include but are not limited to…. Fish and seafood. Vegetables and fruit. Whole grains. Olive oil. What are Liver superfoods? There are no superfoods as such, but fortunately hundreds of fabulous everyday foods that when combined in correct amounts and consumed regularly can provide you with the best macro and micronutrient intake for a healthy liver and life. What medication can I take for Fatty Liver? There are no direct medicines for non-alcoholic fatty liver disease. Losing weight, eating healthily, and regular exercise can help. If you have elevated lipids, type II diabetes, and high blood pressure with lifestyle changes you may be able to reduce some of the medication you take. Adopting a healthy lifestyle is the main way of managing NAFLD. For example, it can help to: lose weight – losing more than 10% of your weight can remove some fat from the liver eat a healthy diet – try to have a balanced diet high in vegetables, fruits, protein, and healthy carbohydrates, but low in pro-inflammatory fats, sugar, and processed
Sports Nutrition looking forward
Sports Nutrition The field of sports nutrition is vast. Personalised performance nutrition can be super confusing with so many options to choose from. This blog dives into the following: The basics for you to be optimal What is the ultimate approach Research and the future in sports nutrition It can be all too easy to get it wrong or spend a fortune on a quick fix, or several! I see this every day in my clinic and also when I provide nutritional advice to followers on my fitness friend Caroline Girvan’s Facebook page in my Sunday live 1-hour session. As I have been involved in the world of Nutrition and health for over 25 yrs, including successfully working with athletes for the commonwealth games and Olympics, I love looking forward to what new ideas are ahead. Sports Nutrition – First things first Some background advice on getting you optimized! No point in not having the basics nailed….So. Know that you have to adopt a balanced real food approach that is nutrient-rich, otherwise, you will be disappointed with the amount of training, supplements or protein powder you pack in. These alone will not fix your physique or do anything for your health. 80% of success IS nutrition but the biggest part of this is consistency – whether it is counting macros, intermittent fasting, keto, the cabbage soup or Atkins these are all names of various dietary restrictions either by changing timings, altering nutrient intake e.g. fats or increasing fluids to reduce hunger etc but all in all they point to a kcal deficit to be successful. Are they successful – Sadly not all, and if they are they are often short-lived. I see many many hundreds of desperately miserable people doing everything they can to follow these restrictions. They may start well and see some changes but when something is too difficult, things slip and the feeling of failure can occur. I am firmly against this as Yo-Yo -dieting decreases energy expenditure, increases energy intake, and impairs brain-periphery communication. The Ultimate sports nutrition approach What many people HATE me telling them AND what works for the majority for the longterm is. Clever intuitive eating It is important to get the right mindset for this. You need to know that your body is not determined by numbers but by genetics, emotions, your food and life choices and all these interact with your overall diet and health. Bizarrely the belief that “no pain no gain” and a strict impossible plan is the answer, pushing the responsibility to someone else -and how many times do I hear the list of people that one person has taken a plan from and when it doesn’t work – it all stops and food becomes the comforter again. It’s true if you are totally confused by the past 30 yrs of inaccurate nutritional info, being able to choose your own nutrient-rich meals, snacks, fluids, party foods etc that are not on a strict plan can be overwhelming. If this is you then it may be worth working with someone (a nutrition expert) for a while, just to make sure you know what is necessary for you and you are able to enjoy it for the long term. That’s what we love and are experts in! Training to see ripped muscles takes far longer for many than they anticipate. As a beginner hypertrophy (building muscle) can be more difficult to achieve as the body is making neural adaptations. Progress and increasing strength allows for muscular growth but it does take time and patience. And finally – sufficient fluid intake and the types consumed are definitely overlooked. Fluid and enough fluid is critical to prevent dehydration, overheating causing confusion, low energy, and mood change, and also if ongoing can link to constipation and kidney stones. The Future of Sports Nutrition Research So what’s out there? It’s always a buzz to know brand-new areas are emerging with exciting products. Companies are more and more using science to optimize performance and especially important post-COVID with the resurgence in exercise, the gym and the importance of