Food & Symptom diary

The Benefits of Keeping a Food & Symptom Diary

Food & Symptom diary


In amongst the busyness of everyday life, it’s easy to fall into repetitive, unconscious patterns of consumption – that might inadvertently be contributing to, for example, fatigue or gastrointestinal discomfort. Writing it all down can be the first step in increasing awareness of the feedback our body is trying to send us.

Once we become conscious of our current food, lifestyle and symptoms, we can then start to think about some simple, gentle adjustments that we might try making, to support our overall wellbeing. For example, reducing our caffeine consumption if we realise that drinking more than 2-3 cups a day is negatively affecting our sleep, or noticing that we feel hungrier in the afternoons if we haven’t had a balanced breakfast. Often, it is the simplest tweaks that can make the biggest difference. And don’t forget that it’s not all about the food – relaxation, stress reduction, appropriate movement, social connection and restorative sleep are all vitally important contributors to how we feel. You can include notes on these aspects of wellbeing in the diary too, if you wish.

Please note: Completing any sort of food and/or symptom diary without appropriate professional support is NOT recommended if you have or have had an eating disorder, or any sort of excessive worry or anxiety around food. Please be compassionate to yourself and avoid using this resource if you feel it may not be beneficial for any reason.

If you have any concerns about your symptoms, it goes without saying that this should always be discussed with a healthcare professional. This diary serves as a useful piece of information to share with them if you’re happy to.

How to complete


1. I recommend that you print the diary off and keep it with you throughout your day. It’s usually more accurate to fill in ‘as you go’, rather than trying to remember everything that happened come the evening. If you’d prefer, keep notes on your phone or computer instead (using the headings suggested), and then transcribe or print them in the evening.

2. Write down absolutely everything you eat and drink, including rough timings and quantities (don’t worry too much about being accurate to the last gram; a handful of spinach, 2 slices of toast, 1 large mug of coffee etc. is fine).

3. Next, note any symptoms you might experience throughout the day and what time they started / ended. See the list below for common symptoms people might experience (although anything goes, so feel free to just write what you feel – it is not an exhaustive list).

4. Finally, you can record anything else that might have had an impact on your food intake or symptoms, such as how well you slept, whether you were feeling particularly stressed or relaxed, how your mood was, what sort of activity or exercise you completed, how rushed you felt whilst eating, supplements or medications you took, even the weather etc. The final column is yours, so add as much additional detail as you wish to give colour and detail to your diary.

Possible symptoms*

Gastrointestinal: Bloating, gas, abdominal discomfort or cramping, diarrhoea or constipation, nausea, tongue or mouth ulcer

Appetite: Cravings, hunger, excessive fullness, loss of appetite.

Energy & mood: Fatigue or low energy levels, ‘foggy’ head, lack of concentration or focus, low mood, anxiety or jitters, insomnia or disturbed sleep.

Skin: Rash, itching, flushing, skin irritations, spots, dry skin.

Other: Headaches, head pressure, general pain, muscle or joint aches, sinus congestion or runny nose, cough, bladder or urinary changes, libido.

*Not all of these symptoms are related to the food we consume – they can arise from myriad different causes. However, it can still be helpful to note when and how we notice them, even if just to provide ourselves with a more complete picture of our current state of health.

Food & Symptom Diary

What to do with your completed diary

Completing a food and symptom diary is NOT about doing an elimination diet or identifying foods to cut out. In fact, I highly recommend avoiding any unnecessary dietary restrictions, because enjoying a widely varied diet is really important to maximise our intake of different essential nutrients and to minimise stress around food.

If, however, you feel that you might be having symptoms related to a specific food group, it’s always a good idea to speak to a nutrition or healthcare professional about your concerns. They will help you identify if there might be an underlying medical condition triggering your reaction – and can then provide the appropriate testing, support and follow-up if required.

What this diary can help us to do, however, is to identify if there are any small, manageable tweaks that we could make to what or how we are eating, that might help us feel our best. Nobody eats ‘perfectly’ or is entirely symptom free all of the time. We all have off days – and that’s both normal and OK.  So, with an enquiring and compassionate mind, take some time to re-read your completed diary and see if there are any obvious and consistent patterns. There is space on the final page to make observations and notes as you do so. Try to think about what is going well, as much as what you would like to improve upon.

While maintaining that sense of kindness towards yourself, have a think about some simple, achievable steps that might be beneficial to your overall nutritional balance or wellbeing. I generally suggest focussing on no more than three small changes at a time, as we all have limited bandwidth for making lifestyle changes. Again, there is space on the last page for these ideas.

For more information and support

While I am a nutritional therapist, I am not your nutritional therapist, so unfortunately I cannot tell you specifically what to look out for in your completed diary, nor exactly what changes to make. We are all unique individuals and will have hugely varied diaries by the end of the week.

I have, however, written extensively about my general approach to nutrition and wellbeing, so please do take a look at my books, Eat. Nourish. Glow and Nourish & Glow: The 10-day plan for lots more nutritional information and advice. Cook. Nourish. Glow and my latest book, Simply Good For You, both contain plenty of delicious recipes too, in case you’d like a little extra culinary inspiration.

For advice on how to find a nutrition practitioner to work alongside, please take a look at the FAQ pages.



Gut Health, Part 3: 10 Ways to Help Support Gut Health

Gut Health, Part 3: 10 Ways To Help Support Gut Health

This is the third part of my series on gut health. Do check out The Basics of Gut Health and Probiotics and Prebiotics in Gut Health for further information on this popular topic.

How to eat more fibre

  1. Start with the basics

Whenever I am asked to consider ways to support individual organ systems or processes (such as brain health, skin health, immunity etc.), I always start by saying that we can’t isolate just one part of the body and focus only on that.

We exist as an intricately connected whole system. What affects one area of our body will also affect everywhere else, to a greater or lesser extent. This concept applies to our gut health. So while there are certain strategies that may specifically benefit our microbiota or digestive health, we must consider their wider effects, too.

Likewise, many aspects of our lifestyle beyond just diet can also influence our gut – from lack of sleep, to stress, to being consistently sedentary. Therefore, perhaps the most important first step to nourishing our gut is actually to nourish our whole body and mind. To establish those fundamental basics of health: restorative sleep, moderate alcohol intake, regular movement, a balanced and nourishing diet, active stress management and social connection.

Often, we may find that when these basics are in place, consistently (not perfectly – that’s not a realistic goal), much of the rest takes care of itself.

  1. Take time to eat, sit down & chew properly

Our digestion needs time to work properly, so sit down to eat, and try to give yourself at least 10 minutes for each meal, ideally undistracted. The more relaxed we are when eating, the more we activate the ‘rest and digest’ state of our nervous system. Which, as the name suggests, is very helpful to support efficient digestion.

Chew your food well and give your digestion a break between meals (I suggest at least 4-5 hours). These two simple factors can do an awful lot of good when it comes to gut health, especially bloating, without changing a single thing in your diet.

If you’d like more information on how to practice mindful eating (including a mindful exercise) as well as more on digestive health and nutrition, I suggest taking a look at my online course  which explores many of these topics in detail.

