Now the X-PERT advice is low carb, high fat

[Bluetit1802]

Thank you Trudi. I will be emailing my stats to you forthwith.

 

[Avocado Sevenfold]

Hi Doctor, welcome from me

Dear Low Carbers,...
It has always been the case that people learn what carbs are and which foods contain them. In week 3, people are then supported in assessing how many carbs they are eating and setting goals to reduce if they wish to reduce blood glucose levels and/or lose weight. Generally we find that most people reduce their carb intake after becoming more carb aware...

If you read around the forum, you will notice that a lot of T2s are actively discouraged by HCPs from self testing. This must make your course more difficult for people trying improve bg levels But that is a different battle. I will email you my results when my latest are available sometime next week.

 

[CollieBoy]

Dr Deakin, my details e-mailed this evening as PDF, with my thanks

e- mailed @ 23:30
Replied by 00:30
And I thought I was a night owl

 

[Caractacus]

I've just completed week 2 of the x-pert course based on v10 of the handbook. Here's my feedback, in the hope that it's useful.

We did nutrition this week. Generally the instructor has been pretty good in my view and given the composition of the class.

She's made it clear that advice on fats is changing and that some of the causes for recommending low-fat diets are no longer seen as valid. I get the idea that she's not pushing too hard on "this advice is right and that's wrong" but rather trying to gently untangle misconceptions acquired elsewhere. I could see this was the right approach in at least one instance where she was dealing with someone who had some odd ideas acquired at her weight-loss support group and was inclined to be stubborn when challenged on them directly.

I don't think the course so far pays enough attention to economic issues around healthy eating. I live in a severely economically depressed area and most of the audience of this class are pensioners, so I think it's crucial to make sure they're getting advice they can actually afford to follow. When we were discussing low carb and I raised the issue of the role of cheap but carb heavy staple foods like rice, pasta, bread etc and the relatively higher cost of healthy alternatives, you could see that she got the point but didn't have a sensible answer ready as she had for everything else discussed so far, which I took to imply that it wasn't something that her training had covered.

The instructor did question the value of snake-oil products like 'diabetic foods' or 'anti-cholesterol spread' and helped the class to conclude that they're a con-job without actually saying so. God help us when the NHS is privatised, the makers of such products sponsor courses and she isn't allowed to even gently question their value.

There was a quite entertaining video, that accurately illustrated the difficulties of a crash diet but then seemed to go off into la-la land on the miraculous qualities of exercise. A room-full of mostly morbidly obese pensioners, about half of them with walking aids is not a receptive audience for a story that basically goes: 'and then after one day of gym-induced muscle soreness, he's back to playing basketball and getting dates with beautiful women ... '

I really think that this audience was better served by the instructor's approach after the yelling and waving of walking sticks had died down, which was to make it clear that any exercise is a help and emphasising the way that exercise and diet support each other.

I also found myself biting my tongue frequently during the 'Eatwell Plate' part of the course. The instructor was trying her best, but 'Well, yes there are carbohydrates in baked beans, but we classify them as proteins' was causing far more confusion than clarity.

Low-fat and low-carb diets were briefly compared with examples of each (low fat was around 300g/day carbs and low carb was around 50g/day or so) I gather that next week is 'carbohydrate week' so maybe we get more detail then, but the instructor gave the impression of presenting both as valid, with a bit of 'current thinking is moving more towards low carb' and she again referred to the changing research picture around saturated fats etc.

She hadn't heard of Prof Roy Taylor's study of reversing Type 2 with extreme low calorie diets (nor had my GP or DN) but was very interested once she realised it was pukka research and not a random loony on the internet and got me to give her the link.

 

[brummybri]

I think Trudy is an advocate of lower carbs but not sure if she endorses LCHF diets where carbohydrates are severely restricted, she spoke at the DUK conference last April in a debate entitled Is it time to stop promoting carbohydrates to people with diabetes, here is a short extract of what she said but you can read the article in full following the link I've provided:

Everything in moderation rings so true. Low Carbohydrates does not, but moderation in carbohydrates sounds good to me,
High fat being good does not sound right. From this you can tell I'm confused. I attended the NHS Expert course in November, it seemed to make sense at the time but now I don't know. Does anyone have a clue on this subject?