getting and staying healthy. Muscle Mass Everyone wants to build muscle right? Well, when I was starting out 25yrs ago that was not the case and it used to be for a few men in the gym and for really beefing up it was just a select few bodybuilders in competitions! Now we know that building muscle at all stages of life is mega important. Research into the physiology of improving muscle mass and strength is massive! While protein is the most important in terms of dietary supplementation, other researched ingredients include nitrogen oxides, nitrates, and creatine and these are used by millions daily. Carnosine and beta-alanine are also on the radar in muscle physiology research and may certainly be in some of your cupboards already! Carnosine is a naturally forming dipeptide (two linking amino acids beta-alanine and histidine) specifically found in the tissues of the body when they are active. Carnosine is also located in the heart, brain, and other parts of the body and is known to improve muscle strength and performance during exercise. Beta-alanine is a naturally occurring amino acid that supports the synthesis of muscle carnosine in the body. It is known to delay the onset of muscle fatigue and failure and is found in foods such as certain meat turkey, chicken, beef, pork and fish. It combines with the amino acid histidine to form the dipeptide called carnosine. This helps delay the onset of lactic acid and muscle fatigue and failure while building endurance and improving recovery. Hydration We know water is the best fluid to drink before exercise. Drinking 2-3 litres per day depending on your requirements is perfect especially if your activity is less than one hour. However, if you exercise for longer an isotonic sports drink with carbohydrates and sodium, and possibly potassium, calcium, and magnesium before and during exercise can be beneficial. There are gazillions out there
Vitamin D Benefits – 9 awesome reasons
Vitamin D Benefits everyone’s health young and old. Vitamin D has multiple benefits and I have been a massive advocate of Vitamin D for many years due to my autoimmune family. Further strengthened when asked to write for the New Scientist on the tragic case of a murder trial.… So lets dive in to why you and your family need Vitamin D today….. It has been known for many years that Vitamin D is important for the following reasons: Vitamin D helps our body absorb calcium and phosphate, lowering the risk of tooth decay, cavities, and gum disease as well as ensuring our bones are flexible and strong. Vitamin D support the immune system which allows our body to fight off harmful bacteria and viruses. Vitamin D helps to strengthen muscles. Excitingly there is more to vitamin D than it was originally believed…..but before we get into that lets cover the basics…. Low levels of Vitamin D It is important to be aware that nearly half of the population have low blood levels of Vitamin D during winter months. This is especially low from January through to April/May when any summer sunshine stores you may have gained the previous summer are truly depleted. Those living in latitudes above ∼35° are significantly affected. In addition to depleted stores, many more people than ever have low levels of vitamin D due to changes in our lifestyles, less time outdoors, and the use of sunscreens. The elderly or those who are housebound are at very high risk all year round. Dark skinned people are also at risk. Further risk has been found in people who are obese, pregnant or a child due to either a lack of availability as Vitamin D is locked away in high fat stores or due to an increased need for development and growth in childhood and pregnancy. What are the Symptoms of a low vitamin D? The following symptoms can be common in those with Vitamin D deficiency: Fatigue Not sleeping well Bone pain or achiness Depression or feelings of sadness Hair loss Muscle weakness Loss of appetite Getting sick more easily What does vitamin D do for you? Tonnes!!! Interestingly Vitamin D is actually a steroid hormone but also known as a fat-soluble vitamin. This helps the body absorb and retain calcium and phosphorus; essential for building bone. How does Vitamin D work as a hormone? The body synthesizes Vitamin D after you have been exposed to the sun. It is then activated by the liver and kidneys. This activated form acts like a hormone to regulate calcium metabolism around the body. Vitamin D Benefits Cancer Exciting studies are now showing that vitamin D can reduce cancer cell growth, help control infections and reduce inflammation by stimulating the production of T-cells. These T cells help our bodies respond correctly to fight infections, including viruses, bacteria and fungus. These infections are responsible for various types of illnesses, including the common cold, and flu, Strep A and similar community-wide diseases. Vitamin D also aids in the repair and regeneration of cells, stimulate the death of cells that have been damaged by cancer, and lower the formation of blood vessels in tumours. Mood Vitamin D