huge conflict with dietician

kendod666 said:

Guess I was just typing in the heat of the moment.

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It's sad to hear that you had a 'huge conflict' with your dietician. Those are quite emotional words and it must have been an unpleasant experience, probably for both of you. When I proudly presented my new svelte figure to my GP, she said I could do with losing another 1/2 stone. That blew the wind out of my sails.

Obviously, none of us were privy to your meeting. If your conflict is unresolvable and you are certain that you are being given the wrong advice or unadequate support, then I guess you could consider going elsewhere, if that is practicable.

I've been doing low carb since diagnosed with type 1 over 3 years ago. My daily carb intake is limited to 70 carbs maximum and other than my morning oat bran (have to have it!) the rest of my carbs are from veggies, fruits and nuts. I get enough calories from lots of nuts and healthy oil. A low carb diet has made my cholesterol profile incredibly better and keeps my weight perfect. In the USA the ADA also suggests way more carbs (complex type) but I chose to go low carb because it made more sense to me. Fortunately my dietician is fully supportive of my choice. I did a lot of research online before going lower carb and couldn't find anything negative about it. There appear to be many of us following a lower carb approach to dealing with diabetes in spite of generalized diet recommendations!! If it works, don't fix it :O)

Best to all,
Helenbeth

EllisB said:

NHS /NICE guidelines are predicated with the assumption that most diabetics:

• Do not have the resolve to lose weight (if they need to)
• Will not get enough exercise, whether due to laziness or other medical issues
• Will be unable to successfully manage their BG in the long term.
• Are not able to understand the complex mechanisms going on in their own bodies
• Will not follow the advice anyway

I know that is patronising but, unfortunately, the truth is that there is a large body of evidence that this is the case and that those of us who can take control and keep our BG at close to normal levels are in the minority.

There is a much smaller body of evidence that the secret of successful management of DM is for the patient to be empowered and supported in learning how different foods and treatments affect their BG.

So your Dr and other HCPs are used to dealing with people who are not in control and getting them to improve bit by bit.

So trust in your evidence : energy, general well being, HbA1c, Blood Lipids, BMI and, if you are self monitoring, your BG measurements. If it is working for you brilliant! If not, then it is time to listen to the HCPs.

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Brilliant post Ellis. I was going to reiterate this. I have a number of friends who are GP's and they say that the majority of diabetic patients have poor motivation and as such they do not follow advice given. Even my friend, who knows how motivated I am, still said to me "yeah, but you have to live a bit!" meaning I should be eating at least a square of 70% dark chocolate per day...

It seems from what I've heard that many dieticians/members of the medical fraternity are not used to meeting highly motivated individuals like us.

I've just joined the forum as I'm newly diagnosed pre-diabetic with Fasting BG of 7.1mmol/l and an HbA1c of 40.
Just 2 years ago my Fasting BG was 5.4 which was reasonable.

My father had diabetes as did a number of relatives on his mother's side.

I was gutted to receive the diagnosis 4 weeks ago but am now not eating/drinking:
1) Alcohol
2) Refined sugars of any type
3) High GI carbs - in fact only eating very low GI carbs
4) Upping my intake of walnuts, almonds, pistachios, red grapes, cinnamon and the usual suspects.

My Fasting BG has gone down to 5.9 mmol/l in just 12 days and I'm intending to run as fast and as far as possible away from diabetes as I can, knowing that my dad was insulin dependent despite dropping the weight.

Congrats as well to you for your motivation and results. And forget what they say about loading with carbs - it's a crock, in my humble opinion. It may work for some, but for many it doesn't. And right now, where I am in no man's land, I'm avoiding them as much as I can.

Good luck on your continuing journey.

Suzi

I had exactly the same experience with my Dietician! She had a student with her and asked me if I minded if the student conducted the session, which I didn't.

The student mentioned that my Hba1C was 5.7, and had been for a couple of years, she asked me how I had done it. I explained that I was following the low carb diet and it was very effective, as she could see. The dietician then seemed to panic slightly and insisted on swapping places with the student and taking control of the session from her. She then proceeded to tell me that she thought I had been mis-diagnosed, which I clearly have not been, as is obvious if I ever fall off the wagon and eat something very sweet or high carb! which happens from time and time, as being 'good' all the time can sometimes be hard, and when you are a diabetic on a low carb diet, there are so many ways to be bad when you are feeling a bit rebellious! :?

My Hba1C continues to be 5.7/5.8 so whatever the Dietician thinks, it is definitely working for me.

My dietician was the same. Told her that i was low carbing and she freaked out about it. Yet i was the only one there that had lost weight and had my bloods at 5.0. Surely the nhs need to change there policy on there dated advice.

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When I speak to a dietician/GP/Nurse, or other HCP, I DO NOT LOW CARB, I am on a "controlled carbohydrate" diet :lol: :lol:
When I deal with potenial "raving bigots" I try not to "press their buttons" :thumbup: :thumbup: :lolno:

kendod666 said:

She was insistent that I needed/ to eat loads more carbs/pizza/chocolate/ice Cream!!!!!!! Just take more insulin!!

