Dietetics

[SweetHeart]

Soapbox moment, sorry.

Agghhhhhhhh! Just spent huge amounts of money on hospital parking charges, were kept waiting for three quarters of an hour (not good with someone who can't sit/stand for long) only to see the same dietician that MH bumped into last Thursday on his Living with Diabetes education day.

We gave her all of Xyzzy's print outs and she put them straight into the waste paper basket in front of us. She will not admit that MH's progress - low BGs, weight loss, lower BP - is anything whatsoever to do with cutting carbs. She is insistent that he should be eating large amounts of carbs three times a day with snack-sized amounts in between meals. She's had a fit when cheese and cream were mentioned, another hissy when we said not a lot of fruit was eaten (veg doesn't count for nutrition apparently) and another fit when we said we now buy whole milk. At first she said the difference was negligible between whole and semi skimmed, but contradicted herself in the next sentence.

I was most annoyed when she had a go at him about his weight - he's put on half a stone since last Thursday!! Well, no he hasn't. Last week you took his weight from his records (weighed in the bathroom naked) today you weighed him wearing all of his clothes, his walking boots, his field jacket, wallet, watch etc etc so of course he weighs considerably more.

The biggest bugbear is "you're doing so well but not because of anything you've done diet-wise" (I knew that magic wand would work!) :***: :crazy: :eh: roblem: :lol:

Ju

 

[tree-peony]

Strewth!

another candidate for a swift whack on the shins (I think we should all start carrying hockey sticks!)

 

[Defren]

So maddening isn't it Jules? Honestly, ignore her, you and hubby know because you are living it, the diet you have chosen does work, we all do. I do wonder if she will remove the papers from the bin after you have gone! The standard of care across the UK is in the main very sadly lacking, apart from very small oasis's of sanity. If a few Doctors can be enlightened enough to see the benefits from a low carb diet, why can't they all. Or, why can't we as patients do what we feel is working for us without the criticism? This is a side of the NHS I really don't like.

 

[SweetHeart]

It is soooo frustrating. We feel that all we have achieved this morning is keeping the dietician in a job - our attendance has justified her existence even though, in our case, she was next to useless.

I even pointed out that it's the first time I've lost weight in over ten years - low carbing is the only way for me with the Hypothyroidism. She thinks I've only lost weight through stress over my husband's diabetes because it was, more than likely, my cooking that has caused him to be a diabetic. I don't think so, thank you very much, cheeky besom.

She definitely had a degree in stonewalling.

Ju

 

[Sanober]

I so want to revert to sweary words here. She sounds like a nasty nasty person.

Incidently, is she slim?

 

[SweetHeart]

I so want to revert to sweary words here. She sounds like a nasty nasty person.

Incidently, is she slim?

No, she was about 5ft4" and was at least a size 18 dress size. Of course, she might have a genuine reason for being clinically obese, but it doesn't inspire confidence in her advice - even though she didn't give us much.

We were frustrated because she simply could not see that we are both doing well with a low carb diet. We can accept that it isn't for everyone, she cannot accept that it might be for some people.

Ju

 

[borofergie]

It's a bankrupt profession. The worst thing is that these people are university educated (for three years apparently), but instead of being encouraged to apply any sort of independent thought they are obviously encouraged to just to pump out the same old incorrect dogmatic nonsense, no matter what the needs of the patient are.

I'm sure that there are some good ones somewhere, but the fact that we here reports again and again and again of so called "dieticians" and "nutritionists" discouraging diabetics from following carbohydrate diets makes me very frustrated and sad.

You should make a formal complaint about the big tossing incident.

 

[jopar]

Can I ask you several questions

Exactly how many carbs was she telling your husband to eat in his meals?

And What Exactly did she consider to be the a Snack Size carb amount?

As it's very important to clarify the exact amounts, because say is large to most other people is snack size or small meal size!

As to his weight, they will always take the weight of their scales, two reasons behind this, first one being their scales are regularly checked and calibrated so consider correct, home scales may not.. The other main reason being, that our weight fluctuates slightly throughout the day and from day to day. so dependant at what time of day etc a home weighing information has the possibility to distort the picture!

