Dietetics

[borofergie]

Talking about it over dinner, we think that his card was marked with this particular lady after asking her searching questions about low carbing at the education day last Thursday.

Good plan!

Mark my words, this false consensus is going to crumble soon. When it does, people like this woman will be left with a whole lot (of presumably very sweet and sticky) diabetic blood on their hands:
"It's not my fault," they will scream, "I was only following orders...".

Sometimes I wish I believed in karma.

 

[SweetHeart]

Boro,

Oddly, I said as much to MH on leaving the hospital this morning. I'm beginning to see images of Citizen Smith in my head, chanting 'Up the Revolution'

MH was very shocked at the info given to people, last Thursday. One chap was 27 stone, with very high BG levels - high teens - and he was still being advised to eat what seems to be very high carb levels. MH said you could see the chap's confusion, he could see MH's average levels, was listening to the dietary advice and not getting 2+2=4.

Ju

 

[xyzzy]

Boro,

Oddly, I said as much to MH on leaving the hospital this morning. I'm beginning to see images of Citizen Smith in my head, chanting 'Up the Revolution'

MH was very shocked at the info given to people, last Thursday. One chap was 27 stone, with very high BG levels - high teens - and he was still being advised to eat what seems to be very high carb levels. MH said you could see the chap's confusion, he could see MH's average levels, was listening to the dietary advice and not getting 2+2=4.

Ju

Ju you could try complaining to her proffesional body. If she is a Dietician she has to be registered.

Dietitian (also Dietician*)
To call yourself a dietitian you have to be registered with the Health Professions Council (HPC – http://www.hpc-uk.org ) and you will be a State Registered Dieitian (SRD) or simply Registered Dietitian (RD).

 

[jopar]

MH has decided that we'll go back once more, after his next HbA1c. As long as that has gone down, and his other lipids(?) are fine, cholesterol gone down etc, then we'll try again with the print outs and politely request that, as we have studied her literature, she would be impolite not to read ours.
Ju

Can I give you some tactical suggestion here...

Just handing a set of print outs over with the expectation of somebody reading them doesn't really work, generally they either end up in the bin, most HCP's are polite enough to dispose of after the patient has left!

By what you've said, she lead the appointment, you followed and/or defended your position within the appointment... You need to take charge and lead the appointment, and a good way of doing this is tactical planning before hand...

You need to use your print out's as your tool, don't use them has this says this that or the other, but pick out a relevant point, hight light it and use your information, in comparison to hers to show a improved outcome...

Not sure how keen you would be on this idea, but here goes...

Make a meal to her suggestion (perhaps cut back a bit on the carbs if worried about impact) do your blood testing... Then show her both the results..

Perhaps, do a nutritional comparison between a meal/snack of hers and one of your choices..

And perhaps ask, for idea's if concerns of micro-nutrients if supplement might be appropriate or another food source that complies within your ideas..

So you tantalise her into looking at the printouts you have further...

 

[SweetHeart]

Jopar, brilliant suggestions, all of them!

MH was trying to expand on the print out information and how it applied to him - he's a very good public speaker - and knows how to put his point across politely but succinctly. The dietician listened, shaking her head the whole time, and then she simply talked over him saying he had no understanding at all of just how important a regular intake of starchy carbohydrates are to the diabetic and that he would eventually end up harming himself. When asked for sources of information to back this up she replied that it was in medical texts unavailable to the general public. The look on her face for the entire half an hour suggested that she was humouring an idiot.

You're quite right about leading the appointment and I'm sure you're very good at it - but I think it requires the other party to listen and that wasn't happening. As I said before she had already decided that MH was a troublemaker, a heretic, and she wasn't prepared to give an inch to his opinion of what was right for him personally.

He has his own charts etc that are made from his downloaded meter readings - we now have almost 8 weeks worth since diagnosis - and he has kept a record of which foods give him spikes and, of course, the readings themselves. The chart also shows his readings after starting to use Bitter Melon capsules. The capsules were dismissed outright, as was the drop in BG levels after starting to use them. The drop must have been due to his Metformin and Statins in her opinion. They are the only things that could have caused the drop and weight loss, most certainly not our diet or any supplement.

With some people you can have every point, every fact, of your argument covered - but if they are determined not to see what you are saying then, no matter how persuasive you try to be, you are bound to lose. At present, we have facts and figures from research and we have our own evidence but we have not been in this game long enough to have anywhere near enough to convince someone as dyed-in-the-wool as this lady seemed to be. Next time we'll be better armed.

Ju

 

[jopar]

Satins lowering blood glucose level, Err new one on me must admit, I thought they only had the power to strip the LDL's out of the blood!

I hold at my hands now, I do have a cynical approach to supplements, whether the bitter melon is making a difference or other factors at play can only be partially resolved by stop taking them see and see what happen, if control remains the same then it's more likely that weight loss and/or metformin achieved it, if it's gets worse then yes the bitter melon did...

As to taking control of an appointment yes it can be pretty difficult when you've got a stubborn opposition...

Perhaps it's needs to be pointed out pretty early in the appointment, that this is your husband's decision, and it's not for her to agree but it's her job to work with you, provide advise that ensures that your nutrient needs are met within the confines of your choices... So if he's missing roughage she needs to come with a source that isn't based in complex carbs etc..