  1. Drink enough water

Your body maintains a finely tuned fluid balance by absorbing more water from your gut if you are getting a little dehydrated. This hardens the contents of your bowels, and so dehydration is a common cause of slow gut transit time and constipation.

Good hydration enables good elimination! For gut health, it is suggested that we aim for around 30-25ml fluids per kg of body weight per day (although this will vary according to the temperature and amount of exercise you are doing too, so as always, please listen to your body).

  1. Include healthy fats in your diet

For simplicity’s sake when it comes to healthy fats, I generally recommend using plain olive oil for cooking, and your fancy extra-virgin olive oils for salad dressings and drizzling. Other healthy fats, such as avocados, oily fish and nuts & seeds, are also very gut friendly.

There is a lot more information on how to build a healthy diet, including which healthy fats to go for in my third book, Nourish & Glow: The 10 Day Plan.

  1. Focus on fibre

A fibre-rich diet is associated with an increased diversity of the gut microbiota (and, in general, the greater the diversity the better), as well as helping to reduce constipation and other bowel-related problems. It may potentially even help to reduce the risk of heart disease and stroke (Wald, 2013) (Gobson and Shepher, 2010) (De Filippo et al., 2010).

Plus, fibre is filling and low in available calories, so great for those who are watching their weight. Aim for at least 30g/day, which you can get from lots of fresh vegetables, beans and pulses, and unrefined, whole-grain carbohydrates (oats, millet, quinoa, amaranth etc.).

See my article ‘Eat More Fibre’  for lots more on this topic.

  1. Eat a colourful diet rich in polyphenols

Plant polyphenols are important naturally occurring compounds that are found in a range of plants, fruits and vegetables which are thought to have all sorts of beneficial effects for both your gut and your body as a whole (Puupponen-Pimia et al., 2002).

Good sources of polyphenols include:

  • Citrus fruits (whole fruits though, not just the juice!).
  • Dark green leafy vegetables (spinach, chard, cabbage, kale etc)
  • Green Tea
  • Red and purple berries (I often recommend a portion a day for gut health – frozen ones are fine when fresh are out of season)
  • Nuts and seeds. Linseeds (also known as flax seeds) and chia seeds are a good example, although I would recommend soaking them for a few hours or overnight in water before eating them for maximum nutrient absorption. I would suggest trying to have a moderate portion of nuts, seeds or nut butter every day (assuming you tolerate them well and have no allergies)
  • Cacao – yep, that means chocolate! Either go for raw cacao or organic cocoa powder, or look out for organic chocolate with a cocoa content of > 85%. 10-25g per day is a sensible amount (that’s about 1-2 large squares).

For more information on polyphenols, take a look at my article Why ‘eating the rainbow’ is not just a cliched phrase – also contains lots and lots of colourful recipe inspiration.

  1. Include some probiotic & prebiotic foods

Probiotic foods include organic fermented dairy products such as bio live plain yoghurt, sour cream, aged cheese or kefir (if you tolerate casein protein and lactose). Alternatively, kimchi, kombucha, miso, natto, sauerkraut and tempeh are fermented too. Do make sure that these contain ‘active, live cultures though’ – if they have been pasteurized or heat-treated after fermentation then they will no longer have significant probiotic function.

Prebiotic foods include things like asparagus, under-ripe banana, aubergine, endive, garlic and onions, Jerusalem artichokes, leeks, pulses (such as beans, peas and lentils) and chicory. Unrefined wholegrains may also have some prebiotic function.

Please note: It’s recommended that you always start to include these foods very gradually into your diet. Adding a lot of probiotics and prebiotics at once can potentially lead to a significant exacerbation in gut symptoms. Sometimes I recommend just a teaspoon every other day to begin with (although others may be fine adding more). Listen to your own body, as always.

  1. Consider possible food allergies & intolerances

If you have a specific food allergy or intolerance, this food may need to be eliminated for a while (or indeed, indefinitely in some instances), to allow your gut and symptoms to heal.

It’s always best to speak to a Registered Nutritionist, Nutritional Therapist or Dietitian to advise you on this (head over to my FAQs page for info). As far as possible, eating a widely varied diet is important to ensure we don’t inadvertently develop nutrient insufficiencies, and to minimise the stress and anxiety we might feel around eating.

Please be wary of any online company that offers at-home tests to find if you have any allergies or intolerances – most of these are not proven to be effective, and may result in you restricting your diet unnecessarily.

  1. Reduce ultra-processed foods

It’s a good idea, both for our overall health as well as for our gut health, to cut down on the amount of heavily processed and/or junk food we consume, especially processed meats and high-sugar, high saturated fat foods. Although all foods do have their rightful place in a balanced diet, moderation is important when it comes to these sorts of foods. It’s best to base the majority of our meals on whole foods, such as fruits, vegetables, high-quality proteins, pulses, wholegrains and nuts & seeds, cooked simply.

  1. Actively manage stress

Stress can be a big factor in both our gut health and our overall health. Our brain, microbiota and gastrointestinal tract are all intricately connected, and can all affect each other. This book explains that connection really well.

Although we all feel stress, and a bit of it can actually be beneficial to us, too much is definitely unhelpful. Actively managing stress can take many forms. Some people find exercise incredibly helpful, others self care and others still seek social connection in times of challenge.

It’s less about what you do than actually doing it consistently. This book, offers a great deal of ideas, tips and suggestions if you’re not sure where to begin when it comes to reducing your own stress levels.


Eat Yourself Happy | Dr Megan Rossi


Be Good To Your Gut | Eve Kalinik


The Joy of Healthy Eating | Amelia Freer


Nourish & Glow: The 10 day plan | Amelia Freer


Green Tea | Clipper Tea


The Stress Solution | Dr Rangan Chatterjee


Please note, this website uses some carefully selected affiliate links. If you buy through these links, we may earn an affiliate commission, at no additional cost to you. This helps to keep all of our online content free for everyone to access. Thank you.

Please note: This article is for information only and in no way replaces medical or personal nutrition advice. You should always speak to your healthcare provider in the first instance if you have any concerns whatsoever about your digestive or gut health. Please do not disregard or delay treatment based on anything you read on this website. I am not a doctor, nor am I your Nutritional Therapist. The information I share is very general and may not be relevant or appropriate for you as an individual.

References & Bibliography:

Bjarnason, I., Williams, P., Smethurst, P., Peters, T.J. and Levi, A.J. (1986) ‘Effect of non-steroidal anti-inflammatory drugs and prostaglandins on the permeability of the human small intestine’, Gut, 27(11), pp. 1292–1297. doi: 10.1136/gut.27.11.1292.

De Filippo, C., Cavalieri, D., Di Paola, M., Ramazzotti, M., Poullet, J.B. and Massart, S. (2010) ‘Impact of diet in shaping gut microbiota revealed by a comparative study in children from Europe and rural Africa’, Proceedings of the National Academy of Sciences, 107(33), pp. 14691–14696. doi: 10.1073/pnas.1005963107.