One average your cloths, shoes etc only add on 4LB on your weight...

Admittedly yes I have dealt with quite a few dieticians, but in the main it's been on a professional bases, only limited concerning my own diabetes... But there again I'm lucky not to have weight issues to tackle so in 23 years of diabetes, dealt with the dietician around 10 times (and spent a week with them on the DAFNE course) but they've always been positive about what I eat being balanced then do the but side of things..

The Buts are

I should be changing my Full Milked, to Skimmed or at least semi-skimmed yulk..
I should stop roasting my taddies in Beef dripping, should dry roast them or at least use Sunflower oil..
Avoid Fry Up's, if I must then grill all, dry fry the eggs and toast the bread... It's not a fry up

I just smile sweetly, so I think about it :roll:


The only time I've been told by a dietician to eat an certain amount of carbs, was at the very beginning when T1's regime was 2 injections a day, a a regular intake of carbs.. Both prescribed, she decided on 180g's to start which just too much food, within a week it was down to 130g's of carbs, even then it was too much and I struggled..

But if you found her to be rude, then complain there's no excuse for being rude to people, you can do this by either writing to the department head or via the hospital PAL's service..

Or if you feel that seeing her is both a waste of time for your husband, and herself then decline any further appointments...

 

[claymic]

i had a dietician's appointment on Tuesday - did not say anything about it because it upset me and guess what!! caused me to binge the last two days on blo**dy carbs!!

anyway, she was nice enough but i still felt like a total loser and highly embarrassed trying to explain to someone who probably was just under or close to my age why at 33 i still cant control my food.
i told her that i only lose weight when i control my carbohydrates and i see improvements in bg's..... - well she did not say outright no but out came the diet plate :roll:

and she kepts saying...well surely you can eat 2 slices of bread......surely you can eat 1/3 of a plate of pasta or rice....and i was like...nope...not according to my meter....

i even mentioned the Newcastle diet and she was ..we are not endorsing it yet....finally she gave me the updated versioni of the diabetes uk nutrition book....no change there! and when she asked me if i wanted another appointment i said no....

*and breathe nowwwww*

 

[borofergie]

One average your cloths, shoes etc only add on 4LB on your weight...

Well that depends on how much clothing you had on doesn't it?

The fact that a so called trained dietician thinks that it is physically possible for someone to put on half a stone in fat in the course of a week beggars belief.

To attempt such a feat, Ju's hubby would have to be consuming of order 6000kcal per day while lying in bed. It isn't physically of practically possible, and any intelligent person would think "there is something else I'm not accounting for here", most a likely a combination of:
1) the difference between a clothed and naked reading
2) the difference between two sets of scales
3) the natural 4-5lb fluctuation in body weight that we all go through on a daily basis.

 

[librarising]

Sweetheart wrote :

We were frustrated because she simply could not see that we are both doing well with a low carb diet. We can accept that it isn't for everyone, she cannot accept that it might be for some people.

It's been in the news about paying teachers for results.
Well what about dieticians and DSNs ?
They might start paying attention to who gets the results and how.

Do I really believe that ? I know I want to :roll: :roll:

Geoff

 

[SweetHeart]

Can I ask you several questions

Exactly how many carbs was she telling your husband to eat in his meals? For his size (6ft 2") she was recommending portion sizes of 75g uncooked rice/pasta and at least 225 gm potatoes - probably a fair amount of carbs in there. No butter, stick to margarine. Three or four slices of bread - any variety not necessarily low GI.

And What Exactly did she consider to be the a Snack Size carb amount? Now this she mentioned by carbs - 15 to 20g carbs is an acceptable snack

One average your cloths, shoes etc only add on 4LB on your weight... We've stripped him & weighed his clothes for today; jeans, rugby shirt, t-shirt, underwear, socks, walking boots, tweed field jacket, wallet and divers watch weighed just under 12lbs on an accurate fishing scale. By why use our scales one week and hers the next? Next to her scales there was a sign on the wall saying not to move these scales out of the tape-marked square on the floor as they had been calibrated to that spot on the floor. So she moved them.....

Or if you feel that seeing her is both a waste of time for your husband, and herself then decline any further appointments...we did so and were told is isn't our decision. Cue polite smile and MH saying he begs to differ!