As she would do with any dietary needs, where culture or region will play a part in dietary choice...

I wish you luck...

 

[SweetHeart]

We tackled the issue of roughage - her suggestion was a goodly portion of All Bran or two Shredded Wheat every day. Both of which are 'excellent all rounders for diabetics'.........but they give MH high spikes.....oh, that's fine, an odd spike won't hurt him.

Ju

 

[Pneu]

Sweetheart... I have had many a battle with numerous 'Dietitians' over the years... I am yet to find one that doesn't like the sound of their own voice or the look of their oh so wonderful diet plate... (to be fair my sample of probably 10 or so is not massive but then nor is my sample of consultants and I have found some very good consultants....) Off all the HCP's in the NHS they seem to be the most stuck in their ways when it comes to low carb...

The best HCP's know that if a patient is doing something right and controlling their diabetes then they should be supportive of the methods used.. we are all individuals..

By the sounds of things you are doing a good job... keep making informed choices.. at the end of the day it is not the dietitians diabetes.. but yours.

 

[xyzzy]

Actually Ju and Jopar may need to sit down cos she might fall over and faint I think her statement ...

Perhaps it's needs to be pointed out pretty early in the appointment, that this is your husband's decision, and it's not for her to agree but it's her job to work with you, provide advise that ensures that your nutrient needs are met within the confines of your choices... So if he's missing roughage she needs to come with a source that isn't based in complex carbs etc..

... is a **** good one. You would need to be pretty assertive to pull it off and maybe call her bluff by threatening to walk out if she doesn't respect your opinion. It is what I have always called the "I AM YOUR CUSTOMER!" approach. I use it against shops or any business that gives me bad customer service.

I'd give it one more go with her then as Pneu says give up and concentrate on the GP and the DSN because as he says they are far more likely to be interested in overall outcomes than the dietician.

Up the revolution!

 

[SweetHeart]

Psychologically, I think going to a hospital for any reason is fairly debilitating for some people. Even if you aren't dropping dead, you are still going to see a member of the medical profession who holds your life, or a part of it, in their hands. You automatically assume that this person has had specialist training in their field and that they know exactly what is best for you - you are going to consult their knowledge with a view to recovering your health. Health professionals are aware of this and are quite arrogant and will exploit your ignorance in some cases.

MH did point out that if he had dietary requirements pertaining to a particular religion the dietician would have had to work with us, as Jopar said, within the confines of our choices. The reply was along the lines of she, as a professional, cannot countenance anything which might harm in the long term, she must advise to the best of her knowledge - whether the advice is agreed with or not.

We were incredibly miffed yesterday to discover that we don't have an HbA1c to add to our armoury of facts, especially as we were hoping that there would be another for comparison by the time we go back to the dietician. However, yesterday, the doctor did say that we need not visit the dietician for another whole year, not the recommended three months.

Ju

 

[Artichoke]

My GP asked me if I'd like to see a dietician, at no point did he pressure me into going. He totally accepted my view, that it would be a waste of time since the dietician would likely yawn on about carbs, just like the DSN did.

I think if you're low carbing and have to see a consultant, dietician or DNS then it pays to be prepared and to take not just your own improving Hb1Ac and other figures, but also references to proper medical studies and examples of low carb being used to treat other diseases ie Crohn's disease, epilepsy and NAFLD.

Then if the dietician is as appallingly rude as the OP's was, personally I'd feel entirely justified in complaining on the grounds that though my diet goes against NHS guidelines, a healthcare professional should be polite to a patient not bin info that s/he had gone to the trouble of preparing for the appointment.

 

[WhitbyJet]

Just saw this thread, how did I miss it. I have seen 4 dietitians over the past 9 years, the last one bent over backwards to help me, I want to do low carb, but wanted to make sure that I get all nutrients my body needs to keep healthy.
She had in front of her a laptop with various diet related software, and this type of diet just didnt come up. She realised that if she came the usual spiel of 'eat your carbs' I would just smile and walk away.
She admitted that to help work out a diet for me she would need to do it without her pre loaded software, it was quite funny actually. But at the end of the day, she came up with the goods, made some useful suggestions on achieving good balance to ensure optimum nutrition, I was impressed.
But mostly my opinion on dietitians in general is that their tiny little text book is three pages long. A title, a back cover and a page that says, eat a 'health balanced diet' whatever that is and cut the fat out of your diet. None of it backed up by any real science. Oh I forgot, the intro page at the front which say 'this book is based on 'evidence-based science'. Pity they don't actually read the science for themselves.

 

[hanadr]

If someone is rude to me, I sometimes ask them personal questions. Always in a gentle quiet voice. I NEVER start it.
Hana

 

[borofergie]

I wonder if I can con my GP to get me another referral to a dietician at my annual review. I'd love to watch their face as they went through my food logs for my 70-80% fat diet. Last time I went, she told me off for eating a single piece of cheese in my 7 day food log.

 

[phoenix]

their tiny little text book is three pages long. A title, a back cover and a page that says, eat a 'health balanced diet' whatever that is and cut the fat out of your diet.

It's a bit longer than that.
http://www.bda.uk.com/Downloads/manuals_ad.pdf
and no at almost £70 I don't have a copy