My letter to DUK in response to complaints on this forum abo

[wallycorker]

...........It would be difficult to carry out a study retrospectively with any of you I think.......

Not certain that it would be too dificult Ally! I'm fairly confident that I know what would happen to my glycaemic control if I started to follow the "eat plenty of starchy carbohydrate" advice - especially the almost universally acclaimed by healthcare professionals porridge and cereals for breakfast.

I'd be reluctant but might just be willing to consider doing it in a controlled situation if I thought that it might change the advice being given out.

............ The thing is the people on here who are eating carbs will counteract what you are saying...........

Again, I'm not certain that would be the case in a controlled experiment if the type of carbohydrate that they were looking at was starchy carbohydrate such as cereals, bread, potatoes, rice and pasta etc. I'm still eating around between 100g and 200g of carbohydrate a day in a low calorie slimming diet of around on average 1,500 calories per day. However, very little - almost none - of it is from the refined starchy carbohydrates mentioned previously. These days, I get most of my carbohydrate from fruit, vegetables, yoghurt etc. Moreover, I put my major improvement in reversing my Type 2 condition and normalisation of my blood glucose levels over the last twelve months mainly down to that change in my dietary intake.

John

 

[IanD]

hi ian

Sorry I havent pm you - been crazy few days!

Anecdoatal info will get you no where - unless it is part of a study they will not use it. It would be difficult to carry out a study retrospectively with any of you I think.

Not at all. Our Drs have our records that will show the progress of the disease, and will show the improvement with a change in diet.

There are several points I think they need to address

1) Ditch the sugar - that is sending the wrong message
2) They cannot give individual advice so they are just giving a range - it works for some
3) they are not consistent in portion sizes of anything
4) their meal plans need ditching
5) more effort on testing

I'll try tomorrow to get your message across.

How do they know it works for some, if their message is that diabetes is progressive? If they were honest, they would admit that it works for no-one.

Maybe they should be looking at what diabetes units are actually doing - there is a lot of carb reduction and counting going on - this forum does not apear to reflect what i see in practice.
Get then to fund some more research.

What YOU see in practice is either: people following the DUK advice & going downhill, or people not following any advice, & going downhill. Thankfully some will conscientiously follow your advice, & test to maintain control, your advice actuaklly being reduced carb, even though you argue against us.

I do not want to sound negative but a few letters and voices will have no impact I am afraid - its fact they need. The thing is the people on here who are eating carbs will counteract what you are saying.

Someone claiming to be a Dr came here & objected to bias because so many postings advocated reduced carb & so few the high carb diet. Even those who claim they are not low carbing have reduced their carb intake & maintain low/med GI carbs.

 

[TheTartanPimpernel]

And the depth of the fluff in the navel is......?

Reality is that until some controlled study is conducted we will never know. And again,simply observing on an individual basis that BG is 'better'/'lower' says nothing without some measure of what the overall impact on the 'whole' might be/is. You might well die without your feet on, but who said life without feet is all that bad. On the other hand you might live a very long time; but then never mind the quality, feel the width.

For me, I will stick with portion control which is perhaps lower/fewer everything including carbs.

 

[wallycorker]

.................who said life without feet is all that bad..................

Not sure that I understand that question/statement! I suppose that, in coming from Yorkshire, I might have missed something in translation but that situation certainly dunt sound too good to me! :shock:

 

[ally5555]

Ian - a retrorespective study would not show what you were eating before or what your results were at the start - the scientists would rip it to bits I am sure . All you could provide would be data and tbh i could provide the same !

It is a shame DUK do alot of good work but they are letting themselves down pushing so much refined CHO.

It seems to me and correct me if I am wrong or getting confused between posts that many of you are not low carbing , that is 30-50g /day! John you are consuming around 200g and that has suprised me tbh!

I think one of the important things is that people get individual advice but not from nurses or doctors. Also diabetics should get the time they need with dietitians as soon as they are diagnosed not 6 months later. Some departments are so busy they can only allocate a 20 minute appointment - crazy! I went to a national obesity forum meeting this week and one of the topics discussed was the fact that so many doctors just have no interest in diabetes and obseity - considering the scale of the problem that may suprise many of you.

