Dietician - Grrrrr!!!!

[Sid Bonkers]

The dietician that I saw was extremely knowledgeable and helpful and I learned a lot but I guess there are good and bad in ever profession.


Then again I was prepared to listen to her and didnt go in all guns blazing telling her I knew better than her

 

[TokSik]

Personally, I prefer to take the advice of an alternative NHS dietitian - Dr John Briffa who tends to shoot down most NHS advice on diet for diabetics, and always provides web-links to the research on his advice.
You can view his blog here :--
http://www.drbriffa.com/blog/

 

[Sid Bonkers]

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.

Hi Chev, this is often the argument used by those who advocate very low carb or Paleo diets but I just cant get my head around it due to one basic fact, the human body chooses to look for carbs to convert to glucose before it looks for fat, now surely if we where evolved to process fat to glucose our bodies would look for fat before carbs and no one on this planet would be fat or overweight.

How would you answer this?

 

[Gillijack]

:clap: I am relieved to read this and found your strong attitude to be very uplifting. I am 8st 10 and have been training for over 20 years, going to the gym 4 times per week, several half marathons, 2 sprint triathlons, many 10k runs, age 49 and just been diagnosed with type 2 ( they think, query type 1). I have so much to learn. I didn't want to take any medication. I was advised to take statins to bring down my cholesterol and metformin. I point blank refused statins when I read about the side effects and reluctantly agreed to take metformin. But I have also had a urine infection that has been hanging around for some time. I read that I shouldn't be taking metformin if I have a urine infection, yet the doc didn't mention this. I know that is nothing to do with any dietician, but its an added issue with me at present.

Anyway, I Just started one week ago and feel dreadful. My energy has dropped dramatically, I feel sick most of the time and down right miserable. today i could barely lift my head with exhaustion. I cant sustain my fitness regime like this, so I decided today to stop the metformin and give myself a chance to manage this through my usual very healthy diet. I found this thread of discussion so supportive. To be honest i was looking forward to my first session with a dietician, but unless they can guide me on how to maintain my high level of fitness with food whilst dealing with this condition then I'm not interested. Sounds to me like they are not trained enough to deal with such circumstances.

Your comments have given me back a bit of confidence and reminded me that I can be in control. So thanks!!! PS spurillina really good.

 

[sandysan]

oh great im in the right place ,

I was diagnosed last week , and seen the diabetic nurse yesterday , hmmm didn't think much of her , i have a meter a spare one of my husband as he is diabetic ,, i am t2 and no meds at moment , i done all monitoring blood all week and 2 hours after food , to be told by the nurse they don't want to know about meters she wasn't interested in them or my doctore in my readings ,, just told me to eat a healthy dirt and gave me a magazine ,,,
i wasn't happy , as being diagnosed a week ago this monitoring my blood has helped me a lot , without it i will be thinking have i eat the right food ,,, it puts my mind at ease to use the machine until i get used to what carbs are , which i am understanding slowly..
i am overweight a lot 17st ,, but in one week i have lost half a stone ,, i don't agree with the nhs stopping the meters i have just bought an up todate new one ,

without me monitoring myself , i could go back in 3 months have a hb1ac and find next they say your high u need tablets ,
so with the help of my machine meter hopefully i can go back and the levels will have dropped a bit more

great site thisis thanks

 

[Chev Chelios]

Sid Bonkers

That is a very good question and is I think why Health Professionals and indeed medical practitioners say that glucose is the bodies preferred fuel source. This is a very hard one to answer, with no definitive conclusion either way I am afraid and I definitely cannot fully elucidate it. But I can give my in-experienced thoughts on this certainly.

Ok - in support of the Glucose is king argument is related to the fact that the brain certainly appears to prefer glucose. This prioritising of glucose during metabolism as well as the fact the body will breakdown precious muscle during low glucose episodes may be linked to the fact this most important organ needs it. Indeed, even during ketosis there is still some brain tisue that appears to still need glucose as does some renal tissue - so we never fully adapt to ketosis. Even in complete starvation when the body down regulates everything to spare energy and survive, we still see some gluconeogenesis occuring to supply glucose to these tissues. So no doubt about it - we need glucose.