De-Souza, D.A. and Greene, L.J. (2005) ‘Intestinal permeability and systemic infections in critically ill patients: Effect of glutamine*’, Critical Care Medicine, 33(5), pp. 1125–1135. doi: 10.1097/01.ccm.0000162680.52397.97.

Dethlefsen, L. and Relman, D.A. (2010) ‘Incomplete recovery and individualized responses of the human distal gut microbiota to repeated antibiotic perturbation’, Proceedings of the National Academy of Sciences, 108(Supplement_1), pp. 4554–4561. doi: 10.1073/pnas.1000087107.

Gibson, P.R. and Shepherd, S.J. (2010) ‘Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach’, Journal of Gastroenterology and Hepatology, 25(2), pp. 252–258.

Lambert, G., Boylan, M., Laventure, J.., Bull, A. and Lanspa, S. (2007) ‘Effect of aspirin and ibuprofen on GI Permeability during exercise’, International Journal of Sports Medicine, 28(9), pp. 722–726. doi: 10.1055/s-2007-964891.

Puupponen-Pimiä, R., Aura, A.., Oksman-Caldentey, K.., Myllärinen, P., Saarela, M., Mattila-Sandholm, T. and Poutanen, K. (2002) ‘Development of functional ingredients for gut health’, Trends in Food Science & Technology, 13(1), pp. 3–11. doi: 10.1016/s0924-2244(02)00020-1.

Wald, A. (2013) Patient information: High-fiber diet (Beyond the Basics. Available at: UpToDate (Accessed: 1 December 2015).

Photos by Jen Rich and Darryl Leja

Gut Health, Part 2: Probiotics and Prebiotics in gut health

Gut Health, Part 2:  Probiotics & Prebiotics in Gut Health

What are probiotics?

Probiotics are “live micro-organisms, which when consumed in adequate amounts, confer a health effect on the host”. Use of probiotic foods is an ancient tradition – even as far back as the time of Genghis Khan, fermented milk was being drunk as an elixir of strength and health.

In the second part of this gut health series, we are going to look at the role of probiotics and prebiotics in gut health – possibly one of the most exciting new topics to emerge in nutrition in the last few years. If you missed Part 1: The basics of gut health  take a look at it first to give you a little more background.

Most often, probiotic foods or supplements contain strains of either Lactobacillus or Bifidobacterium bacteria, usually from fermented dairy products. However, before starting to act, they have to survive the hazardous journey to reach our gut:

  1. They need to first get through manufacturing, transportation and storage processes, to reach our fridge or kitchen cupboards alive and in good condition.
  2. Then they must make it through the acidic environment of our stomach (designed precisely to kill off any wayward bacteria) and through the swamp of potent digestive juices and enzymes secreted by the gallbladder and pancreas.
  3. Finally, if they succeed in reaching their destination, the large bowel, they then actually need do some good for the host rather than just going along for a free ride, or even possibly doing some untoward harm.

Because of these difficulties with getting the right probiotics to the right place, it is important to point out that the benefits which are seen in clinical trials may not all be possible to achieve with the yoghurts, tablets or other supplements available over-the-counter.

Despite all these challenges, however, good quality strains of probiotics have been associated with beneficial effects in some disease processes, such as reducing antibiotic-associated diarrhoea.  Researchers are also examining a huge range of other conditions that may benefit from probiotics (Tuohy et al., 2003) (NHS Choices, 2015). Further research is very much ongoing.


Most of the clinical research that has been carried out on prebiotics has been in unwell populations, and even then they are not yet in widespread use. We do not yet know much about the impact that taking probiotics might have in generally healthy people (Puupponen-Pimia et al., 2002). Anecdotally, I have found them to be of tremendous benefit for myself and some of my clients. However, anecdote is not a strong form of evidence, and I am always cautious about recommending any supplements on this sort of platform, so please do speak to your doctor or an appropriately qualified nutrition professional prior to commencing any supplements.

Furthermore, probiotics, even as tablets, are also still regarded as foods. Therefore they do not have to undergo the same rigorous testing as medicines do, so it is difficult to know if they actually contain the bacteria they claim, alive, in an adequate dose, and are able to give you a tangible benefit (NHS choices, 2015). The European Food Safety Authority has even gone so far as to ban the probiotic food industry from certain advertising claims, such as that they ‘boost the immune system’, because there is insufficient evidence to back such claims up at the moment. A healthy dose of skepticism is often helpful in nutritional science!

As Dr Alessio Fasano so neatly puts it, we can compare our current knowledge of the microbiota to our knowledge of space. We know the universe exists (our microbiota), and we are getting to grips with the fact the Milky Way is there (the major strains of bacteria), but we are far off knowing where London is! In other words, there is a lot of detail still to understand before we are able to fully utilize probiotics for health.

What about prebiotics – are they the same thing?

No. Prebiotics are a class of nutrients called ‘oligosaccharides’ (a type of fibre) which pass through the upper portion of the gut undigested, to feed and stimulate the growth of microbes further down. I think about it as nectar for gut bugs!

Types of prebiotic that are thought to influence the microbiota include (Tuohy et al., 2003);)

  • Inulin & Fructooligosaccharides – found in foods such as Jerusalem artichoke, asparagus, leeks, green bananas, chicory and onions (Sabater-Molina et al., 2009)
  • Lactulose
  • Galactooligosaccharides – found naturally in breast milk to help feed the microbiota of new born babies.

In general, a dose of more than 20g a day of all of these combined, may lead to unwanted side effects such as flatulence and bloating (Tuohy et al., 2003). I would therefore suggest it is a sensible idea to always ‘start low and go slow’ when introducing these to your diet.

As an added benefit, when our gut microbes break down these prebiotic fibres, especially inulin, they release a compound called butyric acid (Scott et al., 2013). This may be particularly important in gut health, as not only is it thought to be anti-inflammatory, but it also helps build up the gut defence barrier and decreases oxidative stress. Plus it might even help to signal to our brain that we are full and satisfied at the end of a meal (Hamer et al., 2007).

My pragmatic approach, if you are generally well, and would like to boost your probiotic and prebiotic intake, is to use foods first as much as possible.

In part 3 of this series,10 Ways to Help Support Gut Health, we will explore lots of practical ideas on how to do this.


Gut | Giulia Enders


The Joy of Healthy Eating | Amelia Freer


Eat Yourself Happy | Dr Megan Rossi


Be Good To Your Gut | Eve Kalinik


Smoky Pink Kraut | Eaten Alive


Organic Kefir | BioKef


Please note, this website uses some carefully selected affiliate links. If you buy through these links, we may earn an affiliate commission, at no additional cost to you. This helps to keep all of our online content free for everyone to access. Thank you.

Please note: This article is for information only and in no way replaces medical or personal nutrition advice. You should always speak to your healthcare provider in the first instance if you have any concerns whatsoever about your digestive or gut health. Please do not disregard or delay treatment based on anything you read on this website. I am not a doctor, nor am I your Nutritional Therapist. The information I share is very general and may not be relevant or appropriate for you as an individual.

