March 2018 NEWSLETTER
DON'T miss our 2018 open Days. Click here for more information
P.3: BCNH Open Days
P.4: IBS - What Lies Beneath? By Melissa Marston
P.7: Food in Season - Watercress
P.8: IBS Quiz
P.9: Q&A with BCNH lecturer Virginia Blake
P.11: Science Update with Ben Brown
P.12: Considering a Career Change?
P.12: Meet BCNH graduate Kirsty Cullen
P.15: BCNH Courses
P.16: Quiz answers and references
Welcome to the Spring newsletter. April is Irritable Bowel Syndrome (IBS) Awareness Month so this issue will be focusing on the causes, symptoms and management of the digestive disorder and BCNH graduate Melissa Marston will be talking about her experiences in clinic.
You can also expect some delicious recipes using watercress, which will be at its best from next month, as well as, two insightful Q&As from one of our lecturers and graduates.
This is unfortunately my final newsletter as editor as I will be focusing on the new and exciting journey of being a mum for the first time! The new editor will be revealed in the June edition. I do, however, wish you all the best with your studies and careers and I hope you have a wonderful Easter.
We hope you enjoyed the latest edition of the BCNH newsletter. We would love to hear your comments, suggestion and questions, which we aim to incorporate in future editions.
Simply get in touch: email@example.com
We look forward to hearing from you all!
Breda & Joanne
The best way to get a feel for what BCNH is all about is to come and visit us on our Open Days. This will give you the chance to find out more about the academic and clinical work you will experience at BCNH, in addition to the career options that will be open to you as a graduate of our college.
At the Open Days you will have the opportunity to learn more about the courses we offer, experience the UCL campus and facilities (where BCNH lectures and seminars take place) and also ask questions of staff members
2018 OPEN DAY / OPEN EVENINGS DATES
Saturday 12th May: 10am-1pm
Tuesday 12th June: 10am-12pm
Saturday 7th July: 10am-1pm
How to register your interest in attending the Open Days?
You can now register for all our events via our Eventbrite page.
Please note that places are on a first come, first served basis.
If you cannot attend the Open Days, you can always book an interview / friendly chat with a member of our team via Skype or in person at our offices in NW3.
FEATURE: IBS - What Lies beneath?
By Melissa Marston, Registered Nutritional Therapist
BSc (Hons), Dip BCNH, mBANT, CNHC
Melissa grew up in South Africa and moved to the UK in 2001, living and working in the legal profession in London for many years. Having always had an interest in nutrition, Melissa embarked on a BSc (Hons) degree in Nutritional Therapy with BCNH and the University of Greenwich, graduating 6 years (and 2 children) later with a first class honours qualification.
Melissa’s interest in gut health began soon after she started practicing as she quickly realised that the root cause of many diseases could be traced back to the gut. Melissa has helped people with a range of health issues including auto-immune conditions, rosacea, psoriasis, IBS and acid reflux, to name a few. Melissa approaches each new case with care and enthusiasm and never ceases to be amazed by how life-changing the right nutritional intervention can be for her patients. She is delighted to be part of the IBS Clinics team (www.ibsclinics.co.uk), where her interest and knowledge in gut health continues to grow.
Irritable Bowel Syndrome (IBS) is a common, but often debilitating condition, that affects the digestive tract. Symptoms can range from mild to severe and include; gas, bloating, stomach cramps, constipation and/or diarrhoea. In severe cases, people find that they are unable to go about their daily lives, impacting on their social lives, relationships and careers. But, what causes IBS, and how do we get to the root cause? The truth is that every client will be slightly different. But, this is how I approached one of my IBS cases:
Medical history and symptoms
My client is a male in his early 30s. He is the CEO of his own software company and travels a lot. He is also obese at 22 stone. He had been suffering with digestive issues since he was a teenager, but his symptoms became worse after a bout of food poisoning in his early twenties. He consulted with his doctor, but after the usual medical tests showed no abnormalities, he was diagnosed with IBS 6 years ago. When he came to see me, his symptoms included chronic diarrhoea (for which he had been taking 4 Imodium tablets per day for years) severe bloating and painful cramps. He also described feeling tired and often getting achy joints for no apparent reason. His diet was high in saturated fat, processed meats and carbohydrates, and low in vegetables and fibre.
