Dietician - Grrrrr!!!!

Hazehkm

Active Member
Messages
26
Okay so I saw the dietician for the first time this morning since being diagnosed. What a complete and utter waste of my time!! And the woman clearly had issues!

First of all - I've now lost 3 stone since June when I knew they were testing me for diabetes and of my own accord, decided to make a lifestyle change to eat all natural, fresh, healthy produce, nothing processed and cut out the heavy carbs (bread, pasta, rice, potatoes). I now have a FANTASTIC diet that I absolutely LOVE with lots of nutritious and delicious meals/recipes that are high in lean protein and delicious fresh veg, herbs, spices, I have fresh fruit, water and black tea or coffee only, and I feel FANTASTIC! I'm also working out 4-5 times a week. As I say I've lost 3 stone since June and so far, touch wood, since I've been using a monitor, my levels haven't been outside the "normal" range even once, so it's all looking good.

So I see the dietician this morning and DESPITE the OBVIOUS good results and my stressing OVER AND OVER that I ENJOY my new diet and it's NOT a chore or restrictive, she INSISTED it must be too extreme and boring and kept ON and ON about my eating plenty carbs (!), that it's apparently "IMPOSSIBLE" to sustain a diet with no bread or potatoes (erm... YES IT IS!), and she kept pointing to her little picture of the "plate" with the carbs and chocolate etc.. on it, which I looked at... and then looked at her like she had lost her mind. I pointed out the benefits of a low carb diet and she went on about "controversy" - and I was like "I've lost 3 stone in under 3 months, I have a delicious, nutritious diet that I ENJOY, I've got more energy than ever before, I can work out more than ever before, my skin is better than ever, I feel fantastic, and my blood glucose levels are normal - what EXACTLY is controversial?". She wasn't impressed! :lol:

Thing was, the dietician was heavier than I am now, when I told her my goal weight (well she asked!) she looked at me like she wanted to stab me, and I got the distinct impression that she struggles with diet/weight herself and was raging that I, a type II diabetic, should even DARE to THINK of having a healthier diet than her and even worse - have a goal weight that she can't achieve herself. Honestly, she gave me the same looks and condescending comments that I get from people at work who are positively green at my recent very obvious weight loss and the fact that I'm NOT struggling with it! They all want to see me crawling on the floor begging for a crumb of chocolate and I'm like "I'm good, I'm fine, I feel great!" - it's killing them! And the dietician was exactly the same!

By the time I left she was resorting to ACTUALLY telling me how I'd NEVER make it through winter on my diet (just watch me lady! I've got a whole range of healthy homemade soups ready to roll - and that's just for starters!), and how she'd "see me again..." but in a "only when you've gained back those three stone and more and I can say I told you so" tone! So to sum up - she won't be seeing me again anytime soon! :lol:

Dietician my backside! :roll:
 

Engineer88

Well-Known Member
Messages
2,130
Type of diabetes
Type 1
Treatment type
Pump
Well done! good for you:)

Dietitions have screwed me up so bad over my childhood I have a general dislike of them - I know exactly what you mean :)
 

dawnmc

Well-Known Member
Messages
2,431
Type of diabetes
Type 2
Treatment type
Non-insulin injectable medication (incretin mimetics)
Well done you. I had the same experience with my dietician silly cow, they signed me off.
 

Daibell

Master
Messages
12,642
Type of diabetes
LADA
Treatment type
Insulin
Hi. I'm not in the least bit surprised and good for you in arguing with her. There have been many such examples on this forum over the last few years and I wish we could survey just what percentage of these 'expert' dieticians talk total nonsense and make our condition worse. The NHS could save a lot of money by removing these people from the NHS and letting people sort their own diet out; the patients just don't need bad advice.
 

paul-1976

Well-Known Member
Messages
1,695
Type of diabetes
Type 2
Treatment type
Insulin
Dislikes
Dishonesty
Not surprised at all either and it reminds me of my time on the DESMOND course where the same old dross was spouted Re 'healthy' diets and I disputed it all throughout the session and I was politely informed that I would not be welcome at the 2nd session ! :twisted:
 
Messages
6,107
Type of diabetes
Type 2
Treatment type
Diet only
I was sent to see the dietitian a couple of years ago and I couldn't believe my ears. We did not seem to connect at all and after a time she said, "Well it's like doggies and bunnies racing round a track" (I am 70 years old).

