Confused!!

[Felinia]

I finally got my Training course underway yesterday, with a 1 hour phone consultation with a diabetic dietician, and it has left me rather confused. I would welcome feedback from members on what I was told - both for and against.
The lady was very pleasant, but English was not her first language, and I think we both struggled to understand exactly what each was trying to say or explain. I explained my medical conditions, my medications, and the foods that exacerbated my Diverticular Disease (DD) (gluten, full fats, nuts, seeds), cholesterol levels (fats) and hiatus hernia (acidic foods and fruits). Most of what she said was direct from the NHS recommendations, with no regard for what I had said affected me, but some things I had never heard before.
2 small portions of fruit, 80gm a day (yes, fine), but NEVER with a main meal, only 2 hours after, as a mid-morning and mid-afternoon snack, and only ever one type of fruit. So for example, no fruit with my breakfast, no chopped fruit on my salad, no gammon and pineapple, or pork with sliced apple, no home made fruit salad.
At least 4 pints of plain water a day, tea and coffee does not count. I do have 4 pints of fluid a day, but it's mixed. I have de-caf tea only with a dash of skimmed milk, but was told the milk negated something or other. No drinking after 6pm. I always take a glass of water to bed with me.
Have lots of nuts and seeds, even though they give me some of the more unpleasant side effects of DD, on my cereal. Well I'll try and see what happens.
Eat lots more protein and fats at every meal. I've always had small portions of proteins so I'll just increase the portion size. But, boiled eggs with porridge - one of her suggestions!! Fats are a real problem, as for years I've believed low fat is the way to lower cholesterol, as I'm severely allergic to statins, and they also affect my DD. Also I need to LOSE weight, not increase my calorie intake. I take Benecol and Fybogel as advised by my GP, but was told they are loaded with sugars, and the claims made are merely advertising hype.
She did make the point that over the years I have developed fears and phobias, plus taken some mis-information as the truth, which I think is valid, so is why I'll try some of the suggestions, but nothing will ever persuade me to have avocado again - I find it simply disgusting in my mouth lol!!! It's all a learning curve.

 

[Drummer]

The advice given to you seems to make no sense.
Mind you - finding that eating protein and fat and losing weight also seems to make no sense when done so in the teeth of the accepted knowledge pushed for decades but when it works - what can you do?
No drinking after 6pm? Why? What possible benefit could that have?
I would have the boiled eggs at breakfast time - but with cheese and a huge salad, never porridge, as it is a high carb food.
Eating fats doesn't usually result in increased cholesterol levels - unless it is associated with weightloss, which it can be. I have only ever managed to lose weight eating Atkins style low carb high fat diets. High carb low fat increases my weight - I was practically spherical at diagnosis on a supposedly cholesterol lowering diet.

 

[Felinia]

The advice given to you seems to make no sense.
Mind you - finding that eating protein and fat and losing weight also seems to make no sense when done so in the teeth of the accepted knowledge pushed for decades but when it works - what can you do?
No drinking after 6pm? Why? What possible benefit could that have?
I would have the boiled eggs at breakfast time - but with cheese and a huge salad, never porridge, as it is a high carb food.
Eating fats doesn't usually result in increased cholesterol levels - unless it is associated with weightloss, which it can be. I have only ever managed to lose weight eating Atkins style low carb high fat diets. High carb low fat increases my weight - I was practically spherical at diagnosis on a supposedly cholesterol lowering diet.

I'm glad you find it a bit weird as well. The drinking bit was supposed to stop me getting up several times a night, after the increased fluid intake. But weeing more often is also common with DD and I currently get up 4 - 6 times a night.
I know of another diabetic who has a ham and cheese salad for breakfast, so I think I'll have something like poached egg, turkey rashers and mushrooms. I would have said plus tomatoes, but tomatoes are actually a fruit I think! So when are you allowed to eat them!!!!! Do you have any advice on reduced salt and sugar baked beans please? I do like them but have avoided them since diagnosis.
I'm having my cholesterol measured in about 6 weeks time so I'll be interested to see the result. I might end up on bezafibrate, which was the drug used before statins.

