Dietitians

[Eddy Edson]

Seeing my diabetic nurse tomorrow; she's probably going to hassle me about seeing a dietitian because I haven't checked that one off my list yet.

Are dietitians any good?

I know that's a dumb question, but before now I've tended to think of nutrition science as being pretty much junk & its practitioners as being like acolytes of some dumb religion in which I had zero interest; and quite likely the kind of people who *really* enjoy telling people to eat their vegetables, if you know what I mean.

Having to get into this stuff is a really tedious part of the D DX for me. Before, I thought I ate fairly well without being obsessive, didn't drink much, moderately active, BMI just a tad over 25, cholesterol fine, BP ok-ish. I was more expecting a diagnosis of cancer or LFEB (latent flesh-eating bacteria) or something, forgetting family history - father and his father were both T2.

So, I've been learning a bit & am resigned to getting more serious about things, but I want some hard-edged advice backed up by real data & insight & stuff, not just opinions etc. Can I expect that from a dietitian & how do you tell good ones from bad ones (by their plumage?)

EDIT: For example, the dietitian at my clinic is a practitioner of "Healthy At Every Size" and the "Non-Diet Approach". Both of these sound to me like nonsense, for a T2D at any rate: she's probably more likely to tell me to go eat a pizza rather than eat my vegetables; and I need a BG tester because my body usually tells me absolutely nothing about sugar spikes, while assuring me that eg a nice plate of melon is just what it needs.

Am I wrong?

 

[SB2015]

Seeing my diabetic nurse tomorrow; she's probably going to hassle me about seeing a dietitian because I haven't checked that one off my list yet.

Are dietitians any good?

I know that's a dumb question, but before now I've tended to think of nutrition science as being pretty much junk & its practitioners as being like acolytes of some dumb religion in which I had zero interest; and quite likely the kind of people who *really* enjoy telling people to eat their vegetables, if you know what I mean.

Having to get into this stuff is a really tedious part of the D DX for me. Before, I thought I ate fairly well without being obsessive, didn't drink much, moderately active, BMI just a tad over 25, cholesterol fine, BP ok-ish. I was more expecting a diagnosis of cancer or LFEB (latent flesh-eating bacteria) or something, forgetting family history - father and his father were both T2.

So, I've been learning a bit & am resigned to getting more serious about things, but I want some hard-edged advice backed up by real data & insight & stuff, not just opinions etc. Can I expect that from a dietitian & how do you tell good ones from bad ones (by their plumage?)

EDIT: For example, the dietitian at my clinic is a practitioner of "Healthy At Every Size" and the "Non-Diet Approach". Both of these sound to me like nonsense, for a T2D at any rate: she's probably more likely to tell me to go eat a pizza rather than eat my vegetables; and I need a BG tester because my body usually tells me absolutely nothing about sugar spikes, while assuring me that eg a nice plate of melon is just what it needs.

Am I wrong?

The help that I had from the Dietitan at the start of managing my Diabetes, was in understanding carb counting and information about glycemic index and the impact of this on how quickly the glucose is released from the carbs.

The main points that I picked up were
Carbs:
The public focus on ‘sugar’ as being the problem does not help. It is all carbs that get converted to glucose. Our stomachs don’t care what they started out as.
One bit of advice on veg I like:
If it is grown under the ground it will be high in carbs (potatoes)
If it grows above the ground it will be medium carbs (most fruit apart from berries(low) and grapes (high)
If it grows in the ground it will be low carb (lettuce,
As a T1 I had to start counting all of these from the start. I was amazed at the amount I was consuming, even thought they were healthy carbs. I found swaps that I could make to reduce the amount of carbs I eat, and have a target amount of carbs for each of my meals (I am not a ‘Low Carb’ person I have just reduced them to what is a sensible level for me). Many on here have found that a target of around 100 g per day has helped them.

