Nutrition & Diet

What our nutrition and dietetics unit covers — and who it is for

Clinical dietetics is the medical use of food. It is not weight-loss coaching, it is not wellness, and almost none of it is about eating less — a substantial share of the work here is getting enough into people who cannot eat, or removing one specific component from a diet for a specific medical reason.

That distinction matters because the internet has almost entirely colonised the word nutrition, and most of what is sold under it — detox regimens, IgG food intolerance panels, superfood claims, elimination diets adopted without a diagnosis — is either useless or actively harmful. A hospital dietetics unit spends real time undoing that, and what follows is written accordingly: it says what is supported, what is not, and where the honest answer is that nobody knows.

At Acıbadem International the work is organised into six strands.

• Nutritional assessment — identifying who is malnourished or at risk, which is a measurement rather than an impression and is missed in hospitals everywhere.
• Therapeutic diets — the specific modifications prescribed for a specific condition or procedure, from a low residue diet before a colonoscopy to a low oxalate diet after kidney stones.
• Texture and swallowing — modified consistency for people who cannot swallow safely, which is a safety intervention rather than a preference.
• Artificial nutrition — feeding through a tube or a vein when the gut cannot be used normally, and the complications that follow if it is started carelessly.
• Nutrition in disease — cancer, kidney disease, liver disease, diabetes, inflammatory bowel disease and the perioperative period, delivered with the specialty concerned.
• Correcting misinformation — which is not a side activity here but a significant part of the consultation.

Where the borders sit. Diets built around weight-loss surgery — the pre-operative liver-shrinking diet and the staged post-operative progression — belong with bariatric and metabolic surgery, which covers them in full. The renal diet in chronic kidney disease belongs with nephrology. Low FODMAP and the medical management of irritable bowel syndrome and coeliac (celiac) disease belong with gastroenterology; this unit delivers the dietary side of both. Insulin and glucose-lowering medication belong with endocrinology.

Dietitian and nutritionist — what the words mean

A dietitian is a regulated healthcare professional qualified to assess nutritional status and prescribe therapeutic diets, including for people who are acutely unwell, and is the only nutrition profession that can do so in a hospital. The registered dietitian vs nutritionist question comes up constantly and the answer differs by country, but the pattern is consistent: the dietitian title is legally protected and tied to a defined qualification and registration, while nutritionist frequently is not — in many countries anyone may use it.

That is not a status argument. It matters because the advice that follows differs in kind: prescribing a modified-texture diet for someone at risk of aspiration, calculating an enteral feed for a patient in intensive care, or managing refeeding risk in a severely malnourished person are clinical acts with consequences, and they are not opinions about food. When you are choosing whom to see, the useful question is what qualification and registration they hold, and it is entirely reasonable to ask.

Our team is dietetics rather than medicine: the clinicians listed further down are dietitians, working alongside the doctors of the specialty involved rather than in place of them. Prescribing and diagnosis remain with the treating physician.

Nutritional assessment and malnutrition

Malnutrition in hospital patients is common, measurably worsens outcomes — longer stays, more infections, poorer wound healing, higher readmission — and is missed routinely, because it does not look like the images the word evokes. A person with obesity can be severely malnourished, and frequently is.

Screening is therefore systematic rather than by eye. Validated tools such as the MUST score combine body mass index, unintentional weight loss over three to six months, and the effect of acute illness on intake, producing a risk category that triggers a full assessment. That assessment goes further than weight: dietary intake history, gastrointestinal symptoms, functional status, and physical examination for muscle and fat loss.

Handgrip strength is worth naming because it is quick, cheap and more informative than most of what surrounds it — grip correlates with total muscle function and falls before weight does, which makes it an early signal and a practical way to track whether an intervention is working. Bioelectrical impedance analysis estimates body composition and is useful for following a trend in one person over time; its absolute numbers are affected by hydration and should not be over-read, and the body-fat percentage printed by a consumer scale is not a clinical measurement.

