Dietitian Laura Tilt Answers Your Questions

Dietitian Laura Tilt Answers Your Questions

A few weeks ago, we asked you via Instagram and our Facebook community, if you had any questions for dietitian Laura Tilt, and the answer was a big yes. From tips on dealing with bloating after eating, to what to eat before working out, now’s your chance to get Laura’s expert answers.

1. “Are there any easy food swaps I could be making to my diet?” 

 2. “How much fibre should I be eating and what kind of foods have lots of fibre in them?” 

5 ways to 30g of fibre a day

3. “I’m eating more lentils/pulses which I want to but struggling with bloating. Will it ease in time?”  

Pulses (which include beans, peas and lentils) are high in various fibres which feed your gut microbes. The side effect of your microbes breaking down these fibres is gas production, which can result in sensations of bloating, although research shows there’s wide variation in how this is perceived between individuals. For example, you could eat the same meal as a friend, produce similar levels of gas and you might experience bloating but they may feel nothing! We know that people with IBS are more sensitive to the presence of gas in the gut than those without IBS.   

Rather than cut pulses out and miss out on all the beneficial nutrients they offer, try smaller portions - start with a tablespoon or two in a meal to begin with, try canned pulses and rinse well before serving (this reduces some of the ‘gassier’ components) or try soaking overnight then drain and rinse before cooking.   

Lastly, yes, evidence suggests bloating will ease with time - one study found that people who were asked to eat half a cup of beans daily felt that after an initial increase in gas (farts!) things returned to normal levels after a few weeks.

4. “I’m a runner and would appreciate suggestions about what to eat the night before race day, when I am racing away from home. Before gut issues kicked in, I would just head to the nearest Italian restaurant for spaghetti Bolognese but now find these often contain too much garlic/ onion for me.”  

Distance running (and travelling) when you have gut symptoms is challenging - I hear you. Eating a carbohydrate rich meal the night before race day is a smart move as it will top up your glycogen (fuel) stores, which can delay fatigue during the race. If you’re heading for an Italian restaurant, you could try a pizza topped with a tomato base (check no garlic), veggies and some cheese. Otherwise, rice dishes are a good bet - think sushi or steamed rice or noodles with protein / veggies on top. It also makes sense to pack some carbohydrate rich tummy friendly foods in case there aren’t suitable options available. I’d think along the lines of microwaveable steam rice packs (that you could then add your own topping to) oatcakes, bananas, oatmeal sachets or cereal packs.

5. “What three things do you recommend to patients who want to support their gut?” 

6. “At times I have to rush to the toilet after eating, how can I help?”  

There could be a few things going on here. Are there any patterns to this happening i.e. is it after a specific meal (like breakfast) or after eating a specific food/s? The action of eating a meal (particularly a large or high fat meal) triggers something known as the gastrocolic reflex, which is a strong muscular wave that moves food through the gut, particularly the colon which triggers the urge to poo. This reflex is heightened in some people, especially those with a sensitive gut.  

Drinking coffee can also be a trigger to poo urgently in some people, and anxiety can have a similar effect. A food and symptom diary may help you identify a pattern - as for what will help, it depends on the cause - e.g. splitting larger meals into smaller meals, limiting caffeine (if there’s a link) and changing up your routine / breathing exercises (if anxiety is the cause). Lastly, if this symptom is happening after most meals or is causing pain or distress, speak with your G.P.

7. “Can we have water while eating? If no, then why do we eat soups?” 

You absolutely can have water whilst eating. The idea that we shouldn’t (as far as I can work out) is a myth around water diluting stomach acid and digestive enzymes interfering with how well your body can absorb nutrients. But the truth is when we drink water it doesn’t really change the pH (acidity) of the stomach. Our digestive enzymes and stomach acid work just as well in its presence, and your stomach is a pro at producing as much acid as it needs to digest your food. So if you like drinking water whilst eating go ahead - and yes to soups too - they are great during winter and contribute to your daily fluid intake.

8. “Hi Laura, I was told that wheat was something I should avoid because I get terrible bloating. But I’ve always had terrible bloating. What’s your opinion on this? Are there other things I can try?" 

9. “Is it bad to have coffee in the morning? Boosts acidity?”  

In short no - but it might depend on whether you feel it is associated with any gut symptoms. A few studies have found that drinking a cup of coffee can trigger the urge to poop in some people. This is thought to be because coffee can stimulate colonic motor activity - i.e. movement in the large intestine, where poo is formed and stored.   