 

[xyzzy]

Hey Ju

Well I'd go back one more time. Take the same printouts and when she puts them in the bin just walk over and take them out again, put them on her desk, tell her to her face how rude and childish she is and that you will be writing a letter of complaint, then just walk out.

Alternatively, I think it IS your decision if you see her again. I thought there was something called getting the patients consent. In any event as part of self management your DSN at your practice should be discussing what is the best approach for you. Mine asked "Do you think seeing a dietician would help?" I simply said "no thanks as we'd just end up arguing." That was even before my latest successful visit to her. When does your husband have his next HbA1c? The only way to shut them up maybe to prove to your local DSN / GP that you are doing really well. That way you can do what I did the other day and talk from a position where they know you've done everything "wrong" and yet can't argue will the results.

Pass on my best regards to your husband and tell him he's doing great. Oh and tell him he should be proud to have a wife as caring and supportive as you!

 

[jopar]

For a 6ft2 man, the weights she's suggesting and their carb value are reasonable amount of carbs.. But I do mean a standard amount so may not be suitable for various reasons for your husband..

In the mashed potatoes there's just over 35g's of carbs, 3-4 slices of bread, depending on what size of bread but probably minimum amount is going to be around 36g's-44g's of carbs.. Fair wack of pasta, Considering that the carb difference between uncooked and cooked weight is uncooked it's around 77g of carbs per 100g, but when cooked it drops back to 22g of carbs per 100g's... because pasta swells when cooked, so 75g's would be a fair amount on the plate.. So perhaps you mistook what she said here...

10-15g's for a snack, not a large amount either when you think about it..

As to weighing his cloth's before you went to his appointment, I think what ever the outcome it would have been negative... As it seems you was going pretty armed to come back disappointed..

As to the 'it isn't your decision' being uttered well this can't believe that was ever said... I have dealt with and been treated by many of the health care profession and even been called a liar by one of my original consultants... But I have never heard a patient being told 'it's not their decision' when that patient is campus mentus (Isp) I've only heard it uttered to an relative who is trying to enforce a relative into a decision they don't want or when somebody has been sectioned under the mental health act!

It's not said, purely because it's pointless to say it...

Edited to clarify,

 

[Truffle]

When I was first diagnosed my very forward thinking doctor told me to eat a diet high is fish, chicken, salad and veg and nothing else - he then stated that he wasn't the practice specialist so in future I would have to see the diabetic doctor. When I finally saw her three months later she immediately told me that I needed to eat carbs, go on statins and take anti cholestoral pills (I don't have high cholestoral or high blood pressure). I asked her why and she said - because it is NHS policy. I refused and refused to see her again - I only see my forward thinking doctor who goes with whatever suits me best!
Interestingly I also spoke to a friend of mine who is a district nurse and she said - don't follow any advice given by the diabetic doctor, go on the Atkins diet! I do however still take Metformin.
Do what suits you!

 

[SweetHeart]

Hey Ju

Well I'd go back one more time. Take the same printouts and when she puts them in the bin just walk over and take them out again, put them on her desk, tell her to her face how rude and childish she is and that you will be writing a letter of complaint, then just walk out.

Alternatively, I think it IS your decision if you see her again. I thought there was something called getting the patients consent. In any event as part of self management your DSN at your practice should be discussing what is the best approach for you. Mine asked "Do you think seeing a dietician would help?" I simply said "no thanks as we'd just end up arguing." That was even before my latest successful visit to her. When does your husband have his next HbA1c? The only way to shut them up maybe to prove to your local DSN / GP that you are doing really well. That way you can do what I did the other day and talk from a position where they know you've done everything "wrong" and yet can't argue will the results.

Pass on my best regards to your husband and tell him he's doing great. Oh and tell him he should be proud to have a wife as caring and supportive as you!

Thanks from both of us Xyz! Immodestly, I'm proud of both of us too! :lol:

Wish I'd thought to do exactly as you said in your first paragraph. MH got annoyed towards the end - unusual for him, he's very laid back - but we still don't know what his diagnosis HbA1c was otherwise we would have mentioned that - we aren't quite as armed as you were with test results. Yet . So far, the DSN has yet to mention having another one done. We have to go to the surgery tomorrow so I shall get MH to request a print out and make an appt for another test. I'm looking at self-testing meters just now.....a tad costly.