 

[Drummer]

I know tomatoes are, botanically a fruit but they end up in my salads - just the one, though, as I know that I can eat the salads I make with little effect on my blood glucose levels - I have a meter to check that is so. I have about 10 gm of carbs in my first meal, as I am more resistant in the mornings - or I was, I just stick to what worked. I have fried eggs, real bacon, mushrooms, courgette and green sweet pepper fairly frequently.
I don't eat beans other than runner beans as I am susceptible to the carbs in them for some reason, they hoist up the blood glucose more than the listed carbs would indicate, and they keep it high for some time. I do eat peas, but in small amounts for the same reason - and I avoid peanuts, as they are a legume too. I do add salt to my coffee each morning, a tiny pinch, and in hot weather put some on my food too, as we do need salt and I do not have many processed foods which is where most people get their salt, sometimes in overdose.
People respond differently which is why it is a good idea to get a meter to check your reactions and progress.

 

[Felinia]

I know tomatoes are, botanically a fruit but they end up in my salads - just the one, though, as I know that I can eat the salads I make with little effect on my blood glucose levels - I have a meter to check that is so. I have about 10 gm of carbs in my first meal, as I am more resistant in the mornings - or I was, I just stick to what worked. I have fried eggs, real bacon, mushrooms, courgette and green sweet pepper fairly frequently.
I don't eat beans other than runner beans as I am susceptible to the carbs in them for some reason, they hoist up the blood glucose more than the listed carbs would indicate, and they keep it high for some time. I do eat peas, but in small amounts for the same reason - and I avoid peanuts, as they are a legume too. I do add salt to my coffee each morning, a tiny pinch, and in hot weather put some on my food too, as we do need salt and I do not have many processed foods which is where most people get their salt, sometimes in overdose.
People respond differently which is why it is a good idea to get a meter to check your reactions and progress.

Thanks. I love runner beans and have them with most dinners! Interesting about peanuts. I am following the instruction about nuts and have ordered a bag of chopped assorted nuts. I noticed they comprised almonds, hazelnuts and peanuts. I monitor my sodium intake and am usually under 2000mg pd, where the recommended limit is 2300mg. But I have been avoiding real bacon, because of the sodium level. So far I haven't got a meter, but after the first set of follow up tests that may follow. Sometimes I feel very tired which my GP said was partly the diabetes and partly increased BP medication. But twice now I've had to lie down for a couple of hours, after my Aquafit class. I'm starting to monitor what I have for breakfast before the class, to see if that makes a difference. So far it's all a work in progress.

 

[TheClockworkDodo]

Some of your dietician's recommendations seem very peculiar to me, @Felinia - though it's not my area of expertise or anything, my Mum has diverticulitis, hiatus hernia, and high blood pressure, so I know what she can and can't eat, and what she's been told she should or shouldn't eat, and it really sounds to me as though the dietician you spoke to didn't understand the other conditions you're juggling with your diabetes. (Having multiple other conditions myself, I've found it's quite common for medical professionals to think the one they specialise in somehow trumps all the others - it doesn't, and it's really unhelpful).

Firstly there is no way Mum could eat nuts, seeds, or pips of any kind or any fruit (or anything else) which contains seeds or pips or anything of that sort (including tomatoes) - they are all an absolute no-no with diverticulitis. Also, the diabetes dietician told you to have nuts and seeds on your cereal? Why didn't she tell you not to eat cereal?! Most cereals are full of sugar and really high-carb.

Secondly if you can't tolerate much acidity then having fruit as a snack rather than as part of a meal is a peculiar recommendation. It's also a peculiar recommendation for someone with diabetes, quite frankly - a chunk of fruit is going to send your blood sugar up any time, but particularly if you have it on its own, whereas if you have it as part of a meal the protein or fat in the meal's going to slow down the effect. I'm surprised you can eat pineapple or even apple though, they're both quite acidic (my Mum certainly couldn't).

4 pints of water a day sounds good to me though, it will help lower your blood sugar and also help you to feel full, which is obviously good if you're trying to lose weight. Tea and coffee aren't supposed to count towards your 4 pints, but I think herbal and fruit teas do count, if you can't bear to drink that much plain water.