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kendod666 said:

"You can basically eat whatever you want with diabeties nothing is restricted at all. So if you like ice cream or pizza or chocolate that is fine to eat, you just count the carbs and take an appropriate amount of insulin to cover"

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Be fair to her! Maybe she misunderstood how much knowledge you have about diabetes. Maybe she deals with people all day who don't understand it at all, and believe you can't eat certain things. I know a lot of people who think the same.

I think she was using those types of foods to show what she meant, whilst not actually recommending you eat them all day!

FergusCrawford said:

When I speak to a dietician/GP/Nurse, or other HCP, I DO NOT LOW CARB, I am on a "controlled carbohydrate" diet :lol: :lol:
When I deal with potenial "raving bigots" I try not to "press their buttons" :thumbup: :thumbup: :lolno:

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Flipping heck Ferg, look at you!! What a difference.

wiflib

noblehead said:

if she wanted you to up your carbs from 40g a day recommending pizza, chocolate and ice-cream in doing so is bad advice, very very surprised a Dietitian would say this to you :?

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maybe she has shares in Pizza Hut

leking said:

Maybe she misunderstood how much knowledge you have about diabetes. Maybe she deals with people all day who don't understand it at all, and believe you can't eat certain things. I know a lot of people who think the same.

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On the face of it, that's reasonable enough but the dietician on my Desmond course answered a question about what foods to eat by stating that they don't recommend any particular diet as it may be misunderstood. I commented that it may not be long before someone asks 'why do we employ you then?' They are paid to offer useful advice. There's no other reason for them to be there. What next? 'We are not allowed to say because of health and safety and the data protection act?', common excuses for not doing one's job.

Yorksman said:

maybe she has shares in Pizza Hut

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Maybe she had :lol:

Hogeymama said:

The student mentioned that my Hba1C was 5.7, and had been for a couple of years, she asked me how I had done it. I explained that I was following the low carb diet and it was very effective, as she could see. The dietician then seemed to panic slightly and insisted on swapping places with the student and taking control of the session from her.

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She'd probably primed the student saying that this next patient, you, is a good example of how well some patients do who follow her advice and then you go and blow all her credibility away. Shame on you :lol:

Had she not asked how you had kept it under control before?
Maybe she was embarrassed that the student had thought to ask the question and she hadn't.

Maybe she thinks her advice is good because she never asks whether those that have control are actually following it.

This is a really interesting thread for me as a newly diagnosed T1.

I have a relatively low carb diet compared with a lot of people, but nowhere near 40g per day. I'd been moving my diet over the last few yeasr more towards low GI carbs from beans, pulses, lentils etc swapping potatoes for sweet potatoes as lower GI and having no more than one slice of dark rye bread a day. Even so with all that I'm around 150g per day for my main meals.

Then I come to sports. None of you mentions exercise here, so not sure what you do, but as a long distance runnner (training 5-6 times a week) I'm used to a slow drip feed of carbs for anything over a 90 minute run. After that you start to burn more fats but you still need to keep the blood sugars topped up to allow the fat burning mechanism to work from the physiology I've read.

I'm still geting used to the whole thing and having discussions with my dietician who specialises in helping athletes, but I'm a little concerned about her attitude to throwing more carbs at the problem. I'm hoping to educate her that you can run/exercise successully as an endurance athlete without huge volumes of carbs, and lower my (already low) insulin doses to match the physiology rather than the other way round

I've asked several dieticians what harm I'll come to on low carb. Still no answer, however, I've met a couple recently who are all for low carbing. The one who saw T1 about his kidney failure, also said it was ok. Now he's on low protein as well, because of the kidneys, It's not easy to plan a diet. I'm finding a load of things to do with veggies. I made a superb Minestrone soup [without pasta] yesterday. Very flavourful and quite filling. I'm going to find one for a Mulligatawney next.
Hana

You need carbs, and the advice I got from my DN was to eat chapati because it releases carbs slowly (like some meds).

My motto is "everything in moderation" -- the source of carbs, protein and all the other nutrients is as important as the amount of daily intake.

Also, I believe the guy who "invented" the low-carb diet with a massive heart attack in the middle on New York as all his arteries were clogged-up. Didn't do him very good then.

Sip if you are on about Atkins, he fell in the snow and banged his head. We get our carbs from veg, you don't actually need processed carbs.

I'm with sip, I changed all carbs to low GI and reduced the portion size...

With regard to the medical profession and their advice I was told it was because too many diabetics just cut out carbs so they don't have to exercise as much which apparently is not the right thing to do... Apparently you should eat low GI carbs and aslong as you burn off what you put in that's classed as being healthy - not just stopping the carbs to make things easier. No evidence was provided to back this up though but to be fair I can maybe see a point in it....about the needing less exercise if there's less carbs....


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 23 currently controlled by only Metformin, 500mg twice a day.

sip said:

You need carbs, and the advice I got from my DN was to eat chapati because it releases carbs slowly (like some meds).

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That depends on which chapatis. I've tested several brands of nan, roti and paratha and many that claim to be wholemeal are far from it. Sounas wholemeal seems to be the genuine article. I bought a sack of wholemeal chapati flour and will make some parathas. Lets see if what I bought is 100% wholemeal or not.

My wife buys white chapati flour which has brown mixed if, if not, she mixes them herself -- TBH I don't know what percentages are but the white seems to be dominant.