References & Bibliography:

Hamer, H.M., Jonkers, D., Venema, K., Vanhoutvin, S., Troost, F.J. and Brummer, R.. (2007) ‘Review article: The role of butyrate on colonic function’, Alimentary Pharmacology & Therapeutics, 27(2), pp. 104–119. doi: 10.1111/j.1365-2036.2007.03562.x.

NHS Choices (2015) Probiotics – NHS choices. Available at: (Accessed: 11 December 2015).

Puupponen-Pimiä, R., Aura, A.., Oksman-Caldentey, K.., Myllärinen, P., Saarela, M., Mattila-Sandholm, T. and Poutanen, K. (2002) ‘Development of functional ingredients for gut health’, Trends in Food Science & Technology, 13(1), pp. 3–11. doi: 10.1016/s0924-2244(02)00020-1.

Sabater-Molina, M., Larqué, E., Torrella, F. and Zamora, S. (2009) ‘Dietary fructooligosaccharides and potential benefits on health’, Journal of Physiology and Biochemistry, 65(3), pp. 315–328. doi: 10.1007/bf03180584.

Scott, K.P., Martin, J.C., Duncan, S.H. and Flint, H.J. (2013) ‘Prebiotic stimulation of human colonic butyrate-producing bacteria and bifidobacteria, in vitro’, FEMS Microbiology Ecology, 87(1), pp. 30–40. doi: 10.1111/1574-6941.12186.

Tuohy, K.M., Probert, H.M., Smejkal, C.W. and Gibson, G.R. (2003) ‘Using probiotics and prebiotics to improve gut health’, Drug Discovery Today, 8(15), pp. 692–700. doi: 10.1016/s1359-6446(03)02746-6.

Photos by Darryl Leja

Gut Health, Part 1: The Basics of Gut Health

Gut Health, Part 1: The Basics of Gut Health

In the Autumn of 2020, I asked my lovely newsletter subscribers what they would like to see more of from me in the future. The overwhelming response was ‘gut health’.

So, in response I have given this gut health mini-series (originally written a few years ago) a real overhaul, updated it to meet my current practice and philosophy, and linked in all sorts of useful and relevant articles to expand on various topics. I’ve also added some of my favourite products and gut health books at the end of each section, in case you’d like a few of my personal recommendations.  I hope you find it helpful.

What do we mean by the ‘gut’?

The gut is a collection of organs, running from the mouth to the bowels, with help from the stomach, liver, pancreas and gallbladder along the way. All of these structures work together to extract the greatest amount of nutrition from whatever we choose to eat.

Alongside our digestive organs, we increasingly understand the powerful impact that our gut microbiota has on health. The microbiota consists of trillions of microbes (bacteria, yeast, funghi and viruses), which live inside our bowels, interacting not only with the food we eat, but also with each other and with us. Each microbiota is unique to each person.

When in harmonious balance, these microbes helpfully aid our digestion, make vitamins and other nutrients, break down dietary toxins, strengthen the body’s internal barrier against the contents of gut, prevent overgrowth of bacteria which can make us unwell, and can even influence our immune system and mood (Butel, 2014). But when out of balance, these microbes may also have the potential to negatively impact our health, too. I therefore now see the ‘gut’ not only as an organ system, but as an ecosystem too.

All sorts of factors may affect the composition and function of our microbiota, and therefore our gut health, including:

Hippocrates reportedly said that ‘all disease starts in the gut’. Clearly this isn’t true all of the time (take genetic disorders, for example), but a significant proportion of chronic diseases may indeed be linked to gut health. It has just taken medical science a few thousand years to catch up!

What is a healthy gut?

There is actually no specific definition of what makes a ‘healthy’ gut, because that depends so much on the individual.

But in general, I personally would consider a healthy gut to:

  1. Be free from persistent digestive symptoms (such as bloating, abdominal pain or disrupted bowel habits). We all get the odd mild symptom from time to time though, but when things change, are persistent, or show any worrying signs (see below) this should be flagged to your healthcare provider promptly.
  2. Eliminate regular, formed (but easily passed) stools*
  3. Allow complete digestion and absorption of nutrition. The average time for the entire process of digestion / absorption is 24 hours, although this does vary a lot between individuals.

* This little step, which wraps around your loo, helps your body adopt a physiological squatting position when opening your bowels which some people find beneficial with constipation.

What is an unhealthy gut?

There are certain unhealthy gut symptoms that are known as ‘red flags’. These are important warning signs that should be discussed with a doctor as soon as possible. Although some of them may represent a harmless condition that will settle itself, it is important if you have any of these symptoms to seek a medical opinion promptly.

These signs may include (note that this is absolutely not an exhaustive list – please speak to your GP if you have any concerns whatsoever about your gut health);

  • A sudden, persistent change your bowel habits
  • Any bleeding, or black, tarry stools
  • Persistent bloating
  • Increasing heartburn, indigestion or stomach pains
  • Abdominal pain
  • Losing weight unintentionally
  • Any difficulty or pain on swallowing

Within the scope of my nutritional practice, I would also look at all sorts of other symptoms (even if they are not necessarily directly related to the gut), such as skin, mood, energy, weight and more. There’s an old phrase in Nutritional Therapy that states ‘what happens in the gut doesn’t stay in the gut’, and so I do look beyond just digestive symptoms when talking with my clients.

How might gut health affect weight?

We know that our gut needs to be functioning effectively to be able to digest and absorb the nutrition that we are eating. If this function becomes impaired, it could potentially lead to both weight loss, and perhaps even weight gain.

Perhaps the most important question to ask is firstly whether there could be an underlying medical problem that is driving poor digestion? The best way to work out if this is a possibility is to speak to your doctor or other healthcare provider. Problems with maldigestion or malabsorption may lead to an unintended decrease in weight (although not always).

Once any medical concerns have been ruled out (if necessary), the next step would be a more comprehensive look at overall digestion, and to see whether there are any signs and symptoms gut inflammation or irritation. This is often highly variable between people, so again, I would suggest that you find a well-qualified Nutritional Therapist, Dietitian or Registered Nutritionist (see FAQs for more info) to help. There simply isn’t a one-size-fits-all approach to gut health, so this individualised support is very important.

There is also a lot of interest at the moment around the potential role of the gut microbiota in the development of obesity, and obesity-related diseases. Lots of this revolves around how certain microbes may potentially alter appetite, metabolic function and energy absorption by the body.

Unfortunately, we do not know enough about this topic yet to know which types of microbe could potentially help us to lose weight (or indeed, help us to gain weight). However, there are some promising studies emerging and research is certainly ongoing (Abenavoli et al.l, 2019, Kadooka et al., 2010)

Please click the links below for further related information;

Gut Health Part 2: Probiotics & Prebiotics in Gut Health

Gut Health Part 3: Ways to Support Gut Health

Eat More Fibre


Gut | Giulia Enders


The Joy of Healthy Eating | Amelia Freer


Eat Yourself Happy | Dr Megan Rossi


Be Good To Your Gut | Eve Kalinik


The Mind-Gut Connection | Emeran Mayer


Step Stool


Please note, this website uses some carefully selected affiliate links. If you buy through these links, we may earn an affiliate commission, at no additional cost to you. This helps to keep all of our online content free for everyone to access. Thank you.