My Mum has been told not to drink in the evenings too, because of her high blood pressure. I'm at a loss on that one, no idea why Mum was told that. If fluid increases blood pressure why are they telling you to drink 4 pints of water per day? And my GP told me some time ago that drinking more doesn't make you go to the loo more frequently, it just increases the volume when you do go! Mum was told not to drink in the evenings though, rather than after 6pm, and she interprets that as being after dinner, and she does still take water to bed with her, just for the occasional sip.

Maybe the dietician meant boiled eggs or porridge rather than and porridge? If her first language wasn't English? Or porridge followed by boiled eggs? Porridge is, as Drummer says, high carb, but I think it's good for cholesterol and for some digestive problems.

Agree with you about avocado - yuck!

 

[Drummer]

If you are getting adequate salt from some source, that is fine, but I was suffering cramps which was partly down to low salt intake - but I almost always boil bacon for a minute or so before frying it - which removes a lot of the soluble nitrate/nitrite preservatives and of course the salt too.

 

[belugalad]

I finally got my Training course underway yesterday, with a 1 hour phone consultation with a diabetic dietician, and it has left me rather confused. I would welcome feedback from members on what I was told - both for and against.
The lady was very pleasant, but English was not her first language, and I think we both struggled to understand exactly what each was trying to say or explain. I explained my medical conditions, my medications, and the foods that exacerbated my Diverticular Disease (DD) (gluten, full fats, nuts, seeds), cholesterol levels (fats) and hiatus hernia (acidic foods and fruits). Most of what she said was direct from the NHS recommendations, with no regard for what I had said affected me, but some things I had never heard before.
2 small portions of fruit, 80gm a day (yes, fine), but NEVER with a main meal, only 2 hours after, as a mid-morning and mid-afternoon snack, and only ever one type of fruit. So for example, no fruit with my breakfast, no chopped fruit on my salad, no gammon and pineapple, or pork with sliced apple, no home made fruit salad.
At least 4 pints of plain water a day, tea and coffee does not count. I do have 4 pints of fluid a day, but it's mixed. I have de-caf tea only with a dash of skimmed milk, but was told the milk negated something or other. No drinking after 6pm. I always take a glass of water to bed with me.
Have lots of nuts and seeds, even though they give me some of the more unpleasant side effects of DD, on my cereal. Well I'll try and see what happens.
Eat lots more protein and fats at every meal. I've always had small portions of proteins so I'll just increase the portion size. But, boiled eggs with porridge - one of her suggestions!! Fats are a real problem, as for years I've believed low fat is the way to lower cholesterol, as I'm severely allergic to statins, and they also affect my DD. Also I need to LOSE weight, not increase my calorie intake. I take Benecol and Fybogel as advised by my GP, but was told they are loaded with sugars, and the claims made are merely advertising hype.
She did make the point that over the years I have developed fears and phobias, plus taken some mis-information as the truth, which I think is valid, so is why I'll try some of the suggestions, but nothing will ever persuade me to have avocado again - I find it simply disgusting in my mouth lol!!! It's all a learning curve.

Hi when you mention Fybogel,I was of the understanding that it contains hardly any sugar,I use a fibre supplement myself as low carbing can cause constipation,I'm not sure if it's just for a short period while the body adapts to the new way of eating but I take Psyllium husk every morning and will continue to do so

 

[Felinia]

Some of your dietician's recommendations seem very peculiar to me, @Felinia - though it's not my area of expertise or anything, my Mum has diverticulitis, hiatus hernia, and high blood pressure, so I know what she can and can't eat, and what she's been told she should or shouldn't eat, and it really sounds to me as though the dietician you spoke to didn't understand the other conditions you're juggling with your diabetes. (Having multiple other conditions myself, I've found it's quite common for medical professionals to think the one they specialise in somehow trumps all the others - it doesn't, and it's really unhelpful).

