By Joanna Teece
Dietitian, NHS Fife
Over a sunny summer bank holiday weekend Janet was diagnosed with ovarian cancer. She was a fantastic cook and had a real thirst for life and fun. She was also a close relative. Sadly her story did not have a happy ending but it often reminds me why, as a Dietitian our role in disease and diet is so important.
Ovarian cancer is the 5th most common cancer among women and last year 7,100 people were diagnosed. There are a few main symptoms of ovarian cancer:
- Increased abdominal size and persistent bloating (not bloating that comes and goes),
- Persistent pelvic and abdominal pain, and
- Difficulty eating or feeling full quickly
- Needing to wee more urgently or more often than usual
Occasionally there can be other symptoms such as changes in bowel habits, extreme fatigue (feeling very tired), unexplained weight loss or loss of appetite. Any post-menopausal bleeding should always be investigated by a GP [1].
After hearing of Janet’s diagnosis a previous conversation about her starting a gluten free diet vividly hit me. She had found she was getting bloated and had read about gluten free diets thinking it might help. This bloating was a classic symptom of ovarian cancer but sadly we as a family, the health professionals she saw, or Janet never made the connection.
With my dietetic hat on, I remember mumbling to the family that she should really be encouraged to see the GP, as you should only need to follow a gluten free diet if you have coeliac diease or dermatitis herpetiformis. Looking back, perhaps I should have got on my soap box and ranted a bit louder that following a gluten free diet for any other reason will not benefit your health. I didn’t, but now is my chance! So I will say it again, gluten free diets should only be advocated for medical reasons such as coeliac disease and dermatitis herpetiformis.
A gluten free diet is also not the same as a wheat free diet. Coeliac disease is an auto-immune condition where the body’s immune system attacks its own tissues. The reaction is triggered by gluten. Gluten is a protein found in wheat, barley and rye. When people with Coeliac Disease eat gluten, an immune reaction occurs. This damages the small bowel by causing inflammation of the gut lining. Following a strict gluten free diet for life is essential for their long term health. Despite this, and judging by the range of products I’ve spotted creeping onto the supermarket shelves which exclude sugar, wheat and gluten, these diets seems to become more mainstream each day. I guess I may need to shout a bit louder from my soapbox!
Although this story doesn’t have a happy ending, I am proud that later on when she was admitted to hospital over another bank holiday weekend with severe stomach pains and blockage of her bowel, I was able to help. Janet had not seen a Dietitian during her admission. She went home and was living on custard as she had no idea what the ‘low residue, high protein diet’ that she was advised to eat involved, or why it was needed. I was able to explain to her that the idea was to prevent her bowel becoming blocked again and to also improve her overall nutrition. I sent her some practical information and she was delighted that she could expand her repertoire beyond custard 3 times a day. She e-mailed;
“Thank you so very very much for sorting out the diet info. It’s really comprehensive and is just what I wanted! Can you believe that in a large hospital someone else couldn’t have pulled up something similar from a NHS site? Anyway – won’t stop now”.
Dietitians are experts at translating complex nutritional and medical information into practical dietary advice. I am very glad I was able to use these skills to improve Janet’s enjoyment of food butsaddened that I didn’t shout louder at the beginning.
So before I finish here is one final reminder, the signs of ovarian cancer can be:
- Increased abdominal size and persistent bloating (not bloating that comes and goes),
- Persistent pelvic and abdominal pain, and
- Difficulty eating or feeling full quickly
- Needing to wee more urgently or more often than usual [1]
Bloating does not mean you should start a gluten free, wheat free or dairy free diet. Your first step should be to seek advice from a health professional.
Gluten free diets should only be advocated for medical reasons such as coeliac disease and dermatitis herpetiformis.
A gluten free diet is not the same as a wheat free diet.
Always Trust a Dietitian to know about nutrition!
References
AHPs across health and social care. 
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