Based on the client’s symptoms and his history, I suspected that he may have small intestinal bacterial overgrowth (SIBO). SIBO is a term used to describe an overgrowth of bacteria in the small intestine (SI), an organ of the digestive tract that should have low bacterial counts. SIBO is commonly caused when the normal action of the migrating motor complex (MMC) is inhibited. The MMC is a cleansing wave that occurs in the SI every 90 minutes during the fasted state, pushing bacteria and undigested food out of the small intestine and into the large intestine. When the MMC fails, SIBO can result. The action of the MMC can be hindered by obesity due to pressure on the SI that can affect motility, but can also be auto immune, triggered by food poisoning. Auto immune SIBO is caused when the immune system creates antibodies to the toxins produced by common food poisoning bugs (like Campylobacter and Salmonella) which mistakenly target special ICC (pacemaker) cells in the SI which help to generate the MMC. As the client reported 2 distinct waves of bloating following meals I recommended a GI MAP stool test as well as a Hydrogen breath test (lactulose) for SIBO.
The results of the SIBO breath test showed high levels of both hydrogen and methane gases, confirming the presence of SIBO. The stool test revealed that the client had a Clostridium difficile infection, salmonella, numerous opportunistic bacteria, a parasite and whipworm. Unsurprisingly, he had elevated sIgA and raised calprotectin.
As there were many types of microbial overgrowths, I thought it important to support his immune defences in the first instance, and so I recommended a 4-week immune supporting protocol before starting on an 8-week anti-microbial programme. I also gave him a liver support supplement throughout this phase of the programme to support detoxification. Alongside the supplements, he followed the SIBO bi-phasic diet, a very low carbohydrate diet aimed at starving out the bacteria colonising the gut. As the diet is also low carbohydrate it is likely to facilitate weight loss, thus taking pressure off the small intestine and improving MMC function. I also encouraged him to gently taper off the Imodium so that we could accurately monitor his symptoms throughout.
Compliance to both diet and supplement regime was good, and after completing the12-week programme the client repeated the SIBO breath test and the GI Map stool test.
the 12-week programme the client repeated the SIBO breath test and the GI Map stool test. The SIBO results showed no methane and a significant drop in hydrogen. The stool results showed that Clostridium difficile, salmonella, whipworm and the parasite were cleared, but there was still some dysbiosis to address. SIgA is now within range, but calprotectin was still slightly raised.
Symptomatically, the client had lost just over a stone in weight and his digestive symptoms had dramatically improved. Although his stools were still a bit loose, he was only having a bowel movement twice a day, (compared to 8 or more) and is bloating less frequently, with no more painful cramps. Going forward, the client will follow a slightly modified anti-microbial programme and continue on the diet for a further 8 weeks before testing again, but this is a remarkable turnaround from where he was at the beginning.
These results show that IBS can be permanently resolved with pertinent testing, diet and short-term supplementation, and the improvement is a person’s life can be profound!
IBS occurs in 10-20% of the population in the UK
It is more common in women than men
Peak prevalence is between the ages of 20 and 30
It is associated with increasing levels of psychiatric distress and poor coping strategies
Increasing physical activity can have a positive effect on symptoms
FOOD IN FOCUS - WATERCRESS
By David Lebovitz
Pink grapefruit and watercress salad
By the view from great island
This mineral-dense leafy green vegetable, which has a unique peppery flavour, can not only spice up a variety of dishes but may also have the ability to fight chronic diseases due to its mineral, vitamin and phytonutrient content including; calcium, omega-3, vitamins A and C, folic acid and phosphorus. Watercress has been associated with reduced risk of colon cancer and may help to reduce blood pressure, strengthen bones and teeth and support healthy skin. Furthermore, watercress may also be beneficial for IBS sufferers due to its high fibre content, which stimulates digestion. So, next time you're at the supermarket stock up on this cruciferous vegetable and reap the benefits!
Salmon and watercress tart
By Nigel Slater
Aloe vera juice may help with IBS, potentially due to its anti-inflammatory properties
There is a genetic component to IBS.
IBS sufferers with lactose intolerance (due to lactase deficiency) will experience which of the following within 30 minutes - 2 hours following lactose ingestion?
a) Abdominal cramps
Click here for answers
Which of the following fruits are traditionally used as a digestive aid in many tropical countries?
Excessive consumption of fermentable carbohydrates, or FODMAPs, is particularly implicated in IBS.