There’s limited evidence that the combination of compounds in coffee may stimulate acid secretion in the stomach, but studies looking into whether this leads to heartburn is mixed and poor quality. Some people with IBS identify coffee as a symptom trigger, but again we don’t have any high-quality studies looking at the impact of coffee and gut symptoms.  On the other hand, coffee is rich in plant compounds which may have a positive effect on gut microbes!  

So, if you like coffee and you don’t experience any side effects, go for it. Morning is probably the best time to drink coffee, as it does interfere with sleep latency (the time it takes to fall asleep) so can impact your sleep quality if consumed in the afternoon.

10. “My gut can’t tolerate onions, leeks and peas which can make life tricky! Any advice would be appreciated.”  

Onion, leeks and peas are rich in fermentable carbohydrates which can trigger gut symptoms in people with irritable bowel syndrome. Onions are particularly challenging to avoid as they are an ingredient in many dishes, so you’re not alone in finding this hard, I empathise! Here’s what I would suggest;   

First - try alternatives. Chives and spring onion tops (the green part) give an onion/leek-like flavour in recipes. You can also try a pinch of Asafoetida powder - it’s extracted from a herb in the celery family, comes as a yellow powder and smells potent (but don’t let this put you off!). Half a teaspoon can replace a medium onion in cooking.   

Second, check portions and tolerance. Smaller servings of fermentable foods are often well tolerated. For example, a tablespoon of peas or leek or a cup of leek leaves (the green part rather than the bulb) contain low levels of fermentable sugars. With onion, you may want to recheck your tolerance over time as it can change - try smaller amounts (like an eighth of an onion in a dish you know you can tolerate) and see how you go. Third, find great onion-free recipes - Emma Hatcher is brilliant for this, and BBC good food have a range of low fodmap recipes which will be onion free.

11. “Dairy, what’s the impact on my gut?”  

12. “Hi, I suffer from bloating in the afternoon. Any advice please?”  

If you’re experiencing persistent bloating, always speak with your G.P. as it can be a symptom of an underlying condition. If there’s no organic cause, bloating can often be eased through lifestyle and dietary changes.   

Bloating that builds up through the day but eases by the next morning is usually due to gas produced by the bacteria that live in our large intestine. They produce gas when they break down fibre (indigestible carbohydrates) in our diet. This is completely normal, and simply a side effect of gut bacteria doing their job, so some bloating may follow higher fibre meals (like those containing beans or chickpeas for example). Some people however have a more sensitive gut, which may amplify sensations of bloating, discomfort and pain.   

Take a look at what you are eating for breakfast and lunch and see if there are any links between certain foods and how bloated you feel. It may be that you are consuming lots of higher fibre or fermentable foods which are contributing to gas and bloating in the afternoon. Examples include wholegrain foods like wholewheat bread & cereals, pulses (beans, peas and lentils), and veggies like broccoli, garlic and onion - these foods are fab for our gut bacteria but sometimes smaller portions or eating them in rotation (rather than at the same time) can be helpful if you experience bloating.   

Avoid wearing tight clothes as these can add extra pressure, increasing sensations of tummy discomfort. Try building in a gentle walk or some yoga after lunch or at some point in the afternoon - there’s some evidence that gentle exercise can help gas move through the intestines, so this may ease discomfort.   

If none of these measures help after four weeks, it’s worth chatting with a GI specialist dietitian who can help review your diet in more detail and give you some personalised advice. They are also experts at knowing when to refer on for more help.

13. “Hi, how can I be a dietitian in the UK with an afn accredited masters degree?” 

In order to become a dietitian in the U.K. you’ll need to complete a full time approved undergraduate (3-4 years) or postgraduate dietetics degree (1-2 years), which includes placements that are usually completed within the NHS.   

Because you have an accredited nutrition degree, you may be able to do the postgraduate route, as your course will (I guess) have included a good level of human physiology and biochemistry. Completing another degree is a huge commitment and you already have a brilliant degree, so it’s worth thinking about your end goal - what sort of work do you want to do? Is dietetics absolutely necessary for this type of work? Having a chat to a few dietitians about what their day to day work life involves can be helpful. You can read more about the process and which universities offer approved courses here.

Thanks Laura.