She Followed her ‘Gut’ Instinct
May 17, 2017

Firstly, tell us a little about your background — where are you from and where did you study?
My father is a Colonel in the Indian Army, a 1971 Indo-Pak war veteran, and my mother, an economist and a celebrated army wife. Our roots are from Coorg, Karnataka. Growing up as an army officer’s daughter, made me appreciate my country, accept her people’s diversity, and rely on myself. I was schooled at varied convents and Army Public Schools across Indian states. My professional qualifications include a BSc Honors degree in Dietetics from Mount Carmel College, Bengalore, a MSc degree in Nutrition from VHD Central Institute & Research Center, Bangalore and a MBA in Marketing from Welingkar Institute of Management. A self-made person, by God’s grace, I’ve been a recipient of much appreciation for my work. The most recent one was being featured by Karnataka.com, as one of the notable personalities of the state.
How did you get drawn towards the field of nutrition — what sparked your interest in the area?
I’m in general a STEM person, and in particular, a science fan girl.As a 18-year-old exercising her choice of a first degree, the B.Sc. Honors in Clinical Nutrition and Dietetics, piqued my curiosity as opposed to, say a B.Pharm or B.Sc. Microbiology. I was also sold on the novelty of the field, and of a degree which was not common place i.e. it was not the traditional choice for people in my generation. The fact that it meshed well with my innate desire to do something with healing, sealed my decision.
From being someone who consults for disorders like obesity or PCOD, what made you shift to consulting for rare and challenging diseases?
In India, the science of Nutrition and Dietetics in private practice and hospital care settings, has not evolved beyond Basic Diets i.e. diets for better known disorders like obesity, underweight, hypothyroidism, PCOS, diabetes mellitus, hypertension, hypercholesterolemia. The reason these diets are “Basic” is, (a) most are taught at an early stage to B.Sc. Dietetics students (in the 1st year itself, especially, the diet for obesity) (b) the skill-set needed to plan these diets is not as challenging as planning one for a disease like phenylketonuria or refractory pediatric epilepsy.
When I started private practice in 2008, my website and practice was tailored around Basic Diets. Over time, everything about it felt run-of-the-mill and done and dusted. I decided I need challenges. I had also understood that the upper limit of my abilities cannot be merely making people lose weight. After all, I didn’t have to acquire two degrees, and study Nutrition & Dietetics for five years just to plan diets for obesity– anyone with a Certificate/Diploma in Nutrition can do that.
I then explored the advancement levels of my field in both, private practice and hospital care settings, in countries like USA, Canada, Australia, UK via a LinkedIn networking group I created for professionals from my field (https://www.linkedin.com/groups/166730/profile). What I found was quite interesting. Private practices abroad have not upped their game, for they too are oriented around Basic Diets, but the nutrition and dietetics protocol in hospital care settings and government and research organizations is advanced. I interacted with a NASA dietitian who plans diets for astronauts to mitigate bone loss during prolonged space stay. Yet another is specialized in neo-natal dietetic care. This got me thinking. I realized only 25% of the nutrition and dietetics field was being translated into private practice. There were diets which never made it to a college syllabus owing to their complexity. For instance, no one taught me the diet for Glycogen Storage Disease, but an evidence-based diet for the disease exists in my field’s knowledge bank. I decided to harness these complex diets and not let their technicality or difficulty levels stand in my way. Patients needed these (diets), and if no one else wants to or can do it, let me be the one to take it to them.
Presently, I am the only bona fide clinical dietitian in the country who handles complex diet management for rare and challenging diseases, like phenylketonuria, systemic lupus, refractory pediatric epilepsy, Sjögren’s Syndrome and others. I coined the term “rare and challenging diseases” and also the term “better known disorders” to differentiate my work, from others. I intend to create a new extensive website this year, to showcase my work and the diets which patients need but were deprived of so far. The older/present website will remain online as an archive of the stage of my career I have left behind.
I am in no way undermining the Indian education system here. I’ve studied in almost every state in India, from J&K to West Bengal. Our institutes, syllabi and academicians were excellent. If they were not, I would not have been where I am today. Global Thought Leadership consultancies like WPP, Kantar Futures, Futures Group, bank on my advice to help their clients shape their future strategies for the Indian health/nutrition/diet market. This wouldn’t have happened if our education system, which produced me, was not competent.
With regards to chronic, invisible illnesses like autoimmune disorders or chronic pain/ intestinal conditions, how important is diet to improve the body and mind?
Every disorder, save a mere handful, is invisible to an outsider . In many conditions, dietary management is the primary treatment e.g. diseases of amino acid metabolism (phenylketonuria, maple syrup urine disease), conditions of the small intestine (short bowel syndrome), autoimmune disorders (Sjogrens syndrome). One cannot rely or use pharmacotherapy gainfully in such patients. In certain other diseases (e.g. cancer, HIV+ status, AIDS) diet management has to be deployed in tandem with pharmacotherapy e.g. unless the dietary management of a patient with Kaposi’s sarcoma–an opportunistic infection seen in AIDS patients–is in place to handle symptoms like inability to chew, diarrhoea, nausea, weight loss, fever, continuing with HAART (a drug therapy specific for the virus) has no meaning, as a patient with such an infection has a compromised nutrition status, and this always spells poor recovery, pharmacotherapy or not. Thus, the importance of diet management for a patient recovery depends on the disease in question. Depending on the disease it may play a primary or secondary role.

