NHS Dietitian Contradicting Himself

[zand]

One of my nurses years ago was a slightly tubby lady. The subject of weight came up and I said that I couldn't lose weight no matter what I tried. She misunderstood me. She replied that she found the biscuits difficult to avoid too. I tried to explain that sticking to a diet wasn't the problem, my body just didn't lose weight like it was supposed to. She clearly didn't believe me. So maybe in some cases there's a twist to this argument. Maybe some of the obese medical professionals believe that they are at fault in their own lifestyle choices and think this applies to everyone?

The medical professionals I have had most problems with are skinny female doctors. I went to one when I had a chest infection and she told me the problem was that I was obese. I told her I was so ill I was only eating 4 oranges a day ( I wasn't diabetic then) , she screamed at me that I should eat less because I was so fat! I desperately needed antibiotics but didn't get them.

 

[Guzzler]

One of my nurses years ago was a slightly tubby lady. The subject of weight came up and I said that I couldn't lose weight no matter what I tried. She misunderstood me. She replied that she found the biscuits difficult to avoid too. I tried to explain that sticking to a diet wasn't the problem, my body just didn't lose weight like it was supposed to. She clearly didn't believe me. So maybe in some cases there's a twist to this argument. Maybe some of the obese medical professionals believe that they are at fault in their own lifestyle choices and think this applies to everyone?

The medical professionals I have had most problems with are skinny female doctors. I went to one when I had a chest infection and she told me the problem was that I was obese. I told her I was so ill I was only eating 4 oranges a day ( I wasn't diabetic then) , she screamed at me that I should eat less because I was so fat! I desperately needed antibiotics but didn't get them.

I find patient blaming far more abhorrant than fat shaming especially from HCPs many of whom have never looked further into the (flawed) mechanics of thermodynamics. How could you possibly be eating too much while having just four oranges per day? What that particular doctor was saying in not so many words was that you were not eating only four oranges but that you were eating far more than that, in essence, you were telling lies. When patients are judged by their appearance rather than their physiological anomalies then HCPs are far worse than the layman.

Edited for rubbish spelling which happens a lot when I hear a story that just plain gets my goat.
I hope that you never saw that doctor again.

 

[Brunneria]

@Guzzler
I am 100% in agreement with you.

However, some patients DO lie, and lie with a purpose.
So I suppose health care professionals develop a sceptical attitude, just like the police, probation officers and school teachers do.

We get posts here on the forum where members tell of sitting in consulting waiting rooms watching fellow patients fill in their blood glucose diaries, making numbers up as they go along.
And about 15 years ago, in Wales (very close to where I was living at the time) a woman lied about her age to get IVF, and was brought to term of a baby in her 60s. She was something like 15 years over the cut off for IVF
There are 1000s of other examples.
People are people, and some of them lie.

I am not sure that it is a question of whether a health care professional believes us. More that they are professional enough to behave with dignity and not accuse us of lying to our faces, or base their treatments on suspicion and distrust.

Like @zand, no healthcare professional has EVER believed me when I talked about finding weightloss impossible, and weightgain irresistible - right up until I got a diagnosis of a prolactinoma (benign tumour of the pituitry gland).

Now there is ONE person who believes me (my endocrinologist). The others still don't. Basically because they don't understand the implications of the tumour, or because it isn't on the front screen of my medical notes, so they don't know about it. Also of course, because a fat middle aged woman is sitting before them.
Cue cultural stereotypes and judgements.

 

[Guzzler]

@Guzzler
I am 100% in agreement with you.

However, some patients DO lie, and lie with a purpose.
So I suppose health care professionals develop a sceptical attitude, just like the police, probation officers and school teachers do.

We get posts here on the forum where members tell of sitting in consulting waiting rooms watching fellow patients fill in their blood glucose diaries, making numbers up as they go along.
And about 15 years ago, in Wales (very close to where I was living at the time) a woman lied about her age to get IVF, and was brought to term of a baby in her 60s. She was something like 15 years over the cut off for IVF
There are 1000s of other examples.
People are people, and some of them lie.

I am not sure that it is a question of whether a health care professional believes us. More that they are professional enough to behave with dignity and not accuse us of lying to our faces, or base their treatments on suspicion and distrust.

Like @zand, no healthcare professional has EVER believed me when I talked about finding weightloss impossible, and weightgain irresistible - right up until I got a diagnosis of a prolactinoma (benign tumour of the pituitry gland).

