Dietary decisions and neurological conditions

What does a neurological specialist dietician do?
19 March 2021

Interview with 

Rebecca McManamon, dietician


photo of a man smelling some pasta


There are many ways that a dietician might be support someone with a neurological condition. There are the complex neurological pathways involved in coordinating chewing and swallowing, and texture alterations that can be made to make ingestion easier and safer if someone is finding the mechanics of eating difficult due to a nervous system problem. There are the muscles involved in picking up food, dealing with changes to senses of taste and smell, there are the psychological factors around food, recognising hunger and remembering to eat, as well as weight management in some cases. Katie Haylor spoke to Rebecca McManamon  - a neurological specialist dietician and formerly policy officer for the Neurosciences Group of the British Dietetic Association...

Rebecca - For example progressive neurological conditions, things like motor neuron disease, tend to happen later in life, but they can affect people in their twenties, thirties, forties. Regretfully, there isn't a medical cure or definitive treatment for those conditions. So the aims of our treatment are slightly different. It's around supporting their quality of life and what's important to them. So it's a different kind of science. It's the science of marrying goals - what's important to them, talking about the medical impact of what can be quite invasive treatments like having a feeding tube placed. And that can then be further complicated by, for example, if their lung capacity has already been impaired by the motor neuron disease, they may have to have their tube inserted in a radiological way, rather than having a camera or an endoscope down their throat.

So there's so many different factors we need to think about. For some people, food is an incredibly important part of their lives and it's something that is shared with their friends and with their family. But for others, it may be less important. They may be quite happy to receive all of their nutrition in an artificial way so that they can go and spend more time outdoors or spend more time with their family doing other activities. So it's a very, very personal type of treatment. But we're not necessarily treating to cure a condition, but rather to improve their quality of life. But that can very well mean preventing infections, preventing pressure ulcers that can occur if somebody is not able to ingest all the nutrition they need.

So it's quite different to maybe how we may treat someone who acquires a brain injury, perhaps in childhood or in adolescence. Their brain is still developing, at the same time as there having been an injury. So it's quite complicated. There's a lot more potential for them to rehabilitate as much as possible. And again, their nutrition makes a difference. Should they gain too much weight, that could be a barrier to their physical health improving. Should they not grow, should they not be reaching the milestones we expect them to meet, that could be problematic for their future. And then nutrition is quite key there. The type of their overall diet, for example, a Mediterranean diet that has lots of fruits and vegetables that has very little processed meat, that may contain some amounts of oily fish that provide omega 3 for example. That kind of a dietary pattern, whole grain foods, again, rather than processed foods, may very well help with the recovery. But also thinking about long-term prevention because regretfully there can be further injury in the future. So someone who sustains a brain injury is at increased risk of other neurological conditions, like a brain injury related dementia in the future.

Katie - It's really interesting you mentioned the Mediterranean diet because generally, as much as you can generalise with nutrition, a Mediterranean diet is probably a good idea for most people, regardless of whether you have a neurological condition or not. Is that right?

Rebecca - That's fair to say. There's a lot of research that this kind of pattern of eating is beneficial for heart health, for depression, so it can help with so many aspects of one's health. And I guess it's just thinking that where you have sustained a condition where it may benefit you further. So there could be an inflammatory process that's there where you've sustained a neurological injury and that therefore has an impact that you would perhaps get more benefit from it than someone without any medical condition. But it's a good pattern of eating for many people.

But I guess it also leads on to thinking about our gut and the bacteria that live within our gut. And there's a huge amount of research that's going on globally around the gut microbiome. So the community that is living within our guts. And that feeding that community so that perhaps the more beneficial bacteria thrive, which may include some of those aspects of the Mediterranean diet, but not exclusively that, but particularly a lot of those elements. The diversity of what we eat impacting the diversity of our gut bacteria could impact our neurological pathways and that communication between our gut and our brain. There's some interesting research going on here in the UK around Parkinson's Disease. So it's really fascinating.


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