In cases of IBS, there is no evidence of any structural abnormality / defect to the gut.
Which of the following symptoms suggest you could be suffering from IBS?
a) Alternating constipation and diarrhoea
b) Severe diarrhoea and dehydration
c) Severe constipation and bloating
d) Abdominal pain / discomfort
e) Flatulence and nausea
Many individuals suffering from IBS report that symptoms are triggered by foods such as:
a) Apples and pears
b) Spicy foods
d) Pork products
Which of the following aid digestion and may therefore benefit IBS sufferers?
d) Fennel seeds
1. What or who inspired you to study nutrition?
Like a lot of people who go on to study nutritional therapy, my health wasn’t great and changing my diet was the one thing that worked. I had been unwell with a mystery illness for a number of years, changing my diet relieved most of my symptoms. Years later I was diagnosed with Hashimoto’s and continue to support my health with food.
2. Have you always been interested in food, health and wellbeing?
No, I wasn’t at all interested in health until I didn’t have it any more.
3. What does a typical day usually look like for you?
I don’t really have typical days as my work is very varied. I teach, lecture and work in my own clinic. Today, I am preparing for a full day lecture in a few days time. I am researching, writing and working on the presentation. Tomorrow, I will be planning and researching for next year’s curriculum. Later this week, I will be in clinic, working one to one with clients with a variety of health complaints.
4. What is your area of expertise and why did you decide to specialise in this?
I haven’t specialised but, I do have areas of interest. I work with children on a wide variety of childhood illnesses and complaints. I enjoy this work as most children respond quickly to interventions and even when unwell are good fun to work with. I have done a significant amount of research on obesity – I work with another practitioner on delivering group intervention programmes for weight management. I am also interested in autoimmunity and a large proportion of my clients have autoimmune diseases.
BCNH lecturer Virginia Blake, BSc (Hons), DipBCNH, mBANT, CNHC, talks about the day-to-day diversity of being a nutritional therapist...
Since graduating from BCNH, Virginia works as a lecturer in nutrition and is a specialist in childhood obesity. She lectures on undergraduate and post-graduate qualifications in both nutrition and health and social care. She has developed and delivered award winning obesity intervention and prevention projects in community settings funded by the NHS. Virginia also runs a busy private nutrition practice and is currently completing an MSc in Nutritional Medicine at the University of Surrey.
For more information about Virginia's clinic visit: http://dulwichtherapyrooms.co.uk/prescripitive-team/4522969792
Publications to date: Blake V Patel K (2015) Treatment of adolescent obesity British Journal of Obesity 1: 142-7
QUESTION TIME WITH VIrginia Blake, Bcnh lecturer
"Question everything, even your lecturers."
group intervention programmes for weight management. I am also interested in autoimmunity and a large proportion of my clients have autoimmune diseases.
5. What is the biggest challenge you have faced in your career to date?
The main challenge I have faced is getting used to public speaking. The first time was in front of a group of mums and under 5s in a children’s centre in Lewisham and I really struggled with nerves. Since then I have gone on to present at lectures, funding events and conferences at the NEC, Birmingham.
6. What is your favourite lecture to present to BCNH students and why?
I deliver three lectures at BCNH – one on children, one on obesity and one on skin health. My favourite is the children’s lecture. It is such an interesting and varied topic and the stories from practice are some of the best.
7. What would your one piece of advice be for budding nutrition students?
Think and study critically. The evidence base in nutrition is emerging (i.e. weak). There are huge challenges with designing effective research studies on food and nutrition. Most of the evidence we have is epidemiological or from very small intervention studies (not all particularly well designed). It is up to us to translate this for our clients and students. Question everything, even your lecturers.
What our GRADUATES say about BCNH
A special type of digestive enzyme supplement could help people with irritable bowel syndrome (IBS) tolerate prebiotic fiber rich foods, suggests a new clinical study.
Previous studies have found that digestive enzyme supplements work well to relieve symptoms of IBS including bloating, pain and diarrhoea. Because digestive enzymes help with the breakdown of food they may also more specifically help people whose digestive symptoms are due to a food intolerance.
Some people with symptoms of IBS do poorly on gas-producing foods, like beans, legumes and onions. For several years, a digestive enzyme called alpha-galactosidase (α–galactosidase) has been used for the relief of gas from such foods, but never tested in people with IBS to see if it could help them tolerate these foods better.