Now there is ONE person who believes me (my endocrinologist). The others still don't. Basically because they don't understand the implications of the tumour, or because it isn't on the front screen of my medical notes, so they don't know about it. Also of course, because a fat middle aged woman is sitting before them.
Cue cultural stereotypes and judgements.

I agree with you wholeheartedly. I am completely honest when asked about my smoking habit and why wouldn't I be? It serves no purpose to lie to a doctor but when a doctor makes it quite plain that they think you are telling porkies when you are being honest where do you go from there? Not back to that doctor in some cases.

 

[LooperCat]

I agree with you wholeheartedly. I am completely honest when asked about my smoking habit and why wouldn't I be? It serves no purpose to lie to a doctor but when a doctor makes it quite plain that they think you are telling porkies when you are being honest where do you go from there? Not back to that doctor in some cases.

Don’t “they” say to tell your doctor half your actual alcohol consumption, because they will take the figure you give them and double it? Can’t see the point of lying myself, otherwise how are any of us supposed to get the the bottom of the problem at hand?

 

[Dexterdobe]

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.

When I told a dietician that my HBa1c had fallen from 53 to 42 in three months she said that it wasn't the low carbohydrate diet that had done that, it was the fact that I had lost so much weight. Presumably, she thinks its okay to eat a high sugar diet so long as we lose weight. I suspect that most NHS professionals realise that low carb diets work, but they have to tow the NHS line. How long before they realise and bow to the inevitable I wonder?

 

[rom35]

When I told a dietician that my HBa1c had fallen from 53 to 42 in three months she said that it wasn't the low carbohydrate diet that had done that, it was the fact that I had lost so much weight. Presumably, she thinks its okay to eat a high sugar diet so long as we lose weight. I suspect that most NHS professionals realise that low carb diets work, but they have to tow the NHS line. How long before they realise and bow to the inevitable I wonder?

Probably it is because she never had the daily measurement of LCHF diet person, where she would see, that excess carb intake will elevate BG to the sky even if you had lost 50% of your body fat...

 

[first14808]

Probably it is because she never had the daily measurement of LCHF diet person, where she would see, that excess carb intake will elevate BG to the sky even if you had lost 50% of your body fat...

I think the problem is still diet advice vs medical advice. I'm free to promote my Chip Butty diet because diet & lifestyle stuff is either unregulated, or very lightly regulated. A doc or a qualified dietician is expected to offer qualified medical advice and follow approved guidelines. If they don't, they may get sued and find malpractice/liability insurance doesn't cover them. I also watched an interesting presentation from Low Carb Downunder where a dietician said she may get struck off for recommending LCHF. Not sure if she was joking, but also made some good points about defining carb & fat ranges for LCHF. Which is part of the issue with getting guidelines changed, ie defining approved levels, which means trials, and clinically significant improvements in outcomes.

For us who've followed LCHF and seen big improvements, we're free to ignore bad advice, even if it's from 'experts'. Which includes some diet peddlers, and doctors. Things seem to be improving slowly, ie rising obesity strongly suggests a problem with diets, and LCHF trials like ND have raised awareness. It'll still be an uphill battle though to get obesity and diabetes uncoupled, although there seems to be more evidence that obesity's a symptom of hyperinsulemia/insulin resistance than the cause.

 

[rom35]

A doc or a qualified dietician is expected to offer qualified medical advice and follow approved guidelines.

it wasn't the low carbohydrate diet that had done that, it was the fact that I had lost so much weight.

@first14808 Even I agree with your post - this is not the case. She just cannot accept, that low carb intake will have direct impact on HbA1c - and thats peculiar from diabetolog. It's just plain logic - carbs will sent your BG high - thus HbA1C will go high, very limited carb intake will keep your BG down - thus HbA1C will go down. The fat in your body has no corrleation to that - only that you can accept more carbs - but it is not this case.

 

[Mick1959]

I must admit to struggling in these early days since being diagnosed in February 2018, as to what advice (or lack of) given by health professionals, and the experiences of the many on this web site, is the best to follow.

Professionals are not infallible, and some make genuine mistakes, but it is the contradiction and lack of initial support that is most confusing. The photocopied booklet I was given initially stated you do not have to change your diet, then pages later stated cut down sugary food and amend your diet!!!

I have found the general advice from health professionals falls in to the generic: eat healthily, eat less with portion control and exercise. How this is achieved seems to be the issue.

So, I decided to do my own experiments with diet in the past 2 weeks, and decided on LCHF as way to start, along side going for a 40 min bike ready every day, and purchased a Frestyle Libre (still waiting for delivery) and received a Accu-chek Mobile from my daughter.

Well, I can only say that so far my own version of LCHF is the way to go for me.

