Unexplained Symptoms

Increasingly, I am seeing patients who have had many medical tests in an attempt for a diagnosis, but all results are normal. While it is good that there does not appear to be any serious underlying illness, it can be frustrating as there is no obvious treatment. Typical symptoms include:

  • fatigue or sluggishness
  • poor concentration
  • stomach upsets
  • nausea
  • reflux/heartburn
  • diarrhoea
  • constipation
  • asthma
  • feeling of low blood sugar
  • headaches
  • rashes
  • swelling
  • running nose
  • blocked nose
  • aching joints
  • tinnitus (ringing in the ears)
  • anxiety
  • brain fog
  • poor memory

Other factors to consider:

  • symptoms may worsen with stress and menstrual cycle
  • cyclical bouts of illness
  • you may react badly to aspirin
  • you may get symptom relief from anti-histamine medication e.g. Clarityn

Food intolerance may be a cause or contributing factor to symptoms. Examples of food triggers include gluten/wheat, fermentable carbohydrates and chemicals found naturally in foods e.g. salicylates or histamine. The symptoms of these intolerances are many, and confusing in their presentation.

It is my job to assess your individual set of symptoms, your previous medical history, your food and symptom diary, determine the possibility of a food trigger, and to guide you, when appropriate with dietary treatment.

What my patients say:

Mr RD, IBS (March, 2016): Hi Sarah. Hope you’re well; I came to see you a year ago to help with IBS issues which have improved dramatically. I very rarely suffer any of the symptoms I used to – brain fog, stomach cramps etc and find I’ve been able to reintroduce a lot of foods that did give me problems previously, so thanks again!

Mr A.J. (February 2014) Chronic Fatigue, IBS. “Thank you so much for helping me identify the gluten issue, you’re right that it’s very positive, it’s made a huge difference to my energy levels – a big lifestyle change! I didn’t realise how tired I was getting until I reintroduced it, amazing how quickly we adapt to feeling a certain way!”

UnknownWhen did food become so confusing? We all know that there is no quick fix when it comes to health.

My job is to advise you on the best diet for your health issue. No faddy diets or calorie counting.

Dietitians are the ‘gold standard’ of nutrition professionals, and with 14 years of experience, you can trust my advice.
Specialist areas include digestive issues, women’s health, disordered eating, weight loss and sports nutrition. I am experienced in the innovative and scientifically proven ‘low FODMAP diet’ for digestive problems.
Consultations are at Kingston Health Centre, online or by telephone. 
Following the completion of a pre appointment questionnaire and food diary, at your consultation I will take the time to listen to you so that I can understand your needs, your life and your issues. I will answer all your questions (no matter how silly you think they may be) and using up to date science as well as my experience, we come up with a way forward that you are happy and comfortable with.
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Speciality areas:
IBS & Digestion Problems
Sports Performance
Disordered Eating
Allergies & Intolerances


Do you struggle to get your blood sugar levels under control? Are you worried about having to increase your medication or even having to inject insulin? Type 2 Diabetes does not have to be a disease that gets worse over time. It is possible to keep your blood sugar under control by eating the right things.

Contrary to the outdated advice that many UK health professionals are giving, a diabetes diet is not the same as a healthy eating or weight loss diet. The problem for diabetics is that the body has difficulty keeping blood sugar levels down. Sugar in the blood comes from the food that we eat. The foods that turn into different types of sugar as soon as they reach the stomach are called carbohydrates. This means sugar (as in sugary drinks, fruit juice, sweets) and starch (as in bread, pasta, rice and potatoes). The science shows that avoiding these foods can improve blood sugar levels and halt the progression of diabetes.

Carbohydrate foods will increase blood sugar levels
Carbohydrate foods will increase blood sugar levels

The more carbohydrates we eat in a meal, the more sugar is absorbed into the blood stream. The more sugar that’s absorbed into the blood stream, the higher the blood sugar will be. Here is an example of how a high carbohydrate meal (sandwich, fruit and flavoured yogurt) affects the blood sugar levels compared to a low carbohydrate meal (beef, vegetables and a creamy sauce):

High carbohydrate (red) Low carbohydrate (green)
High carbohydrate (red)
Low carbohydrate (green)

Outside of the UK e.g. in Sweden and America, the medical community is recognising the benefits of reducing carbohydrates. The American Diabetic Association has approved lowering carbohydrates since 2008. Unfortunately, in the UK, official dietary advice has been slow to catch up! Advice from health professionals continues to be ‘a balanced healthy diet’ including plenty of carbohydrate foods. Unfortunately, for people with diabetes, carbohydrate foods are not healthy! There are however, lots of delicious foods that you can eat Are you confused and don’t know what to think? Try it yourself for a few weeks and monitor the effect. Here are some examples of what you can expect:

  • Improved blood sugar levels from when you reduce the carbohydrate foods
  • Increased feelings of fullness and weight loss
  • Reduced sugar cravings
  • Many people with bloating experience considerable improvements

If you would like some help and guidance with controlling blood sugar levels with your diet, then contact me on 07758 100727, or use the contact form at the top of the page.