It is said that gut health has a huge role to play when it comes to chronic/autoimmune conditions. Can you elaborate on this?
The human gut is a key location of the human microbiota, or the symbiotic microbial cells which colonize the human body. These microbial cells in particular, the bacterial ones, are very sensitive to our diet–food, water, alcohol, medications, anything we eat or drink–and in turn, influence the human health via the human microbiome (the combined gene pool of these microbial cells). To elaborate, each change in our diet is accompanied by changes in our gut microbiota, which is followed by the strengthening or weakening of corresponding genes (microbiome) e.g. when an infant begins to receive a full adult diet, genes in her microbiome associated with vitamin biosynthesis and carbohydrate digestion became strengthened. The key point here, is that our diet in conjunction with our microbiota is constantly influencing our microbiome.Also, the ratio of microbial cells to human cells in our body is almost 1:1, and sometimes, 10:1 . They outnumber us and hence they are influential.Keeping this information as a base, it’s not difficult to understand why the health of the human microbiota is found to overarch all aspects of human health, including autoimmune conditions and psychological conditions like depression.
As someone who has won various accolades and awards for your contribution to the field, what keeps you going?
I feel the greatest need to change stereotyping and misconceptions of my field and this is one of things which keeps me motivated.
To clear the air about one stereotype — my profession is not cosmetic. It’s not about appearances (of the dietitian or her client). It’s not candy floss. It’s not about a XYZ dietitian helping a celebrity client lose weight (Note: the obesity diet being hyped here is a Basic Diet). My profession is about dietitians who plan diets for a burn victim in a hospital ward by keeping in mind factors like the “total surface area of the body burnt” or “fluid lost via the open burn wound”, or dietitians who manage the nutrition of a pre-term infant.
I also wish to clear the misconception that as nutrition and dietetic students, all we were taught is the nutrition profile of all the foods known to mankind. As a student, I was never asked to learn “Why is mango/apple/carrot/rice healthy?” or write about “The health benefits of eating oats”. I studied Nutritional Biochemistry, Food Microbiology, Research Methods, Chemistry, Medical Physiology, Food Science, Entrepreneurship, etc along with Nutrition and Dietetics. It’s quite ridiculous how the Indian population is fed articles on “Why to eat a Mango” come summer, and “Why to eat ghee” come winter. It’s time we grew up and evolved from kindergarten-nutrition and grocery-list-nutrition.

When it comes to treating chronic/invisible illness, research being done is not enough in a country like India — do you agree and if so, what kind of change would you like to see the field?
Yes, I do agree about the lack of research.I would love to see investments into research, and organizations, where the role of nutrition and diet management as a (a) primary (b) palliative © ancillary, mode of treatment (along with pharmacotherapy) of invisible illnesses is highlighted. It’s also important to use IEC channels to make the public understand that nutrition and dietetics is an offshoot of allopathy and aligns itself with principles of allopathy alone. It’s not complementary to ayurveda/naturopathy/herbalism/holistic nutrition/macrobiotics. One cannot call oneself a dietitian but give advice based on ayurvedic principles of “kapha vata pita”. Doing so is merely an exploitation of the dietitian title owing to its greater patient acceptance.
Nutrition and dietetic professionals are paramedicals and one needs a BSc or MSc degree in dietetics (key word: dietetics) to plan any diet, including that for obesity. This academic differentiation too needs to be highlighted, for protection of patients from fraud.
On a personal note, how do you like to spend your time when not working?
I love the visual arts, nature, animals, writing, architecture, and books. Any activity connected to these helps me unwind. I try to preserves nuggets of my very small community of Kodavas, online, for posterity, and have put together blogs/social media pages about Kodava jewellery , Vintage Photos of Coorg and the Kodava Ancestral Homes It’s the least I can do to make up for the fact that I never grew up in Kodagu)
Author : Ikyatha Yerasala
Ikyatha Yerasala is a consulting correspondent who brings with her a varied experience in interviewing some very interesting people — from sports stars to actors and artistes. A true blue Bangalorean, she’s passionate about women’s rights, music, cricket, movies and rasagullas. She hopes to see more research focusing on invisible illnesses.