I have lost Lost 1Kg, with finger prick tests my BG went from 14 down to 10.1 following a meal and is 5.9 average before meals currently. (I have not yet started testing when I get up - as I wanted to be happy that I am doing finger pricking correctly and confident in it).

I am an individual and want to see what foods have an affect on me - so self test I do not drink alcohol other than the odd bottle of beer once a month, but want to know I can still enjoy the odd treat when going out for a family meal and have an awareness what will be good or bad on the menu and not feel guilty

 

[LooperCat]

From the DAFNE handbook: “You can choose to eat as little or as much carbohydrate as you want, so long as it is matched by quick-acting insulin.” Yet further on it goes on to say: “Carbohydrate intakes of less than 130g (13 CPs) per day are generally not recommended.” - so this official guide contradicts itself.

You can eat as little as you like - as long as we approve.

 

[first14808]

@first14808 Even I agree with your post - this is not the case. She just cannot accept, that low carb intake will have direct impact on HbA1c - and thats peculiar from diabetolog. It's just plain logic - carbs will sent your BG high - thus HbA1C will go high, very limited carb intake will keep your BG down - thus HbA1C will go down. The fat in your body has no corrleation to that - only that you can accept more carbs - but it is not this case.

It does.. kinda. But it's where this site is great, ie discusssions and links to presentations from oiks like us to experts presenting to their peers at conferences.

For me, the 'Eureka!" moment was digging down into what my pancreas does, then insulin, then basic metabolism.. Which is where I think there's confusion. So:-

Glucose is C6H12O6. Carbohydrate's a simple lable that covers a whole range of chemistry, eg sucrose is C12H22O11, and cellulose is also a carbohydrate, C6H10O5. So we could meet our Eatwell dietary reference value for carbohydrates by eating, say, 100g of cardboard. Except we can't really digest cellulose. Luckily things like cows & goats can, so we use those to make the inedible edible.

So it's complex. So we're told we need carbs because our brains need glucose. Which is true, but typically only 4-5g circulating glucose in our bloodstreams. If we eat more carbs, glucose levels rise, triggering insulin production telling the body to use, store or excrete the excess. Storage is converting carbs to lipids & depositing them in our fat cells. So while there's an excess, we gain fat. Then if the pancreas produces too much insulin, or cells resist it, we get double jeopardy due to high levels of both insulin and glucose/sugars, which are damaging to cells.

Then there's the complementary process from the pancreas. If BG is getting too low, insulin production should be supressed and glucagon produced instead, which then starts processes to use lipids and eventually proteins as glucose or ketone bodies.. Which is I think the key mechanism to make LCHF work, ie we become 'fat adapted' and use that for energy rather than carbs/sugars.

That's all basic biology, even though it seems to get misunderstood by people telling us we need to eat more carbs. We really don't.

 

[rom35]

For me, the 'Eureka!" moment was digging down

For me the "aha" moment was the glucometer readings - I eated carbs (I remember 40g to cope with 175g daily target) and my BG was 14 1h after (from 8). I eat "no carbs" meal (just meat and veg) and my BG went to 8 (from 7). AHA... It was long before I even heard something about LCHF diet - it was just experimenting and plain logic... Add carbs -> BG up, limit carbs -> BG not so up.

 

[first14808]

It was long before I even heard something about LCHF diet - it was just experimenting and plain logic... Add carbs -> BG up, limit carbs -> BG not so up.

Yup, eat to the meter! S'why I think everyone who's diagnosed diabetic should get a meter & strips so they can find a diet that keeps their BG within the safe/normal range. And ideally more people get CGMs so docs can look at the data and apply more pressure to change dietary guidelines.

It's hard to ignore the evidence.. unless you're lobbying for a high-carb recommendation. Like much of the junk food industry does..

 

[Zilsniggy]

Re some of the heated posts about fatness and doctors being fat...

Personally I don't think doctors have an obligation to "set an example". They have an obligation to do their job. If a doctor is fat, and tells patients that being fat increases their chances of poor health, that does not make the doctor a hypocrite. It makes them a human being.

Also, we all know, and science backs this up fully, that life is not a level playing field on practically anything we can measure about human biology. Being fat, and appetite, are very much included in this.

One person resisting a plate of pie and chips is not exercising the same willpower as another person resisting a plate of pie and chips. If we just accepted what people tell us about their appetites, we already know this is true. But even if we don't believe people, science helps us out, as we now know about things like the hunger hormone ghrelin. People have radically different levels of this. Just look at the poor sods in the 'Biggest Loser' study.

