Walking a mile in the patients’ shoes –going dairy free

 

“You never really know a man until you understand things from his point of view, until you climb into his skin and walk around in it.”

Harper Lee To Kill a Mockingbird (1960)

 

 

For the first three months of my son Noah’s life he cried pretty much non-stop. Well-meaning relatives and friends assured me that this was just ‘colic’ (a catch-all term for ‘my baby won’t stop crying and no one knows why’) and that it would get better with time. In my sleep deprived and frankly utterly exhausted ‘new mom state’ I failed to make the connection with Noah’s other symptoms – a red bumpy rash on his face, sickness and positing after feeds, green diarrhoea and a severe aversion to being laid on his back. After multiple teary visits to various GP’s, one eventually took us seriously and referred us to a paediatrician. We were given a diagnosis of gastro osophogeal reflux (GOR) and advised that in approximately 40% of cases this is due to cows’ milk protein intolerance (CMPI).  We learned that in some cases, babies are so sensitive that the protein travels through the breast-milk which seemed to be the case with Noah.  I removed dairy from my diet and after two weeks we had a completely different baby, the transformation was miraculous!

 

Going dairy free

Just one problem then, I really wanted to continue breastfeeding which would mean the ongoing removal of dairy from my diet. Given my previous experience as a community dietitian, I knew the basics – which foods to avoid, what to look for on food labels, non-dairy sources of calcium and vitamin D and how to deal with eating out. I remember feeling pretty blasé about it actually. But, how wrong I was.

 

For a start, all of my favourite foods were out. Cheese, cream cake, chocolate – NO! So many foods were now off limits that I started to feel a bit sorry for myself. It dawned on me that my relationship with foods was much more complex than I had known. These foods were my comforts: when I was tired, stressed or down I craved them. Eating out became a minefield.  What was the point of going to our local Italian restaurant when I would just be pining so much for the carbonara?  I really hated making the fuss of having to ask for food to be prepared in a certain way.  Every time I asked for a sandwich without any spread on it I felt a bit like I was putting the staff out (very British of me I know).  Shopping took forever.  We had to plan meals much more carefully and really think in detail about everything that we cooked.  The social impact was hard too, I felt left out at social occasions when I couldn’t join in and have a piece of cake at my mother-in-law’s house. I’d listened to patients telling me about these problems previously, so perhaps I hadn’t always been as empathetic as I had thought or maybe you just really need to experience something to know what it’s actually like.

 

Very quickly, things did start to get a lot easier. I learnt the dairy free essentials and found that they weren’t as bad as I thought, for example, almond milk in tea and vitalite on toast were indispensable. I discovered through trial and error the dairy free products that were terrible and needed to be avoided at all costs and the ones that made life bearable again. I learnt to adapt my normal recipes and researched new places to eat out. I was touched by how kind and accommodating people could be. The friend that popped round one day just to drop off some bourbon biscuits as she had noticed they were dairy free and the friend who made me some dairy free donuts (oh the joy!). There is also nothing quite like discovering something that you didn’t think you could eat, is actually ok. I almost hugged the lady standing next to me in M&S when I discovered I could eat the raspberry iced buns.  Of course, the biggest motivator was knowing that if a small amount of dairy passed my lips my precious baby would be ill, there was no question of slipping. Very gradually this way of eating became the new normal, I established a different dietary pattern and now after a year I hardly give it a second thought.

 

Restricted diets as a learning opportunity

On reflection, I can see the positive in quite a difficult year.  My practice as a dietitian will be affected dramatically with my deeper understanding of following a restricted diet.  Hopefully for me and Noah this is just a temporary measure as most babies grow out of CMPI by three-year-old but I have so much admiration and respect for those who follow a restricted diet long-term and for those for whom the restriction is more extreme. I was surprised at how it felt to be in the patient’s shoes and how the attitude and treatment by health professionals in my exhausted, vulnerable state was sometimes quite difficult to deal with. There are obvious training needs around the issue of infant reflux and CMPI in general practice and health visiting services.