When she asked me if I wanted to make another appointment I said I didn't and got the hell out of there.

My action plan included more exercise and to eat carbs with every meal.

Even my DN blinked when she read it.
 

whompa73

Well-Known Member
Messages
396
Dislikes
Chavs
Do for it dude .got a feeling im goma have same argument (or at least hope so exelent on thw weight mate) proof of the pudding is in the eating ok maybe not lol oo try this one if it walks like a duck and talks like a duck the it is probably a duck or prehaps a dn. Joking a seide if it works for you and increases your quality of life then keep doing what you need to do to feel great . Good on ya !!!
 

julifriend

Well-Known Member
Messages
373
Type of diabetes
Type 2
Treatment type
Diet only
I had an appointment with the dietician at the end of June. I went through what I'd eaten the previous day, which had probably around 150gms carbs (not exactly low, but way below the 300gms recommended on my XPert course) and explained the types of food I was now eating. She said everything was fine, she didn't think I needed any further dietary advice and it wouldn't be beneficial to make another appointment to see her. I was happy with that as she seemed to support the type of diet I was following.
 

Lucyturner

Well-Known Member
Messages
89
That's great how much weight you've lost and well done for standing up to the stupid witch. My diabetes nurse has just changed and the one I have more is actually trying to tell me NOT to go to the gym despite that I have lost a lot of weight and gained some muscle and my insulin doses have dropped by half she seems to think that my body doesn't agree with the gym as my blood keeps dropping surely it's a good thing that I have to keep dropping my insulin doses. Sometimes I think the diabetes nurses and dieticians don't have a clue. Keep it up and well done.

Lucy
 

Hazehkm

Active Member
Messages
26
Thanks for the great replies! :D

The thing that got me was that she simply could not comprehend that I ENJOY the way I eat now... that I don't see it as punishing myself for being diabetic by imposing a draconian diet that is a miserable existence! (Please Sir, can I have some more?!) :lol: My lifestyle change has resulted in a wide variety of tasty, enjoyable, nutritious meals that are low carb and low calorie and that keep me satisfied with plenty energy.

She kept on asking me if I had enough energy, if I felt tired etc... like she was trying to trip me up and I just kept saying "I have more energy than ever before!" - she couldn't handle it! She was ADAMANT that I could not POSSIBLY have enough energy without starchy carbs... it REALLY upset her that I did and that I made it clear I did not need them, nor did I feel like I was missing out by not having them.

It was like she was desperate for me to say that I was miserable, tired, not coping with my diagnosis and NEEDED her nutritional expertise in order to survive! When I went in she was like (in a patronising way) "and how are you coping since you were diagnosed?" - and I was like "I'm doing GREAT!" :lol: She didn't know how to deal with me AT ALL! She had decided before I walked in there how I'd be feeling and what I'd need - so when I didn't feel that way and didn't need what she was suggesting, it really threw her!

Somehow I don't think the DESMOND course thing will be a good idea for me - if they start saying things that make no sense I'll find it REALLY REALLY difficult to keep my mouth shut! :silent: I'm a lawyer, I'm trained to make my point and to argue it strongly, using questions that are designed to trip people up - I'd get kicked out! LOL! :lol:

I would say though - this experience really proves the point that no one knows our bodies like we know them ourselves. Just because one person feels a certain way or believes they need something, it doesn't follow that the same will be for everyone. If you have found a healthy, sustainable way of managing your condition that suits YOU and is working for YOU, then don't let some dietician with a script to follow tell you that you are wrong! The more people speak up about other ways of managing this condition beyond carbs and drugs, the better! Don't let them fob you off with bad information that is simply going to cause weight gain and an increased need for drugs... if something else is working for you, then stick with it and let them know that they need to open their eyes, ears and minds to the real world, which happens to exist beyond some leaflet that was drafted with a "one size fits all" mentality! :D
 

Hazehkm

Active Member
Messages
26
Lucyturner said:
That's great how much weight you've lost and well done for standing up to the stupid witch. My diabetes nurse has just changed and the one I have more is actually trying to tell me NOT to go to the gym despite that I have lost a lot of weight and gained some muscle and my insulin doses have dropped by half she seems to think that my body doesn't agree with the gym as my blood keeps dropping surely it's a good thing that I have to keep dropping my insulin doses. Sometimes I think the diabetes nurses and dieticians don't have a clue. Keep it up and well done.