Note for diabetics                        

Avoiding the carbohydrates that raise your blood sugar decreases your need for medication to lower it. Taking the same pre-low-carb diet dose of insulin might result in hypoglycemia (low blood sugar). You need to test your blood sugar frequently when starting this diet and adapt (lower) your medication. This should ideally be done with the assistance of your doctor or diabetes nurse. If you’re healthy or a diabetic treated either by diet alone or just with Metformin there is no risk of hypoglycemia.    

Chronic Fatigue (ME)

CFS/ME involves a complex range of symptoms that includes fatigue, malaise, headaches, sleep disturbance, difficulties with concentration and muscle pain. The pattern and intensity of symptoms vary between people, and during the course of each person’s illness. People often have symptoms for many years before CFS/ME is diagnosed.

The causes and disease processes of CFS/ME are still not understood,  and different combinations of approaches will be helpful for different people.

Dietary manipulation is one of the approaches for managing the symptoms:

Step 1: Diet analysis to assess nutritional content of the diet: vitamins, minerals, protein, calories etc. Correction of any nutritional deficiencies with appropriate dietary advice.

Step 2: Depending on presenting symptoms, look at possibility of food intolerances. For example, Coeliac Disease or non-coeliac gluten sensitivity (NCGS). The symptoms in NCGS may resemble those associated with Coeliac Disease but with a prevalence of additional symptoms, such as behavioral changes, bone or joint pain, muscle cramps, leg numbness, weight loss and chronic fatigue. Treatment of Coeliac Disease is elimination of gluten, while for NCGS gluten restriction/reduction can significantly improve symptoms.

Guidelines for the NHS (NICE, 2009): “Exclusion diets are not generally recommended for CFS, but many people find them helpful in managing symptoms, including bowel symptoms. If a person with CFS undertakes an exclusion diet or dietary manipulation, seek advice from a dietitian because of the risk of malnutrition.”








5 ‘unhealthy’ foods you should eat – food myths busted

Whether you are trying to lose weight, increase energy, reduce cholesterol, control blood sugar levels, improve fertility or just ‘feel better’, here are five foods that you may have been avoiding unnecessarily:


Peanut Butter – Frowned upon as a guilty indulgence, peanut butter can bring you many health benefits. Keep portions sensible at about two tablespoons a day i.e. don’t attack the jar with a spoon!Unknown-12

  • low glycaemic index, helping to keep blood sugar levels from fluctuating
  • good fat – peanuts are high in heart healthy monounsaturated fat
  • protein from nuts are fabulous for helping to make you feel full up for longer and maintaining or building muscle mass
  • High in fibre for healthy digestion and appetite control
  • Have on a piece of wholemeal toast, on an oatcake, mixed in to some chunky oat porridge, or in homemade flapjacks


Eggs – these little powerhouses of nutrition have had bad press over the years due to the cholesterol levels. Research shows that the cholesterol in food is not absorbed well in to the body and does not affect levels of cholesterol in the blood.Unknown-8

  • Full of choline for brain development (essential for pregnant women!)
  • Curbs your appetite – people eating eggs for breakfast consume fewer calories throughout the day
  • High in protein – important for keeping your muscle, and helping to build more to stay lean
  • Easy and cheap – boiled, scrambled, dry fried, poached, microwaved in a minute………..they are so easy to incorporate


Dark chocolate – 80% cocoa chocolate may be an acquired taste, but it is worth it! A small amount will satisfy, as well as having numerous health benefits.images-4

  • low glycaemic index so keeps blood sugar levels steady (good for diabetics, overweight, PCOS, curbing cravings)
  • high in antioxidants which may be protective against cancer, heart disease and ageing
  • lower in caffeine than milk chocolate


Dairy – milk, cheese, yogurt all have health benefits. Unless you have a dairy allergy or intolerance, there really is no reason to remove from your diet.Unknown-13

  • controls appetite: dairy products are digested slowly therefore help you to feel full up for longer
  • a great source of amino acids – essential for maintaing and building muscle
  • calcium – essential for bone formation and muscle function
  • yogurt has probiotic bacteria which are essential for healthy gut function. Keep it natural to lower the sugar content……add your own fruit for some sweetnessUnknown-7


Avocados – traditionally, avocados were relegated to the ‘foods to avoid’ list due to the high fat and calorie content. In fact, eaten in moderation, they actually provide immense health benefits.

