X-PERT course

sue - I cannot find the guidelines !

I think you may find that it is not patronising at all .

I did a talk at a Dafydd course before xmas and there was a great rapport between the HP and the clients - they arent out to patronise you they want to help you honestly. The nurse and dietitian at the course were very knowlegdable and their enthusiasm lit the place up. Not all Hp are idiots like this forum likes to claim

I don't think I mentioned the word 'patronising' anywhere?

Oh goody, another bunfight!

Not all Hp are idiots like this forum likes to claim

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Don't think the forum has ever claimed such a thing, Ally. Maybe some HP's, but not all.

All the best,

fergus

fergus said:

Oh goody, another bunfight!

Not all Hp are idiots like this forum likes to claim

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Don't think the forum has ever claimed such a thing, Ally. Maybe some HP's, but not all.

All the best,

fergus

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Being one of those HCP's I would therefore not say all are idiots otherwise I would have to include myself and ,trust me,I'm no idiot!!But I have been on the receiving end of that advice Ally.Bad advice given out ,probably in good faith, by colleagues that I know personally!!Now what am I supposed to say to them???

Hi Sleepylu,
An HBA1C of 6.5% equates to an average actual blood sugar level of 7.5 mmol/l. As 7.5 is the level at which diabetic complications start, what your nurse is saying is that she would be happier if you remained at a level where neuropathy and retinopathy are pretty much a future guarantee.

And Ally - I'm sorry if it sounds like I am denigrating a health care professional, but if you believe the advice that nurse gave sleepylu is good advice to give a patient then your standards must be very different to mine (and the rest of the diabetic community)!

There are no doubt may excellent HCPs out there who do a wonderful job. Unfortunately we rarely hear about them. It does appear that there are far too many, doctors, nurses and dietitians who give advice that is so appalling that you wonder how on earth they ever qualified. And those are the ones that we hear about on here when their totally confused patients turn to us for some common sense.

sue - the patronising comment was a ref to one post that said supermarket tours maybe just that.

Dennis - people on here regularly say very scathing things about hp - but no one ever repsonds if someone says my hp is fab. There are around 30 -40 people on here who post on a regular basis so does that represent the advice given by the nhs. I am certainly not saying all hp are brilliant but look at your own professions - it is probably the same.

My biggest gripe is that too many people are chipping in with info on food - nurses and doctors have very limited knowledge /understanding and dietitians are snowed under .I recently had to have a word with a physio who was giving patients incorrect advice! In many depts diabetes may not be a priority when it is a choice between providing a service to an Intensive care Unit or a community clinic!

I think my role with the gps is quite unusual - I have time with patientsand no waiting list.

Going back to these courses - go on one if they are available . People on here who have been have found them very useful.

People will find such courses useful if they knew nothing before. I have never been on one BUT given what i have learnt since neither would i.

As for chipping in with info on food, Like countless others i followed the advice for 7 years. Result nearly 20st and insulin next stop . By being naughty and doing the opposite i now weight what i did when i was 17 have bs in 5/6 standard and to be frank have never been healthier


Dave P

Some more on the Xpert course including some patients comments.
http://www.diabetes.org.uk/Professi...Routine_Treatment_X-PERTbr_Updated_July_2006/

Personally, I think you should take any opportunity you can for education.

My biggest gripe is that too many people are chipping in with info on food - nurses and doctors have very limited knowledge /understanding and dietitians are snowed under

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It does appear to me, and I guess quite a few other people I know, that the dietetics profession is extremely territorial about information on food. There seems at times to be an unsettling feeling of priesthood about nutritional advice - that only qualified health professionals are educated enough to understand the issues and tell good advice from bad. Doctors don't know enough about it, and patients must be saved from themselves, bless them.

This is not a criticism of dieticians per se, because, believe it or not, I have a very good friend who works for the NHS in that role. You would find it hard to meet a finer, more dedicated person in any walk of life.

What she will happily admit, however, is that there are many dietetic commandments that are clearly irrational and downright counterproductive.