Lucy

You were told NOT to go to the gym?! OMG!!! :lol: :lol: :lol: :crazy: How does that even begin to make sense?! It's like as soon as they see something working for you they want you to do the opposite! My dietician today asked about exercise - I said I'm working about about 5 days a week - I do at least 10k on the cross trainer, some swimming, walking... and again I got that "look" like she was unimpressed that I didn't fall into the stereotype she wanted to be dealing with. I could tell she was about to suggest I was working out too much but she thought better of it at that point. I could see it was on the tip of her tongue though! :lol:

I feel GREAT with my workouts - I have more energy to work out than I've ever had in my life and I'm looking and feeling better for it. That, coupled with what I'm eating is just amazing and I'm seeing and feeling the results on a daily basis. So frankly, Ms Jealous Dietician can take her little plate drawing with enough carbs to feed a small country - and do one! :wave:

Keep going with your exercise and doing what works for you!! Sounds like you're doing GREAT! :D :thumbup:
 

Thommothebear

Well-Known Member
Messages
1,186
Type of diabetes
Type 2
Treatment type
Tablets (oral)
We dont get to see dieticians in my area, we get sent on Xpert courses instead. Got the usual you must eat at least 135g of carbs or your brain wont work (yes, she really said that), but she did admit that low carbing would work for some. I just kept my mouth shut, nodded occasionally, got my completion certificate and left. The only thing i did do was recommend the other people on the course to join this forum.

Here diabetic care rests solely with your GP if you have good control, so no dieticians and no consultants, even for newly diagnosed diabetics unless you are dangerously high or low.
 

Paul_c

Well-Known Member
Messages
432
Type of diabetes
Type 2
Treatment type
Diet only
Hazehkm said:
I feel GREAT with my workouts - I have more energy to work out than I've ever had in my life and I'm looking and feeling better for it. That, coupled with what I'm eating is just amazing and I'm seeing and feeling the results on a daily basis. So frankly, Ms Jealous Dietician can take her little plate drawing with enough carbs to feed a small country - and do one! :wave:

I'm now looking to start High Intensity Interval Training (HIIT) now that I'm at a safe weight to avoid hurting myself and my blood pressure is under control... up until now, I've been out power-walking 3 miles every day (or cycling to/from work), resistance training using a "Bullworker" clone and also free weights.

I had my DSN at my annual review take note of my LCHF diet and was very impressed with my weight loss and HbA1c figure... still claimed that my diet was not safe in the long term though... and that it was responsible for my total cholesterol figure being way over the limit...
 

dawnmc

Well-Known Member
Messages
2,431
Type of diabetes
Type 2
Treatment type
Non-insulin injectable medication (incretin mimetics)
As for cholesterol, theres more evidence to suggest that low cholesterol causes more heart problems than high.
 

Shzz46

Well-Known Member
Messages
131
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Dislikes
People who try to tell me what to do
Hazehkm said:
Lucyturner said:
That's great how much weight you've lost and well done for standing up to the stupid witch. My diabetes nurse has just changed and the one I have more is actually trying to tell me NOT to go to the gym despite that I have lost a lot of weight and gained some muscle and my insulin doses have dropped by half she seems to think that my body doesn't agree with the gym as my blood keeps dropping surely it's a good thing that I have to keep dropping my insulin doses. Sometimes I think the diabetes nurses and dieticians don't have a clue. Keep it up and well done.

Lucy

You were told NOT to go to the gym?! OMG!!! :lol: :lol: :lol: :crazy: How does that even begin to make sense?! It's like as soon as they see something working for you they want you to do the opposite! My dietician today asked about exercise - I said I'm working about about 5 days a week - I do at least 10k on the cross trainer, some swimming, walking... and again I got that "look" like she was unimpressed that I didn't fall into the stereotype she wanted to be dealing with. I could tell she was about to suggest I was working out too much but she thought better of it at that point. I could see it was on the tip of her tongue though! :lol:

I feel GREAT with my workouts - I have more energy to work out than I've ever had in my life and I'm looking and feeling better for it. That, coupled with what I'm eating is just amazing and I'm seeing and feeling the results on a daily basis. So frankly, Ms Jealous Dietician can take her little plate drawing with enough carbs to feed a small country - and do one! :wave:

