Would you trust a dietician/clinical nutritionist?

moonage

About a year ago my mother was diagnosed with diabetes and was referred to a woman who is a consultant dietician and clinical nutritionist, and I went along.

It seems clear that a high carbohydrate diet raises insulin levels and is the likely cause of diabetes (along with genetic factors), so a diabetic should be put on a low carb diet. At the time I didn't know much about diabetes and didn't know the link between carbs and insulin levels.

The dietician put my mother on the traditional calorie controlled, low fat, high carb diet.

I wonder did the dietician not know the true cause and proper diet for diabetes; or did she know it but towed the offical recommendations out of fear of being reported as offering unsound dietary advice.

Frankly, I wouldn't trust a dietician/clinical nutritionist as far as I could throw them.

corkcomp

moonage wrote: »

About a year ago my mother was diagnosed with diabetes and was referred to a woman who is a consultant dietician and clinical nutritionist, and I went along.

It seems clear that a high carbohydrate diet raises insulin levels and is the likely cause of diabetes (along with genetic factors), so a diabetic should be put on a low carb diet. At the time I didn't know much about diabetes and didn't know the link between carbs and insulin levels.

The dietician put my mother on the traditional calorie controlled, low fat, high carb diet.

I wonder did the dietician not know the true cause and proper diet for diabetes; or did she know it but towed the offical recommendations out of fear of being reported as offering unsound dietary advice.

Frankly, I wouldn't trust a dietician/clinical nutritionist as far as I could throw them.

why are you assuming a diabetic would need a low carb diet? was it type one or type two diabetes? and more importantly, how is your mother now?
type two diabetes is often caused by obesity and lack of physical activity, and insulin resistance. eating lots of fats and simple carbs together is a major problem. complex carbs are fine for most people with diabetes

Sapsorrow

Usually the first issue to address with type two is obesity so I'm not suprised she got put on a calories controlled low fat diet, as that works for people who stick with it and losing weight often rectifies a lot of the problems by itself. Saying you woudn't trust a dietician or nutritionist is a bit silly, it's a good idea to think for your self always and to try and look into things for yourself but saying you wouldn't trust the whole profession after one 'bad' (as you perceived it) experience is ridiculous. I've had bad doctors in the past but I still go to one when I'm sick don't you?! Do you trust what you read on the internet or in books? It's all the same some people know what they're talking about some don't.

moonage

corkcomp wrote: »

why are you assuming a diabetic would need a low carb diet? was it type one or type two diabetes? and more importantly, how is your mother now?
type two diabetes is often caused by obesity and lack of physical activity, and insulin resistance. eating lots of fats and simple carbs together is a major problem. complex carbs are fine for most people with diabetes

It was Type 2 and she's ok now but I think she'd be a lot better on a low carb diet.

You say diabetes can be caused by obesity, lack of exercise and insulin resistance. There's no proof that lack of exercise has anything to do with it. Obesity and insulin resistance are themselves the result of a high carb diet because that type of diet keeps insulin levels elevated, which is what causes people to put on weight.

corkcomp

moonage wrote: »

It was Type 2 and she's ok now but I think she'd be a lot better on a low carb diet.

You say diabetes can be caused by obesity, lack of exercise and insulin resistance. There's no proof that lack of exercise has anything to do with it. Obesity and insulin resistance are themselves the result of a high carb diet because that type of diet keeps insulin levels elevated, which is what causes people to put on weight.

im guessing your kidding? if not, you are grossly mis-informed. exercise is one of the greatest factors in ensuring good insulin resistance, diet is very important also. I think the fact your mum is doing ok now is a good thing, and like the previous poster pointed out, loosing excess weight is often enough to reverse early type two diabetes. what causes a lot of type two diabetics to become over weight is poor diet choices - simple carbs, bad fats and excess calories and lack of physical activity.

Sapsorrow

corkcomp wrote: »

im guessing your kidding? if not, you are grossly mis-informed. exercise is one of the greatest factors in ensuring good insulin resistance, diet is very important also. I think the fact your mum is doing ok now is a good thing, and like the previous poster pointed out, loosing excess weight is often enough to reverse early type two diabetes. what causes a lot of type two diabetics to become over weight is poor diet choices - simple carbs, bad fats and excess calories and lack of physical activity.

Agree 100% exercise immproves nearly all typically abnormal risk factor parameters in type two diabetes. You said yourself she's fine now so whats the probem?