Sarcopenia — loss of muscle mass and strength with age or illness — is the outcome all of this is trying to prevent. It is diagnosed by strength and function rather than by weight, it accelerates during any period of bed rest, and the response is protein intake distributed across the day combined with resistance exercise. Neither works well without the other, and the exercise half is arranged with rehabilitation.

The therapeutic diets, and what each is actually for

These are prescriptions rather than lifestyles. Each has a defined indication, a defined duration, and a defined point at which it stops — and the commonest harm in this area is a temporary diet that nobody ever discontinued.

Low residue diet

A low residue diet restricts fibre and other components that increase stool bulk, reducing the volume and frequency of stools and the amount of material left in the bowel. It is used before colonoscopy and some bowel imaging, during acute flares of inflammatory bowel disease and diverticulitis, in bowel obstruction or narrowing, after bowel surgery, and during pelvic radiotherapy.

Practically it means limiting wholegrains, raw fruit and vegetables, nuts, seeds, skins, pulses and tough meat, while allowing refined grains, well-cooked vegetables without skins, tender protein and most dairy. The low residue diet foods lists circulating online vary enormously and many are wrong in the direction that matters — because the point is not fibre alone but the total residue reaching the colon.

The critical thing about it is that it is temporary. It is nutritionally incomplete over time, it reduces the diversity of the gut microbiome, and long-term unsupervised use causes its own problems. A low residue diet without a stop date, or without a plan for reintroducing fibre gradually afterwards, is a prescription half-written — and reintroduction is where a dietitian earns their place, because patients who felt better on it are frequently reluctant to return to normal food and need it done in a structured way.

Clear liquid diet, full liquid diet, pureed diet and soft food diet

These form a progression rather than a set of alternatives, and knowing which rung a patient is on prevents both premature advancement and being left on a rung far longer than intended.

A clear liquid diet allows only fluids you can see through — water, clear broth, strained juice without pulp, gelatine, black tea and coffee. It is used before procedures, immediately after some operations, and during acute gastrointestinal illness. It provides almost no protein and very few calories, and it is safe for a day or two and inadequate beyond that.

A full liquid diet adds anything liquid at room temperature including milk, cream soups, yoghurt drinks and nutritional supplements. It can be made nutritionally adequate, which the clear liquid stage cannot, and it is the rung where oral nutritional supplements start to matter.

A pureed diet has a smooth, uniform consistency with no lumps and holds its shape on a spoon. A soft food diet allows food that is naturally soft or has been cooked and cut to require minimal chewing. Both are used after oral, dental and some gastrointestinal surgery, and in people with chewing difficulty — and both are where food most often becomes unappetising, which matters because a nutritionally correct diet that nobody eats is not a diet.

Bland diet

A bland diet avoids foods that irritate the gastrointestinal tract mechanically or chemically — spicy, acidic, high-fat and heavily seasoned foods, alcohol, caffeine — and is used during gastritis, peptic ulcer, reflux flares and after some procedures. The honest note is that evidence for blanket bland dietary restriction in reflux is weaker than its popularity suggests: individual trigger identification works better than a general restriction list, and treating reflux with diet alone while ignoring the medical management is not a plan.

Dysphagia diet and the texture modified diet

A dysphagia diet is a safety intervention rather than a comfort measure. When swallowing is impaired — after stroke, in Parkinson disease and motor neurone disease, after head and neck cancer treatment, with advanced dementia — food and fluid can enter the airway, and aspiration pneumonia is a leading cause of death in these groups.

A texture modified diet works by slowing the bolus and making it more cohesive, and it is prescribed after a swallowing assessment by a speech and language therapist rather than assumed. The IDDSI framework standardises this internationally with numbered levels from thin liquid through to regular food, replacing the incompatible local terminologies that used to make a patient moving between hospitals genuinely unsafe. If you are travelling with a person on modified texture, the IDDSI level is the single most useful thing to know and to carry in writing.

