Mike Stroud: exploring nutrition at the limits of endurance

Abstract

“I am really just a jobbing gastroenterologist”, proclaims Mike Stroud, a touch modestly, when we speak at his office at the University of Southampton, UK. Stroud has spent his career in various areas of internal medicine, and is a leading light in malnutrition and intestinal failure. His deep interest in malnutrition stems from his belief that this aspect of care is often looked after poorly by health professionals, especially doctors. “Obesity is high profile these days, but there is very poor awareness among doctors of the other end of the spectrum: undernutrition and starvation”, he says. His youthful passion for rock climbing could have taken him towards a career in geology, but a gap year before university introduced Stroud to the hospital environment; first after he became injured during a rugby match, and later during work as a hospital porter. These experiences were transformative. Stroud qualified from St George's medical school, London, in 1979. “If I could be a medical officer on overseas expeditions, so much the better”, he says. Stroud's dream of working in extreme medicine was first realised when he joined the 1980-81 British Antarctic Survey as a medical officer. While in Antarctica, he met Robert Swan, who later invited him to join the 1984–86 In the Footsteps of Scott expedition. It was on later trip where Stroud, tackling frostbite in temperatures below −60°C, started his now well-known work assessing bodyweight changes and energy expenditure in the context of extreme exercise. “On this expedition I calculated that daily expenditures when manhauling sledges were around 6500 calories”, he recalls, “though this paled into insignificance with the energy output we later used in other polar expeditions”. Turning his thoughts towards a medical registrar job, Stroud received a call from the celebrated explorer Sir Ranulph Fiennes, who Swan recommended should approach Stroud to join an expedition to the North Pole. “It was daunting and exciting to be asked to join Fiennes”, Stroud recalls, in what were eventually five unsuccessful attempts to walk unsupported to the North Pole. After the first failed North Pole venture in 1986, and still unsure of his path in medicine, Stroud joined the Institute for Aviation Medicine and later the Army Personnel Research Establishment in Farnborough, UK, where he eventually became head of a department investigating human environmental exposure, endurance, and nutrition. These full-time posts gave Stroud the opportunity to continue his own nutrition and energy research on further polar expeditions with Fiennes, including their completion of the first unsupported walk across Antarctica in the 1992–93 expedition, where their daily energy expenditures sometimes exceeded 11 500 kcal/day. A year later Stroud received an OBE for human endurance and services to charity, in recognition of the millions of pounds that his and Fiennes' polar expeditions had raised for the Multiple Sclerosis Society. Stroud moved to the Institute of Human Nutrition at Southampton University in 1995, which created a post of Research Fellow in Clinical Nutrition for him. He soon became fascinated by gastroenterology, and was promoted to senior registrar “where I was taught endoscopy by my registrar—an unconventional way to proceed in medicine”, he recalls dryly. Stroud was then made a senior lecturer and honorary gastroenterology consultant, but, enjoying clinical work so much, had to relinquish some academic interests in nutrition to focus on what he does now: luminal gastroenterology, from a nutritional perspective. He is clear about how social deprivation and chronic illness often lead to poor nutrition. “Being undernourished leaves people vulnerable to disease”, he says, “and having disease leaves people vulnerable to undernutrition, a true vicious cycle”. He has contributed to the formulation of the MARSIPAN guidelines, to help manage patients with eating disorders. Additionally, he has worked closely with respiratory physicians on the management of patients with chronic obstructive pulmonary disease, and colleagues in renal medicine who look after patients who are often malnourished. He is currently president of the British Association of Parenteral and Enteral Nutrition (BAPEN), a UK charity which campaigns for better understanding of nutrition within the health-care community. Stroud's other main area of interest concerns the management of intravenous fluids and electrolytes. “It seems to be everyone's task, and nobody's responsibility”, he says. “It is not taught well at medical school, yet is probably the most important task that junior doctors have to do when they start on the wards.” This interest resulted in Stroud chairing a NICE guideline committee to improve intravenous management within the UK's NHS. Approaching 60 years of age, Stroud plans to reduce his heavy clinical workload to undertake new adventurous pursuits—mainly hill and mountain climbing, and sea kayaking—with his wife Thea. “Thea has always been fantastically supportive over the years, having joined in many of my expeditions”, he says. “If we stay healthy, plenty more expeditions lie ahead and, based on knowledge gained from my life in medicine and research on human endurance and performance, I am hopeful that age should not be too much of a barrier.”