Please note: This article is for information only and in no way replaces medical or personal nutrition advice. You should always speak to your healthcare provider in the first instance if you have any concerns whatsoever about your digestive or gut health. Please do not disregard or delay treatment based on anything you read on this website. I am not a doctor, nor am I your Nutritional Therapist. The information I share is very general and may not be relevant or appropriate for you as an individual.


Kadooka, Y., Sato, M., Imaizumi, K., Ogawa, A., Ikuyama, K., Akai, Y., Okano, M., Kagoshima, M. and Tsuchida, T. (2010) ‘Regulation of abdominal adiposity by probiotics (Lactobacillus gasseri SBT2055) in adults with obese tendencies in a randomized controlled trial’, European Journal of Clinical Nutrition, 64(6), pp. 636–643. doi: 10.1038/ejcn.2010.19.

Krajmalnik-Brown, R., Ilhan, Z.., Kang, D.. and DiBaise, J.K. (2012) ‘Effects of gut microbes on nutrient absorption and energy regulation’, Nutrition in Clinical Practice, 27(2), pp. 201–214. doi: 10.1177/0884533611436116.

Abenavoli, L.; Scarpellini, E.; Colica, C.; Boccuto, L.; Salehi, B.; Sharifi-Rad, J; Aiello, V.; Romano, B.; De Lorenzo, A.; Izzo, A.A.; Capasso,R. Gut Microbiota and Obesity: A Role for Probiotics. Nutrients 2019, 11, 2690.

Credit – top image:  Darryl Leya, National Institutes of Health (NIH)

Life as a Nutritional Therapist, Amelia Freer

Life as a Nutritional Therapist

life as a nutritional therapist

Life as a Nutritional Therapist, Amelia Freer

life as a nutritional therapist

One of the wonderful things about my profile as a nutritional therapist is that I get lots of budding nutritional therapists asking for advice. And of course I believe that there is plenty of room for more well-trained and enthusiastic nutritionists to help support a population which is suffering from an increasing number of diet-related diseases.

I receive many requests asking where to study, how to get started or those with an interest who are considering a new professional path. Regrettably I am unable to answer each individual request, so I have tried to answer all of the queries and share all that I think is necessary to consider and give you a little more insight into the reality of the vocation and lifestyle of nutritional professionals.

1: Get properly qualified

An online, or weekend course does not properly qualify you for this profession. Nutritional Therapy is a challenging profession that requires a huge amount of time and dedication. Working with an individual’s health, advising and supporting them appropriately needs to be managed responsibly. This is very different to running a glamorous blog! This is an industry that is now starting to achieve better recognition and hence regulation. Ensure that your course is recognised by The British Association for Applied Nutrition and Nutritional Therapy (BANT) ( which is the professional body for Registered Nutritional Therapists. Its primary function is to assist its members in attaining the highest standards of integrity, knowledge, competence and professional practice, in order to protect the client’s interests, nutritional therapy and the Registered Nutritional Therapist. BANT offers a wide range of benefits to students and full members and has its finger on the pulse for any changes or new developments within this dynamic profession.

I studied at The Institute for Optimum Nutrition ( and absolutely loved it. I have continued my education with The Institute for Optimum Nutrition ( I am not familiar with the other courses available having not done them and suggest you really research each one that is recognised by BANT in order to choose which one feels right for you and your professional goals.

2: Your qualification is just the beginning

The moment you complete your studies is the moment you really start learning as a nutritionist. You have the foundations to practice safely, but you will still need to learn on the job, make mistakes and gain in wisdom, experience and confidence. What works with one client won’t work with another. Gradually you will build up a set of skills, phrases and knowledge which will become your own personal toolbox.

3: Work with the mind as well as the body

You may have a million and one scientific facts up your sleeve about the dangers of eating sugar, but you also need the skills and ability to help support someone who is bingeing on ice cream every evening because they are depressed. The mind and the body are inextricably linked, and food is almost always attached to a great deal of emotion. Understand where your role lies here – it is not your job to ‘fix’ people – you are only part of the process. And be aware when and where is the right time to seek help from colleagues who may be more able to support your client (psychologists, counsellors, GP etc.) to resolve these issues. I have built my own “toolbox” of appropriate practitioners to refer my clients to so that they can get the help they need.

4: It’s not all about looks!

I would say that the majority of clients that seek out a nutritional therapist are not just looking to lose a few pounds. They often have complicated medical histories, multiple symptoms, exhaustion, allergies, take a cocktail of medicines or behavioural problems around food, and need careful and safe support to help them move towards a healthier place. If in doubt, ask for advice from a mentor or specialist, and don’t be afraid to work closely with the other health professionals involved in your clients care. The wider impact of your actions and advice always need to be carefully considered. The best thing about helping these types of clients however, is the hugely positive impact that nutritional changes can have – and the weight loss is just a lovely side effect!

5: Keep developing

Science keeps on moving forwards, and you need to keep up to date with the most relevant changes. Attending regular professional development seminars, workshops or lectures is vital to keep your knowledge current. There are lots of networks and associations for nutritional professionals that provide information about lectures, seminars and events. You can’t stop learning once you have your qualification, even if it has felt like a mammoth mountain to climb!

6: You will often be changing your mind

Following on from the last point, you may find that as your knowledge progresses over time, your views and opinions also change. For example, I used to advise my clients to snack regularly. Now I encourage them to just have three proper meals everyday. Don’t be afraid to hold your hands up every now and again and say ‘Hey, I want to change my mind!’. Be open minded to new developments. You could not have known what was not yet discovered. Don’t adopt a “my way or the highway” approach. Everyone is individual.

7: Be aware that you might need to ‘unlearn’ a few things

Of course, by this I don’t mean go and throw all your textbooks away, but what you need to know is far, far more detailed than what your client needs to know about nutrition. In fact, most clients are not really interested in the science or the facts – they want practical action steps. Bombarding them with all of your passionate knowledge can be overwhelmingly confusing and not attending to their needs. Learning how to make things simple, even when they’re complicated and hard, is a vital skill for a great nutritional therapist. Think about it like an iceberg – just give them the curated tip of your knowledge.

8: Balance

This is a hard one, because so many nutritional therapists are passionate about what they do, and so many clients become rather reliant on their nutritional therapists. But you need to create boundaries you are happy with right from the beginning. I assure you that you will have happier clients as a result! I leave work behind at 6pm and do not answer work emails at the weekends. I explain all of this at the beginning of my partnership with a client, so everyone is clear from the start. Have a think about what you’d like your boundaries to be and don’t be afraid to state them clearly to any new client.

9: Money…

This is a tricky one to tackle, but I think it is important. Nutritional therapy is not a lucrative business, and many friends and colleagues I know have really struggled to make ends meet. The successful and glamorous side of the field is very rare, and although there are opportunities (such as book deals, sponsorship, meal delivery services etc.) to make a good profit, it is hard from seeing clients alone. It is definitely more a vocation, something you do because you love doing it, than a profession to make a fortune in! However, it is still an important profession and it’s reputation must be protected and so you need to be professional and run your business efficiently, charging appropriately for your time. Free advice and free consultations puts the client in an awkward position.