Two honest points. Thickened fluids reduce aspiration but also reduce how much people drink, so dehydration is a real trade-off and is monitored rather than ignored. And in advanced dementia, texture modification and tube feeding have not been shown to prolong life or prevent aspiration pneumonia, so the conversation shifts towards careful hand feeding and comfort — a discussion held early, with the family, rather than at a crisis.

The IBS diet, FODMAP and the gut

IBS diet management is where dietetics has the strongest evidence in gastroenterology, and where it is most often done badly by self-direction. The low FODMAP approach restricts fermentable carbohydrates and improves symptoms in a majority of people with irritable bowel syndrome — but it is a three-phase protocol, not a permanent diet: strict restriction for a limited period, then systematic reintroduction to identify which groups actually matter for that person, then long-term personalisation with the fewest possible restrictions.

Almost everyone who does it alone stops after phase one. That is the failure mode, and it is not trivial: prolonged restriction reduces microbiome diversity, restricts calcium and fibre intake, and turns a manageable condition into a socially isolating one. The medical diagnosis and management of IBS sit with gastroenterology; the dietary protocol sits here, and the reintroduction phase is the part worth paying for.

A SIBO diet is frequently requested and deserves a careful answer. Small intestinal bacterial overgrowth is a real condition, its diagnosis by breath testing is imperfect and over-applied, and the dietary approaches promoted for it are less well supported than the antibiotic treatment. Where an underlying cause exists — previous surgery, motility disorder, structural abnormality — treating that matters more than the diet.

An elimination diet is a diagnostic tool with a defined structure: remove a suspected component completely for a defined period, then reintroduce it deliberately and observe. Without the reintroduction it proves nothing, and open-ended elimination on suspicion is how people arrive here eating fifteen foods with no diagnosis. In children this is done with particular care, because unnecessary restriction affects growth.

Food intolerance testing — the honest answer

Food intolerance test is one of the highest-volume searches in this field and the answer is uncomfortable. The commercially marketed IgG antibody panels — the ones offering to test dozens or hundreds of foods from a finger-prick sample — are not supported as diagnostic tests. IgG antibodies to food indicate exposure rather than intolerance, and healthy people without symptoms have them to the foods they eat regularly. Major allergy and immunology societies advise against their use, and the practical harm is not the cost but the outcome: a long list of foods to avoid, unnecessary restriction, and a genuine diagnosis missed while the person believes they have an answer.

What is legitimate: skin prick and specific IgE testing for true food allergy, interpreted alongside the clinical history and arranged with allergy assessment; hydrogen breath testing for lactose and fructose malabsorption; coeliac serology performed while gluten is still being eaten; and a supervised structured elimination and reintroduction, which remains the reference method for identifying food intolerance. That last one is slower and less satisfying than a test, and it is what actually works.

Coeliac disease and the gluten free diet

A gluten free diet is the only treatment for coeliac disease and is lifelong and absolute — not a reduction. The order of events matters more than anything else here: coeliac testing must be done while gluten is still being eaten, because stopping first makes both the serology and the biopsy unreliable and the person then faces a gluten challenge, reintroducing gluten for weeks while feeling unwell, simply to get a diagnosis they could have had. Do not start a gluten free diet before testing.

Non-coeliac gluten sensitivity is real for some people, less well defined, and does not require the same absolute avoidance. And a gluten free diet adopted without coeliac disease is not automatically healthier: gluten free processed products are often lower in fibre and higher in sugar and fat, and unsupervised avoidance commonly reduces fibre, iron and B vitamin intake.