  • Healthy fats – lower cholesterol and reduce appetite
  • Avocado eaters more likely to have lower body weight, BMI and waist circumference
  • high in vitamins and fibre
  • rich in phytochemicals which may protect against cancerce06a4d58d06170de2cab0101e6324ae
  • the fat content helps the absorption of fat soluble vitamins (A, D, E & K) from vegetables
  • try half an avocado sliced on toast, mashed as a replacement for mayonnaise or butter, or whizzed up in a smoothie

As with most things in life, “everything in moderation”! Including these nutrient dense foods everyday as part of an all round healthy diet can help your body to function at it’s best.



Low FODMAP diet: information for GPs

  • relatively new concept in the UK
  • evidence based approach to managing IBS symptoms
  • significantly better improvements when compared to NICE guidelines for IBS treatment
  • effective for about 75% of people with IBS
  • more GPs and gastroenterologists in the UK are referring patients for advice from a registered dietitian who has experience in advising on a low FODMAP diet

Guy’s & St Thomas’ Hospital:

Researchers at King’s College London have implemented the low FODMAP diet at Guy’s and St Thomas’ hospitals. They compared it with standard advice based on National Institute for Health and Clinical Excellence guidelines and found it reduced symptoms in at least six out of seven patients, compared with half following the NICE- based advice.

“We have been using the low-Fodmap diet in the U.K. since 2009 and have very good success,” said Dr Miranda Lomer, a consultant dietitian with Guy’s and St Thomas’ NHS Foundation Trust. “The diet is used quite widely now across the U.K.”

What are FODMAPs?

FODMAPs (stands forFermentable Oligo-saccharides,Disaccharides, Mono-saccharides and Polyols) are malabsorbed carbohydrates which are fermented by gut bacteria to produce gas. Current research strongly suggests that this group of carbohydrates contributes to IBS symptoms. FODMAPs are found in a wide range of foods.

What healthcare professionals are able to give low FODMAP dietary advice? 

The evidence shows that patients should be seen on a one-on-one basis by a specifically trained dietitian. The dietitian should obtain a full patient history, an understanding of the IBS symptom(s) experienced and assess the diet in detail. The patient is then taught about how the FODMAP system in a step-by-step process. The diet is individualised for each patient, providing suitable alternatives for foods they need to avoid. Menu plans and appropriate information on label reading, eating out and recipe adaptation should be provided. Patients will often have many questions and require reassurance. A full hour is usually needed for each patient.

Is the diet easy and how long should it be followed?
Patients often report that aspects of the diet are difficult to follow, but compliance rates are high, with 77% following the diet most of the time. Skilled dietitians will be able to individualise the diet accordingly for patients who may struggle with certain aspects of the diet. It is likely that the more strictly the diet is followed the quicker the symptom response will be, but most people take between 2-8 weeks to improve.



Something I see regularly in my clinic is clients with acne. And it’s not usually teenagers, it’s more likely to be women in their 30s and 40s. I’ve even had one lady in her 60s who suffered from cystic acne on her chin, not bad enough for a dermatology referral, but none the less, unpleasant to put up with.

My clients have usually been suffering for years, and while their GP or dermatologist may be sympathetic, the prescribed treatments offered have not provided a long term solution.

As an acne suffer myself from the age of 14, I spent 20 years wondering when I’d

Roaccutane - a last resort
Roaccutane – a last resort

‘grow out’ of it. Every medication in the BNF (the doctor’s prescribing bible) has been given to me, from benzyl peroxide cream to the liver toxic Roaccutane. Each would help for a while, but the spots always returned. It was evident that the root cause was not being treated. I was always told by GPs, dermatologists and even dietitian colleagues that there was no relationship between acne and diet.

What does the research show?

The outdated opinion that acne is not related to diet comes from a 1969 study looking at the effect of chocolate on acne, in which the inappropriate conclusion was drawn that, as chocolate did not appear to affect acne, neither did any dietary factor. However, there is growing evidence of more recent studies supporting the relationship between diet and acne. In particular a high glycaemic index diet and dairy have been implicated.

There is also emerging medical evidence and a growing number of clinicians acknowledging that up to 10% of the population may have a gluten intolerance, despite testing negative for coeliac disease. Gluten intolerance can manifest in skin conditions.

What causes acne?

Acne is caused by a combination of imbalanced hormones and inflammation. Diet can have an effect on both. A diet high in refined carbohydrates (sugar, white bread, white rice, biscuits, sweets, pastries etc.), low in fruit and vegetables, and low in essential fatty acids may have a negative effect on hormones, and may also contribute to inflammation.

