NHS Dietitian Contradicting Himself

kev-w

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I saw a dietician (2 of them) 3 times over a 6 week period, and the first one asked me to keep a food & injection diary, when I returned I saw a different person who asked me to keep a different diary, which I took to my 3rd appointment, where I saw the first dietician who couldn't work with their colleagues diary and theirs wasn't current so I gave up....

Edit, it was a long time back when we started working out carbs to fast acting insulin....
 

Resurgam

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Decades ago I went along to the baby clinic and explained that I was breast feeding and becoming exhausted, but the midwife then demanded to know if I was adding anything to the milk.
My son was at the very top of the graph for weight gain and she thought that I was giving extra carbs.
I looked at her blearily from the depths of sleep deprivation and inquired how I could get it in there so he would let me sleep for more than two hours at a time.
Some HCPs have their minds set on rails and they just do not think before speaking, plus their attitude is always that the patient is in error.
 
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Bluetit1802

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In situations like this I think we get confused with the HCP's personal view and the official line. They are not allowed to deviate from the official line unless they wish to be charged with malpractice. My DN and I have a way of talking on and off the record which has taught me that she would like to advocate low carb and wishes that dietitians would stop telling people to eat carbs with every meal. I have my dietitians action plan somewhere where it says just that.

The fact that your dietitian had carbs and cals lying around might suggest what her personal thoughts are.

My nurse is the same. At my first appointment I was given the glossy guide to the Eatwell Plate and told all the things most of us are - jacket spuds, baked beans, wholemeal bread etc. At my next but one meeting with her she could see how well I was doing, both weight-wise and BS-wise, and how happy I was with my LCHF eating plan. She never mentioned the Eatwell Plate stuff again, and instead told me about Trudi Deakin's book "Eat Fat", of which she had a copy. Her problem, and probably the same with every other DN, is that she has to complete a tick box on my computer records. One of these tick lists is about which diet I follow. There is a list of several choices. Low carb is not among them, although low fat is. I don't really fall in any of these, so she ticks "high fibre" in order to get round it. She is slim and non-diabetic but eats low carb in order to stay that way.
 
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Dr Snoddy

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When first diagnosed I had a 30 minute discussion with a NHS dietician. She advised a restricted carb diet and, when pushed said 30-40g carb per meal. I stuck to that immediately and since. I resisted the temptation to just have 8 meals per day!
This was the opposite of the Desmond course which I also attended.
I now see a Health Care Assistant who is almost worse than useless. Fortunately I have full access to my medical records and his record of my recent review bears little resemblance to what actually happened!
 
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lindisfel

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Hi,
I heard Dr.Tedstone on radio 4 lunch time program the other week.
I wouldn't say what she said was a complete waste of space, but IMHO!.. I
was astounded by the complete lack of a strategy to deal in any constructive way with the current epidemic of obesity.
D.
 

dbr10

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How where you cheating , did he elaborate. A HBa1C of 38 is a fantastic drop well done. But it works out at an average of
6.39 mmol/l thats if Im reading this right.
It really is an idiotic comment isn't it.
 

ringi

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The fact that your dietitian had carbs and cals lying around might suggest what her personal thoughts are.

Or it may just be to help people on inslin to count carbs, while telling them, they can eat as many carbs as they like.
 

JohnEGreen

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Of course you can as long as you discount insulin resistance.
 

nickm

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I don't think we should be fat shaming anyone, this is a support forum. I am glad there are some obese workers in the NHS, they are more likely to be sympathetic to those of us who really struggle to lose weight. All the willpower in the world sometimes simply does not work. It's a tough life if you are obese, let's not make it worse for those worse off then ourselves by judging them.