An example. To try and improve my own understanding, I took an OU course last year called 'Understanding Human Nutrition'. In order to pass the course, here are some examples of nutritional 'facts' I was required to accept and repeat in my written exam.

There is no clear link between starch / sugar consumption and obesity. :shock:

Carbohydrates are not normally converted to fat. :shock:

There's no direct link between carbohydrate consumption and diabetes. :shock:

If I had been a young student, learning about nutrition I might have been forgiven for accepting some of these 'facts'. As a diabetic, I know they are completely wrong. To say so in the context of the educational course would have been foolish of course, but you can imagine how it stuck in my craw to have to repeat such stuff.

Anyway, the point I suppose is that the more people like us who 'chip in' with information about food, the sooner some of the misinformation is exposed. So we're actually trying to save the dietetics profession from itself!

All the best

fergus

Pheonix thank you v much for the link, and as you rightly say participants comments, the first of which was particularly poingnant.

I endorse your view that Education is to be sought and prized wherever you can get it,

Which is why i would like to take this opertunity to publicly thank this site for helping me and long may it continue to help others.

Good health
Dave P

interesting fergus - I have looked at the ou course - hard to see what it can be used for really and who wrote it?

The facts you have stated I wasnt taught in uni or are you just cherry picking again.

You think dietitians are precious about their role - yes we are because we see and hear the rubbish that is given to pts !

I do not know what you do for a living but do you get the cleaner , gardner etc telling you your job after looking at a few internet sites - i think not!

Every week we hear about other so called nutritionists causing problems for their pts and maybe that is why I am also precious about a profession I work in.


here is an example!

http://www.thesun.co.uk/sol/homepage/wo ... 132543.ece

I hope the link works.

The HPC is currently working with all the professions to promote good practice and encourage people to see qualified HP - we are well aware that many people have been harmed by seeing unqualified quacks - in fact one of the case studies they are using is a client of mine!

food is a powerful tool Fergus in the wrong hands .I am suprised that you did not comment on my analysis by the way - I feel it does hilight in a small way that low carbing is not perfect either.

No, the reason I didn't post on the analysis thread was that there was nothing really to say. Thank you for doing the analysis, but as a snapshot of a single day's diet, it's not really going to shed much light is it? The 6 monthly HbA1c, lipid panel, blood pressure, weight, eGFR etc. is surely the acid test of whether a diet is helpful or harmful for a diabetic. A few milligrams deficiency of vitamin c in a single day is pretty small beer really, isn't it? Particularly since the need for vitamin c in the diet appears to rise in proportion to the amount of carbohydrate in the diet?

I hear what you're saying about nutritionists causing problems for their patients. Would you include the dieticians who advise SpecialK for a diabetics's breakfast in that category?

Interstingly, one of the text books used for the OU course was Extracts from Human Nutrition by Mary Baresi, Principal Lecturer in Nutrition at the University of Wales Institute. Ring any bells?
I quote

under normal circumstances very little carbohydrate is actually converted to fat

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:shock:

All the best,

fergus

Ally, I went on the Desmonds course and was very impressed and followed the advice given to the letter, I went low fat and ate all my carbs only to find my BG levels were worse than before, it took this forum and the help of an enlightened Dietitian ( yes Ally I have praised her before on the forum, I think you'll find the good HPs are given the credit they deserve here ) to put me right about my diet. The most frightening thing to me is the feed back we are getting about newly diagnosed being told they are only T2 and therefore don't need to test, given the high carb low fat diets being promoted on these courses, what's going to happen to the compliant Diabetics who do not question the HPs dietary advice :?:

Graham

What always happens,Graham,they will be accused of being non-compliant because they will put on weight and need more and more medication,but will it be the fault of the advice given,,,no way,,it will always be the patients fault.