Low oxalate diet, low purine diet and the kidney

A low oxalate diet reduces dietary oxalate to lower the risk of recurrent calcium oxalate kidney stones, and it is one of the most frequently misapplied diets in this list. Three points change the advice substantially. Fluid volume matters more than oxalate — achieving a sustained high urine output is the single most effective preventive measure and it is what most stone formers actually need. Calcium should not be restricted, and restricting it makes stones more likely rather than less, because dietary calcium binds oxalate in the gut and prevents its absorption; the correct advice is normal calcium taken with meals. And oxalate restriction is directed at the genuinely high-oxalate foods rather than at everything, because the lists circulating online are long enough to make eating impossible for a benefit that only applies to some stone formers. A 24-hour urine collection identifies who actually needs it, and that assessment sits with urology and nephrology.

A low purine diet reduces the intake of purines that are metabolised to uric acid, and it is used in gout. The honest framing is that diet alone rarely controls gout: the reduction in serum urate achievable by diet is modest compared with what urate-lowering medication achieves, and a patient told to fix gout with diet while medication is withheld is being under-treated. What diet does do is reduce attack frequency at the margins — limiting alcohol, particularly beer, and sugar-sweetened drinks high in fructose matters more than avoiding lentils. The medical management sits with rheumatology.

Nutrition in chronic kidney disease — potassium, phosphate, protein and fluid — is delivered here and directed by nephrology, which covers the renal diet in full, including the point that restricting potassium is done on measured blood results rather than pre-emptively, and that the foods restricted are not the ones most lists suggest.

A low iodine diet is short, specific and easy to get wrong. It is used for a defined period before radioiodine treatment or a diagnostic scan for thyroid cancer, to deplete the thyroid of iodine so that the radioactive dose is taken up efficiently. It is not a long-term diet and it is not a thyroid treatment: outside that specific preparation window it has no role, and the main practical difficulty is that iodised salt, dairy, seafood, egg yolk and many processed foods all contribute. It is planned with nuclear medicine and started on their schedule rather than early.

Nutrition in diabetes

There is no single diabetic diet, and saying so is the starting point. What the evidence supports is a range of approaches — Mediterranean, low carbohydrate, plant-based, calorie-controlled — with the strongest predictor of success being whether the person can sustain it rather than which one it is. That is a genuinely different conversation from the one most people arrive expecting.

Three practical tools do most of the work. Carbohydrate awareness — knowing which foods raise glucose and roughly how much — matters more than counting anything precisely for most people with type 2 diabetes, while carbohydrate counting is essential for those on multiple daily insulin doses. The plate method is the simplest structure that works: half the plate non-starchy vegetables, a quarter protein, a quarter carbohydrate, and it requires no numeracy or app. And distribution across the day, rather than total alone, changes glucose patterns substantially.

Two things are worth stating plainly. Weight reduction in type 2 diabetes can produce remission in a meaningful proportion of people, particularly within a few years of diagnosis and with substantial weight loss — that is real and is discussed as a goal rather than a fantasy, without promising it to anyone. And glucose-lowering medication, insulin dosing and the newer weight-affecting drugs are prescribed and adjusted by endocrinology; a diet that changes intake substantially requires the medication to be reviewed at the same time, and doing one without the other is how hypoglycaemia happens.

Nutrition in cancer

Nutrition in cancer is where the gap between what patients are told online and what actually helps is widest, and where the harm from the former is greatest.

Cancer cachexia is a metabolic syndrome of the disease itself — inflammation-driven loss of muscle with or without fat loss — and it is not simply undereating. That distinction has a direct consequence: it cannot be reversed by calories alone, and telling a family to feed harder produces distress on both sides without changing the outcome. Management combines nutritional support with treatment of the underlying disease, symptom control, and resistance exercise where possible, and it works best when started early rather than when the weight loss is already advanced.

The practical problems during treatment are usually symptoms rather than appetite in the abstract: taste changes that make familiar food repellent, mucositis making the mouth too painful to eat, nausea, early satiety, and altered bowel function. Each has specific approaches, and addressing the symptom is more effective than urging the food.