Glycemic index
I had never heard of this before diagnosis. It simply describes how quickly the carbs are converted to glucose. If it is a slower release it gives you pancreas more time to release the insulin needed to match the glucose (smaller spikes after meals).

The dietitian I met was great for giving general patterns, but it was a while before I cottoned on to the idea that if I reduced my carbs I would reduce the BG increases after meals.

 

[Pumper_Sue]

Most people tend to go with a negative and they know best attitude, this obviously then leads to the thinking that the dietitian is rubbish etc., So pick out what you think is useful to you without shutting down, thank the person for their time and leave on a happy note.

A negative attitude leads to a negative outcome. 🙄

 

[SadhbhFiadh]

Hi, I will just stick my oar in the water here...

I see a dietician at the diabetic clinic, and have done for just over a year and a half. I told her I was choosing to count carbs, even though I am type 2. She supported me in that. She was brilliant, but also I had my own goals going in to her. My HbA1c went from 87 to the 50s in the months, then the next 3 months to 37, where it had started for over a year. So I view her as a partner: I set the goal and she guides me to achieve it.

Returning to the pier now.
S.

 

[Deleted member 21371]

My dietitian was good

 

[trophywench]

The dietitian at my clinic is one of the official trainers on the BERTIE based course delivered to T1s at UCHW. For T2s they have always recommended carb care, and do a lot to explain about correctly balancing the diet, to all of us to try and make sure we're not stuffing too much of anything or not enough of something else, down our necks and we're eating the right balance of all the trace elements the body needs.

They don't say 'You must eat' but instead eg 'It would be nice if you could have a bit of X with that, cos I can't see there's any potassium/zinc/iodine/whatever in your diet at the moment and that's very helpful in preventing whatever'

 

[Ralph-YK]

Some bad some OK. I've met some on diabetic sessions who were helpful. The dietician I had for individual sessions was worse than useless and I'd advice people not to see that one.
It's a case of trying them and see what they're like.

"Non-Diet Approach".

Most of the diets, the things for loosing weight, are short term and not sustainable. (Many people loose weight. Then put it all back on again. Go back &try it again.) What we need to have is a long term way of eating.

 

[TheClockworkDodo]

I didn't find the dieticians I saw incredibly helpful, but they did pick up on a few things I wouldn't have known - eg I had a very healthy diet when I was first diagnosed, but I didn't know at that point that fruit juice was so fast-acting it would spike my blood sugar if I had it as anything but a hypo treatment - I went through everything I ate with the first one I saw and the fruit juice was the only thing she told me to stop having (ironically I now have more of it than I did before I was diagnosed because I have so many hypos!). They also told me about things like the way temperature effects foods - if I freeze that fruit juice into ice lollies I can eat those because fast-acting carbs slow down if they're frozen or heated, apparently.

So I'd agree with Sue, pick out what you will find useful, thank them, and forget anything you won't find useful! It might help if you go in with a list of questions related to the foods you eat or want to eat, or to any food problems you're having (eg in my case it might be why do eggs spike my blood sugar when there are no carbs in them?) so you can direct the discussion the way you want it to go ...

 

[Deleted member 21371]

I didn't find the dieticians I saw incredibly helpful, but they did pick up on a few things I wouldn't have known - eg I had a very healthy diet when I was first diagnosed, but I didn't know at that point that fruit juice was so fast-acting it would spike my blood sugar if I had it as anything but a hypo treatment - I went through everything I ate with the first one I saw and the fruit juice was the only thing she told me to stop having (ironically I now have more of it than I did before I was diagnosed because I have so many hypos!). They also told me about things like the way temperature effects foods - if I freeze that fruit juice into ice lollies I can eat those because fast-acting carbs slow down if they're frozen or heated, apparently.

So I'd agree with Sue, pick out what you will find useful, thank them, and forget anything you won't find useful! It might help if you go in with a list of questions related to the foods you eat or want to eat, or to any food problems you're having (eg in my case it might be why do eggs spike my blood sugar when there are no carbs in them?) so you can direct the discussion the way you want it to go ...