This thread (and many others) focuses on carbohydrate intake almost exclusively. To put it bluntly, one gets the impression that if any course or hcp doesn't suggest a low carb diet its not going to work so the course won't be any good.
The Xpert course (according to the syllabus) adopts a low GI/GL approach, in other words the quality (glycemic and nutritionally) coupled with the quantity of the carbs. This approach to lowering BG levels has at least been shown to have some scientific validity ( Cochrane review .January 21. 2009 )Admitedly a lowish reduction in BG levels but clinically significant and better than any other dietary intervention examined so far. A previous review only found good evidence for exercise. It is worth remembering that there are people on this forum, perhaps less vociferous than others who have used a low GI diet effectively

In addition I think that it would be a very negligent form of therapeutic education that suggested a diet that excluded or severely reduced many nutrients hence putting the person at risk of other problems.
One only has to look at Ally's recent diet analysis to see that in those few samples, (ok only one day and possibly not representative ) low calorie intakes, which may well have been responsible for weight loss and better glycemic control and extremely low levels of fibre, iron, calcium and in some cases fat(!) It was not just a case of a few mgs of vit C. I have to agree with her that I was surprised at the lack of comment .

Pheonix thank you for providing support for the contrary point of view it is refreshing to find some at last

phoenix said:

This thread (and many others) focuses on carbohydrate intake almost exclusively. To put it bluntly, one gets the impression that if any course or hcp doesn't suggest a low carb diet its not going to work so the course won't be any good.
I might suggest that this is possibly the most telling observation you could present, and the numbers seem to be growing

The Xpert course (according to the syllabus) adopts a low GI/GL approach, in other words the quality (glycemic and nutritionally) coupled with the quantity of the carbs. This approach to lowering BG levels has at least been shown to have some scientific validity ( Cochrane review .January 21. 2009 )Admitedly a lowish reduction in BG levels but clinically significant and better than any other dietary intervention examined so far. A previous review only found good evidence for exercise. It is worth remembering that there are people on this forum, perhaps less vociferous than others who have used a low GI diet effectively

In addition I think that it would be a very negligent form of therapeutic education that suggested a diet that excluded or severely reduced many nutrients hence putting the person at risk of other problems.
One only has to look at Ally's recent diet analysis to see that in those few samples, (ok only one day and possibly not representative ) low calorie intakes, which may well have been responsible for weight loss and better glycemic control and extremely low levels of fibre, iron, calcium and in some cases fat(!) It was not just a case of a few mgs of vit C. I have to agree with her that I was surprised at the lack of comment .

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On any day your diet will nearly always be deficient in something or other according to someones list, For myself i am not a natural veggie eater but i now eat more green leaf than i ever did.

But enough of arguement, You clearly believe that view and i for one respect that and we should all be free to follow the same. Please keep in touch and let us know of your success`s

Good luck
Dave P

Before this thread goes the way of most of the diet threads on this forum just let me add my comments.
We are always going to get arguments on here about the 'best' diet because we have all found what works for us.Some have found low carb and are happy with it,some have found Gi/GL and they are happy with that.If it works for you and helps control your BG then fine,keep at it.
I'm a low carber,it works for me,it's simple and I find GI/GL too complicated ,being a lazy sod I will stick to low carb.I'm losing weight,my BG is nearly under control so I'm happy with that.The same can be said for those that choose other diets.

Can we please all remember that ,'we are all different, 'one size does not fit all' and ,most of all to respect other members choices.
We will argue till the cows come home about diets on here but,in the end ,the important thing,however we do it,is to get the BG under control so that we can lead as normal a life as we can.

Absolutely right, Sue.

fergus

phoenix that was a very good post.

If a dietitan is doing her job properly then she will not use a one size fites all because we are all different in the way we live our lives, activity etc.

Low carbing may suit some people but it has to be at the expense of something else. If I was a diabetic would I follow it - no as I have tried to follow atkins for research purposes and found I could not .

Sue - your comments about one size fits all intrigues me - the one person who only has one size is in fact bernstein - there doesnt seem to be any other way - fascinating!

Hi Phoenix
Could you please point me to the study that shows the following to be true about GI/GL
>>This approach to lowering BG levels has at least been shown to have some scientific validity ( Cochrane review .January 21. 2009 )Admitedly a lowish reduction in BG levels but clinically significant and better than any other dietary intervention examined so far.<<
I'm always trawling for evidence that's scientifically valid.