10: Sometimes you’ll need to defend yourself

Often I have met people socially who (for some unknown reason), feel obliged to tell me that they think my job is ridiculous. That nutrition is just calories in vs. calories out and people just need to stop being lazy. Where are their manners?! I used to get cross with this, but now I don’t rise to it. Their ignorance is a shame, but it doesn’t need to upset me. The best tip here is just to let it go – for every rude dinner party bully, there are a hundred other people who are on board with your message.

Although, as with every job, nutritional therapy has its challenges, it is also a wonderful, exhilarating and very rewarding job. There is no greater feeling than helping someone win an inner battle they’ve been fighting and become a healthier, happier person. The field is rapidly expanding and becoming a more dynamic and exciting place to work and learn. And so enjoy the journey and ride the wave of knowledge as it sweeps and expands throughout the health care of the future.

Wishing you the very best of luck for your future career!


amelia freer

FdSc, Dip ION

What's Your Body Image?

what’s your body image?

With today’s cultural and technological appetites, especially for social media, we have laid sadly ourselves bare to the constant bombardment of staged and altered images of perceived beauty. For many, the relentless nature of it has become an assault on our rational minds. Selling the idea of physical perfection is now a multi billion-pound, 24/7 business.


We no longer serve as mere observers, we are now also participants, creating our own content or seeing ourselves recorded in the videos and photographs of others – it has become increasingly difficult to remain visually anonymous. It can feel as if the scrutiny and pressure is all-pervading; instead of relaxing and being present in the moment, we are worrying instead about how we look, how we will be recorded, and how many social media hits we’ll receive. These worries may be justified: many people now rely financially and professionally on their ability to promote an inspirational lifestyle (even traditional occupations command a headshot or visual representation) and the added pressure of a thousand anonymous eyes can sometimes feel overwhelming.

Away from our digital footprint, we are also open to the scrutiny of others ‘in the flesh’ so to speak – people we meet during our day, each of whom presents an opportunity for our natural curiosity of comparison to rear itself. “Does so-and-so look slimmer than me? Younger? How about their hair – is it better than mine? Oh, I wish I had their shoes…”. Much of this internal dialogue is so automatic that we are often barely conscious we are even doing it. And yet we may have been thinking that way for so many years that it has now become a deeply inherent daily habit.

Turning our attention inwards, the mirror is yet another cue for our automatic chatter to rev up uncontrollably. But, notably, have you ever taken a moment to pay attention to what it is you are actually saying to yourself? One day, write down these internal thoughts and statements, as once seen objectively in black and white, many people are taken aback by how unkind and derogatory they can be to themselves. Would you talk to friends like that? No! Furthermore, let me pose one further question: does it work? Do the constant negative comparisons, unpleasant comments to your reflection and the feelings of self-doubt empower you to lead a healthier, happier life? Again, no. I thought not!

So let’s explore the idea of body image a little deeper. With better, greater insightful understanding, can we afford ourselves a more positive, contented, kinder view of our incredible selves (for we are all incredible in different ways!)?

What is Body Image?

Body image is a subjective picture of one’s own physical appearance established both by self-observation (how we inherently feel about ourselves) and by noting the reactions of others (be that personal and/or cultural). It is a self imposed verdict of our own aesthetic born from past and present experiences, perceptions and beliefs – but, thankfully for those with a negative body image, it carries huge and positive scope for change.

How do you move towards a more positive body image?

If you feel your negative body image is significantly and detrimentally impacting your life, it may be sensible to seek out help. There is nothing at all to be ashamed of in recognising that your negative internal dialogue may be affecting your happiness, relationships and daily activities.  An element of support to break the cycle of negative thought would be a good thing, not only for you but also for those around you.

Blog Post: What’s Your Body Image?

What does a positive body image look and feel like?

I can hazard a guess that many of you understand what a poor body image feels like. But what about the flip-side?

Well, firstly, it is an honest, clear and true perception of your shape, without skewed perception or lens of negativity. Contrary to often popular belief, having a positive body image is neither a sign of arrogance, nor ignorance (of the things that we can do to keep ourselves healthy and optimally nourished – I say this as the media is too often scathing of women that defy the need to conform to what many regard as ideal body shape).

Next is a true appreciation of your natural body shape and a deeply held understanding that physical appearance is in no way a reflection of character, personality or value as a person. Sadly, this belief can be a hard one to shake. We are repeatedly conditioned by marketing and advertising to believe that skinnier, younger, wealthier, blonder etc. means better in some way. This message feels particularly strongly pushed toward women. But of course it is not true. When we actually stop to think about it, we all know this logically – there will be hundreds of people you look up to and feel inspired by, whose bodies do not conform to the marketer’s vision of what is ‘right’.

Outward appearance is only one minute part of what makes up a person’s contribution to this world, yet we often seem to be giving it the biggest chunk of our mental energy. Perhaps a little more balance, a little more focus on the other attributes we aspire to, may be a useful starting point. What would your chosen attributes be? How could you give them more of your conscious space?

Asking yourself these questions can be a truly beneficial exercise, which may then lead to healthy lifestyle changes started with all of the right motivations. All too often it is about shape or weight and not, as it should be, focused on the celebration of having a happy, healthy, well cared for body and soul. We are better placed to seek out healthy changes started with all of the right motivations. After all, it is far easier and more pleasurable to maintain new habits if started with a true desire to nurture optimal health than it is to maintain habits that are for the sole purpose of running away from self loathing. Losing weight is never the key to happiness or fulfilment. But promoting your thoughts into a more positive place, daring to show yourself some support and affection, and making changes because you genuinely feel that your mind and body deserve to be nourished wonderfully well – now, that may well be the magic bullet that you’ve been searching for. The foundation for all lasting physical change starts with psychological change.

Finally, a positive body image is one in which you feel comfortable, confident and grateful for your body. Out-loud gratitude can be a brilliant way to instantly disarm the perpetual cycle of negative, internal dialogue. Why not try, quite literally, to thank your body for legs that can walk, kidneys that don’t need dialysis, and eyes that can see vivid sunsets? It is, obviously, a slightly trite exercise and you may well be suffering from a body that doesn’t work as well as you’d like, but by focussing on the good things and remembering that not everyone is lucky enough to share them, you’ll seek out a new perspective that you may have struggled to find beforehand.

“and i said to my body. softly. ‘i want to be your friend.’ it took a long breath. and replied, ‘i have been waiting my whole life for this.’ ” – Nayyirah Waheed

Here are suggestions of other tips and tricks to think about:

Here are suggestions of other tips and tricks to think about:

1. Reduce the opportunity for comparison. Do you really need to check social media multiple times a day? Or continually compare yourself to contemporaries? It may help to temporarily suspend social media accounts to afford yourself space to invest in your body confidence.

2. Be kinder to yourself! If that sounds an impossible task, make it more achievable by being kinder at specific points in the day. For example, when getting dressed each morning, be more conscious of your internal dialogue and the moment you hear a negative thought, consciously say (in your head or out loud) “Be kinder!”. Practice this increasingly throughout your day and, soon enough, new connections will be made in your brain that break old, negative habits in place of new, positive ones.