For years, I have followed a very healthy diet including lots of veg, fruit, whole grains, healthy fats, low sugar etc. however, still suffered with acne. In desperation, 2 years ago I thought I would have nothing to lose by trying a gluten free diet. With in a few weeks the spots had cleared. The ‘gold standard’ way to genius46_460 challenge the intolerance is to reintroduce the food. I have done this twice, once on holiday in Morocco where breakfast was almost completely bread products, and in Ireland where I wasn’t going to offend my husband’s Granny by turning down her scones! The result? With in about 3 days I had horrible spots which took about a month each time to clear up.

Everyone is different and there is no magical ‘one diet fits all’. For me, gluten is my trigger, however, this will not be the case for all. For some of my clients, just cutting out the refined carbs and increasing the good fats is enough to see 100608182647-largeimprovements. A change in diet can take time to show in the skin. Some people see a difference in a few days, for some it may take a few months.

My recommendations:

  • avoid refined carbohydrates, change to wholegrains
  • have a good intake of vegetables and fruit (at least 5 portions a day)
  • take a daily fish oil supplement containing 500mg DHA & EPA
  • include healthy fats e.g. nuts and seeds, olive oil, avocados
  • consider a trial exclusion of dairy
  • consider a trial exclusion of gluten

If you don’t feel confident with changing your diet, seek the advice of a dietitian to guide you. Cutting out food groups such as dairy, can leave you lacking in important nutrients. A dietitian can also help you with the practical aspects of applying the recommendations to your current diet and lifestyle. For example, what to buy in Pret a Manger or Starbucks, ideas for incorporating more veg, how to go gluten free.

Iron & Anaemia – not just tiredness

Recent statistics show that 40% of women under the age of 34 have seriously low intakes of iron and are at risk of anaemia as a result. Up to 15% of children don’t get enough iron, and 1 in 8 children between 1 1/2 and 2 years are anaemic.

Anaemia can cause:

  • tiredness and weakness
  • decreased work and school performance
  • slow cognitive and social development during childhood
  • difficulty maintaining body temperature
  • decreased immune function, which increases susceptibility to infection
  • glossitis (an inflamed tongue)
  • palpatations
  • restless leg syndrome

Symptoms of iron deficiency anaemia could be caused by many different things. A blood test is needed to confirm the presence of iron deficiency anemia.

People at risk of anaemia:

  • Infants over 6 months
  • Toddlers
  • Adolescents
  • Pregnant women
  • Pre menopausal women

How much iron do I need?

Gender Age Group Recommended intake (mg/day), number of 
Children 1-3 years 7
Children 4-6 years 6
Children 7-10 years 9
Teenage boys 11-18 years 11
Teenage girls 11-18 years 15
Men 19-50 years 9
Women 19-50 years 15
Men 50+ years 9
Women 50+ years 9


Food sources of iron

  • Iron from animal sources is much better absorbed by the body than plant sources
  • Vitamin C helps with absorption. High vitamin C foods include: red peppers, broccoli, strawberries, kiwi fruit & oranges.
  • Tea and coffee reduce the absorption of iron, so don’t drink a cup too close to a meal

 Meat sources:

Food Average portion Stars
Liver 40g, thick slice ★★★
Liver pate 1 tbsp
Beef steak 150g, medium size ★★★
Sausage 2
Beef mince 125g, 4 tbsp cooked ★★★
Chicken 100g cooked
Pork chop 120g, 1 average
Sardines/salmon/mackerel 50g
Tuna 100g (1/2 tin)

 Other sources (less well absorbed):

Food Average portion Stars
Ready Brek 20g dry (1 small ptn) ★★★★★★
Branflakes 25g (4 tbsp) ★★★★
Weetabix 2 biscuits ★★★
Rice Krispies 30g (4 tbsp) ★★
Chickpeas 100g (4 tbsp) ★★
Lentils green/brown 75g (1/2 cup cooked) ★★
Lentils red 75g (1/2 cup cooked) ★★
Baked beans 120g (3 tbsp) ★★
Humus 50g (1 tbsp)
Eggs 1
Sunflower seeds 30g (1/4 cup) ★★
Sesame seeds 12g (1 tbsp)
Dried Apricots 8 ★★
Dried figs 4 ★★★
Raisins 35g (1 tbsp)
Spinach 120g (3 tbsp) boiled ★★
Avocado ½
Peas 75g (2.5 tbsp)
Broccoli 4 spears (200g)
Ovaltine 25g serving (4 tsp) ★★★
Milo (chocolate malt) 20g serving (4 tsp) ★★★★★★
Sainsburys: £3.99Tesco: £2.99  


Iron Supplements

If you have iron deficiency anaemia, your doctor may prescribe you iron supplements, as even a diet rich in iron will not be enough to correct the deficiency.

If you experience a stomach upset with iron tablets, try taking a liquid form instead.

For further information on iron or for a dietary assessment to assess the amount of nutrients in your diet, use the contact form to get in touch.