Firstly there is no way Mum could eat nuts, seeds, or pips of any kind or any fruit (or anything else) which contains seeds or pips or anything of that sort (including tomatoes) - they are all an absolute no-no with diverticulitis. Also, the diabetes dietician told you to have nuts and seeds on your cereal? Why didn't she tell you not to eat cereal?! Most cereals are full of sugar and really high-carb.

Secondly if you can't tolerate much acidity then having fruit as a snack rather than as part of a meal is a peculiar recommendation. It's also a peculiar recommendation for someone with diabetes, quite frankly - a chunk of fruit is going to send your blood sugar up any time, but particularly if you have it on its own, whereas if you have it as part of a meal the protein or fat in the meal's going to slow down the effect. I'm surprised you can eat pineapple or even apple though, they're both quite acidic (my Mum certainly couldn't).

4 pints of water a day sounds good to me though, it will help lower your blood sugar and also help you to feel full, which is obviously good if you're trying to lose weight. Tea and coffee aren't supposed to count towards your 4 pints, but I think herbal and fruit teas do count, if you can't bear to drink that much plain water.

My Mum has been told not to drink in the evenings too, because of her high blood pressure. I'm at a loss on that one, no idea why Mum was told that. If fluid increases blood pressure why are they telling you to drink 4 pints of water per day? And my GP told me some time ago that drinking more doesn't make you go to the loo more frequently, it just increases the volume when you do go! Mum was told not to drink in the evenings though, rather than after 6pm, and she interprets that as being after dinner, and she does still take water to bed with her, just for the occasional sip.

Maybe the dietician meant boiled eggs or porridge rather than and porridge? If her first language wasn't English? Or porridge followed by boiled eggs? Porridge is, as Drummer says, high carb, but I think it's good for cholesterol and for some digestive problems.

Agree with you about avocado - yuck!

Hi and thanks - I'm glad your feelings about the advice given to me matches mine!! You are spot on thinking she simply didn't seem to understand my restrictions. She also didn't understand my medications - she actually admitted she'd never heard of one of them - and not to take 2 prescribed ones because they contain sugar is ridiculous. By acidic fruit I meant oranges, grapefruit, lemon, lime, raspberries, gooseberries, rhubarb. I can eat a little of the less sharp apples, but am aware of their high sugar so avoid them. Funnily enough pineapple is OK in 40gm portions, but I now only have frozen fruit, not fresh (so I can control portion size), and it is not as sharp. Cereal for me is just porridge, oatbran or Oatibix, as wheat based products are one of my diverticular disease triggers. So not loaded with sugar, just carbs, and I only ever have a half portion. At the moment I feel like I'm tiptoeing through a minefield and just hope my next HbA1c will show if I am making the right choices.

 

[Felinia]

Hi when you mention Fybogel,I was of the understanding that it contains hardly any sugar,I use a fibre supplement myself as low carbing can cause constipation,I'm not sure if it's just for a short period while the body adapts to the new way of eating but I take Psyllium husk every morning and will continue to do so

I've been taking Fybogel for 20+ years, on prescription, for my Diverticular Disease. My app showed a little sugar, but not, I thought, enough to get into a flap over. But I was very interested to read about low carb diets causing constipation. I have been suffering with that since cutting right down on carbs, followed afterwards by the runs. Not good for my bowel at all! I did get some sugar free dark chocolate (sweetened with Stevia) and had a strip. Dreadful tummy upset, then I read Stevia can cause diarrhoea! That was a learning experience! It's banned now in the UK, but Ex-Lax had the same effect!!

 

[Sally W]

I've been taking Fybogel for 20+ years, on prescription, for my Diverticular Disease. My app showed a little sugar, but not, I thought, enough to get into a flap over. But I was very interested to read about low carb diets causing constipation. I have been suffering with that since cutting right down on carbs, followed afterwards by the runs. Not good for my bowel at all! I did get some sugar free dark chocolate (sweetened with Stevia) and had a strip. Dreadful tummy upset, then I read Stevia can cause diarrhoea! That was a learning experience! It's banned now in the UK, but Ex-Lax had the same effect!!

How about some good quality low sugar chocolate? Hotel Chocolat make Supermilk which has less sugar, more cocoa & milk. It’s less than dark chocolate [which I’m not a fan of). Creamy and delicious. The price tags puts me off eating too much!