3. Consider meditation. There is now a plethora of apps and programmes that offer beginner guides to meditation, some needing just a few moments a day to follow. Many focus on acceptance, compassion and gratitude, and these can be incredibly beneficial in allowing yourself the time and space to develop a more positive body image.

4. Explore mindful self-compassion. Unlike many self-esteem based exercises, mindful self-compassion avoids any external comparisons. It aims to teach you how to better manage feelings of inadequacy by learning how to respond with heightened kindness and understanding. It’s the practice of repeatedly evoking good-will toward ourselves especially when we’re suffering. There are books, online articles and courses around the UK which offer assistance with developing this powerful skill.

5. Write to yourself from the perspective of a wonderful, wise sage. Seek out a quiet, private moment and write a letter to yourself with the sentiments of someone who knows your innermost thoughts and anxieties and is present purely to be kind, reassuring and supportive. Imagine it was sent from a best friend or cherished relative. Use your imagination and don’t hold back because no one else need ever read it.

6. Make a list of all the wonderful things you feel nourished by – be that physical, emotional or spiritual. Grab some blank paper and your favourite pen and jot down the times when you feel especially nourished, loved and cared for. Be as specific as you can. Whenever you feel negative thoughts creeping back, refer back to this list to reinforce the feelings of love and completeness.

If you are struggling, try breaking it down into the following headings:

• Physical nourishment, for example: Walking on the beach with the wind in your hair; picking berries on a sunny afternoon; drinking iced mineral water to quench a real thirst.
• Emotional nourishment, for example: Watching a comedy that makes you laugh out loud; listening to much loved music; sharing old and happy memories.
• Spiritual nourishment, for example: 10 minutes of guided meditation; a peaceful walk alone in the woods with no distractions; taking a moment to just be still and listen to the birds.
• Social nourishment, for example: Cooking and sharing Sunday lunch with best friends; spending an evening with cherished friends; weekends away with family.
• Intellectual nourishment, for example: reading an interesting new book; taking a one-off evening class in something creative like pottery or floristry; attending a thought-provoking lecture.

7. Rewrite your story. We tell ourselves multiple stories about who we are and what we are capable of achieving. All too often these stories only serve to limit us: ‘I am too unfit to exercise. I will make a fool of myself’; or, ‘I will never lose weight. I am too busy and it’s never worked before. I don’t want to feel a failure again’. The good news is that once you have identified the counter-intuitive sentiments of your own dialogue, you can consciously start to re-write it: ‘My body is adaptable. If I take things slowly I will be able to work towards that 5K run’; or, ‘Everybody has the potential to lose weight. I will make gradual lifestyle tweaks, maybe just one a week, so that positive change is more achievable’.

Try answering the following questions:

• What are the limiting stories or beliefs you tell yourself?
• With no restrictions, how would you re-write those stories?
• What one small thing could you do today, if you were that person you want to become?

Body image is an intensely personal, intimate topic. If you are someone who experiences negative body image, I do hope this article resonates with you – in whole or in parts. The good news is that there are simple and achievable things you can do to help lift yourself out of the vicious cycle of negativity. Finding what works for you can not only lead to a happier, healthier perception of our uniquely wonderful bodies, but also potentially a happier, health life all around.

Thinking About: Oily Fish

thinking about:
oily fish

We have all seen the headlines that oily fish is apparently yet another ‘superfood’ and therefore something we should be including more of in our diets. But does the evidence support these claims? And if so, what types of oily fish should we be on the lookout for?

Examples of oily fish

Anchovies, Sardines, Pilchards, Herring, Mackerel, Trout, Salmon, Tuna (fresh tuna only)

  What actually is an oily fish?

Oily fish differ from white fish, aside from being darker and stronger in flavour, due to their higher ‘good’ fat content. One such family of ‘good’ fats, the omega-3 fats, are thought to be very important in maintaining our health and preventing ill-health. Oily fish is one of the key sources of omega-3 fats in our diets.

What actually is an oily fish?

Oily fish differ from white fish, aside from being darker and stronger in flavour, due to their higher ‘good’ fat content. One such family of ‘good’ fats, the omega-3 fats, are thought to be very important in maintaining our health and preventing ill-health. Oily fish is one of the key sources of omega-3 fats in our diets.

Examples of oily fish:

Anchovies, Sardines, Pilchards, Herring, Mackerel, Trout, Salmon, Tuna (fresh tuna only)

Can’t we get omega-3 from plant oils, like rapeseed?

Yes, and no. ‘Omega-3’  fatare actually a collection of different fats, which we get from various sources. But it is the long-chain omega-3 fats, known as ‘DHA’ & ‘EPA’ that have been associated with the majority of health benefits in clinical studies. These are mainly found in oily fish, fish oil supplements or some phytoplankton supplement.

Plant sources of omega-3, from walnuts or rapeseed oil for example, provide us with more of the short-chain omega-3 fatty acids. Unfortunately, our bodies are rather inefficient at converting these into the more biologically active long-chain DHA & EPA forms. So, at present, it’s generally considered best not to rely on plant sources as your only source of omega-3 fats. Vegans take note.

The potential benefits of oily fish & omega-3 oils

One of the key benefits of consuming oily fish is therefore thought to come from their high concentration of these omega-3 fatty acids – although they also contain a number of other beneficial nutrients too: protein, vitamin D, iodine, potassium, iron, zinc, selenium, B vitamins and even calcium in the smallest fish (where you eat the bones, such as anchovies & sardines).

Omega-3 fats have been linked to all sorts of potential health benefits. It is important to point out that many of these research findings have not been proven in large-scale population studies, and so may therefore not be applicable to everyone. However, they do give us some enticing hints to possible future uses.

Here are a few examples of current research areas:

  • They may potentially help to reduce blood triglycerides (Musa-Veloso et al., 2010), and blood pressure (Cabo, Alonso and Mata, 2012).
  • They may reduce the risk of stroke (Chowdhury et al., 2012)
  • EPA (one of the long-chain fish oils) could sometimes be beneficial to people diagnosed with major depression (Sarris et al., 2016).
  • They may help to promote optimal growth of the brain and eyes in developing infants when consumed during pregnancy, and may also reduce the risk of pre-term delivery for some babies (Jordan, 2010).
  • They could reduce the risk of autoimmune diabetes in adults (Lofvenborg et al., 2014), although there is no clear evidence that they reduce risk of the more common Type 2 diabetes.
  • They could reduce your risk of developing ‘wet’ macular degeneration (a major cause of adult blindness). (Rahu et al., 2008)

If you do choose to take omega-3 oil supplements, please do make sure it is a high quality form, and that you have discussed it with a healthcare professional

Baked Trout on a Bed of Vegetables

As with all things nutrition related, there is almost always a balance of positives and negatives to consider:

The potential downsides of oily fish 

Unfortunately, most fish and shellfish now contain some levels of pollutants or heavy metals such as PCBs or mercury. The larger oily fish, such as fresh tuna, can contain higher concentrations of these than the smaller fish (Chahid et al., 2014). This may be a concern if you eat a lot of fish, or eat mainly the largest types of fish – such as shark or marlin. Also, farmed fish may contain more pollutants, and less omega-3 fats, than wild or marine fish, although there are some examples of good practice in farmed fish production now (Rodriguez-Hernandez et al., 2017).