A neutropenic diet — restricting fresh fruit, vegetables, and uncooked foods during periods of low white cell count — is worth a plain answer because it is still widely applied. It has not been shown to reduce infection, and it restricts intake precisely when intake matters most. Standard food safety practice is what is supported. Where a unit still applies it, that is a local protocol rather than an evidence-based requirement, and it is reasonable to ask.

Two further honest statements. No diet has been shown to starve a tumour, and restrictive regimens promoted for that purpose — including sugar avoidance framed as starving cancer cells — cause weight loss in people who cannot afford it. And high-dose supplements and herbal preparations are not neutral during treatment: several interact with chemotherapy and some antioxidants may interfere with treatments that work by oxidative damage, so everything being taken is disclosed to the treating team. This work is shared with medical oncology and radiation oncology.

Tube feeding: enteral nutrition

Enteral nutrition delivers liquid feed directly into the gastrointestinal tract when someone cannot eat enough by mouth but the gut works. The governing principle is simple and old: if the gut works, use it. Enteral feeding preserves the gut barrier, carries far fewer complications than feeding into a vein, and costs a fraction as much.

The route depends on the expected duration. A nasogastric tube through the nose is appropriate for short-term feeding measured in weeks; nasogastric tube feeding is uncomfortable, easily displaced, and requires position confirmation before every feed, because a misplaced tube delivering feed into the lung is one of the most serious avoidable events in this field. For longer-term feeding a gastrostomy is placed directly through the abdominal wall — PEG tube feeding — endoscopically, radiologically or surgically. A jejunostomy feeds beyond the stomach and is used where the stomach cannot be used or where aspiration risk is high.

The decision to place a long-term feeding tube is a bigger conversation than the procedure, and it is held properly here rather than in passing. It is straightforward in someone with a mechanical obstruction, a head and neck cancer during treatment, or a recovering stroke with a good prognosis. It is far less straightforward in advanced dementia and in progressive terminal illness, where tube feeding has not been shown to prolong survival, prevent aspiration pneumonia or improve pressure sores — and where the honest discussion, held early with the family, is worth more than the tube.

Enteral formula selection depends on calorie and protein needs, fluid allowance, fibre requirement, and whether the gut absorbs normally. Blenderized tube feeding — real food blended and delivered through the tube — has grown in popularity, has genuine advantages in tolerance and family involvement, and requires careful attention to hygiene, consistency and nutritional adequacy; it is supported here where the tube is suitable rather than dismissed. Regardless of route or formula, the tube site, tolerance, bowel function and biochemistry are monitored on a schedule rather than reviewed when something goes wrong.

Feeding into a vein: parenteral nutrition

Parenteral nutrition delivers nutrition intravenously, bypassing the gut entirely, and it is used only when the gut cannot be used or cannot absorb: short bowel syndrome, prolonged obstruction, high-output fistula, severe malabsorption, and periods after major abdominal surgery where enteral feeding is not possible.

It is not simply feeding by another route. It carries a specific complication profile — line infection, which is the main one and which is prevented by insertion and care practice rather than by antibiotics; liver dysfunction with prolonged use; metabolic and electrolyte disturbance; and thrombosis of the vein. It requires a dedicated line, sterile handling, and biochemical monitoring on a schedule.

Home parenteral nutrition allows people with intestinal failure to live outside hospital for years, and it is one of the more remarkable things modern medicine does quietly. It also requires a level of training, support and vigilance that is easy to underestimate, and it is arranged with the surgical and gastroenterology teams rather than by dietetics alone.

Refeeding syndrome

Refeeding syndrome is the reason severely malnourished people are fed slowly rather than generously, and it is counter-intuitive enough that it is worth explaining. In prolonged starvation the body shifts to fat metabolism and intracellular stores of phosphate, potassium and magnesium become depleted even while blood levels look normal. Reintroducing carbohydrate triggers insulin release, which drives those electrolytes rapidly into cells — producing a fall in serum phosphate that can cause cardiac arrhythmia, respiratory failure, seizures and death.