 

[Felinia]

How about some good quality low sugar chocolate? Hotel Chocolat make Supermilk which has less sugar, more cocoa & milk. It’s less than dark chocolate [which I’m not a fan of). Creamy and delicious. The price tags puts me off eating too much!

Thanks - Where do you get yours from please? It's not on Amazon.

 

[Docb]

Coming back to your original post Felina, the hour long telephone "consultation" rings a couple of warning bells for me. Very difficult to pick up all those clues which you get face to face which are used build confidence (or otherwise) in the value of information being given. I'm guessing that the person on the other end of the phone was not offering you the wealth of her experience but was wandering around computer screens whilst talking to you looking for things that might be relevant.

Maybe you could go back to who referred you to that service and explain that it left you confused and that you are concerned that the person you were talking to did not seem to understand the need to balance your diet against more than one condition. Ask them what to do next.

 

[belugalad]

I've been taking Fybogel for 20+ years, on prescription, for my Diverticular Disease. My app showed a little sugar, but not, I thought, enough to get into a flap over. But I was very interested to read about low carb diets causing constipation. I have been suffering with that since cutting right down on carbs, followed afterwards by the runs. Not good for my bowel at all! I did get some sugar free dark chocolate (sweetened with Stevia) and had a strip. Dreadful tummy upset, then I read Stevia can cause diarrhoea! That was a learning experience! It's banned now in the UK, but Ex-Lax had the same effect!!

Hi if you like chocolate and fancy a treat,Aldi sell an 85% chocolate that is quite low carb called Moser Roth 85% it was recommended to me on this site and I buy a bar now and again as a treat,it comes in a cardboard sleeve and has 5 individual foil wrapped 12.5g pieces,I must get a bar myself this weekend

 

[Felinia]

Coming back to your original post Felina, the hour long telephone "consultation" rings a couple of warning bells for me. Very difficult to pick up all those clues which you get face to face which are used build confidence (or otherwise) in the value of information being given. I'm guessing that the person on the other end of the phone was not offering you the wealth of her experience but was wandering around computer screens whilst talking to you looking for things that might be relevant.

Maybe you could go back to who referred you to that service and explain that it left you confused and that you are concerned that the person you were talking to did not seem to understand the need to balance your diet against more than one condition. Ask them what to do next.

Thanks for coming back to me. Apparently all newly diagnosed type 2 diabetics are entitled to an education course. The national standard course is DESMOND, but my area of Devon does not subscribe to it. Instead they contract out to a company called Oviva, who are based in Leeds. The education consists of a 45 minute phone consultation where, as you say, they follow a bog standard computer question and answer screen, then fish around. The second part is either further follow up phone calls, or a one off half day face to face group training course. I have elected to attend the group training course where I will go prepared with a list of questions. Hopefully the face to face will resolve everything. If asked to provide feedback, I will be honest. Some of what she said was OK - she was right about my fear of fats and not eating enough protein. She simply did not seem to understand my medical issues and occasionally contradicted herself. But I struggled to understand her, and her English might not have come out the way she meant. Fortunately my GP practise is very much on the ball and I will be monitored and chased up regularly, particularly for the first 6 months. I am quite on the ball, and active on a couple of forums - for diabetes and diet - where I have learned a lot.

 

[Sally W]

Thanks - Where do you get yours from please? It's not on Amazon.

Not available on Amazon they have shops. Bristol no where I live in south west has them on every shopping centre & John Lewis. If not, they do mail order but check their store locator https://www.hotelchocolat.com/uk/chocolate-shops

I have the Aldi 85% for cooking but my tastes are for a creamier chocolate & whilst this is darker than say Cadbury milk it’s more to my taste than dark. I think you might enjoy it if you’re a milk chocolate fan & want to avoid the sweeteners.

 

[Felinia]

Thanks. I used to love Cadburys Old Jamaica and Old Seville, which were dark chocolate with a touch of milk. I'll order online and see. There is a branch in Exeter, 25 miles away, but as I can't walk far, I'd struggle to get there as the car park is too distant.

