Interview with Sophie Medlin from CityDietitians

Sophie Medlin is a Consultant Dietitian and Director of CityDietitians. She specialises in helping people with colorectal disorders and surgery. I interviewed her about the amazing things she’s doing on social media and pick her brain on how to help those with a gut condition and/or surgery. 

Tell me a bit about your job

I worked in the NHS specialising in gastrointestinal surgery and colorectal disorders for around 8 years before working as a lecturer and researcher at King’s College London. I now run my business CityDietitians where I see primarily IBD and stoma patients in my virtual clinic, do consultancy work for businesses and provide evidence based nutrition information to the media. 

Why is diet important to someone with a gut condition or a stoma? 

When someone has a stoma or any bowel condition, there is a tendency to prioritise giving advice that will manage the symptoms, over advice that will support good long-term health. For example, many people with a stoma are told not to worry about eating fruit and vegetables if they cause problems with their stoma. The issue with this is, fruit and vegetables or other high fibre foods like whole grains and nuts, are really important to maintain good long-term health and prevent things like diabetes and cancers. They also help our bodies to cope and control the effects of inflammation. So often, the nutritional advice given to patients with gut conditions and stomas, might help their symptoms but not always their overall health. 

With IBD what’s the most important thing someone can do with their diet? 

Patients with IBD are at higher risk of nutritional deficiencies. Iron, vitamin B12 and calcium deficiencies are common. They can lead to lethargy, mood nervous system problems and osteoporosis.

We also know that food related quality of life – measuring enjoyment we get from food – is much lower for IBD patients. For these reasons, the most important things people with IBD can do is: Try to eat a healthy balanced diet, avoid cutting out food groups like meat, dairy or carbs and be conscious of their relationship with food by avoiding anything that is restrictive. Unless it is necessary for medical reasons

How can diet help someone with a gut condition? 

Because everyone’s bowel condition and every person is really different, it’s impossible to give good quality generalised advice. The key is that your diet should help you to manage your symptoms (which may be different at different over the years) and provide all the nutrients you need for good health in the short and long term. If you think that your overall health might be compromised by the diet you follow, it’s a good idea to get some help from a registered dietitian. 

How does the removal of the large intestine and forming of a stoma change how we absorb foods/nutrients/vitamins?

If you have an ileostomy and therefore have had your colon removed, there are a few things to look out for:

You are at higher risk of vitamin B12 deficiency, so if you start to feel tired or get pins and needles or feel low in mood, ask your doctor for a blood test. 

You need to make sure you know how to manage your hydration if you have a high output or if the weather is hot. Your colon absorbs salt and water and without it, you can become dehydrated and depleted of salts, which causes extreme tiredness. Make sure you use rehydration solutions rather than plain water if you feel thirsty or you have a high output. There is more information on this on the Ileostomy Association website

Be careful that your diet doesn’t become too restricted. Many people with an ileostomy eat whatever they like, but some struggle. If you’re worried that your diet isn’t giving you all the things you need for good long-term health, please speak to a registered dietitian. 

People with a stoma can sometimes put on weight which can lead to issues with hernias. Sometimes, healthcare professionals can tell you to lose weight without appreciating the challenges with this when you have a stoma and may not be able to eat some of the foods we consider to be healthier.

Sometimes having a stoma also affects self esteem which may lead to some emotional eating. If you have a stoma and you are struggling to manage your weight, ask to see a registered dietitian with knowledge of stomas. 

When someone first comes out of stoma surgery, what’s the most important thing they can do with their diet? 

Firstly, follow your surgeon’s advice! Second, know that things are going to be different for a while and that your output will settle to something more manageable. At first, your bowel is going to be very unhappy and your output might be unpredictable, but it will settle and your bowel will adapt so try not to be afraid. When you’ve got the all clear to do so, try reintroducing your normal diet bit by bit, chew all your food well and don’t eat too much of any high fibre foods until you’ve built up your confidence.

When someone is diagnosed with a condition that may effect their diet, how can you help? 

As a dietitian, I work with my patients by going through all the dietary factors that might have an impact on their condition and I give them individualised advice to manage their condition and support their long-term health. All IBD teams have dietitian attached so if you can’t afford to pay a dietitian privately, you can still access a dietitian though the NHS. 

It’s important to remember that nutritionists and nutritional therapists do not have medical nutrition training, so they haven’t worked alongside doctors and surgeons treating your condition. For this reason, please always choose a registered dietitian if you have a bowel condition that you see a doctor for. 

On instagram you’re doing so much work to myth bust and filter out the dangerous health/diet claims, can you tell me more about this? 

This comes from my work with IBD patients! I see the dangerous misinformation that is shared and I see vulnerable people being targeted by people without any nutrition qualifications and it makes me really angry. Nutrition is a complex science and our relationship with food and our bodies is precious. When someone says something that is untrue or causes harm, it puts people at risk. 

Myself and my colleague Hala have put together a petition to try and regulate nutrition information online. For more information on that, please follow this link: https://www.change.org/p/matt-hancock-regulate-health-information-on-social-media

A final bit of advice

Please remember that there is no one-size-fits-all answer to managing bowel conditions or stomas. Some of the research work I have done proves how different everyone is. If you would like dietary advice on your condition please ask your consultant to refer you to a dietitian in the NHS or contact me for an appointment via citydietitians.co.uk. Any tests you might need will be done through your GP so there are no additional costs or catches to working with a registered dietitian. 

Follow Sophie on Instagram, Facebook and connect with her on LinkedIn:

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