The answer to this promotion of glucose metabolism may be intimately linked with the forming of the genome during palaeolithic times - at this time glucose was indeed rare in the diet and so perhaps when this substrate was eaten the body would promote its metabolism to ensure it was utilised above the other substrates that were in abundance. Why would the body do this? Well, at rest our body will oxidise fat as its main fuel substrate but in times when rapid energy was needed, such as say life or death fight or flight situations, fat was unable to be oxidsed quick enough to allow for rapid energy mobilisation. Glucose releases its energy much quicker and so the body clearly evolved to make use of this ability of glucose - so when rapid bouts of movement occur our most accesible source of fuel is glucose. So perhaps this argument about it being a vital component and its rarity lends weight to why our metabolism shifts to & indeed is orchestrated by glucose when consumed rather than it beingbecause it is themost important fuel. It is odd that if it is our most important fuel source why would the body only hold 24hrs supply of it. This is all a pure guess by the way.

Therefore I think the answer to glucose as a fuel source is that it is definitely essential for some aspects of physiology and not so much for others. So what is really of chief concern regarding glucose in pathology/weight loss etc will lie in how much glucose we actually need - is a diet of 50% CHO optimal, personally I do not think so but as I have said previously and you will know better than me - what do we replace it with? Extra fat will not be advised due to the cardiovascular risk although admittedly polyunsaturated fats don't appear to confer atherogenesis or raise cholesterol. High protein diets tend not to be palatable, and they simply have not been studies for long term safety as far as I am aware. Renal function may be compromised with high protein diets - remember our avearge UK diet already is already higher in protein than is needed. Again, dangers of high protein diets do not appear to be known either.

I have already commented on the concerns with Low CHO diets and diabetes (DKA) although the risk is greater in type 1 - I have not studied these diets and only will need to do so if I go into ketotic diets as treatment for epilepsy however saying that - interest is gathering now studies are coming out showing these low calorie low CHO diets have been shown to cure type 2 diabetes. This is where my interest in Low CHO diets come in - this diet is in its early days but is indeed very very interesting.

 

[Sid Bonkers]

Sid Bonkers

That is a very good question and is I think why Health Professionals and indeed medical practitioners say that glucose is the bodies preferred fuel source. This is a very hard one to answer, with no definitive conclusion either way I am afraid and I definitely cannot fully elucidate it. But I can give my in-experienced thoughts on this certainly........

I wasnt aware that there was any argument over whether the body needs glucose, our bodies have to have glucose or we die. The brain needs a minimum of around 120g of glucose or something and thats before we get out of bed and move around which of course burns more glucose/glycogen.

Surely the argument is whether it is better to have that essential glucose derived from carbs or from fat and as carbs are the bodies preferred source of energy to convert to glucose/glycogen how could we have evolved to eat a ketogenic diet. As I said before if we were designed/evolved to eat a ketogenic diet surely we would have a metabolism that would look for fat before carbs.

 

[Daibell]

Hi Chev. Although the brain needs glucose the body is quite capable of producing what it needs from carbs, fat or protein which is why the Inuits who eat virtually no carb have survived well over the centuries.

Sid, my understanding from Dr Briffa's many References is that the early hunter-gatherers had a diet of 20% carbs and 80% fat/protein (if I remember correctly). I think the jury is still out on why the body will go for carbs first and then fats. May be the 20% provides very available energy from quick conversion to glucose and then the fat store is raided if needed after that? Same as the brick-wall syndrome when doing marathons; I hit mine many years ago at 12 miles and it took quite a while for the body to start converting fats. Training, of course, helps the body do this changeover faster.

 

[modesty007]

Actually the minimum glucose need for the brain is 30 g/day (google this if you don't believe me), otherwise the brain and especially the heart works fine or better on ketone bodies. Even though your brain needs glucose, you don't have to eat it, if eating enough protein (and most things protein contain some carbs). Nutritional ketosis and keto-acidosis are two complete different things. While keeping your eyes on BG there should be no problem for a type 2 to be in nutritional ketosis. Learn more on www.dietdoctor.com. Still amazes me that type 2s in Scandinavia are able to go very low carb and reverse their diabetes, while people here in UK still find it so difficult to cut carbs (I know not all of you).