 

[Sally W]

Me too- Old Jamaica not seem that one in years! Oh that’s a long way. Not sure if you can join online but they have a VIP card which gives you present on your birthday & special offers. Sometimes they do free postage with it too. Also it’s expensive & if you buy 3 bars they do discount so I always do that. I’m lucky that I had a shop where I live but if I had to have posted I’d be buying in bulk & asking Mr to hide them from me! I love it as chocolate is one thing I struggle to give up completely.

 

[TheClockworkDodo]

I eat Green & Blacks 85% cocoa, but I don't like any milk in my chocolate so it's no hardship for me to eat the really dark stuff
I do also eat their mint chocolate sometimes though, and that's 70% cocoa.

At the moment I feel like I'm tiptoeing through a minefield and just hope my next HbA1c will show if I am making the right choices.

It sounds to me as though you need to be testing your blood sugar to see how different foods effect you - you obviously can't just drastically cut carbs the way a lot of type 2s do because of your other conditions, so you need to know which foods really spike your blood sugar and which you can get away with. The HbA1c will show if you're doing OK overall, but it won't show if (for instance) your blood sugar spikes up to 20 every time you eat porridge, if the rest of the time your blood sugar's a nice 5 and that's keeping the average down; nor will it show if your blood sugar doesn't spike at all when you eat porridge; or whether it's better to eat those pieces of fruit as a snack or as part of a meal, and so on.

Do you have a meter? I'd really recommend getting one if you don't - if you can see what your blood sugar is doing before a meal and then 2 hours after the meal you will feel much more informed and much less as though you're tiptoeing through a minefield. Doctors don't seem to give them out to type 2s very much, unfortunately, so you're unlikely to get one on the NHS if you don't have one already, but a lot of people here get this one - https://homehealth-uk.com/all-products/codefree-blood-glucose-monitoring-system-mmoll-or-mgdl/ - because it has cheaper test strips than most of the others (you'd need to get more test strips with it, but most people re-use lancets at least a few times). If you decide to get one, you can get it VAT free because you have diabetes, and you need to make sure you select mmol/L.

 

[Felinia]

I eat Green & Blacks 85% cocoa, but I don't like any milk in my chocolate so it's no hardship for me to eat the really dark stuff
I do also eat their mint chocolate sometimes though, and that's 70% cocoa.



It sounds to me as though you need to be testing your blood sugar to see how different foods effect you - you obviously can't just drastically cut carbs the way a lot of type 2s do because of your other conditions, so you need to know which foods really spike your blood sugar and which you can get away with. The HbA1c will show if you're doing OK overall, but it won't show if (for instance) your blood sugar spikes up to 20 every time you eat porridge, if the rest of the time your blood sugar's a nice 5 and that's keeping the average down; nor will it show if your blood sugar doesn't spike at all when you eat porridge; or whether it's better to eat those pieces of fruit as a snack or as part of a meal, and so on.

Do you have a meter? I'd really recommend getting one if you don't - if you can see what your blood sugar is doing before a meal and then 2 hours after the meal you will feel much more informed and much less as though you're tiptoeing through a minefield. Doctors don't seem to give them out to type 2s very much, unfortunately, so you're unlikely to get one on the NHS if you don't have one already, but a lot of people here get this one - https://homehealth-uk.com/all-products/codefree-blood-glucose-monitoring-system-mmoll-or-mgdl/ - because it has cheaper test strips than most of the others (you'd need to get more test strips with it, but most people re-use lancets at least a few times). If you decide to get one, you can get it VAT free because you have diabetes, and you need to make sure you select mmol/L.

Thanks for the information. I asked twice at the GP surgery, with my GP and the dedicated diabetic nurse, to be told I didn't need one. No doubt saving money for them!! I hate needles so have so far not got one. But I'm beginning to think I will need to. I'm following the healthy eating plan and have lost almost a stone, plus I now exercise 3 times a week at the pool, then on my mini exercise bike at home. However I don't feel any different - I still feel just as exhausted and pee for England, particularly at night, so don't sleep well. Most days after Aquafit I spend a couple of hours asleep on the bed, catching up!