Good nutritional advice is important for all of us. But not every nutritionist has the hard-earned qualifications that they need

I have had a gastrectomy and have been told to go on a liquid diet, but the only information I have been given is to liquidise ordinary food, vegetables, meat and potatoes with some liquid.
Peter Begley, Bristol

I’d love to be able to talk you through the types of food you should eat but I feel I would be doing you a disservice, as it would be impossible, on the basis of one e-mail, to give you the therapeutic support you clearly need.

The fact that you have written to me suggests, though, that you haven’t been offered the right support from a dietitian. I would strongly recommend asking your doctor to refer you to a dietitian with gastroenterological - ie, gut - experience.

Sadly, you are not alone: I receive masses of correspondence from people with complex health problems such as diabetes, cancer, heart disease, multiple sclerosis and obesity, who for some reason are not being cared for by dietitians. Some have doctors who seem not to believe in dietitians, others have paid large amounts of money to see unqualified nutritionists and have ended up with problems as a result of not receiving the right advice. That’s why I want to explain the difference between dietitians and nutritionists, and to tell you how to get good nutritional support.

I know I’m going to upset some nutritionists, but unfortunately we still don’t have a clear-cut way of distinguishing between someone who has done a weekend course in nutrition, put up a brass plaque and is now giving nutritional advice, and a nutritionist who has studied for a wellrespected degree.

While the British Association of Nutritional Therapists (BANT) and the Nutrition Society are working hard to establish theirs as a highly regulated professional body with well-qualified practitioners, even if not in the traditional dietitian way, and to make sure that no charlatans practise as nutritionists, the public currently has no obvious way of knowing if the person they see has the necessary qualifications and knowledge. If you would like to see a nutritionist who is regulated by the British Association of Nutritional Therapists, go to bant.org.uk or the Nutrition Society, http://www.nutsoc.org.uk.

Although I call myself a nutritionist I am technically a dietitian. Dietitians have to have completed a rigorous degree in dietetics, or a postgraduate diploma following a suitable science degree, and are governed by the Council for Professions Supplementary to Medicine (part of the British Medical Association) as well as by the British Dietetic Association (BDA). You can’t call yourself a dietitian unless you have your state registration in dietetics (SRD).

I prefer to use the word “nutritionist” because it sounds nicer. Dietitians seem to be regarded as stuffy - the put-people-on-diets brigade - whereas the word nutritionist conjures up nourishment and nutrients. I’m not saying that all dietitians are great - some just seem to spout the same old eat-more-fruit-and-vegetables advice and can be under a great strain in the current NHS to give patients the time they need - but at least you know that the person you see has been degree-trained. And with something as important as having had your stomach removed, or suffering from ulcers, you should lobby your NHS practice for a referral to a specialised dietitian. Ask to see another one if you don’t think that yours is good enough. Make a fuss about it, because your nutritional health is incredibly important.

You should get this advice for free through your GP practice but if you want to go privately, get in touch with the British Dietetic Association at http://www.bda.uk.com, who have a list of all professionally regulated dietitians in Great Britain. If you want to see any dietitian, private or otherwise, you need a referral letter from your GP or consultant, as it is illegal for a dietitian to treat anyone without this permission. Currently, nutritionists who can be seen only privately don’t need a referral (although BANT encourages it), but be sure you know whom you’re seeing before you part with your cash.

I was diagnosed with IBS about a year ago. Since then I have made changes to my diet, eating more wholefoods and cutting down on dairy, sugar and wheat. This has really made a difference to my symptoms, which included abdominal cramps and diarrhoea. For the past few months, though, I have suffered from excessive, smelly flatulence. I have tried digestive enzymes and aloe vera juice but they haven’t helped.
Name and address supplied

Poor you. Wind is a very common problem and while the young can get away with it with a cheeky smile, I know from my patients that it can be debilitating and highly embarrassing, so much so that it can stop people wanting to socialise or to have a physical relationship.

It sounds as if you have made a great deal of headway, and indeed some of the flatulence may be the result of the changes in your diet and may settle down.

Try taking a probiotic - for example, a live acidophilus supplement (available from good health food stores; it should be kept in the fridge). Or choose one of the pre-mixed bacterial drinks on the market. These can be extremely expensive and some gastroenterologists doubt that many of the good bacteria make it down to the colon to zap out the bad, wind-causing ones. However, I do see patients experiencing a great deal of gastric relief from taking these regularly - every day for a month and then, once you notice an improvement, keep going, as stopping can bring the bad bacteria back.

Another option would be to eat some live organic yoghurt (a small pot each day, say), as it contains live bifido and lactobacillus bacteria, which, like acidophilus, can get rid of wind. You need to eat the yoghurt cool (similarly, keep bacterial drinks away from hot drinks), as heat kills many of the bacteria.

Finally, smelly wind can be due to too much fat in the diet. Animal and vegetable fats can cause the same amount of flatulence in sensitive guts, so watch olive oils, too. Coffee and tea can aggravate wind, so cut down on these. Mint or fennel tea after meals can help to prevent wind, as can vegetables such as cauliflower, beans, lentils, broccoli and artichokes.