Dieticians have to give people 'do-able' goals, the average person will not do low carb or any other drastically different diet properly or in a healthy way and if it's too unusual/radical they simply won't stick with it if it's too far removed from what they're used to.

The challenge the dietician faces is getting the patient on board, motivated and commited to a plan that they have a good chance of sticking with in order to lose the weight and keep it off.

For most people that means eating the foods they are used too for the most part but in a calorie controlled manner so they can still lose weight.

The dietician then has to try and encourage other smaller and less intimidating healthful changes in and around that, like advising them to eat wholegrain or to be careful of alcohol.

The main point is that you can't scare the patient or be too tough with them of they won't give it a go or if they do theyll either find it too hard or un-enjoyable, do it wrong and so make themselve more unwell and just give up quickly.

Also you have to consider how little time a dietician has for their patients, they might see someone for 20mins once or a few times and thats simply not enough time to get someone doing a radically different diet (safely) or to monitor them to make sure they're doing it right and not compromising their health further with it.

Other issues would be problems with the kidneys etc and low carb may not be appropriate in the early stages if there are other complicating conditions to consider that are part of the overall syndrome.

Sapsorrow

moonage wrote: »

It was Type 2 and she's ok now but I think she'd be a lot better on a low carb diet.

You say diabetes can be caused by obesity, lack of exercise and insulin resistance. There's no proof that lack of exercise has anything to do with it. Obesity and insulin resistance are themselves the result of a high carb diet because that type of diet keeps insulin levels elevated, which is what causes people to put on weight.

No lack of exercise and overeating more often than not results in obesity which precipitates type 2. Typical atheletes eat loads of carbs and yet they're not fat, so saying exercise has nothing to do with weight gain is ludicrous! Maybe now she would be better on a low carb diet, but thats not to say in the intial phases of the disease when she might have any amount of damage done to her internal organs and been in an unstable health condition that it would have been safe!

moonage

corkcomp wrote: »

im guessing your kidding? if not, you are grossly mis-informed. exercise is one of the greatest factors in ensuring good insulin resistance, diet is very important also. I think the fact your mum is doing ok now is a good thing, and like the previous poster pointed out, loosing excess weight is often enough to reverse early type two diabetes. what causes a lot of type two diabetics to become over weight is poor diet choices - simple carbs, bad fats and excess calories and lack of physical activity.

The best thing to prevent insulin resistance is not having continuously high insulin levels, which is what a high carb diet causes.

Exercise has very little effect on weight loss. You might lose a bit but the primary way is through correct diet.

Excess weight does not cause diabetes; the reason they are linked is because of the high insulin levels from a high carb diet. If a person deliberately tried to become overweight on a low carb/high fat diet (which would be quite difficult) I don't think it would increase their risk of getting diabetes because their insulin levels would always be relatively low.

corkcomp

moonage wrote: »

The best thing to prevent insulin resistance is not having continuously high insulin levels, which is what a high carb diet causes.

Exercise has very little effect on weight loss. You might lose a bit but the primary way is through correct diet.

Excess weight does not cause diabetes; the reason they are linked is because of the high insulin levels from a high carb diet. If a person deliberately tried to become overweight on a low carb/high fat diet (which would be quite difficult) I don't think it would increase their risk of getting diabetes because their insulin levels would always be relatively low.

sorry, but most of that is false, but if you believe it more luck to you.

Sapsorrow

Moonage you're over simplifying things, also you're not considering the practicality of the situation which I tried to explain to you in one of the above posts.

Overweight in itself doesn't contribute to weightloss significantly compared to diet in that it is very hard to burn enough calories to create a sufficient calorie deficit for loss to occur that way compared to creating that deifict by eating less. What you're failing to take into account are the effects exercise has on metabolism to ultimately accelerate that loss and makes the diet-strategy much more efficient. It is also important to make sure it is fat lost and not muscle and yes exercise is very important as a therapeutic strategy to treat type 2 and metabolic syndrome because there is more to the pathology than just elevated insulin. Just because it's not as important as a dietary appraoch for weight loss doesn't make it unimportant. Thats like saying well brain surgery is the most important thing so we'll do that and not bother with the rehabilitation medications. There are any number of irregularities to consider, not just insulin resistance, You need to look into the fundamentals a bit more before you make your conclusions if you think it's that clear cut. If the body was that simple we would have cured cancer 50 years ago.