 

[ally5555]

Ian - i don't argue against mod carbing at all - I said time and time again that is what I use and alot of other dietitians do . What I will argue about is extreme carb restrictions - and some of the really awful meal plans I see not just on here.

I am still keeping a straw poll in work on the numbers of my patients who have extreme low carb diets - usually atkins type. About 80% have tried it , lost wt and when I ask why did you stop - here is a list of reasons that crops up everytime - boredom , cant face any more protein, tired , dont feel well, - that is a recurring theme. I have no doubt there will be comments. Oh by the way these are diabetic pts - some are newly diagnosed but not all! Outside of diabetes low carbing is dying out - that is what i am seeing in practice.

Let us know what happens today.

 

[wallycorker]

Ally,

I agree entirely with what you say about DUK - they do seem to do a lot of good work but they are letting themselves down big-style by following other organisations such as the Food Standards Agency in pushing far too much refined carbohydrate in a diabetic diet - especially in a Type 2 diabetic diet.

I for one am not low carbing but I have cut back tremendously on the amount of refined starchy carbohydrate (i.e. cereals, bread, potatoes, rice and pasta) that I eat. I didn't say that I'm eating 200g of carbohydrate daily - I said up to 200g. I'm eating on average somewhere around 150g per day in a low calorie diet - i.e. quite a large percentage - but most of it as fruit and vegetables. In doing that my blood glucose fasting level hardly ever goes above 6 and my one hour after finishing eating level hardly ever goes above 8 - except on the very odd occasion when I'm experimenting with the things that I eat. That is many a mile away from what my levels must have been when my HbA1c was at 9.4% - I wasn't testing then so I don't have any idea what they were - I dread to imagine! I maintain - and have maintained throughout my Type 2 improvement programme - a detailed food and testing diary and would be willing to share details with you if you or anyone else has any interest in what I'm actually doing.

Despite the fact that I'm not what some is generally considered to be 'low-carbing', I am totally convinced that it is the carbohydrate in our diet that diabetics needs to manage. Moreover, if my blood glucose started to rise again then the first thing that I'd do is to make further adjustments to my carbohydrate intake. If that meant going to 50-60g of carbohydrate daily then - without any question - that is what I'd do. It was only late in my improvement - and after arriving at these diabetes forums around six months ago - that I realised that it was carbohydrate that had been the major factor affecting my Type 2 diabetic situation.

Personally, I must have seen more than double figures of dietitians - one in the first eight years and the rest of them over the last twelve months. All of them are looking at their watches from the minute that I enter the room and stressing that I haven't got long and that they better weigh me because I'll have to go soon. In fact your twenty minutes sounds a long time - it seems more like ten minutes to me. All of them treat the session like what I assume a Weightwatchers session must be like. Certainly, I consider my improvement to be due to the dietary changes and hardly anything to be due to my loss of weight. In addition, I do very little exercise and that regime hasn't changed throughout my improvement. Not one of them has ever talked to me about managing my carbohydrate intake. In fact, not one of them has ever asked me how much carbohydrate I was eating. Before I came to learn what was going off, I used to leave such sessions feeling quite down and with the impression that the dietitian thought that I was a liar.

As regards your comment on doctors, I consider that mine is one of the best in this area and, certainly, I have seen no one else for around ten years now. Moreover, from top-level meetings that I attend at the local hospital I know that he is one of the most respected doctors in the area on the subject of diabetes. Despite all that, I think he is absolutely perplexed in trying to comprehend what I have managed to achieve in twelve months by self-management. It's almost as though he thinks that I'm carrying out some sort of hoax. He just keeps looking at my numbers on his computer screen almost speechless uttering single words such as "amazing", "remarkable" etc. Whatever, problem I now go to see him with he welcomes me and wants to talk to me about my improvement and seemingly - and genuinely - wants to know how I have achieved so much to improve my non-insulin dependent Type 2 diabetic situation by disregarding his "do not test" and "eat plenty of starchy carbohydrate" advice.

John

 

[ally5555]

Interesting comments john

It is true dietitians do not have time in out patient sessions and the stupid way , especially in england they are being pushed to just see numbers is shocking. In many places there is a recruitment freeze so they are a very stressed profession. The UK government just do not seem to see diabetes and obesity management as a priority so where we go I am not sure. A meeting i went on Thursday on Obeity was very depressing indeed - it is not recognised as a disease!
Also diabetes is I am afraid very repetitive so alot of dietitians prefer the high tech work in Intensive care or paediatrics. As a newly qualified dietitian that is what I preferred!