Keep going with your exercise and doing what works for you!! Sounds like you're doing GREAT! :D :thumbup:
i
Have just been to see my DN she wasn't bothered I have lost 23lb in 5 weeks just told me I'm not eating enough and to up my food intake she was more interested in trying to get me to take statins which I don't think I need as my cholesterol level was only 4.5


Sent from the Diabetes Forum App
 

kaya659

Member
Messages
7
I had a similar experience with my dietician! I have always eaten whole grain bread,brown rice,etc because thats what I like & I've never eaten a lot of fried food because I don't like them.I was told to eat a low fat ,high fibre diet.When I told my dietician that I found any kind of carbs sent my sugar levels soaring, she looked at me as if I was mad & told my I'd never keep my sugars under control if I didn't follow her advice.Needless to say I've never been back to see her & done things my way, just use my glucose meter frequently to monitor what I can & can't eat.I sometimes think the NHS is trying to kill us all off with their official advice! Have to say though that my diabetic nurse at my doctors is better informed & extremely helpful
 

Chev Chelios

Newbie
Messages
3
Hi Hazehkm

As a newly qualified Dietitian I am very interested in your recent Dietetic experience and would like to make a post, not in defence of but to explain the rationale behind what was advised & to also agree that we indeed seem to be behind the times in certain areas.

Firstly, the infamous ‘eatwell plate’ is basically a very basic summation of what a healthy balanced diet is 'meant' to look like and it is characterised by a low fat high carbohydrate principle where carbohydrate will make up 50% of the diet

We use this 50% CHO principal for a few reasons which I will try and briefly explain for you. Firstly, CHO based foods are inherently lower in calories per gram and so this allows greater amounts to be used which adds bulk to the diet meaning satiety is less of a problem whilst at the same time lowering the diets energy density - both crucial for successful weight loss. Secondly, if less refined CHO sources are used then CHO need not raise your blood sugars in a way that confers any health risk (but I agree that it seems mad that we advise eating 50% CHO when it will eventually be broken down into glucose - I am personally not happy about this). Finally, and perhaps what underpins this CHO avocation the most is that the scientific community believe that glucose is our bodies preferred fuel source. Now this is an area of contention with many suggesting that in hunter-gatherer days CHO was not a staple of the human diet and so our metabolism may favour a diet that is higher in protein/fat.

This leads us to the new therapeutic approaches to dieting and diabetes prevention/management such as the low CHO diet you seem to be on. Such diets evoke a state of ketosis, whereby the body uses acids derived from the breakdown of fat as its fuel source – this in theory will promote an enhanced state of fat burning. This is the main idea behind the recent & potential low calorie diet cure for type 2 diabetes which improves insulin sensitivity due to fat being removed from pancreas/tissues.

A concern arises with ketosis in diabetics however because there is a very serious risk of diabetic ketoacidosis (DKA) which is a situation where blood ketones rise above a tolerable level and is a state of absolute emergency. The reason DKA does not happen in non diabetics is because they will have basal insulin secretion even in a fasting state which buffers the ketone level to keep it within an acceptable range. DKA is more likely in type 1 where insulin release is non-existent whereas in type 2 some insulin response is still present – so it will depend upon the extent of Insulin insufficiency in the patient. This is one reason why a low CHO diet would not be allowed to be advocated.

The 2nd reason is this – if you remove 50% of the diet in the form of CHO then automatically there is a 50% calorie deficit which no Dietitian would be allowed to advise (unless under specific conditions which will have been agreed by the GP) and so under normal weight loss circumstances where the calorie deficit will be advised at about 25%, this will mean that to increase the energy content of the diet we will have to increase the protein and fat ratios of the diet. Increasing the fat content of the diet will enhance the cardiovascular disease risk which again, we would never be allowed to advise on and increasing protein content may have implications in terms of renal health as well as diet palatability. Yes, there are many that believe there is no evidence that fat causes cardiovascular disease however I am yet to see any studies that really support this. I have seen countless ones that suggest the link between fat, cholesterol and CVD to be very close however. Personally, I feel this is an area that needs more study and I am very interested in knowing the absolute facts about fat and CVD. However, at present because government guidelines say fat & CVD have a close relationship Dietitians are simply not allowed to advise on increasing fat ratios of a diet beyond what is currently recommended. Removing CHO also may mean there is an issue with satiety.