I would consider it sensible to therefore try to balance the benefits of eating oily fish (getting the omega-3 fats and other important nutrients) with the risks of eating too much (exposing yourself to an excess of pollutants or heavy metals).

In general, it is advised that this balance falls at around 1-2 portions of oily fish a week, ideally enjoying more of the smaller varieties (mackerel & sardines) than the larger ones (especially tuna): a portion is in the region of 140g, or 1 medium sized fillet (NHS Choices, 2017). You can also enjoy another 1-2 portions of white fish or seafood (i.e., not oily fish) on top of this per week.

A word on fish in pregnancy

Eating fish in pregnancy is good both for you, and for your baby (if you can stomach it!), and is therefore to be encouraged.

However, you can be a bit more vulnerable to the effects of pollutants during this important time, so the dietary advice is slightly different. This advice is also true for those who are considering pregnancy, or are trying to conceive, too.

  • Avoid shark, swordfish and marline altogether, and minimise your intake of fresh tuna. The largest types of fish such as these can contain high levels of mercury which can damage a baby’s developing nervous system.
  • Avoid all raw shellfish, such as oysters.
  • Eat no more than 1-2 portions of oily fish per week – so that means no more than 280g/week. Ideally, try to stick to smaller types; unsmoked mackerel (look in the freezer aisle), sardines in olive oil, and organic or wild salmon or trout.
  • Eat up to 1-2 portions of ‘other’ fish (such as white fish) or seafood products a week on top of this, such as canned tuna. NHS guidelines say no more than 4 cans of tuna a week, but I would suggest 2 cans per week is still a reasonable amount, particularly if you are having your oily fish as well. Eat a variety of fish wherever possible.
  • Be very careful if you are taking fish oil supplements during pregnancy. Some of these, such as cod liver oil, can contain high levels of vitamin A – which can be harmful to your unborn baby. Speak to your midwife or doctor for more information.

I would also generally advise that you follow the same advice for children.

For more information on fish in pregnancy:

A reassuring word in this complex area: It is considered better for you to eat a couple of portions of fish each week than to avoid it altogether due to anxiety regarding mercury or pollutants. The majority of the UK population does not consume enough oily fish to meet suggested dietary guidelines. In other words, be conscious of potential pollutants, but don’t let them put you off eating fish altogether.

Any advice about choosing sustainable oily fish?

Sometimes, it can seem like the more you know about nutrition, the more complicated it can be to decide what to eat. And then adding in environmental mindfulness to that equation can seem rather daunting. But there are lots of resources available to help you make these decisions, and once you’ve done it a couple of times it does get much simpler – I promise.

Intensive fishing and unsustainable farming practices are threatening our fish populations. Check out the Marine Conservation Society’s easy to use website to help guide the most sustainable seafood choices:

In general, I look out for either organic or wild fish whenever I can get hold of them.

A few of my preferred fish suppliers:

  • – responsible, eco-friendly farmed salmon from Scotland.
  • – ethical canned fish
  • – ethical canned tuna (I tend to just stick to the ones in spring water)
  • – mail order fresh fish from the traditional fishing port of Newlyn in Cornwall, packed in a leak-proof box with plenty of ice so it reaches you in great condition. You can phone or email them to arrange delivery of seasonal, wild fish to your preferences – or simply order one of their ready-made selection boxes.

Disclaimer: Please discuss this topic with your doctor or nutrition professional (visit my FAQ page for info) if you are interested in finding more information, or considering taking supplements. There are certain instances where increasing your intake of omega-3 fats is not advisable. As with all articles on, this is no substitution for individual medical or nutritional advice.

Cabo, J., Alonso, R. and Mata, P. (2012) ‘Omega-3 fatty acids and blood pressure’, British Journal of Nutrition, 107(S2), pp. S195–S200. doi: 10.1017/s0007114512001584.

Chahid, A., Hilali, M., Benlhachimi, A. and Bouzid, T. (2014) ‘Contents of cadmium, mercury and lead in fish from the Atlantic sea (Morocco) determined by atomic absorption spectrometry’, Food Chemistry, 147, pp. 357–360. doi: 10.1016/j.foodchem.2013.10.008.

Chowdhury, R., Stevens, S., Gorman, D., Pan, A., Warnakula, S. and Chowdhury, S. (2012) ‘Association between fish consumption, long chain omega 3 fatty acids, and risk of cerebrovascular disease: Systematic review and meta-analysis’, BMJ, 345(oct30 3), pp. e6698–e6698. doi: 10.1136/bmj.e6698.

Jordan, R.G. (2010) ‘Prenatal Omega-3 fatty acids: Review and recommendations’, Journal of Midwifery & Women’s Health, 55(6), pp. 520–528. doi: 10.1016/j.jmwh.2010.02.018.

Löfvenborg, J.E., Andersson, T., Carlsson, P.-O., Dorkhan, M., Groop, L., Martinell, M., Tuomi, T., Wolk, A. and Carlsson, S. (2014) ‘Fatty fish consumption and risk of latent autoimmune diabetes in adults’, Nutrition & Diabetes, 4(10), p. e139. doi: 10.1038/nutd.2014.36.

Musa-Veloso, K., Binns, M.A., Kocenas, A.C., Poon, T., Elliot, J.A., Rice, H., Oppedal-Olsen, H., Lloyd, H. and Lemke, S. (2010) ‘Long-chain omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid dose-dependently reduce fasting serum triglycerides’, Nutrition Reviews, 68(3), pp. 155 167. doi: 10.1111/j.1753-4887.2010.00272.x.

NHS Choices (2017) Fish and shellfish. Available at: (Accessed: 3 February 2017).

Rahu, M., Chakravarthy, U., Young, I., Vioque, J., de Jong, P.T. and Bentham, G. (2008) ‘Oily fish consumption, dietary docosahexaenoic acid and eicosapentaenoic acid intakes, and associations with neovascular age-related macular degeneration’, The American Journal of Clinical Nutrition, 88(2), pp. 398–406.

Rodríguez-Hernández, Á., Camacho, M., Henríquez-Hernández, L.A., Boada, L.D., Valerón, P.F. and Zaccaroni, A. (2017) ‘Comparative study of the intake of toxic persistent and semi persistent pollutants through the consumption of fish and seafood from two modes of production (wild-caught and farmed)’, Science of The Total Environment, 575, pp. 919–931. doi: 10.1016/j.scitotenv.2016.09.142.

Sarris, J., Murphy, J., Mischoulon, D., Papakostas, G.I., Fava, M. and Berk, M. (2016) ‘Adjunctive Nutraceuticals for depression: A systematic review and Meta-Analyses’, American Journal of Psychiatry, , p. appi.ajp.2016.1. doi: 10.1176/appi.ajp.2016.15091228.