I had that.
I though fruit juice was "healthy" too!

 

[CathyB]

I didn’t find mine helpful at all, when I challenged back about the low fat and the carb levels, she got quite shirty with me and completely dismissed the forum advice I wanted to follow. I chose to follow the forum advice and have never been back to see her, nor have I felt as well as I do now for years 😉 I guess it’s a personal choice depending on your dietician and how you choose to manage your diabetes

 

[Deleted member 21371]

I didn’t find mine helpful at all, when I challenged back about the low fat and the carb levels, she got quite shirty with me and completely dismissed the forum advice I wanted to follow. I chose to follow the forum advice and have never been back to see her, nor have I felt as well as I do now for years 😉 I guess it’s a personal choice depending on your dietician and how you choose to manage your diabetes

I thought the forum advice was be nice to everyone, listen to all the advice, and find what suits you personally?
I've certainly not seem any forum advice on what diet you need to follow?
And certainly no need to challenge anyone?

 

[Ralph-YK]

she got quite shirty with me and completely dismissed the forum advice I wanted to follow.

Mine told me to stop going on this forum, "it's just confusing you!" I stopped seeing her.

I've certainly not seem any forum advice on what diet you need to follow?

Would that be advice from the forum. There's strong manage your diabetes support here. And specific self test, manage carb and low carbs sense. All of which some hcp don't like.

I thought the forum advice was be nice to everyone, listen to all the advice, and find what suits you personally?
And certainly no need to challenge anyone?

Huh? What did I miss?

 

[CathyB]

I thought the forum advice was be nice to everyone, listen to all the advice, and find what suits you personally?
I've certainly not seem any forum advice on what diet you need to follow?
And certainly no need to challenge anyone?

Travellor, I was on a DESMOND course, the dietician was telling us to eat our 5 a day, including grapes, as an adult I am perfectly capable of challenging an opinion with respect if I choose to, not all challenges need to be aggressive or offensive. As for the ‘advice’ I chose to follow, it was after reading many, many threads about the benefits of a low carb diet, I then CHOSE to follow that eating plan and am pleased to say it has worked very well for me. No one told me to do it, no one said it was the only way to go. Perhaps my choice of words has been taken a little too literally, I will bear that in mind for future posts. Thank you for pointing this out.

 

[Deleted member 21371]

Mine told me to stop going on this forum, "it's just confusing you!" I stopped seeing her.

Would that be advice from the forum. There's strong manage your diabetes support here. And specific self test, manage carb and low carbs sense. All of which some hcp don't like.

Huh? What did I miss?

No one here ever told me I need to low carb.
I never felt the need to challenge my dietitian either.
We didn't always agree, but it wasn't about winning the argument, it was about pooling knowledge for me.

 

[Deleted member 21371]

Travellor, I was on a DESMOND course, the dietician was telling us to eat our 5 a day, including grapes, as an adult I am perfectly capable of challenging an opinion with respect if I choose to, not all challenges need to be aggressive or offensive. As for the ‘advice’ I chose to follow, it was after reading many, many threads about the benefits of a low carb diet, I then CHOSE to follow that eating plan and am pleased to say it has worked very well for me. No one told me to do it, no one said it was the only way to go. Perhaps my choice of words has been taken a little too literally, I will bear that in mind for future posts. Thank you for pointing this out.

Ok, but the thread was about a dietitian meeting, which is usually a one to one, not a challenge in a DESMOND course with a roomful of other diabetics, who may have a greater understanding of their problems than you, or simply no understanding at all.

 

[CathyB]

No one here ever told me I need to low carb.
I never felt the need to challenge my dietitian either.
We didn't always agree, but it wasn't about winning the argument, it was about pooling knowledge for me.