.
Carbohydrate requirement
Glucose is essential for survival. The brain requires 130 grams of glucose per day and the carbohydrate reference intake (RI) for a healthy adult is 260 grams per day, double the minimum requirement to ensures sufficient carbohydrate is available to meet physical activity demands. But three things should be noted:

• the 260g per day is not a target but a reference;
• it is a reference for a healthy adult who is moderately active and normal weight;
• if the relevant amount of carbohydrate is not consumed, the body can make it from protein and fat supplies.

Individual needs
The reference range of 260 grams of carbohydrate per day does not suit every person with diabetes. In Type 1 diabetes, people may not wish to take the high doses of insulin required to match that level of carbohydrate and, in Type 2 diabetes, insulin may not work properly at clearing the glucose from the blood (insulin resistance) and additional carbohydrate can aggravate the problem, especially if the person is overweight and not physically active.

People with diabetes require structured carbohydrate awareness education so that they understand which foods contain carbohydrate and develop the skills to assess their own diet and be able to work out the amount and type of carbohydrate they are eating.

They can then set themselves goals to ensure they are consuming the right amount of carbohydrate to match their physical activity levels, also taking into consideration their weight and level of diabetes control.

In the UK, many of the starchy staple foods release the glucose quickly into the blood i.e. they are high GI foods. But when people are advised to base their meals on carbohydrate, many of them end up eating over 300 grams a day.

Through our experience of delivering structured education, many people reduce their carbohydrate intake to between 130-260 grams per day and are able to improve their diabetes control and body weight as a result. To date, lower carbohydrate diets have not shown any negative effects.


http://www.diabetes.org.uk/About_us/News/Carbohydrates-and-diabetes-debate/

 

[Deakint]

I've just completed week 2 of the x-pert course based on v10 of the handbook. Here's my feedback, in the hope that it's useful.

We did nutrition this week. Generally the instructor has been pretty good in my view and given the composition of the class.

She's made it clear that advice on fats is changing and that some of the causes for recommending low-fat diets are no longer seen as valid. I get the idea that she's not pushing too hard on "this advice is right and that's wrong" but rather trying to gently untangle misconceptions acquired elsewhere. I could see this was the right approach in at least one instance where she was dealing with someone who had some odd ideas acquired at her weight-loss support group and was inclined to be stubborn when challenged on them directly.

I don't think the course so far pays enough attention to economic issues around healthy eating. I live in a severely economically depressed area and most of the audience of this class are pensioners, so I think it's crucial to make sure they're getting advice they can actually afford to follow. When we were discussing low carb and I raised the issue of the role of cheap but carb heavy staple foods like rice, pasta, bread etc and the relatively higher cost of healthy alternatives, you could see that she got the point but didn't have a sensible answer ready as she had for everything else discussed so far, which I took to imply that it wasn't something that her training had covered.

The instructor did question the value of snake-oil products like 'diabetic foods' or 'anti-cholesterol spread' and helped the class to conclude that they're a con-job without actually saying so. God help us when the NHS is privatised, the makers of such products sponsor courses and she isn't allowed to even gently question their value.

There was a quite entertaining video, that accurately illustrated the difficulties of a crash diet but then seemed to go off into la-la land on the miraculous qualities of exercise. A room-full of mostly morbidly obese pensioners, about half of them with walking aids is not a receptive audience for a story that basically goes: 'and then after one day of gym-induced muscle soreness, he's back to playing basketball and getting dates with beautiful women ... '

I really think that this audience was better served by the instructor's approach after the yelling and waving of walking sticks had died down, which was to make it clear that any exercise is a help and emphasising the way that exercise and diet support each other.

I also found myself biting my tongue frequently during the 'Eatwell Plate' part of the course. The instructor was trying her best, but 'Well, yes there are carbohydrates in baked beans, but we classify them as proteins' was causing far more confusion than clarity.