I work for 2 GP practices amoungst other things and am able to give pts more time and it does make a difference. I don't know whether this service will continue beyond 2011 if it stops the pts will have to wait 4 months to see a dietitian at the local hospital.

My comments about doctors and nurses giving dietary advice I stand by - they have very little training and some of the things they tell pts - ahhhhhh! There is obviuosly some overlap between professions but that is how it should stay I think!

 

[catherinecherub]

Wally,

I am getting confused by your post.

You say that you are not a low carber and yet you belong to a low carb forum? :?

I am not a low carber, probably eat less grammes of carbohydrates than you do, follow the G.I. eating plan and no way do I consider myself to be a low carber. I eat complex carbohydrates and am using portion control. This involves 25% complex carbs, 25% protein and 50% vegetables and some fruit.
I would also say, from your post, that not all rice, pasta, cereals and breads are refined as you seem to think.


Can you clarify?

Catherine.

 

[wallycorker]

Wally,

I am getting confused by your post.

You say that you are not a low carber and yet you belong to a low carb forum? :?

I am not a low carber, probably eat less grammes of carbohydrates than you do, follow the G.I. eating plan and no way do I consider myself to be a low carber. I eat complex carbohydrates and am using portion control. This involves 25% complex carbs, 25% protein and 50% vegetables and some fruit.
I would also say, from your post, that not all rice, pasta, cereals and breads are refined as you seem to think.

Can you clarify?

Catherine.

Hi Catherine,

I don't know why that should confuse you - I support Barnsley but that doesn't stop me going to watch Rotherham play football. Moreover, I've stopped paying to DUK yet I still attend two of their local Support Group meetings - in fact, I'm just about to take over leadership of one of the groups. For the life of me, I can never understand the need by some people - it would seem to be more the case on this forum than it is on others - to try to put me into some sort of box. I'm a member of about five diabetes forums and have no plans limit myself to a lesser number. Whilever, the low-carb forum are happy to have my input I'll be staying a member there.

In any case, when I joined the low-carb forum I wasn't even aware of what some of you meant by low-carb was a very precise 50-60g per day. In fact, at that time, I didn't even realise how much carbohydrate I was eating - that is something that I've only added up very recently. What I did know is that cutting back dramatically on starchy carbohydrates had been the major factor in my the reversal of my non-insulin dependent Type 2 condition. If I ever have the misfortune to encounter more difficulty in maintaining my current level of glycaemic control then I shall certainly be looking to manage my carbohydrate further. Moreover, if that means going down to 50g a day then that is what I will be doing.

I agree that some starchy carbohydrates are less refined than others. Moreover, I do not absolutely restrict any food from my diet - not even sugar or chocolate. However, whenever I eat starchy carbohydrate foods - that I know from my testing - are likely to raise my blood glucose levels I limit the amount that I eat to very small amounts. Moreover, whenever I eat starchy carbohydrates I do try to make sure that they are less-refined and/or low-GI versions such as rye bread, Burgen bread, sweet potato, Lizi's granola, pulse spaghetti, spelt pasta, brown rice, basmati rice, wholegrain versions etc. However, I do stress again that these days I do eat such foods very infrequently and only in very small amounts - I treat them very similarly to how I treat sugar and chocolate etc.

By the way, I do not claim to be an expert but I do know quite a lot about what has happened to me. What's more, I'm finding from these forums that I seem to be very similar to many other non-insulin dependent Type 2s. Moreover, I am still learning every day and still want to learn much more because I know that the situation that prevails with my diabetes today might not stay the same forever.

From what you write, you sound to be eating a very sensible diet to me. However, that is not the sort of advice that I was given for eight years. As I have said many times previously, I was given a very strong message to eat a low-fat diet - and even more importantly told that I needed to "eat plenty of starchy carbohydrates". I still receive that sort of advice today despite my improvement. When I used to tell the dietitians that I ate cereal for breakfast, chicken or turkey sandwiches for lunch and either potatoes, pasta or rice with my low-fat evening meal - and sometimes cereals for supper - they used to look at me as though I wasn't telling them the truth. Even now, these healthcare professionals called dietitians try to get me to move back towards that way of eating. They have absolutely no chance!!!!

