JOURNALIST -Pharmacists role in lifestyle medicine

[rhubarb73]

Hello everyone - I've been contacted by a Freelance journalist who is writing a piece about Type 2 Diabetes for a pharmacists trade journal and specifically on the role that Pharmacists could play in helping to promote lifestyle medicine treatment options such as Low Carb. She contacted me to get a patient's perspective.

My considered response to her was:
"Patients just want workable options. The role of the healthcare professionals should be to help patients to explore and access all available options. A pharmacist who asks a diabetic collecting a repeat prescription if they have heard of the Low Carb Programme and then providing them with some literature - that could be very powerful."

I genuinely think that whilst pharmacists are mongers of the drugs and might not feel incentivised to wean people off them, they can often be very pragmatic and more up to date than the GP's. Also existing diabetics may see their pharmacist 3-4 times as often as they see their GP or DN.
Anyway - I'm not the only patient with a perspective I'm sure, so would welcome any thoughts or experiences (good and bad) on this subject, which I will endeavour to pass on. Thanks in advance.

 

[xfieldok]

On the on hand, I get vaguely annoyed with things like veganism being aggressively rammed down my throat, I am evangelical about lchf/keto!

My problem is that when diagnosed there was no dietary advice apart from the eatwell plate which came along several months after DX.

If I hadn't found this site I shudder to think where I would be now.

If pharmacists could hand out information about diet, it could help I suppose, provided I agreed with the contents of course!

I would be more impressed if the handout was accompanied by a meter with affordable strips. Definite possibilities of interested diabetics considering an informative leaflet going back to the pharmacist to claim their free pack.

 

[Resurgam]

It would have to be done in the full knowledge of just how powerful a therapy low carb is, as combined with drugs which increase insulin secretion or glucose excretion it could result in a swift drop into hypo levels.

 

[rhubarb73]

It would have to be done in the full knowledge of just how powerful a therapy low carb is, as combined with drugs which increase insulin secretion or glucose excretion it could result in a swift drop into hypo levels.

You would hope a pharmacist is aware of the limitations some drugs put on their users. I think this would be a case of them promoting the formal Low Carb Programme as opposed to promoting a change of diet. Entrants onto that programme get the full safety briefing.
Reflecting on my DESMOND course, out of 10 or so people in the room, I was the only one who had even contemplated Low Carb - there is a long way to go to get the average T2 to engage with the opportunity.

 

[Member496333]

Anything that shifts us away from the Diebadly Guide as a means of ‘treating’ type 2 diabetes can only be a good thing

 

[Rustytypin]

A relation of mine is a pharmacist and is steeped in the "old ways". We have had many a discussion on LCHF over the past couple of years, Although she can see the merits of low carb to reduce blood glucose, she cannot get her head around the HF part. She also does not believe in self testing, although she may be coming round to my way of thinking on that. Whilst many pharmacists may be receptive to the LCHF message, a lot of others will need convincing, old habits die hard. Good luck to your journalist!

 

[Mr_Pot]

A relation of mine is a pharmacist and is steeped in the "old ways". We have had many a discussion on LCHF over the past couple of years, Although she can see the merits of low carb to reduce blood glucose, she cannot get her head around the HF part. She also does not believe in self testing, although she may be coming round to my way of thinking on that. Whilst many pharmacists may be receptive to the LCHF message, a lot of others will need convincing, old habits die hard. Good luck to your journalist!

It is probably the HF part that has put a lot of people, particularly HCPs, off the idea. If the diet remained exactly the same but the name was changed to just Low Carb many more people would find it acceptable.

 

[DavidGrahamJones]

A pharmacist who asks a diabetic collecting a repeat prescription if they have heard of the Low Carb Programme and then providing them with some literature - that could be very powerful."

It's a lovely idea but I can see problems. Asking patients if they had heard of a low carb diet is one thing, providing literature is effectively recommending a low carb diet. Pharmacists have less training in nutrition that GPs do, however, there might be a change afoot as some pharmacists believe that knowledge of medicines and knowledge of nutrition go hand-in-hand. You might find some of these rare pharmacists in hospitals but probably not in your local Boots. I feel sure that if pharmacists started recommending any dietary advice that didn't correspond to NICE guidelines there would be trouble. I think some GPs would be the first to complain.

There is another problem and that's with people themselves. I have several friends who are type II and I have often drummed my low carb drum but to no effect whatsoever, they are happy taking the tablets. The saddest thing for me is to watch their condition progress in the fashion that GPs know they will and I am convinced it's not the disease that's progressing but the effects of their medication.

 

[BloodThirsty]

It's a lovely idea but I can see problems. Asking patients if they had heard of a low carb diet is one thing, providing literature is effectively recommending a low carb diet. Pharmacists have less training in nutrition that GPs do, however, there might be a change afoot as some pharmacists believe that knowledge of medicines and knowledge of nutrition go hand-in-hand. You might find some of these rare pharmacists in hospitals but probably not in your local Boots. I feel sure that if pharmacists started recommending any dietary advice that didn't correspond to NICE guidelines there would be trouble. I think some GPs would be the first to complain.

