Dietician - Grrrrr!!!!

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

Well done you. I had the same experience with my dietician silly cow, they signed me off.

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.

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:

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.

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 !!!

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.

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

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.

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:

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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...

As for cholesterol, theres more evidence to suggest that low cholesterol causes more heart problems than high.

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

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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! :thumbup:

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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


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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

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.

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.

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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.

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.

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!