However – you have clearly said you feel great, are losing weight and experience no dizziness, lethargy etc which would be expected with the removal of our 'preferred energy source'! I think this is absolutely brilliant for you and also very fascinating as something is happening that we ‘Health professionals’ are missing. Sadly as Dietitians we are straight jacketed by these guidelines that do have scientific backing but do not expalin everything and so that Dietitian you saw simply had no wiggle room. But it sounds as if she was unhappy with the fact you doing things she is trained to advise against and doing so well that she clearly couldn't explain. As Dietitians we need to be more open minded becauseit has become very clear to me that many Dietitians are not willing to challenge certain things and this is not good for the patient. We must listen to people such as yourselves and learn from them - otherwise we can never ever be effective. You said it perfectly - people are not one size fits all.

Anyway – I am sorry for going on & on because what I really wanted to ask was related to the composition of your diet at present in terms of calories, CHO, fat & protein - I am very eager to learn all I can and you have had remarkable success despite doing things we say not to!! You said a diet can be made without CHO and I agree, creative use of meat, fat and vegetables can make a sustainable diet and because vegetables do contain some CHO you still provide parts of the body that can only use glucose for energy (parts of the kidney and brain). I would also love to know what your blood lipids are - if indeed you are consuming more fat than is recommended.

Many thanks.
 
Messages
6,107
Type of diabetes
Type 2
Treatment type
Diet only
Chev Chelios said:
Increasing the fat content of the diet will enhance the cardiovascular disease risk which again, we would never be allowed to advise on and increasing protein content may have implications in terms of renal health as well as diet palatability. Yes, there are many that believe there is no evidence that fat causes cardiovascular disease however I am yet to see any studies that really support this. I have seen countless ones that suggest the link between fat, cholesterol and CVD to be very close however. Personally, I feel this is an area that needs more study and I am very interested in knowing the absolute facts about fat and CVD.

A very interesting post for which I thank you. It is candid and helpful. I could ask many questions but I am going to stay on just one aspect since it confuses me.

"I have seen countless ones" (studies)" that suggest the link between fat, cholesterol and CVD to be very close."

There are talks on Youtube and articles by Dr. Malcolm Kendrick who says he is yet to discover one such study. Could you provide him with a reference please.
 

Serena51

Well-Known Member
Messages
491
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Dislikes
bigots, racists, homophobes
Chev Chelios

Interesting post but you still miss the point that carbohydrates turn into sugar in the body. As a diabetic we are trying to avoid sugar like the plague, the happy side effect is that low carb helps to lose weight which in turn helps with glucose levels.
 

Chev Chelios

Newbie
Messages
3
Squire Fulwood – I thank you for the reply and it is funny because I wanted to post links or at least the names of the studies taught to me which were what form the basis for the CVD-fat link in my original post . However I have recently moved back from Uni and all my literature/notes etc are everywhere - but I will guarantee you by the end of the day I will post those links up.

It is a legitimate point you make and one I want to know the answer to myself – I think I do – but now I have a bit more time to step outside what I have been taught I want to explore this idea of fat not being linked to CVD. I learnt about this particular area from one of the foremost researchers into cardiovascular health and after years of having to learn the metabolism of fat and how it accumulates in tissue, blood vessels, raise LDL cholesterol etc I just cannot see how he can be wrong. I am going straight to youtube after this to watch that video and will research this and come back to you.

Serena51 – again thank you for your post but I must politely point out that I did raise this very point within my post. I absolutely agree that advising diabetics to eat a diet where the main nutrient will end up as the one thing that will raise your blood sugar sounds ridiculous. I had a problem with this during my training and was always met with the same response – “sugar are not the enemy, sugar does not cause diabetes (75% true) and it is all about the type of CHO we eat” etc.

Again the idea is eating CHO based foods that are low GI will slow its metabolism and so the glucose will enter the blood stream with a trickle – meaning no peak. This is the explanation, I agree with some of this & in theory it sounds plausible but I know this is not 100% accurate. Food is too complex a molecule to work like this, there is much more to it. So I am in a weird situation, because in order to work and get paid (and I really need to start getting paid) I must advise these ideas despite me not having 100% faith in the principle. And I have to have faith in what I say because what means more to me than anything else is helping improve a person’s health.

I will just add – I did my dissertation in diurnal rhythms – basically it is a new idea and an exciting one. The body is much better able to deal with food earlier in the day and insulin sensitivity/ the insulin response/postprandial fat response are all better during the day so again not only do we have complexities of food but we also have the timing of that food not to mention individual variation.

Long story short – I agree with you!