boosts your mood. Studies suggest that the decreased levels of Vitamin D3 may impact the levels of serotonin in the brain, this is a hormone that regulates the mood. By enjoining some safe sun each summer and, if in the Northern hemispheres taking a Vitamin D3 supplement in the winter, you could see a significant boost in your mood. Weight Loss Vitamin D can aid in weight loss. The chemical influence of Vitamin D is on serotonin, the “feel-good” hormone. This is known to assist appetite, sleep, mood, and stress levels. The connection to weight loss is believed that with sufficient levels of Vitamin D you are more likely to be motivated and have the energy to make the changes both mentally and physically to stay fit and healthy at a safe weight. Rheumatoid Arhtritis Vitamin D can lower the risk of rheumatoid arthritis. One of Vitamin D benefits is to help maintain the immune system and ensure that it is working correctly. A deficiency in Vitamin D could therefore increase the risk of developing rheumatoid arthritis as your immune system is more susceptible to attack. Type 2 Diabetes Vitamin D lowers the risk of type 2 diabetes. Not getting enough sunlight can reduce the secretion of insulin from the pancreas, which can create resistance to insulin and affect how the body responds to glucose. Sufficient vitamin D can help lower levels of cortisol. This is a stress hormone produced in the adrenal glands. Cortisol assists in the body’s response to stress. Prolonged high levels of cortisol can lead to increased abdominal fat. This is linked to several health conditions including diabetes type 2. Blood Pressure Vitamin D can help lower blood pressure. a large genetic study that involved more than 150,000 people revealed that low levels of Vitamin D can cause hypertension. In this study, those who had the highest levels of Vitamin D had lower blood pressure. It was found that a 10% increase in Vitamin D led to a 10 % reduction in high blood pressure. Heart Disease Vitamin D might reduce the risk of heart disease. Several studies have indicated that a deficiency in Vitamin D is a risk factor for developing high blood pressure, heart disease, congestive heart failure, peripheral arterial disease, strokes, and heart attack. What causes vitamin D to drop other than sunshine? Vitamin D deficiency as mention is most commonly caused by a lack of exposure to sunlight. However some medical disorders can also cause Vitamin D deficiency. The most common causes after sunlight is a poor diet, medications and certain disorders. Cystic fibrosis, Crohn’s disease and Coeliac disease are conditions that can prevent your intestines from adequately absorbing enough vitamin D through diet and even supplements, especially if
Pistachio nut- interesting facts
Pistachio nut day is on 26th February 2022 We love pistachio nuts here at 121 Dietitian. So when we spotted there was a special world pistachio nut day we felt we had to give them a big shout out! Pistachios are good for you! Pistachio nut facts: • Pistachio are nuts native to Western Asia and Asia Minor, archaeology suggests that pistachios were eaten as a common food as early as 6750 BC. Wow!• They are one of the more expensive of the nuts out there because of the trees on which they grow. It only reaches production 15-20 years after being planted. Isn’t that crazy!• Pistachio trees can only produce about 22kg of nuts each year. Furthermore, pistachios are sorted by hand and not by machine.• Pistachio trees can only grow in cool winters and hot summers, meaning that there’s only a few locations in the world where the trees can grow.• Iran is the biggest producer of pistachio nuts ahead of USA and then Turkey. How to eat Pistachio nuts: When eating pistachios from the shell, split the shell and eat the small kernel inside. The kernel may have a thin skin on it that do eat this for upping polyphenols. If you find a nut in a shell that doesn’t pry apart easily, simply use a nutcracker to open it up. As a snack. Eating pistachios raw or roasted. Both in-shell and shelled pistachios are available in grocery stores. Over salads. Shelled pistachios (either whole or chopped) are often sprinkled over salads. Pistachios can also be puréed and mixed with oil and herbs to make a creamy salad dressing. Ground into sauces. Ground pistachios are popular as a base for sauces and dips, like pistachio-yogurt sauce. Added to bread dough. Ground pistachios can be added to bread dough to give it a thicker texture with extra protein. In desserts. Chopped pistachios are commonly mixed into or sprinkled atop desserts like ice cream, cake, truffles, and pastries. Pistachio nuts are also a common ingredient in dishes from an array of cultures: • In Turkish dishes. Pistachios are most well-known in Turkish recipes for being minced and layered in the traditional baklava.• In Italian dishes. Pistachios are a common addition to Italian pastas, either chopped and mixed in to the noodles or ground and made into a spiced pistachio sauce.