Generally speaking, people do what they want to do. They eat what they *want*, they eat as much of it as they *want*, and they exercise as much as they *want*.

Smugness and judgmentalism are never justified. Most people don't *want* to eat a bag of 5 doughnuts with a cup of tea. They actually say things like "if I have more than one, I'm hyper all day". Me, if I eat 5 doughnuts, I start to feel mildly satisfied, and my brain starts to work really well. The person who only *wants* to eat one doughnut has no business telling me that my willpower is worse than theirs. They haven't exercised any willpower at all.

Conversely, I *want* to be out walking all the time in the mountains, and so, by doing what I want, I can say that I get a lot of exercise. But that doesn't give me the right to tell a fat person who wants to sit down reading books all day that they need to do more exercise and they lack willpower. I'm not exercising any willpower at all when I'm out walking.

Doctors have no obligation to be thin or to eat the "right" foods. We don't know what it takes for each individual doctor to be thin. Not only that, but plenty of doctors who eat the "wrong" foods will be thin and live a long and healthy life, because not only is appetite not a level playing field, but how our bodies can cope with certain foods is also not a level playing field.

I quite liked the fact that most of the staff in the hospital had lots of body fat. It made me feel a normal person. And I am a normal person who happens to be struggling with weight.

Well said, sir!

 

[Mick1959]

Why not remove the 'Want' and 'Will power' from the equation, they are very emotive, and replace them with 'motivation'.

We are all different, individuals, unique, with different things we enjoy that motivate us into doing things.

In my case, my motivation to take more exercise and not eat 5 doughnuts I desire (using example above), is to reduce my weight, get my diabetes under control, so I do not have any health complications that could lead to a miserable existence.

Sometimes in life we must all take a step back to see the bigger picture, and be brutally honest with ourselves, appreciate no one is infallible and we do not know the circumstances of those dispensing advice.

How many times a day/week/month/year, does a health professional dispense sage advice for it to be ignored, that in the end their advice becomes a script and rote, so easier to dispense rather than challenge.

Well that my twopenneth worth, and I now pack my soap box away.

 

[KeithT 2]

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!!!!!!!

As a type 2 for over a decade I can tell you that your dietitian doesn't seem to be able to grasp the truth. In the past 4 months, as part of my New Year resolution, I decided to just make a couple of changes to my intake of food and the difference it has made to my numbers is astounding. Whereas before, my numbers went as high as 11 mmo/l and above at bedtime they are as low as 4.5 and even 3.5 at the moment. I haven't cut out carbs altogether mind you, and still eat homemade bread at lunchtime but not every day. I just don't eat carbs after 4 pm. What I have eliminated from my diet are pasta, potatoes in all their forms and rice. If I have either when it is difficult to refuse them (away from home), then I have only a table spoon of rice and maybe one small roast potato - no fries/chips, crisps, pizza, pasta or sandwiches etc, etc. What I'm getting at is this. We are in control of our own health, our own diet, and our own medication and our own destiny. I have never popped pills easily and will adjust my dosage according to my numbers. I thank dietitians for their advice but I have found that some dietitians think they always know best when in fact they only know what they have been taught by others and not by personal experience. Our bodies are all different and have different food needs. Some can tolerate more carbs than others. I personally think that everyone eats too much carbohydrate and it is that which has caused obesity and the onset of type 2 diabetes in young children along with the lack of exercise. Do it your way but keep taking your BG levels and keep records of them, so that you can see what is going on and adjust accordingly. Don't take your low numbers as a sign of beating diabetes. All you have done is found what foods are poison to your system and eradicated them from your diet. If you eat them, do so with with care. Remember - you're in charge.

 

[Deespee23]

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!!!!!!!

He is an idiot. How is low BG "cheating"? The plain truth is, the NHS guidance just doesn't work. Low carb does. You - and crucially he- know this is true. Ask him WHY low-caring is not "advisable". I suppose having your limbs cut off is?

Anyway, well done, and keep up the good work.

 

[Dexterdobe]

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!!!!!!!

I suppose we are 'cheating' all these poor NHS dieticians out of their jobs

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!!!!!!!

I suppose we are cheating these poor NHS dieticians out of their work. If all you have to do to beat T2 is cut out carbs, who needs them?

 

[jenbags]

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!!!!!!!

My diabetes nurse actually said that I need to lose the weight I carry around my waist. She recommended low sugar/low carb diet. It has been working for me and I am almost non diabetic now.
Apart from consuming more seeds and nuts than the birds on the feeders in my garden, I enjoy the food!!