Low-fat and low-carb diets were briefly compared with examples of each (low fat was around 300g/day carbs and low carb was around 50g/day or so) I gather that next week is 'carbohydrate week' so maybe we get more detail then, but the instructor gave the impression of presenting both as valid, with a bit of 'current thinking is moving more towards low carb' and she again referred to the changing research picture around saturated fats etc.

She hadn't heard of Prof Roy Taylor's study of reversing Type 2 with extreme low calorie diets (nor had my GP or DN) but was very interested once she realised it was pukka research and not a random loony on the internet and got me to give her the link.

Thank you for the comprehensive overview of Week 2 of the X-PERT Diabetes Programme. The Fat Attack video is optional for Educators to play if they think it will deliver the take home message that crash diets are not a long-term solution. I think it is really hard for healthcare professionals to deliver the latest evidence base when for decades the low fat/high carb message has dominated - and this is what they would have been taught at university (and probably still are in many cases). I am delighted that this Educator embraced the latest evidence and has informed participants attending the education programme about it. It may be delivered a little hesitantly in areas as they strive to build their confidence with presenting the new information and get use to dealing with queries and questions. Practice makes for perfection. I know that it took me several months and lots of reading to grasp the approach so that I could talk about it confidently. Update training for Educators since 2011 has included slides regarding Roy Taylors work. Version 10 of the handbook was published in July 2010 and I have undertaken a lot of research since then so there will be more modifications for version 11!! Please do let us know how Week 3 on carb awareness goes!

 

[IanD]

I've had to order by post - I couldn't do it from the web site.

 

[Solestar]

Its possible for any person to become a lay educator if you can afford the fees.... This is why I want gp to pay and then I can volunteer at our practice as pay back. Gp's are signing up to federations (amalgamation of services between practices) so it may be possible I could educate within our federation or go freelance totally.

Yes, I know they do type 1, but can't figure out why type 1's do dafne in the main...

I'd be interested in hearing more about becoming a lay educator. Do you have any links to further information, please?

 

[sanguine]

Just sent my LCHF experiences to Trudi as requested.

 

[donnellysdogs]

I'd be interested in hearing more about becoming a lay educator. Do you have any links to further information, please?

I expect Trudi can give more details but I spoke to a lady by phone who then emailed me details.

Many GP Practices are now joining up together to offer enhanced services to users... These combined GP services are now being called Federations. Our Federation of GP's will be serving 300,000 + patients so if my own GP Practice can't afford then I will approach the Federation as a whole and then our CCG.

It needs a lot of planning for an individual to get the backing from NHS...

I would personally recommend you approaching your DSN to find out how services operate within your area initially. As there are costs involved..

 

[Solestar]

And many will have ignored the old advice and will probably ignore new advice too. I wouldn't be too concerned. As ever, the information is available to those that are interested. You can lead a horse to water...........

...but you can't make him think ... erm, drink! ;-)

 

[Solestar]

I expect Trudi can give more details but I spoke to a lady by phone who then emailed me details.

Many GP Practices are now joining up together to offer enhanced services to users... These combined GP services are now being called Federations. Our Federation of GP's will be serving 300,000 + patients so if my own GP Practice can't afford then I will approach the Federation as a whole and then our CCG.

It needs a lot of planning for an individual to get the backing from NHS...

I would personally recommend you approaching your DSN to find out how services operate within your area initially. As there are costs involved..

Thank you very much. I'll try that approach.

 

[donnellysdogs]

Thank you very much. I'll try that approach.

Speak to the x-pert team by phone and ask for the details. They welcome lay members....

I have wanted to help diabetics for years ref eating, but couldn't whilst the eat carbs galore was being pushed down their throats.

I approached Dr Trudi's team last week and got fantastic help. I could not educate patients towards eating the opposite of my lifestyle that has kept me lean. I can now look forward to helping.. Just like you...

 

[Paul59]

It's a shame we can't have more professionals on the forum like Dr Deakin for giving advice etc, could have a thread for each one so questions can be asked to clarify things. Maybe then the NHS & such may also learn from the ones that are dealing with the condition daily. Win win situation I'd say.