Fat health care workers deserve to be shamed, not because they are fat, but because they are part of a system that goes to extraordinary lengths to prevent valid scientific discussion of the subject and refuse to act on evidence of misconduct in research. Health care workers who aren’t fat deserve to be shamed for the same reason.
 

mazza 2

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I find it hard to understand why your dietician thinks you are cheating!!!! I can only assume he is thinking that if you go back to what is classed as "normal eating" your levels would rise. To me that is like saying to someone with a peanut allergy they are only keeping healthy because they are not eating nuts!!! As long as people are happy to maintain their new lifestyle and as long as it keeps working I don't regard it as cheating and think we should be congratulated for taking (for some people) drastic changes to their diet and lifestyle. Rant over lol
 

zand

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Fat health care workers deserve to be shamed, not because they are fat, but because they are part of a system that goes to extraordinary lengths to prevent valid scientific discussion of the subject and refuse to act on evidence of misconduct in research. Health care workers who aren’t fat deserve to be shamed for the same reason.
So let's take the word 'fat' out then and just say 'health care workers'! Oh and for the record I don't agree with you, it's only those who make the policies that are to blame, not the workers. Surely the fat ones are victims of the system themselves?
 
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lucylocket61

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So let's take the word 'fat' out then and just say 'health care workers'! Oh and for the record I don't agree with you, it's only those who make the policies that are to blame, not the workers. Surely the fat ones are victims of the system themselves?
Agree. I think of them like I do call centre workers, who have to stick to a script, get tight control on the restrictive things they can and cannot say, and get loads of abuse and flack from customers while getting paid a pittance.

I suspect very few people can afford to only work in jobs where they agree with all of what they have to say and do, and most people do a lot of good in amongst the bad bits.
 

first14808

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Agree. I think of them like I do call centre workers, who have to stick to a script, get tight control on the restrictive things they can and cannot say, and get loads of abuse and flack from customers while getting paid a pittance.

Also agree. Medical practitioners have to follow approved guidelines, and if they don't, risk sanctions up to and including being struck off and unable to do their jobs. So if the official diet guidance is the Eatwell plate, that's what we'll be told until that changes. And getting that changed would need evidence showing benefits, ie trials, papers etc, which is happening.

And the junkfood lobby would no doubt object. As might people who've been promoting bad diets, which is another huge industry and could be better regulated. As long as authors are careful about how they promote health benefits, there'd be nothing stopping me publishing the "Chip Butty Diet" and stating it may prevent Kuru.
 

MikeTurin

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And the junkfood lobby would no doubt object. As might people who've been promoting bad diets, which is another huge industry and could be better regulated. As long as authors are careful about how they promote health benefits, there'd be nothing stopping me publishing the "Chip Butty Diet" and stating it may prevent Kuru.

I think the problem is that there are a lot of fad diets, or diets that become fad if explained wrong, like the Atkins diet. Actually I think that a diet explained wrong, because is on a tabloid paper and the like, is a fad.
Now operators in the public health have to follow the published guidelines because as you explained it if they don't stick to it, they are considered liable.

There are a lot of really of diets intermixed with decent ones, and I think in most cases is because someone is trying to sell you something.
Sauerkrauts can help to lower cohlesterol and tho control BG spikes, but eating only cabbage isn't a good idea. Same for some raw diets. Eating salads is a good thing and being from Turin I think that raw meat with lemon, salt and olive oil is a treat, especially if you put some truffles on it. But eating only raw foods sounds me a weird thing.


My idea is that Eatwell plate is prone to misunderstanding. The "Carbs and cals" book follows the principles of the eatwell plate BUT they are a bit better explained. I have it and is an interesting read because makes you aware of the actual nutrients contents of food.
 
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ixi1429

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When first diagnosed, I reduced the "extras" in my diet - biscuits, crisp etc. I was already on a "eat well" diet at home as my wife follows slimming world - low fat, fruit & veg, cook from scratch etc. Removing the "extra's" did help - In 5 months I lost 6 kg's and my HbA1C dropped from 52 to 48. So the Eat well plan does work. I think it just does not work well enough or is not explained well enough.

Following the education course, I then switched to LCHF. Over the next 3 months, I lost another 6 kgs and my HbA1C dropped to 44.
The biggest unexplained (for me) factors are that the eat well plate advises you to eat brown carbs and allows fruit. The last is probably a mistake for someone like me who was 7-8 pieces of fruit a day before diagnosis. Fruit is very good for you just not in the quantities I was eating :). Typically I would eat 2 apples, 2 bananas. kiwi fruit, oranges, berries (of all kings), Grape and so on in one day. The HCP team reckons the fruit intake (sugar) was a contributory factor.