Hope that this post will satisfy your need to know more about my situation.

Best wishes as always - John

 

[wallycorker]

...........It is true dietitians do not have time in out patient sessions and the stupid way , especially in england they are being pushed to just see numbers is shocking. In many places there is a recruitment freeze so they are a very stressed profession......

Ally - I have suggested locally that they ought to overcome this problem by having more group sessions but I've never been aware that anyone is taking up the suggestion. Perhaps, it is because dietitians seem to have difficulty coping in group sessions by needing to reply to people such as me who will certainly question why they give out this seemingly damaging advice. When I ask questions front-line dietitians tend to reply with the stock phrase "This is what we have been trained to say!". Even the Head Dietitian in the PCT that covers my GP's practice, responded to my question as to why diabetics - especially non-insulin Type 2 diabetics such as me - were given the "eat plenty of starchy carbohydrate" message by saying "This is the advice that comes down to us from national level!". That response was given in a high-level diabetes network meeting at the local hospital. I despair!

...........My comments about doctors and nurses giving dietary advice I stand by - they have very little training and some of the things they tell pts - ahhhhhh!

Yes - my well-respected-in-diabetes-circles doctor who has insisted on giving me dietary advice for nine years - including "eat porridge for lunch as well as breakfast" - now keeps telling me that he is "not a dietitian". However, I think that I have managed to convince him that the advice that I was given for so long and which caused my condition to progress - i.e. deteriorate - albeit slowly, was very, very poor indeed.

Best wishes - John

 

[graham64]

Catherine

You say that you are not a low carber and yet you belong to a low carb forum?

John although not stictly a Low Carber, is welcome at the Low Carb Diabetes Forum as he will testify. It's not a case of how many carbs we consume but aknowledging the effects on Blood Glucose and the advice given. John and I are miles apart in relation to fat in our diets, I don't have a problem with that nor I think does he. But we do have an understanding about the role of starchy carbs in the T2 diet.
That he chose to join our forum as he did yours is Johns decision, I don't think its up to you or I to question that.

Regards
Graham

 

[ally5555]

Hi john

I wouldn't be afraid to ans your questions.

Departments are struggling to run these course because of man power - or should I say the lack of it.

One of the most annoying things john and i am sure you will find this out for yourself are the numbers who do not turn up! I am involved in some sessions and we offeerd some in the evenings for those who work - had to cancel them !

I am beginning to think the dietitians I know are in a different league - dietitians are not a walk over and i know so many that do not tout DMUK stance - must be we are different in Wales !!
Your comments about time is true they are not getting time to practice properly all the english boards are interested is bums on seats not clinical outcomes - dietitians do not like this but do not have any choice. TBH many are so fed up they are leaving the profession!

Hana - how did you get on yesterday?

 

[hanadr]

Catherine
you cannot digest unprocessed grains
this means either one extreme, such as breakfast cereals, or the other minimal processing of threshing and cooking.
We DO NOT HAVE ENZYMES to break down starch in its natural state.
You simply cannot digest raw unprocessed starch.
Just try digesting a teaspoonful of wheat grains.

That bit of biology comes somewhere around years 7 - 9 of the National Curriculum. the famous experiment of digesting starch with Amylase(or Ptyalin as it used to be called) doesn't work if you don't boil the starch.
The starch that people consume is ALL processed. The amount of processsing required to make Weetabix or Shredded Wheat is scary. Even porridge oats are processed.
Hana
That doesn't mean that I don't believe GI tables to be useful

 

[wallycorker]

............That doesn't mean that I don't believe GI tables to be useful......

Me neither Hana!!!!

However, sorry to both you and Catherine, all the rest is above my head. I've absolutely no knowledge of nutrition theories except for what I have read over the last twelve months. Oh!.....and the first-hand experience of what has happened to me during the course of my Type 2 reversal.

I'm just a simple man - a coal miner's son and a retired steelworker who is thinking about retraining to become a doctor like Dr Bernstein! :lol:

John