 

[Totto]

It's a shame we can't have more professionals on the forum like Dr Deakin for giving advice etc, could have a thread for each one so questions can be asked to clarify things. Maybe then the NHS & such may also learn from the ones that are dealing with the condition daily. Win win situation I'd say.

You could try the Dietdoctor´s forum on his blog.

http://www.dietdoctor.com/

 

[NoCrbs4Me]

It's a shame we can't have more professionals on the forum like Dr Deakin for giving advice etc, could have a thread for each one so questions can be asked to clarify things. Maybe then the NHS & such may also learn from the ones that are dealing with the condition daily. Win win situation I'd say.

I don't think there are many more HCPs like Dr Deakin! At least not yet. Perhaps the times are a-changing.

 

[daddys1]

I will stick my neck on the block here - and approve this .
Normal protocol here - is to have this type of scene run past the approval team .
As has been reported in .

It is a huge step forward to influence change(s) within Diabetes I understand .

Hi Anna,

Have only just picked up this thread which I find exceptionally enlightening that Dr Trudi Deakin has honored us and attended this forum.

It is fantastic that we can all post our results by email to Trudi, my only little concern is that like me I may have missed this thread, I came in at the end and it was only that I saw the Name mentioned 'Trudi' and knew that name, but many don't. That I picked up on this thread and read back and found the details. I clearly will be sending my data.

My worry is that there will be so many members that will miss this opportunity because they are not aware of this thread, and as a Forum we will miss the opportunity of passing some BULK information over.

Is there someway we a can alert members, to this or start a thread asking just for then to 'post those details only' maybe for a mass collation & mailing.

See what you think
Neil

 

[Deakint]

I expect Trudi can give more details but I spoke to a lady by phone who then emailed me details.

Many GP Practices are now joining up together to offer enhanced services to users... These combined GP services are now being called Federations. Our Federation of GP's will be serving 300,000 + patients so if my own GP Practice can't afford then I will approach the Federation as a whole and then our CCG.

It needs a lot of planning for an individual to get the backing from NHS...

I would personally recommend you approaching your DSN to find out how services operate within your area initially. As there are costs involved..

It probably best to email or phone the office as all NHS organisations do it a different way. Some embrace lay educators and some don't. Some use the acute trust and some don't. Some put out a tender and get an outside organisation to deliver. However, some CCGs or Federations are open to suggestions so there is no harm going to speak to them and asking them about the local model. Generally speaking if they were going to support you in delivering structured education locally they would have to pay for you to be trained and pay you on a sessional rate to deliver the programme to patients.

 

[Deakint]

I don't think there are many more HCPs like Dr Deakin! At least not yet. Perhaps the times are a-changing.

I do think that there is beginning to be a shift. I have delivered around 7 training courses since updating the latest manual and the educators have truly embraced the latest evidence base. The problem we have is that that may be just a handful of healthcare professionals in one organisation so how do we get the non-educator health professionals on board to prevent people receiving conflicting and outdated messages? It's often a case of "you don't know what you don't know" i.e. if health professionals think that they are knowledgeable about the lifestyle approach to diabetes they are not going to register on a training course to update themselves. A lot of awareness raising is needed!

 

[sanguine]

Have only just picked up this thread which I find exceptionally enlightening that Dr Trudi Deakin has honored us and attended this forum.

It is fantastic that we can all post our results by email to Trudi, my only little concern is that like me I may have missed this thread, I came in at the end and it was only that I saw the Name mentioned 'Trudi' and knew that name, but many don't. That I picked up on this thread and read back and found the details. I clearly will be sending my data.

My worry is that there will be so many members that will miss this opportunity because they are not aware of this thread, and as a Forum we will miss the opportunity of passing some BULK information over.

Is there someway we a can alert members, to this or start a thread asking just for then to 'post those details only' maybe for a mass collation & mailing.

Copy the link around to other threads frequented by members who might be interested. Go to the post number (#238 in this case, next to the 'like' button), right-click on it and select 'copy link' - you can then paste it anywhere like this

http://www.diabetes.co.uk/forum/thr...s-low-carb-high-fat.70271/page-12#post-736708