Symprove spotlight series
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Renee McGregor is a leading Sports and Eating Disorder Specialist Dietitian with 20 years’ experience working in clinical and performance nutrition with Olympic, Paralympic and Commonwealth teams. She works with individuals, athletes of all levels and ages, coaches and sports science teams to provide nutritional strategies to enhance sport performance and manage eating disorders.
She is also a best-selling author and co- founder of #TRAINBRAVE; a campaign raising the awareness of eating disorders in sport. She is on the REDS advisory board for BASES (The British Association of Sport and Exercise Science) and the International Task Force for Orthorexia. She writes for many publications and is often asked to feature in the national press. We caught up with Renee as part of our Symprove Spotlight Interview series to find out more about her career and the impact of eating disorders on the gut microbiome.
Hi Renee, thanks for joining us today. Could you tell us a bit about yourself?
I am a sports dietitian that specialises in eating disorders, Relative Energy Deficiency in Sports (RED-S), overtraining and athlete health. As well as my work I am also a very keen runner, preferring mountain and forest trails over the road. I enjoy all distances but particularly multi-day events.
How did you end up working as a Specialist Sports and Eating Disorder Dietitian?
I was a clinical dietitian working in a variety of specialist areas before I worked in sport. One of these was adolescent eating disorders. It was an area I found fascinating – I was interested in how a mental illness can impact physical health equally and how you have to work on both areas in order to get recovery.
When I moved into sports nutrition, I was surprised initially at the high number of athletes suffering from dysfunctional relationships with food and training. This was often disguised by the fact that they were an athlete. I was even more surprised at how this was being missed and ignored within the sports world. I like a challenge and it has been so satisfying being able to use both my clinical and sports nutrition knowledge together in order to support individuals and help them to become sustainable athletes.
Could you tell us about some of the varied roles that you’ve worked within?
As a clinical dietitian I worked in areas such as gastroenterology, renal, burns, paediatrics, allergy, cystic fibrosis, liver and eating disorders. As a sports dietitian, I have worked with many sports ranging from gymnastics, triathlon, ultrarunning, wheelchair basketball, wheelchair fencing, ballet and football to name a few. I have also been team manager and sports science lead during my role in the run-up to the Rio 2016 olympics.
We loved your book ‘Orthorexia: When healthy eating goes bad’. What does the term ‘orthorexia’ mean?
Orthorexia is the obsession with eating correctly or purely. This is also why it has close links with the term “eat clean”.
What sorts of signs and symptoms suggest someone may have a disordered relationship with food?
Some of the signs that you should look out for include:
- Elimination of entire food groups in an attempt for a “clean” or “perfect” diet
- Severe anxiety regarding how food is prepared
- Avoidance of social events involving food for fear of being unable to comply with the diet
- Thinking critically of others who do not follow strict diets
- Spending extreme amounts of time and money on meal planning and food choices
- Feelings of guilt or shame when unable to adhere to diet standards
- Feeling fulfilled or virtuous from eating “healthily” while losing interest in other activities
- Fear that eating away from home will make it impossible to comply with the diet
- Distancing the self from friends or family members who do not share similar views about food
- Avoiding eating food bought or prepared by others
- Worsening depression, mood swings or anxiety
- Needing to exercise daily in order to justify eating
- Changes to hormonal regulation – in females this would be changes or cessation of periods and in males, this would be a decline in morning erectile function to less than 5 a day
- Changes to digestion which may be misdiagnosed as IBS or a food intolerance
Could the gut-brain axis be linked with the aetiology eating disorders? How so?
At the moment there is no evidence to suggest this; that said, there is a lot of interest and research in the gut-brain axis and how it impacts mental health in general. Eating disorders are complex mental health conditions. They are a coping mechanism when individuals struggle with deep-rooted and difficult emotions which they are fearful to address.
What impact (if any) does an eating disorder have on the gut microbiome?
When there is not enough energy going into the system (as a result of individuals following a restrictive diet), all the biological systems within the body are down-regulated, including your gut. Food moves through the gut at a much slower pace leaving the individual with pain and discomfort.
Are there any gut-related challenges during the eating disorder recovery phase?
Yes, absolutely. Gastroparesis is common in the eating disorder recovery phase. People may experience slow transit time through the gut when they are recovering and trying to restore and increase their nutritional intake. This can prove very challenging and uncomfortable.
How can healthcare professionals help their patients to optimise gut health whilst recovering from disordered eating?
The key thing is to help them to understand that while it feels uncomfortable, they have to think about the long-term picture. Health professionals can offer some advice to manage symptoms while also encouraging the restoration of energy.
Do probiotics have a role in the management of patients with disordered eating?
All eating disorders (from restrictive eating to binge eating) will have an impact on the gut microbiome. Probiotics can play a useful role at restoring gut flora and managing symptoms.
Do you have any recommendations for future research directions relating to disordered eating and gut health?
I would like to see the anatomical changes that occur in the gut during disordered eating, and whether this differs depending on the type of eating disorder. Once this had been identified, it would be great to see how these are reversed through the restoration of energy/health, with and without probiotics.
Where can individuals go for information and support on disordered eating?
Both Anorexia and Bulimia Care (ABC) and Beat are national eating disorder charities offering advice, support and helplines. The Trainbrave podcast and campaign also offers lots of advice for anyone with disordered eating, including those who have an eating disorder within sport.