I’m pleased for you travellor, sounds like you have a good dietician. I also was t looking for an argument, neither am I willing to accept something if I have questions, that’s how I learn by exploring all perspectives and then deciding for myself. I respect your point of view but would ask that you don’t assume meaning without clarifying my intent.

 

[Amigo]

I requested to see the dietician after diagnosis. By the time the appointment came, I’d extensively read, researched and committed to sort this myself. She was pleasant enough and gave me the rudimentary guide to eating healthily with the Eat Well plate which didn’t equate to eating to keep bg’s on an even keel for me. So I thanked her nicely, went away, lost 2 stone, tested and worked out what I needed to do without meds (stopped them myself) and have not registered even a pre-diabetic level since. Mainly as the result of home testing. I declined a follow up appointment with the dietician.

Still and always will be a work in progress however and high levels represent a particular threat to me.

 

[Eddy Edson]

Thanks for all the responses ... processing.

@travellor : PR just out from Newcastle University: https://www.ncl.ac.uk/press/articles/latest/2018/08/directstudy/


A landmark trial has revealed further important insights into exactly how weight loss can put Type 2 diabetes into remission.

Professor Roy Taylor at Newcastle University, suggests that for remission to be possible, insulin-producing beta cells in the pancreas need to recover and make the right amount of insulin again.

In their latest Diabetes UK-funded study, published in Cell Metabolism, researchers at Newcastle University explored exactly how weight loss can put Type 2 diabetes into remission, and why it might work for some people and not others.

I've read yr "Newcastle diet" comments with a lot of interest. I'm not sure how suitable for me - I'm officially "normal weight" now with BMI = 24.9 vs 25.9 three months ago; do I actually have a bunch of fat in my tripes & how would I find out; etc etc - but I guess what I'm looking for is a dietitian or whatever specialist who can help me look into this kind of thing. I have a local lead I'll be checking out - bariatrics practitioner.

I see my BG daily averages edging below 7 now, from FBG = 15.6 a few months ago, with just Metformin and some relatively minor diet tweaks. So could some bigger effort put me into remission? I don't want the focus to be just on BG though - diabetes is more than that & it seems to me in some ways it's the easy part.

Anyway, what an excellent forum this is!

 

[Deleted member 21371]

Thanks for all the responses ... processing.

@travellor : PR just out from Newcastle University: https://www.ncl.ac.uk/press/articles/latest/2018/08/directstudy/


A landmark trial has revealed further important insights into exactly how weight loss can put Type 2 diabetes into remission.

Professor Roy Taylor at Newcastle University, suggests that for remission to be possible, insulin-producing beta cells in the pancreas need to recover and make the right amount of insulin again.

In their latest Diabetes UK-funded study, published in Cell Metabolism, researchers at Newcastle University explored exactly how weight loss can put Type 2 diabetes into remission, and why it might work for some people and not others.

I've read yr "Newcastle diet" comments with a lot of interest. I'm not sure how suitable for me - I'm officially "normal weight" now with BMI = 24.9 vs 25.9 three months ago; do I actually have a bunch of fat in my tripes & how would I find out; etc etc - but I guess what I'm looking for is a dietitian or whatever specialist who can help me look into this kind of thing. I have a local lead I'll be checking out - bariatrics practitioner.

I see my BG daily averages edging below 7 now, from FBG = 15.6 a few months ago, with just Metformin and some relatively minor diet tweaks. So could some bigger effort put me into remission? I don't want the focus to be just on BG though - diabetes is more than that & it seems to me in some ways it's the easy part.

Anyway, what an excellent forum this is!

I found this was my "Holy Grail"
I lost a lot of weight, from the dietitian supporting me on a very low fat, low calorie diet.
But the remission came from the final sweep up, on the Newcastle Diet.

By then I was a normal weight, but it did the reversal.

I have put weight back on since. (I looked like a corpse), and the diabetes hasn't returned.

 

[HOBIE]

They are a good bunch of Drs in Newcastle. 😉