In a new clinical study, giving people with IBS who were also sensitive to foods high in prebiotic galacto-oligosaccharides (GOS) a dose of α-galactosidase (300 GALU/ per dose) with each meal was an effective way to improve tolerance to high-GOS foods.
“This study is the first to show symptom improvement in IBS with the use of an oral α-galactosidase in a subgroup of patients with GOS-sensitivity,” commented the authors. “This new therapy will encourage the re-introduction of high GOS foods and may also assist to relax the level of dietary restriction necessary for patients to maintain symptom control.”
Importantly, people were asked to take one capsule (150 GALU) immediately prior to the meal, and one capsule (another 150 GALU) half-way through the meal, which the study investigators believe is important for success as it increases exposure of the food to the enzyme. *Click here for reference
*Click here for article references.
Dip BCNH BSc(Hons)
Enzymes relieve digestive symptoms
By Benjamin Brown, ND - Naturopath, BCNH Lecturer, Science Writer and Speaker
1.What did you do before you decided to study Nutritional Therapy with BCNH?
I worked as a Senior Manager for a large recruitment firm, specialising in recruiting executive level finance staff. I have to admit that years of interviewing candidates really helped me to fine-tune my questioning skills- which became very handy for nutrition consultations.
2.Why did you choose to study Nutritional Therapy?
Following the birth of my second daughter, it became clear very quickly that she had some health issues. As a small baby she was covered in eczema and would often regurgitate both milk and food. I felt very uncomfortable when the doctor offered us steroid cream to treat the eczema and so I began researching how nutrition approaches might help her. The simple changes that I subsequently made to her diet resulted in amazingly positive results. It was at this point I realised how powerful nutrition could be and I immediately started researching courses, with a view to retraining.
Kirsty Cullen graduated from BCNH in 2014 with a Diploma in Nutritional Therapy - awarded with Distinction. She established Crosemere Nutrition Clinic in Shropshire after graduating and from there has worked with a number of organisations, offering consultancy based Nutritional Therapy services. She currently works for The Optimum Health Clinic in London, alongside running her Shropshire based clinic. You can contact Kirsty via firstname.lastname@example.org.
MEET BCNH GRADUATE kirsty cullen
Interested in our Science Foundation Course?
If you wish to study Nutritional Therapy with BCNH and do not have an A-level (or equivalent) in Biology or Chemistry, you will be required to complete a Science Foundation Course (SFC) first. The tailor-made course covers a range of topics from cell structure and respiration to free radicals and amino acids , which will equip you with a basic science background to follow the modules on the Diploma or BSc (Hons) Nutritional Therapy programmes.
Want to start a Diploma or BSc (Hons) in Nutritional Therapy in September?
There is still time to complete the SFC now!
Contact us at
email@example.com to find out more
CONSIDERING A CAREER CHANGE?
3.Tell us a little about your career since graduating from BCNH...
After I graduated I set up my own nutrition business Crosemere Nutrition Clinic just near Shrewsbury. Since starting the business I have been lucky enough to have some fantastic career opportunities. My work to date has included working as an NT at St George’s Park National Football Centre, as part of a Spire Healthcare scheme that assessed and advised football managers and elite athletes on health and nutrition. This work culminated in an invitation to present to The League Managers Association executives, to report my findings on the health and nutrition trends of football managers in their organisation. I also provided nutrition advice to Universal Pictures, as part of the production process on a health and fitness DVD.
I then worked as lead NT at Derby County Football Club. This role involved; establishing an umbrella nutrition strategy for the club, including liaison with the on-site chef and restaurant team; one-to-one nutrition advice to the first team players, including match day nutrition and training support; the provision of nutrition advice and education to all academy players - aged 8 upwards; holding presentation evenings for parents and carers to advise on how to feed young and aspiring football players.I have also worked within the corporate wellness sector, presenting to companies on areas such as female health. My principal role continues to be working as a member of the Nutrition Team at The Optimum Health Clinic (OHC)– one of the world leading integrative clinics, specialising in Chronic Fatigue Syndrome (CFS), Myalgic Encephalomyelitis (ME) and Fibromyalgia. I have worked for OHC since I graduated from BCNH in 2014 and prior to this I worked as part of their Nutrition Support Team. My work for OHC represents the greatest portion of my clinic week.