As my wife pointed out the Eat well plate is aimed at the general population and the NHS is trying to improve the dietary intake which is sustainable. If we were all told to stop eating bread, pasta, rice etc. from day one, how many would succeed and keep on it? I have but I slip every so often. It can be trying and a pain in the rear to measure the carbs. Yesterday on top of my normal meals I had 150g of pistachios and around 75 g of chocolate...the result my carb intake for the day was over 130g (my target is 75). 130g is still low carb it is just over my target.
 

lindisfel

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I find it hard to understand why your dietician thinks you are cheating!!!! I can only assume he is thinking that if you go back to what is classed as "normal eating" your levels would rise. To me that is like saying to someone with a peanut allergy they are only keeping healthy because they are not eating nuts!!! As long as people are happy to maintain their new lifestyle and as long as it keeps working I don't regard it as cheating and think we should be congratulated for taking (for some people) drastic changes to their diet and lifestyle. Rant over lol
He is cheating!! He's cheating an early death or serious illness!
D.
 

Sue192

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I don't think we should be fat shaming anyone, this is a support forum. I am glad there are some obese workers in the NHS, they are more likely to be sympathetic to those of us who really struggle to lose weight. All the willpower in the world sometimes simply does not work. It's a tough life if you are obese, let's not make it worse for those worse off then ourselves by judging them.
Agreed, and perhaps she was interested in low-carbing to help her and was asking all those questions because of that. I had a long conversation about low carbing from the practice nurse (the surgery doesn't have a DN) who last took bloods; in fact I had to finish the conversation to get back to work! She was also asking a lot of questions and was genuinely interested in how it helped with bg and weight.
 
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DavidGrahamJones

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Just had a visit with my NHS Dietitian.

Whilst congratulating me for going into "remission" and lowering my HBA1c from 85 to 38 in just over 4 months, he did not like the fact that I changed my diet to an extremely low-carb and very healthy diet.

He said my fasting blood glucose readings between 4 - 6 mmols/l are false and I'm cheating.

He also emphasized to me to eat "normally" and stressed out that the NHS does NOT agree with low-carbing and it's strongly NOT advisable.

So I was sitting there in his office thinking this is just another waste of my time and while I was listening to his sermon, I saw a book sitting on his desk about "Carb and Calories", the best selling book on counting carbohydrates and calories for Diabetics!!!

Absolutely confusing!!!!!!!

They're in a stupid place where they can't advise anything that isn't in their operating instructions. Having said that, last year I did actually get to see a diabetic specialist nurse at the local hospital who asked me to go through my diet with her. No problem, it was not only all written down but input into my "Weight by Date" software which shows up to 10 bits of info of what I've eaten including calories, carbs and another 8 things of my choosing (from their list of many).

She said "I don't suppose I need to give you this then?", it was a book called "Low Carb Diets for Diabetics". Maybe you could get a copy and send it to your NHS Dietitian, he obviously isn't keeping up with the program, just reeling out the same old guff (foolish talk or ideas) or, (in Scotland it means an unpleasant smell). As side issue, she was going on an Abbott run, one day training course, on the FreeStyle Libre although she did think it unlikely that our CCG (Chilterns) would fund it.

BTW, if you google "Low Carb Diets for Diabetics" there's some interesting web pages to read.

Edit: Forgot to say "Cheating?", cheeky . . . . . . . . . . (choose any expletive). What would be the pointing in not coming clean with your health advisor (so called professional who was lacking in how to deal with patients.
 
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SueJB

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I know this is going to sound awful but the when I saw "Health Care Assistant " at my local surgery and was being asked if I was eating a healthy diet and taking regular exercise all I could do was look around the room for the hidden cameras, I was sure I was on Candid Camera or someone was playing a practical joke. This women that was asking me all these questions about diet and exercise was almost as wide as she was tall. Not exactly setting a very good example.
I'd really like to be able to press the "funny" emoji twice. You had amazing control