Our interview with Dr James Stewart

Dr James Stewart is the Clinical Lead for Adult Nutrition at University Hospitals of Leicester. He is the person behind the popular twitter page ‘Nutrition Doc’ @Leicnut and was recently awarded the Complete Nutrition ‘Social Media Personality of the Year’ Award. We caught up with him to find out more about his career and his social media work to combat nutritional myths… 


1. Can you tell us about your career path, and how you got to your current position as Clinical Lead for Adult Nutrition?

I’ve always had an interest in nutrition. I remember as a kid reading the back of the cereal packet and wondering at all the vitamins and minerals. As a registrar I was fortunate enough to be taught nutrition by Dr Jeremy Nightingale in Leicester and this fostered even more curiosity. As a registrar I started to run the nutrition teams at various hospitals and when I was appointed a consultant it coincided with Dr Nightingale moving to St Marks so I took over from him. At that time the unit was quite small but over the years I have developed it into one of the largest clinical nutrition teams in the country.


2. What lead to your clinical interest in Inflammatory Bowel Disease (IBD) and nutrition? As a specialist in IBD, you will be aware that patients often seek nutritional strategies to manage their symptoms. Often this advice doesn’t come from reliable sources, and they may receive information telling them to avoid entire food groups or specific foods – what are your views on this? 

See the answer to question one! A lot of clinical nutrition is dealing with the very severe end of IBD when the intestines have failed entirely hence the two go naturally hand-in-hand. There is a huge amount of misinformation around about nutrition generally and this seeps into the world of IBD. This is really worrying as the evidence currently around IBD and nutrition is fairly small. I think it’s important to try and debunk this wherever possible and this is one of my drivers for being on social media.


3. Why is nutrition education and support to patients pre- and post- surgery so important? How can good nutrition make a difference to post-surgery outcomes?   

Nutrition is a vital and often overlooked aspect of the management of all illnesses. In the case of surgical patients nutritional optimisation as part of prehabilitation can make a real difference to reducing intra-operative risks and enhancing post-op recovery. Attention to nutrition in the post-operative phase especially for those who’ve undergone emergency surgery can also enhance and reduce recovery time.


4. You sit in many committees including the Patient Safety Committee of the Royal College of Physicians, Clinical Standards and Services Committee and the Small Bowel and Nutrition Committee of the British Society of Gastroenterology. What do you enjoy the most about the additional responsibilities these roles involve taking on? 

It’s great to meet people from other parts of the country and different specialties and realise that we’re all battling with the same clinical and political problems. I’ve always been interested in patient safety and it’s interesting to hear about issues both within my own and other specialties.


5. What does a typical working day look like for you? 

Varied! Usually a combination of clinics, ward work and management issues. I have a large cohort of patients on Home Parenteral Nutrition (HPN) and these can keep me busy too. I enjoy clinics the most as they can be a big challenge especially with respect to the nutritional issues and the HPN patients.


6. Alongside your clinical commitments, you also teach nutrition to undergraduate medical students at Leicester Medical School – what do you enjoy most about this? 

Interesting question.  I guess it’s re-educating the students from a quite basic level to start with (proteins, carbohydrates and fats) and gradually leading them through nutrition right up to parenteral nutrition. I’m also interested when they challenge me with nutrition myths they have picked up. It can be quite hard to dissuade them otherwise!


7. Congratulations on winning the Complete Nutrition ‘Social Media Personality of the Year’ Award – why did you set up your ‘Nutrition Doc’ twitter account and what is the current aim of the account? How do you find the time to be so active on Twitter alongside other work commitments? 

Thank you! I set it up initially as a simple feedback mechanism for medical students but gradually realised there was a lot of misinformation on Twitter and it might be useful to try and correct some of it.  It also struck me as a useful place to talk about the more technical stuff that might be of interest to trainees and other consultants. I only ever put out short tweets (never threads which I think are boring) so finding time isn’t too difficult. 


8. Nowadays there are many gut health books out there which claim to provide a solution for the perfect diet to getting a healthy gut. What are your thoughts on these? 

I despise these with a passion. They often exploit the vulnerable and are full of inaccuracies. There is no one diet for all and to say otherwise is unadulterated quackery. Looking at the established nutrition science whilst keeping an eye on our mental wellbeing I personally think we should all eat more fruit and vegetables, a little less red meat, and have the occasional treat.


9. If you could give one tip to aspiring students, what would it be?

Read the whole of Sherlock Holmes. He was the ultimate detective and his techniques will arm you with superb diagnostic tools. In particular read about the ‘dog that didn’t bark’; this will remind you that what isn’t there is as important as what is.


10. Can you leave us with one interesting fact about yourself?

I’m happiest when driving my Landrover Defender.