You are looking at one side of the story which is the research, which I dont think you are interpreting correctly. Also you thinking about things from the perspective of someone who has never actually had to work in a clinical setting with real people who are sick, uneducated about nutrition and potentially in a very unstable condition of health and with whom you may only have 20 minutes to counsel them in. You need to look at things from the perspective of the practitioner who has any number of practical and pshycological limitations they have to work around. You're saying well I think low carb will work better doesn't address any of these complicating factors or make it any more practical to try and implement. I tried to explain all this to you already, I don't see much point in reiterating myself any further.

moonage

khrystyna100 wrote: »

Dieticians have to give people 'do-able' goals, the average person will not do low carb or any other drastically different diet properly or in a healthy way and if it's too unusual/radical they simply won't stick with it if it's too far removed from what they're used to.

The challenge the dietician faces is getting the patient on board, motivated and commited to a plan that they have a good chance of sticking with in order to lose the weight and keep it off.

For most people that means eating the foods they are used too for the most part but in a calorie controlled manner so they can still lose weight.

You seem to imply that the function of a dietician is to help people lose weight.

If someone goes to a dietician with a medical condition the dietician should advide them on a proper diet that will help alleviate the condition or cure it or at least stop it getting worse.

If a dietician tells someone to basically continue eating as before but in smaller quantities, it seems pointless.

Sapsorrow

moonage wrote: »

You seem to imply that the function of a dietician is to help people lose weight.

If someone goes to a dietician with a medical condition the dietician should advide them on a proper diet that will help alleviate the condition or cure it or at least stop it getting worse.

If a dietician tells someone to basically continue eating as before but in smaller quantities, it seems pointless.

No I'm not implying that, if you'd read my previous posts you'd notice I mention weight loss is one of the first (and obviously one of the most if not the most important) routes of treatments in type 2 diabetes. Thats why I was discussing the challenge the dietician faces in trying to encourage people to lose weight without scaring them off. Please re-read my other posts more carefully its really self explanatory and I can't be bothered trying to make it any more transparent.

corkcomp

moonage wrote: »

You seem to imply that the function of a dietician is to help people lose weight.

If someone goes to a dietician with a medical condition the dietician should advide them on a proper diet that will help alleviate the condition or cure it or at least stop it getting worse.

If a dietician tells someone to basically continue eating as before but in smaller quantities, it seems pointless.

are you actually reading the replies at all? what we have been trying to say is that loosing weight is a major help with type two diabetes, and the dietician gave your mother a diet that helped her to lose weight? just because YOU dont agree with the diet doesnt mean it is wrong. im pretty sure the carbs the dietician recommended were a little different to ones consumed previously?

jam_mac_jam

I wouldnt assume that I knew more than a person who had gone to college for a few years and studied this because I read a couple of books about low carbs. Maybe I would get a second opinion rather than because I didnt agree with what they said rather than not trust anyone because of one experience. Yes I would generally trust them.

moonage

corkcomp wrote: »

are you actually reading the replies at all? what we have been trying to say is that loosing weight is a major help with type two diabetes, and the dietician gave your mother a diet that helped her to lose weight? just because YOU dont agree with the diet doesnt mean it is wrong. im pretty sure the carbs the dietician recommended were a little different to ones consumed previously?

Of course I'm reading the replies but I think you're wrong and I'm trying to point out where I think you're wrong. I might be wrong but you haven't persuaded me that I am.

With regard to weight loss: if an obese person didn't change his diet and walked for 20 miles every day, yes he would lose a lot of weight over time but that's too extreme and not doable.

If, instead, he did a more manageable moderate amount of exercise, he'd lose a small amount but not much. Many studies have shown that exercise has little on no effect on weight loss in the obese. A change to the correct diet is the key factor.

jam_mac_jam

moonage wrote: »

Of course I'm reading the replies but I think you're wrong and I'm trying to point out where I think you're wrong. I might be wrong but you haven't persuaded me that I am.

With regard to weight loss: if an obese person didn't change his diet and walked for 20 miles every day, yes he would lose a lot of weight over time but that's too extreme and not doable.

If, instead, he did a more manageable moderate amount of exercise, he'd lose a small amount but not much. Many studies have shown that exercise has little on no effect on weight loss in the obese. A change to the correct diet is the key factor.

what studies? of the many that state exercise has little or no effect on weight loss can you please give me the details of one, I find that very interesting

Sapsorrow

moonage wrote: »

With regard to weight loss: if an obese person didn't change his diet and walked for 20 miles every day, yes he would lose a lot of weight over time but that's too extreme and not doable.