4. Do you have any exciting career plans for the future you can share with us?
The OHC has a long-term vision of making our integrative medicine protocols for ME/CFS available to all. With this in mind OHC published a preliminary study in the BMJ in 2012, which showed promising results. From here we have embarked on the process completing a randomized controlled trial with the University of Surrey. I am very excited to be involved in this project as one of the operational NTs in the study. It is fascinating to experience at close quarters the challenges involved in trial design, ethics application and approval – which is the stage that we are at currently. Having read hundreds of research papers and analysed study design, I can honestly say I had no real concept of how challenging and expensive it can be to see a piece of research through from conception to realisation. As we work through the ethics phase, we are all busy fundraising for the project at the clinic. In fact my husband and I are putting our trainers on and running a 10k next month to offer our support – any donations are much appreciated.
5. Did your BCNH training prepare you well for working in this field?
The training at BCNH was very comprehensive. The reason that I chose the BCNH course over other colleges, was that I was impressed with how academic it was. In addition to this, I felt that because the final year of the course was focused on clinical application it would equip graduates to launch into their nutrition career at full pace. I can certainly say that the BCNH course allowed me to achieve this. The academic nature of the course has enabled me to liaise regularly with medical professionals, discussing cases with well-informed confidence. The practical elements of the course meant that I was ‘consultation ready’ as soon as I qualified - which played a huge role in my ability to secure work immediately post-graduation.
6. Are there any particular client success stories that stand out for you? Can you tell us a little about them?
CFS/ME is a complex multi-system condition and, therefore, my work with clients can often span many months and sometimes longer. Working in this specialist area requires a lot of tenacity and often clients arrive at their initial consultation having been ill for many years and, doubting their own ability to be well again. Many of my clients are bed-bound or house-bound. One particular client I worked with had become seriously ill with CFS initially in 2000. She had to leave her job and return to her parents' home, where her Mother provided 24-hour care for an initial period of 18 months. We began working together in 2015. At this point she was housebound and her fatigue was still severe. Her main reported symptoms were fatigue, depression, widespread musculoskeletal pain and insomnia. She also presented a range of other symptoms including; food intolerances, digestive issues and anxiety. We embarked on a complex nutrition journey together, complemented at every step by work with my colleague in our psychology team at OHC. The process was slow and steady, as we worked to unpick the jigsaw puzzle of factors that had contributed to her CFS diagnosis. At times, her progression and improvement was not always linear – but each time we hit a bump in the road we reviewed the clinical clues, tested, assessed and applied new principles. As the pieces of the jigsaw came together, her progress became more stable and sustained. Then gradually throughout the course of last year she reported starting to feel ‘normal’ again. In January of this year, I received an email to tell me that she had secured her dream job. I was so delighted for her. Emails like this remind me why I love my job and how important clinical perseverance is.
7.Have you got any tips or words of wisdom for current students?
Know your mechanisms - I can hear Breda cheering in my mind! This knowledge grounds your daily Nutritional Therapy practice. When I was studying with BCNH, they encouraged us to create a mechanisms database - which detailed functional system specific mechanisms and the supporting research source. I have expanded upon this continuously since I graduated and still use it in clinical practice today.
1. a), d), e)
2. a) True
The main problem appears to be dysregulation concerning the functioning of the gut (altered bowel motility).
3. a), d)
IBS tends to run in families.
5. a), b), e), f)
Sensitivity to food in IBS is an individual factor. What one may be sensitive to, may not be the case in another.
FODMAPs are fermentable oligo-, di-, monosaccharides and polyols, which in the large-intestine lumen provides a substrate for bacterial fermentation, with consequent gas production, abdominal distension and abdominal pain or discomfort.
The papaya preparation (Caricol®) contributes to the maintenance of digestive tract physiology and it ameliorates various functional disturbances, like symptoms of IBS.
Some studies suggest that aloe vera juice is thought to be useful for treating some of the symptoms associated with IBS, such as constipation and diarrhoea due to its anti-inflammatory properties. IBS is considered low-grade inflammation of the gut.
9. a), b), d)
Tuck CJ, Taylor KM, Gibson PR, et al.Increasing Symptoms in Irritable Bowel Symptoms With Ingestion of Galacto-Oligosaccharides Are Mitigated by α-Galactosidase Treatment. Am J Gastroenterol. 2017 Aug 15. doi: 10.1038/ajg.2017.245.