There is another problem and that's with people themselves. I have several friends who are type II and I have often drummed my low carb drum but to no effect whatsoever, they are happy taking the tablets. The saddest thing for me is to watch their condition progress in the fashion that GPs know they will and I am convinced it's not the disease that's progressing but the effects of their medication.

The main problem I guess is peoples' reaction to anything outside of the accepted norm.

So, would a pharmacist stick his neck out and suggest a regiman that is not main-stream?... I think not.
Just one patient reporting a stomach disorder or whatever and he risks being sued, or chastised by his professional body.

Imagine your typical GP prescribing a very low fat, 5 a day diet (they do you know) to bring a T2D's cholesterol down, only to discover that his dispensing chemist is distributing LCHF information.

Even my allegedly intelligent, educated and open-minded friends are appalled when I spoon butter into my coffee and are absolutely convinced that I am well on the way to clogging up my arteries.

There is too much dogma that has to be dispelled before schemes like this might work. I'm afraid it's a case of too much, too soon... regretably.

 

[Member496333]

The main problem I guess is peoples' reaction to anything outside of the accepted norm.

So, would a pharmacist stick his neck out and suggest a regiman that is not main-stream?... I think not.
Just one patient reporting a stomach disorder or whatever and he risks being sued, or chastised by his professional body.

Imagine your typical GP prescribing a very low fat, 5 a day diet (they do you know) to bring a T2D's cholesterol down, only to discover that his dispensing chemist is distributing LCHF information.

Even my allegedly intelligent, educated and open-minded friends are appalled when I spoon butter into my coffee and are absolutely convinced that I am well on the way to clogging up my arteries.

There is too much dogma that has to be dispelled before schemes like this might work. I'm afraid it's a case of too much, too soon... regretably.

Gary Fettke was accused of “inappropriately” reversing a patient’s diabetes

 

[BloodThirsty]

Gary Fetke was accused of “inappropriately” reversing a patient’s diabetes

That's rich isn't it?

 

[Member496333]

That's rich isn't it?

Yes indeed it is. Or was. Without wishing to derail;

https://www.dietdoctor.com/dr-gary-fettke-exonerated-receives-apology-from-regulators

 

[BloodThirsty]

Yes indeed it is. Or was. Without wishing to derail;

https://www.dietdoctor.com/dr-gary-fettke-exonerated-receives-apology-from-regulators

Thank you for the link.
I was aware of the debacle with Tim Noakes and Jennifer Allison but this one completely passed me by.

Isn't it telling that at the same time there was a DAA Public Announcement ... "The DAA Board, together with new CEO Robert Hunt, have decided to conclude Corporate Partnership Agreements with companies within or related to food manufacturing and food industry associations. Prior to this decision being made, Nestlé and DAA had already mutually agreed that their partnership would conclude at the end of the year in line with their current contract. DAA will honour existing contractual arrangements until Corporate Partnerships conclude on the 31st December, 2018."

 

[rhubarb73]

@BloodThirsty , @DavidGrahamJones - this would be less of a neck stretch now for UK pharmacists and no longer contrary to NICE guidelines - since 4 January this year, the Low Carb Programme has been formally added to the digital app for doctors to use in offering treatment / management options for Type 2 Diabetes. This is in addition to the Low Calorie shake approach.
This is a big step forward for the UK - obviously it needs to be followed up with a) the doctors being trained about it, b) the doctors discarding years of Eatwell and actually recommending it, c) the patients being prepared to listen.
It also needs to be followed by a rewrite of Desmond, and training of their dieticians etc.
But it's a start and should mean that the RSA -Noakes or the Aussie - Fettke debacle shouldn't happen here. (although there is plenty else going on to undermine the Low Carb movement)

However it may be another 12 months before existing diabetics see their GP, even if the GP was minded to suggest a switch. Most will be in their pharmacist before then.
To get on the Low Carb program at the NHS subsidised rate patients would still need to be referred by their GP, but that is more likely to happen if the patient hears about the programme and asks the GP about it.

 

[rhubarb73]

There is another problem and that's with people themselves. I have several friends who are type II and I have often drummed my low carb drum but to no effect whatsoever, they are happy taking the tablets. The saddest thing for me is to watch their condition progress in the fashion that GPs know they will and I am convinced it's not the disease that's progressing but the effects of their medication.

Notwithstanding my comment above - I completely agree with this DGJ. The approach of some diabetics is to say effectively "help me find a way to die slowly and painfully, but with ice cream". Diabetes.co.uk posted one such story this morning on its FB feed...a woman literally going blind but still unable to find the willpower to stop eating the wrong foods. So sad.

 

[rmz80]

Perhaps Pharmacists could be facilitators in giving diabetics in what's called "empowerment" i.e. Give enough information to the patient on a particular disease that they can manage it themselves without the need to run to the doctors surgery for every answer.
As a first step giving a BG level to people without a meter would be useful