She admitted that MH was doing well and, if it wasn't through anything that we have done - then was it a miracle that happened all by itself? It IS our decision to see her again - I think I'm correct in saying that no one has to do anything their GP, Nurse, Consultant says if they do not agree with it; I think there's something about that in the Patient's Charter.

On the plus side, our GP won't actively endorse low carbing but she did say 'carry on the way you are; it's showing good results' so I think that's better than nothing at all.

Up the Revolution!

Ju

 

[xyzzy]

For a 6ft2 man, the weights she's suggesting and their carb value are reasonable amount of carbs.. But I do mean a standard amount so may not be suitable for various reasons for your husband..

:lol: Well I'm 6' 2" and it would kill me dead. I take it by "not be suitable for various reasons for your husband" you might mean

"not be suitable for various reasons for your husband because he's a Type 2 diabetic"

or

"not be suitable for various reasons for your husband because he can't inject insulin to cover the amount of carbs as he's diet only"

just asking...

 

[ladybird64]

As to the 'it isn't your decision' being uttered well this can't believe that was ever said... I have dealt with and been treated by many of the health care profession and even been called a liar by one of my original consultants... But I have never heard a patient being told 'it's not their decision' when that patient is campus mentus (Isp) I've only heard it uttered to an relative who is trying to enforce a relative into a decision they don't want or when somebody has been sectioned under the mental health act!

It's not said, purely because it's pointless to say it...

Edited to clarify,

Careful Jo, that kind of a statement is guaranteed to provoke a strong reaction and rightly so. It is irrespective whether you have heard this said or not, you were not there, Ju was and she has repeated what was said. To say it wasn't said impies she is a liar and that is an unreasonable and provocative accusation.

There are many of us here who have had a lot of contact with medical professionals in both work and personal life There are many who have been on the receiving end of statements that you may consider fabrications. They happen, of that there is no doubt.

I wouldn't have thought that calling someone a liar, or rather implying it is a good way of promoting cordial relations on the forum, would you?

 

[SweetHeart]

As to the 'it isn't your decision' being uttered well this can't believe that was ever said... I have dealt with and been treated by many of the health care profession and even been called a liar by one of my original consultants... But I have never heard a patient being told 'it's not their decision' when that patient is campus mentus (Isp) I've only heard it uttered to an relative who is trying to enforce a relative into a decision they don't want or when somebody has been sectioned under the mental health act!

It's not said, purely because it's pointless to say it...

Edited to clarify,

Careful Jo, that kind of a statement is guaranteed to provoke a strong reaction and rightly so. It is irrespective whether you have heard this said or not, you were not there, Ju was and she has repeated what was said. To say it wasn't said impies she is a liar and that is an unreasonable and provocative accusation.

There are many of us here who have had a lot of contact with medical professionals in both work and personal life There are many who have been on the receiving end of statements that you may consider fabrications. They happen, of that there is no doubt.

I wouldn't have thought that calling someone a liar, or rather implying it is a good way of promoting cordial relations on the forum, would you?

Agreed. I was there, I asked pertinent questions to clarify certain points. I am neither stupid or deaf. I know it's easy to misinterpret information if you are a bit cheesed off - but I didn't.

Ju

 

[hanadr]

I've been told several times by dieticians [who I've met at meetings never as a patient] that if I don't eat carbs, I'll suffer some kind of deficiency. I always ask them what One said "Calcium", so Iasked about the calcium in dairy foods. the others haven't been able to tell me anything. Likewise when I've asked for the scientific evidence, they've got none.
I have convinced my GP AND my DSN that it's OK and they've both come to agree with me.
If anyone tells you again to eat carbs, ask for the title of the study which proves it. When none is forthcoming,and i doubt it will be, just turn and go away.
I've come to the conclusion that dieticians know[ from their reference books] what's in a food, but have little idea of how it acts in the body. They also don't seem to have much idea of good science.
Hana