The people at risk are identifiable in advance: very low body mass index, minimal intake for days, significant unintentional weight loss, alcohol dependence, and low electrolytes before feeding begins. In those people feeding starts at a reduced rate and is increased gradually, thiamine and micronutrients are given before or with the first feed, and electrolytes are measured and corrected daily during the first days. Refeeding risk is assessed before anyone is fed, which is exactly why a nutrition referral in a severely malnourished patient is urgent rather than routine — and why enthusiastic feeding by well-meaning relatives is discouraged in that specific situation.

Nutrition around an operation

Two changes in perioperative nutrition have reversed long-standing practice and both are worth knowing before surgery.

Prolonged fasting before an operation is unnecessary and harmful. Current guidance permits clear fluids until two hours before anaesthesia in most patients, and carbohydrate loading — a specific drink taken the evening before and two hours before surgery — reduces insulin resistance, thirst, anxiety and post-operative nausea, and shortens recovery. Being starved from midnight for an afternoon list is a tradition rather than a safety measure in most cases, though the decision belongs to the anaesthetist with anesthesiology and there are specific situations where longer fasting is required.

Afterwards, early feeding is better than waiting for bowel sounds. Enhanced recovery protocols reintroduce oral intake within hours of most abdominal surgery, and it is associated with fewer complications and shorter stays. This is delivered with general surgery, where enhanced recovery is covered in full.

Before major surgery, four to six weeks of nutritional optimisation in a malnourished patient measurably reduces complications, and immunonutrition — formulas enriched with specific amino acids and fatty acids — has evidence in major gastrointestinal cancer surgery. As with stopping smoking, that period is treatment rather than delay.

The metabolic and specialist diets

A PKU diet is the clearest example of food as medicine. In phenylketonuria the amino acid phenylalanine cannot be metabolised and accumulates, causing irreversible neurological damage — and the entire treatment is a lifelong diet severely restricted in natural protein, supplemented with a phenylalanine-free amino acid formula that supplies everything else. Newborn screening identifies it before damage occurs, which is why the programme exists, and lifelong dietetic supervision with blood monitoring is not optional. It is managed with medical genetics and pediatrics.

The ketogenic diet for epilepsy is a medical treatment rather than the popular weight-loss version, and the two are not the same thing. It is used in drug-resistant epilepsy, particularly in children and in specific syndromes, reduces seizure frequency in a meaningful proportion, and requires precise ratios, supplementation and monitoring for growth, lipids, kidney stones and acidosis. It is initiated and supervised jointly with neurology, and attempting it without that supervision in a child with epilepsy is not a small thing.

Other conditions where diet is the treatment rather than an adjunct include galactosaemia, urea cycle disorders, glycogen storage diseases and other inherited metabolic conditions, all managed with metabolic and genetic services. What they share is that the diet is not negotiable, is calculated rather than advised, and requires the supervision of someone who does it regularly.

Weight management, honestly

A weight management program that works looks different from what is marketed. Four things are true simultaneously and are usually presented one at a time.

Sustained weight loss through diet and activity alone is achievable and is achieved by a minority over years — that is a statement about biology rather than about willpower, because the body defends its weight through hormonal and metabolic adaptation that persists long after the diet ends. Structured programmes with regular contact outperform advice given once, and frequency of contact predicts outcome more than the content of the diet. Weight-affecting medication has changed what is possible for many people and belongs with endocrinology, with the honest note that weight returns when it stops. And surgery remains the most effective intervention for sustained loss in people who qualify, delivered by bariatric and metabolic surgery, where the diets specific to it are covered in full.

What we will not do is prescribe a very low calorie regimen without supervision, promise a rate of loss, sell a programme to someone whose weight is not the problem they came with, or treat the number on the scale as the only outcome — because improvements in glucose, blood pressure, lipids, sleep apnoea, joint pain and fitness occur with modest weight loss and matter more than the figure.