 

[the Boissetarian]

Hi everyone
just read all your posts about Dieticians and their "helpful" !!!!!! advice. I have experienced similar. I was told to eat 200grms of carbs with each meal. Being green behind the ears at the time I tried it - result - I put on weight wich did not help the diabetes! GP also changed my medications because I was having digestive problems with the ones I was on, and I put on even more weight. It was then I started to investigate the drugs I was on and what they did. I began to take control of my diabetes myself. As you say Hazehkm, no one knows our bodies better than ourselves. My GP certainly doesn't. I then came across the "Fast Diet" or 5:2 diet as it is also known. Started it in June and began to lose weight. Went to see GP to run it past him. He said it would not work but I said I wanted to try it. He just shrugged his shoulders. Tried diet for a month and kept record of BS readings BP readings and weight. Went back to see him with evidence of weight losss and lower BS readings. I had also reduced my medication to one tablet instead of 3. He was not impressed and said readings were not reliable as I would still have a residue of other medications in my system!!!! So we agreed on another trial month, just taking Dialmacron and BP tablet, then have a blood test and go back and see him. I came away thinking that he expected my BS to be all over the place so he could say "I told you so!" How wrong could he be. I had lost even more weight and more importantly my HbA1c was down almost 1% from the previous reading 4 months before. When he say that he just uttered a short synical laugh!!! He could not say anything against the results.
But when he was on holiday a couple of weeks ago I had to see a colleague of his who had an entirely different attitude. I told him about this diet and he too was a bit sceptical but when I showed him an article about the diet and showed him how my weight & BS had dropped he was very supportive. I said how my BS rose after the evening meal and he suggested that I took half a metformin along with Diamacron with the evening meal to help steady the BS; I have done this and now have a more even level. Shows how GPs differ. I cannot eat carbs - my body does not seem to deal with them properly and they just turn to fat. I now weigh in at 90kg - the lowest I have been for ages. I was over 95kg when I started. Like you I have more energy most days and my mental attitude has improved. We have bought a running machine and I now do about 10-20 mins of fast walking each day. So think I am now living a healthier life than before.
I fully recommend a person taking control of their diabetes and not letting it take control of them. One will never be non-diabetic, it is with us for the rest of our lives, but we can live a full rounded life in it's company. There are no foods I do not eat, but some less often than I used and in not so great a quantity. I am 71 and want to live what years I have left to the full and not be a slave to a rigid diet that give no pleasure. I would suspect you feel the same.

 

[judithamilton]

I've had similar problems with 2 dieticians...I went in with an open mind hoping for useful advice but they wouldn't listen to my needs/experience. One was actually trying to recruit for a commercial weight-loss outfit! The outcome of my experience seems to be: take their advice and I put on weight; listen to my body and devise my own approaches to eating and I lose weight. No brainer!

 

[Sid Bonkers]

Sid, my understanding from Dr Briffa's many References is that the early hunter-gatherers had a diet of 20% carbs and 80% fat/protein (if I remember correctly). I think the jury is still out on why the body will go for carbs first and then fats. May be the 20% provides very available energy from quick conversion to glucose and then the fat store is raided if needed after that?

I would have to agree to disagree with both you and Dr Briffa and say that I think it is fairly obvious why our bodies look for carbs first over fat to convert to glucose, its because you were designed/evolved that way. I cant think of any other answer.

If we had evolved to eat fat then surely our bodies would have evolved to convert fat to glucose faster than carbs, isnt that what evolution does/means?

I know low carbers and palea fans want to believe this theory about hunter gatherers evolving to eat fats but it just has way too many holes in it for me to believe. We are designed to eat carbs, that may not be the best option for a T2 diabetic but its what we were evolved to eat for fuel.

And I think the jury is still out on what constituted an early hunter gatherers diet as I would have thought that just like hunter gatherers today they would be eating the most abundant food source at any given time and that would change with the seasons along with their % of carbs to fats so I would suggest that it is impossible for anyone to say with any authority what our ancestors eat. All we can know for sure is that they ate carbs as early man have been found with grains in their stomachs but I cant see how anyone could draw any other conclusion from that other than that man had eaten carbs shortly before he died.

 

[Ria]

What do Eskimos eat? Isn't it mainly meat, I.e low carb? Mind you their diet is likely to be low on veg and fruit too.