• In Indian dishes. Indian food makes ample use of pistachios, and they’re a staple ingredient in many Indian rice puddings, pilafs, cookies, and a spiced pistachio fudge called pista barfi.• In Iranian dishes. Pistachios are a common ingredient mixed into Iranian chicken and rice dishes, and also served as a traditional Persian snack, roasted with lemon juice and saffron and tossed with sea salt. What are the health benefits of Pistachio nuts? – Nutrition Pistachios are high in fibre: Eating pistachios can improve your gut health if you have no ongoing dysbiosis issues. Rich fibre foods help move food through the gut and prevent constipation and may help reduce the risk of colon cancer. Pistachios are high in antioxidants: Pistachios are known to contain antioxidants that have strong cancer-fighting properties and cardiovascular disease prevention. Furthermore, pistachios also contain lutein and zeaxanthin, two carotenoids that will help you maintain eye health and overall immunity. Pistachios are great for vegans and vegetarians: With protein accounting for almost 21% of the total weight of the nut, pistachios contribute almost 6% to a person’s daily protein needs. For plant-based diets, pistachios provide that much-needed protein. Relative to other tree nuts, pistachios have a lower amount of fat and calories but higher amounts of potassium, vitamin K, γ-tocopherol, and certain phytochemicals such as carotenoids, and phytosterols. A handful of pistachios (45) contain 156 calories, 3 grams of fibre, and are one of the most vitamin B6-rich foods around. Do you enjoy eating pistachio’s? They are so tasty if you haven’t tried them. Don’t continue to miss out, try them as part of a bigger plan to increase variety in your diet. If you are unsure of how to change your eating habits, or need help optimising the foods you eat please do contact us. We would love to help you or your family and friends with any nutrition related queries big or small. In the meantime do please check out our 121Dietitian Shop If you have enjoyed this blog we would love you to share this with your family and friends on your social media channels. Why not visit our YouTube Channel for more on keeping your health optimal. How can a Dietitian help Book a consultation via our Online Portal About Gillian Killiner Check out our tailored dietary programmes Gillian x [instagram-feed]
Hashimotos and me -the best ever! Part 4…
I was reflecting on my Hashimotos hypothyroidism this morning and realized wow, what a year 2019 has been. My best health year for the past 10! Clinical work has grown and has become immensely intense with more and more patients attending with multiple and complex issues. With my good health these challenges are no longer draining and so I continue to train in new services and collaborate with excellent health professionals and institutions to offer my expertise. My niche is certainly assisting people who have nutritional issues that may also affect their health negatively in ways they did not realise: Eating disorders, mental health and well-being, resistant weight, metabolic syndrome, gut health, fatigue, auto-immune conditions, hormonal issues, fertility, allergies, nutrigenomics, optimization of the workplace….. I personally continue to follow my health programme to ensure that I remain optimised to keeps me tip-top. In addition I run with a running club and have completed several cross-country races and love Park run when I can ever get to it. (kids activities seem to dictate!) Chronic Illness Chronic illness is, I believe, like a jigsaw puzzle. Illness is complex and often can’t be completed/fixed in one go. In relation to chronic ill health, it can take several years for some people to manage this jigsaw – often following unscientific or expensive paths in desperation. The illness is often still there but the medications assists in just getting through the day. This way of living masks the underlying problems. Fixing the cause is King, and working with the body through its ups and downs is the only way out. At 121 Dietitian, availing of a full assessment allows a a complete evaluation of you diet, lifestyle, sleep, inflammation, blood results. A bespoke detailed written programme is then provided – and a follow up to check how all is progressing. Positive results can be achieved in a few weeks. Fantastic for the client and the reason I love to go to work. I look forward to every day and hope that I can help you too feel the same. If you are unsure of how to change your eating habits, or need help optimising the foods you eat please do contact us. We would love to help you or your family and friends with any nutrition related queries big or small. In the meantime do please check out our 121Dietitian Shop If you have enjoyed this blog we would love you to share this with your family and friends on your social media channels. Why not visit our YouTube Channel for more on keeping your health optimal. How can a Dietitian help Book a consultation via our Online Portal About Gillian Killiner Check out our tailored dietary programmes Gillian x [instagram-feed]