What this unit will not do

• Order an IgG food intolerance panel. IgG to food indicates exposure rather than intolerance, healthy people have it to what they eat, and the major allergy societies advise against these tests. The harm is not the cost — it is a long list of foods avoided and a real diagnosis missed.
• Recommend a detox. The liver and kidneys already do this, continuously, and no commercial regimen improves on them. Where a product claims to remove unnamed toxins, there is nothing to measure and nothing to verify.
• Start a gluten free diet before coeliac testing. Doing so makes both the blood test and the biopsy unreliable and forces a gluten challenge later. Test first.
• Restrict calcium in a stone former. It increases stone risk rather than reducing it, and it remains one of the most persistent pieces of wrong advice in this area.
• Leave a temporary diet running. Low residue, clear liquid, elimination and low iodine diets all have a stop date, and a diet without one is a prescription half-written.
• Tell a family with cancer cachexia to feed harder. It is a metabolic syndrome of the disease rather than undereating, and it cannot be reversed by calories alone. Saying that clearly spares everyone a great deal.
• Feed a severely malnourished person quickly. Refeeding syndrome kills, and the response to starvation is careful, monitored feeding rather than generous feeding.
• Promise a rate of weight loss. Or treat the number on the scale as the only outcome worth having.

Your multidisciplinary team

The clinical dietitian assesses nutritional status, calculates requirements, prescribes the therapeutic diet or the feed, and monitors the response — and in a hospital that is a clinical role with defined competencies rather than dietary advice. Our team is dietetics rather than medicine: diagnosis and prescribing remain with the treating physician, and the dietitian works alongside them.

The speech and language therapist assesses swallowing and sets the texture level, and no modified-texture diet is prescribed without that assessment. The nutrition support team — dietitian, pharmacist, nurse and physician together — manages artificial nutrition, and the pharmacist’s role in parenteral nutrition compounding and stability is the part nobody sees. The specialist nurse manages feeding tubes and lines and does the training that determines whether home feeding succeeds.

Around them: gastroenterology for coeliac disease, IBS, inflammatory bowel disease and tube placement, endocrinology for diabetes and obesity medication, nephrology for the renal diet, medical oncology and radiation oncology for nutrition during cancer treatment, general surgery for perioperative nutrition and enhanced recovery, bariatric surgery for weight-loss surgery diets, pediatrics for faltering growth and paediatric feeding, neurology for the ketogenic diet and for swallowing after stroke, nuclear medicine for low iodine preparation, medical genetics for inherited metabolic disease, and rehabilitation for the exercise half of sarcopenia treatment.

The international patient journey

Dietetics travels differently again, because most of it is teaching rather than doing, and teaching transfers across a video call better than most clinical work.

The first pattern is a remote consultation and plan — a therapeutic diet explained, calculated and written out, with follow-up to adjust it. This works well for IBS reintroduction, coeliac disease, stone prevention, diabetes and general nutritional support, and it needs a three to seven day food record kept honestly rather than aspirationally, recent blood results, current medicines and supplements including everything bought without prescription, and an accurate current weight with any recent change.

The second is dietetics attached to a procedure or admission here: preoperative optimisation and carbohydrate loading, the postoperative progression through texture stages, feeding during cancer treatment, or setting up tube feeding before discharge. This is arranged as part of the episode rather than requested separately, and the discharge plan states the feed, the rate, the monitoring schedule and who reviews it at home.

The third is setting up long-term artificial nutrition, which requires more planning than anything else this unit arranges. Formula availability differs between countries and the exact product may not exist where you live, so the plan specifies the nutritional specification rather than a brand name; consumables, pump compatibility and who supplies them are settled before discharge rather than after; and a named clinician at home takes over the monitoring.

Two practical notes. Bring the food record written as the week actually was — a record adjusted to look sensible removes the entire value of the exercise, and nobody here is judging it. And bring the supplements, physically or photographed with the label: doses and interactions matter, particularly during cancer treatment and around surgery, and the label is the only reliable source of what is actually in them.