If, instead, he did a more manageable moderate amount of exercise, he'd lose a small amount but not much. Many studies have shown that exercise has little on no effect on weight loss in the obese. A change to the correct diet is the key factor.

Is that not exactly what I said? And did I not say that just because it's not the most important thing is not the same as not being important at all. You don't seem to be reading the posts very carefully.

Sapsorrow

jam_mac_jam wrote: »

I wouldnt assume that I knew more than a person who had gone to college for a few years and studied this because I read a couple of books about low carbs. Maybe I would get a second opinion rather than because I didnt agree with what they said rather than not trust anyone because of one experience. Yes I would generally trust them.

The girls Im in college with who are going on to be dieticians will have spent 5 and a half years studying to get there as well as doing their clinical work in hospitals, it's pretty presumptious to imply that they're all a bunch of morons who don't know what they're doing ( I can assure you the ones who make it into the post-grads are a very clever bunch, you really have to be the very best to get into it). And at least they will have a very good background in biology, physiology, biochemistry, clinical nutrition and eventually professional experiece from which to draw their conclusions on the research out there. I'd trust them in much the same way I'd trust my doctor to write my prescription and not try and do it myself.

moonage

jam_mac_jam wrote: »

what studies? of the many that state exercise has little or no effect on weight loss can you please give me the details of one, I find that very interesting

The role of exercise in the treatment of obesity. - Votruba SB - Nutrition - 01-MAR-2000; 16(3): 179-88 (MEDLINE® is the source for the citation and abstract of this record )

Abstract:

The prevalence of obesity in the USA has increased dramatically in the past decade. This foreshadows an increase in the rates of morbidity and mortality from obesity-related diseases and increases in the number of individuals undergoing weight-loss therapy. Although exercise has long been recommended for inclusion in such therapy, the present review has found that it has had little or no effect on weight loss per se when the exercise is limited to the typically prescribed 3-5 h/wk of moderate or vigorous activity. However, further review has shown that exercise helps to preserve and at times even increase fat-free mass during weight loss. At the same time, fat loss is generally increased. Neither type nor amount of exercise appears to have much effect during treatment, with the possible exception of resistance training, which is associated with the best outcome for fat-free mass. The most important role of exercise, however, is in the maintenance of the weight loss. In this respect, the volume of exercise seems to be important because several lines of evidence have indicated that exercise must expend roughly 2500 kcal/wk to maintain weight loss. Studies of weight maintenance, however, have generally not included randomized controls; thus, further research is required to solidify these conclusions

Sapsorrow

moonage wrote: »

The role of exercise in the treatment of obesity. - Votruba SB - Nutrition - 01-MAR-2000; 16(3): 179-88 (MEDLINE® is the source for the citation and abstract of this record )

Abstract:

The prevalence of obesity in the USA has increased dramatically in the past decade. This foreshadows an increase in the rates of morbidity and mortality from obesity-related diseases and increases in the number of individuals undergoing weight-loss therapy. Although exercise has long been recommended for inclusion in such therapy, the present review has found that it has had little or no effect on weight loss per se when the exercise is limited to the typically prescribed 3-5 h/wk of moderate or vigorous activity. However, further review has shown that exercise helps to preserve and at times even increase fat-free mass during weight loss. At the same time, fat loss is generally increased. Neither type nor amount of exercise appears to have much effect during treatment, with the possible exception of resistance training, which is associated with the best outcome for fat-free mass. The most important role of exercise, however, is in the maintenance of the weight loss. In this respect, the volume of exercise seems to be important because several lines of evidence have indicated that exercise must expend roughly 2500 kcal/wk to maintain weight loss. Studies of weight maintenance, however, have generally not included randomized controls; thus, further research is required to solidify these conclusions

Quoting the abstract isn't the same thing as providing the results of the study.

jam_mac_jam

khrystyna100 wrote: »

The girls Im in college with who are going on to be dieticians will have spent 5 and a half years studying to get there as well as doing their clinical work in hospitals, it's pretty presumptious to imply that they're all a bunch of morons who don't know what they're doing ( I can assure you the ones who make it into the post-grads are a very clever bunch, you really have to be the very best to get into it). And at least they will have a very good background in biology, physiology, biochemistry, clinical nutrition and eventually professional experiece from which to draw their conclusions on the research out there. I'd trust them in much the same way I'd trust my doctor to write my prescription and not try and do it myself.

exactly

moonage

khrystyna100 wrote: »

Is that not exactly what I said? And did I not say that just because it's not the most important thing is not the same as not being important at all. You don't seem to be reading the posts very carefully.