Sent from the Diabetes Forum App

 

[Sid Bonkers]

Indeed the Inuit and other Eskimos used to eat a diet high in protein and fat, fish and seal/whale meat but they also had one of the worlds highest mortality rates from heart disease and also one of the lowest life expectancies of any of the worlds peoples, that said of course they also lived in a very hostile environment, so statistics can as always be skewed.

 

[paul-1976]

What do Eskimos eat? Isn't it mainly meat, I.e low carb? Mind you their diet is likely to be low on veg and fruit too.

Sent from the Diabetes Forum App

I can happily assure you that my low carb diet consists of a LOT more than just meat ! It's mainly non starchy veggies and berries,dairy,nuts and good quality meats and natural sat fats to complete my calorific needs.

 

[neilblackwood]

Indeed the Inuit and other Eskimos used to eat a diet high in protein and fat, fish and seal/whale meat but they also had one of the worlds highest mortality rates from heart disease and also one of the lowest life expectancies of any of the worlds peoples, that said of course they also lived in a very hostile environment, so statistics can as always be skewed.

Hi Sid,

I have recently found a wealth of information that goes further to explain the evolutionary reasons for using both glucose and ketones in the body (link below).

The summary highlights:

Our brain can only function with glucose and ketones. Since we can’t store more than about 24 hours worth of glucose, we would all die of hypoglycaemia if ever forced to fast for more than 24 hours. Fortunately, our liver can take fat and select amino acids (the building blocks of proteins) and turn them into ketones, first and foremost to feed our brains. Hence, our body’s ability to produce ketones is required for basic survival.

http://eatingacademy.com/nutrition/is-ketosis-dangerous


More data is being uncovered that running on ketones is our bodies fuel of choice, mainly because, until the advent of farming and supermarkets, carbohydrate sources were seasonal and unavailable for at least a few months of the year, we would have resorted to hunting animals and fish (very low carb) to get the food required for basic survival.

My hypotheses is that because carbohydrate has been historically rare, we've therefore biologically adapted to use it when available as a preferred fuel to preserve fat/ketones, and if substantial carbohydrate sources were available, store the carb as fat as a guard against possible future famine.

There's some more info here:
http://youtu.be/NqwvcrA7oe8
http://livinlavidalowcarb.com/blog/jimm ... -120/15560
http://youtu.be/yP6DtqmZ3Mw

 

[phoenix]

There's a great deal of time from farming to supermarkets and a great diversity in what hunter gatherers ate then and now.
Perhaps you would consider the evidence from real experts in the field of evolutionary nutrition.
http://evolvinghealthscience.blogspot.c ... ition.html
and here all the videos from the conference. (quite a lot to watch !)
http://www.uctv.tv/human-nutrition/

You might also find this MOOC which starts in January interesting. It should contain the latest evidence on dietary evolution. I'm looking forward to it. https://www.coursera.org/course/humanevolution

 

[douglas99]

There's a great deal of time from farming to supermarkets and a great diversity in what hunter gatherers ate then and now.
Perhaps you would consider the evidence from real experts in the field of evolutionary nutrition.
http://evolvinghealthscience.blogspot.c ... ition.html
and here all the videos from the conference. (quite a lot to watch !)
http://www.uctv.tv/human-nutrition/

You might also find this MOOC which starts in January interesting. It should contain the latest evidence on dietary evolution. I'm looking forward to it. https://www.coursera.org/course/humanevolution

Good article.

Probably another reason most original hunter gatherers were thin is the thin ones got to eat the sabre tooth, the sabre tooth got to eat the fat ones.

So I guess the correct diet is one you can get from the tiger cage at the zoo, using just a pointy stick if you really want a paleo diet.
Two steaks from Tesco's hunted/gathered with a small square of plastic just won't have the same effect.

 

[fatbird]

Man did not evolve on a diet of HFCS sugar starch hydrogenated vegetable oils artificial colourings chemical preservatives and pharmaceutical drugs that much we know.

 

[douglas99]

True.

We appear to have evolved into that though.

So, evolution, forwards or backwards looking?

Do we want to eat a diet we evolved from, or improve the diet we are evolving into?