 

As dietitians, this is our bread and butter, this is what we do. Of course, these are the issues of following a restricted diet; we all try our best to be empathetic. But, after this experience, I sincerely call for following a restricted diet to be something that all dietitians (if they haven’t already) should try. In fact, wouldn’t it be great if it was part of student training? That way, students could come back and swap ideas of recipes they had tried, places they had eaten and the best alternative products. We could build up fantastic real life tried and tested resources for educating and sharing with patients. Perhaps this is already the done thing with student training but I hope that this article will strike a chord with any dietetic educators who might want to challenge our dietetic students to a short walk in the patient’s shoes.

 

 

 

 

 

 

 

 

 

 

 

 

Move over Mediterranean diet, is it time to eat like a Scandinavian?

The health benefits of the traditional Mediterranean diet (high in fruit and vegetables, oily fish and with healthy fats such as olive oil) are well established in the public conscious.  Ever since a meta-analysis (a study compiling and analysing results from a number of other studies) found evidence that it was associated with better health (1),  the Mediterranean diet has been the focus of attention and health advice.

But now a new dietary pattern is creating a buzz in the nutrition community – the Nordic diet.  The traditional Nordic diet is low in processed meats and high in wholegrain (oatmeal, barley and dark rye bread), root vegetables and cruciferous vegetables (e.g. cabbage) oily fish (such as herring and salmon), rapeseed and wild Nordic berries (i.e. the evocatively named cloudberry, bilberry and loganberry). It’s important to note that research is focusing on the traditional Nordic diet as ironically the modern Nordic diet is actually considered to be linked with poorer health, featuring high fat dairy products, red meat and low in vegetables.  Basically, we are talking herring and rye bread rather than the meatballs you get at Ikea (although they do have their own merits!).

Cloudberries – who knew?

 

Recent studies suggest that the traditional Nordic diet might be beneficial for health in terms of longevity (2).  There are other advantages to the Nordic diet pattern too for Northern Europe in terms of cost and sustainability.  The Mediterranean diet pattern might be easy to follow whilst you’re on holiday in Greece but on a rainy day in Leeds….not so much.  Back home in Northern Europe, the non-native foods of the Southern European Mediterranean diet can be perceived as exotic and often costly.  No wonder then in research studies those asked to commit to a Mediterranean diet often cannot last the duration of the study.  The bottom line is that despite the potential health benefits, very few people are able to stick to a Mediterranean diet outside of Southern Europe.  There is also the issue of air miles and carbon footprint involved in transporting non native foods and the issue of overall sustainability of food supply for the future.

 

Could the Nordic diet catch the British public’s imagination?

In terms of public health, I’m not sure initially how acceptable the idea of the Nordic diet would be.  I’d never even heard of a cloudberry before and I can’t remember the last time I ate rye bread.  In general we have a limited fish culture in the UK, ironic really given that we are an island nation.  On the surface, the Nordic diet appears to be a very different way of eating to what we are used to but actually it might be easier to adapt and put into practice than at first glance given our more similar climates.   We do have lots of wild species of berry in this country and foraging seems to be quite en vogue at the moment.  We also have a tradition of consuming root vegetables and rapeseed is grown throughout the country.   If the popularity and reputation of the Danish restaurant ‘Noma’ is anything to go by then the traditional Nordic diet might become a more palatable health recommendation than the Mediterranean diet.

 

So is it time to don your best Sarah Lund woolly jumper, strap on your cross country snow shoes and go and forage for some berries?  Of course, there isn’t enough evidence yet to fully recommend this pattern of eating.  However, it’s likely that we will be (warning – you are about to hear a fish based pun) herring more about the Nordic diet in the future and I for one would quite like to try some cloudberries.

Time to don your best Sarah Lund jumper?

1)     Sofi FCesari FAbbate RGensini GFCasini A.  Adherence to a Mediterranean diet and health status: Meta-analysis. BMJ. 2008; 337:a1344

2)      Olsen A, Egeberg R, Halkjaer J, Christensen J, Overvad K, Tjonneland A. Healthy aspects of the Nordic diet are related to lower total mortality. J Nutr. 2011;141(4):639–44