We disagree on how important exercise is for weight loss.

You think it's quite important. I think it's not very important.

Please follow your own advise about reading posts carefully.

moonage

khrystyna100 wrote: »

Quoting the abstract isn't the same thing as providing the results of the study.

I don't know how to get the results up. Could someone put them up?

Sapsorrow

moonage wrote: »

I don't know how to get the results up. Could someone put them up?

ehm cut and paste? Have you only got access to the abstract and not the actual article?

moonage

khrystyna100 wrote: »

The girls Im in college with who are going on to be dieticians will have spent 5 and a half years studying to get there as well as doing their clinical work in hospitals, it's pretty presumptious to imply that they're all a bunch of morons who don't know what they're doing ( I can assure you the ones who make it into the post-grads are a very clever bunch, you really have to be the very best to get into it). And at least they will have a very good background in biology, physiology, biochemistry, clinical nutrition and eventually professional experiece from which to draw their conclusions on the research out there. I'd trust them in much the same way I'd trust my doctor to write my prescription and not try and do it myself.

Five and a half years at college and their main advice (according to you) is: don't change your diet too much but eat less.

El_Dangeroso

Yikes, you don't pull no punches moonage!;) A little tip, it's best not to start a thread just to rant if you want to convince anyone of your point of view.

Firstly, don't tar all dieticians with the same brush, those recommendations are government mandated, there is no option B for diabetics in this country. Not if the dietician wants to keep their job anyway. As khrystyna said, they are highly trained, intelligent people. But their hands are tied. Like many other people working in our health service they are bound by protocols that sometime go against their better judgement, whether it be through outdated science or 'cost-effectiveness'. If your gonna get angry at anyone, make it the government that institutes the policies and undermines the valiant efforts of overworked staff.

The thing about diabetics is they have a massively increased risk of heart disease than a normal person, so because the current wisdom is that fat causes heart disease, they put diabetics on a low fat diet to try and mitigate this risk. And they have to get their calories from somewhere, so it comes from the only other energy source, carbs, and because the carbs causes hb1ac to rise, they are then put on medication to aggressively lower hb1ac, and so on and so on.

Exercise does lower Hb1ac, but not nearly as much as diet can, but it has to be the right type, chronic cardio makes it worse, HIIT and weights do wonderful things to insulin sensitivity. Actually magnesium supplementation lowers Hba1c more than exercise so add that on the pile too.

For those who think that a high-carb low-fat diet is in anyway suitable for a diabetic then please look at this graph of Hba1c over 5 weeks:



From Gannon et al. (2004) The filled circles are the low carb diet, the empty circles are the low-fat diet.

I recommend Dr. Bernstein's book on managing, even curing diabetes in some instances with a low carb diet. Just putting a diabetic person on any ol' low carb diet without proper supervision is potentially dangerous, remember that protein elicits an insulin response too. Best advice is to find a doctor sympathetic to the approach. They are out there trust me, they take a bit of digging and a lot of dead ends.

So if a carefully applied LC diet is the best solution to diabetes (and this recent study did it without weight loss or insulin) Buuuut.. you're incorrect in saying that a high-carb diet causes diabetes. It'd be lovely if it were that simple but it is really way more complicated than macro-nutrient composition of diet.There are plenty of populations of people eating 70% of their cals from carbs and they don't have one single diabetic amongst them.

The etiology of diabetes is not yet fully understood, at least not by me..Ha! But the most compelling theory that I've come across is that insulin is a sort of communication mechanism between the liver and the pancreas. So you can say that insulin resistance and eventually diabetes starts in the liver. And what pisses the liver off? Lots of fructose, omega 6 polyunsaturated fat and wheat gluten, these are the most likely culprits. So agreeth pretty much any blogger I've read on the subject, including Stephan from Whole Health Source, and he eats 200g of carbs a day, his fasting insulin is 2.3 uIU/mL, which is spectacularly good.

You are where I was a few years ago, blaming it all on carbs, but it's just not the case. It's about a quality, wholefoods diet that is rich in nutrients and low in anti-nutrients. There's no reason to completely avoid carbs if you haven't completely buggered your glucose metabolism.

Sapsorrow

moonage wrote: »

Five and a half years at college and their main advice (according to you) is: don't change your diet too much but eat less.

I literally feel like I'm hitting my face off a brick wall now, I give up. Night everyone!

moonage

Thanks Temple Grandin, you seem to know what you're talking about.

Temple_Grandin wrote: »

So if a carefully applied LC diet is the best solution to diabetes (and this recent study did it without weight loss or insulin) Buuuut.. you're incorrect in saying that a high-carb diet causes diabetes. It'd be lovely if it were that simple but it is really way more complicated than macro-nutrient composition of diet.There are plenty of populations of people eating 70% of their cals from carbs and they don't have one single diabetic amongst them.

The etiology of diabetes is not yet fully understood, at least not by me..Ha! But the most compelling theory that I've come across is that insulin is a sort of communication mechanism between the liver and the pancreas. So you can say that insulin resistance and eventually diabetes starts in the liver. And what pisses the liver off? Lots of fructose, omega 6 polyunsaturated fat and wheat gluten, these are the most likely culprits. So agreeth pretty much any blogger I've read on the subject, including Stephan from Whole Health Source, and he eats 200g of carbs a day, his fasting insulin is 2.3 uIU/mL, which is spectacularly good.

So you agree that a carefully applied low carb diet is the best solution for diabetes but you disagree that a high carb diet is the cause.

Do you think a high carb diet plays no part at all? Has the consumption of fructose, omega 6 polyunsaturated fat and wheat gluten risen so much in the last 20 years that it would account for the huge increase in diabetes?

As regards dieticians, they spend several years becomming highly knowlegeable about nutrition, yet they're not allowed to apply their expertise in the best way for the benefit of their patients. It seems a bit bizzare.

El_Dangeroso

moonage wrote: »

Do you think a high carb diet plays no part at all? Has the consumption of fructose, omega 6 polyunsaturated fat and wheat gluten risen so much in the last 20 years that it would account for the huge increase in diabetes?

As regards dieticians, they spend several years becomming highly knowlegeable about nutrition, yet they're not allowed to apply their expertise in the best way for the benefit of their patients. It seems a bit bizzare.

I think diabetics (sorry should state that I'm referring to type II DM or 'acquired' type here) got that way eating a lot of sugar (which is 50% fructose - despite the name there's not all that much fructose in fruit comparatively), a lot of white flour and a lot of fast food containing industrially processed vegetable fat.

What these three items have in common is that they are really cheap additives to bulk out cheap food, and all of them disturb not only the function of the liver, but the tightly regulated hunger feedback mechanisms of the body. Next time you're in the supermarket, see if you can find one packet that doesn't have wheat flour, sugar or vegetable oil listed in the ingredients. It's virtually impossible.

And as processed convenience food becomes more and more ubiquitous in our diet, so do these three elements. And they make us hungrier and want to eat more and more, until we're consuming so much we get a disease such as diabetes. It doesn't always manifest itself that way but then every smoker doesn't get lung cancer.

It must be very frustrating for dieticians to not get more time with patients or even funding to do proper follow up in some cases, even if the dietician is the most clued up on the latest research, they still have to tow the party line. Khrystyna mentioned before how competitive it is to get into that role and how little decision latitude they have in some cases. It's really sad.

Sidepoint, I am just struck by the irony of the ad below this post is one for the supermacs chicken deluxe meal. Do you think there's some bot picking up on 'Sugar, white flour and vegetable oil' in my post or do you think it's just there to torment people on the nutrition and diet forum?:D:D

columok

I remember having an argument with a dietician (from a very high profile hospital) when I tried to argue a high protein diet with lots of lean meat, fish, veggies and fruit was arguably a lot better for patients than cheese sandwiches and potatoes, chips and jelly. She insisted that people in recovery from operations + illness needed the high (pasta, grain, potatoes, sugar) carb diet.

Her argument was constantly that she knew they needed it and that she had a degree on the topic thus qualifying her opinion. Just because somebody has letters after their name doesn't make them an expert on a topic.

Similarily I'm sure there are plenty of clued in dieticians that are hamstrung by professional indemnity and hospital policy!!!

Sapsorrow

moonage wrote: »

Thanks Temple Grandin, you seem to know what you're talking about.

*Ouch!* :rolleyes:

tankbarry

i would trust a dietician. When I was sent to a dietician 4 to 5 years ago I knew I had bad problems and they were getting serious. I was putting on weight by the hour by eating crap food all day. If it wasnt for her I wouldnt have lost any weight at all. she made me believe I could do and I did. she even cared to ring and see how I was doing...

so i would trust then

Sapsorrow

columok wrote: »

I remember having an argument with a dietician (from a very high profile hospital) when I tried to argue a high protein diet with lots of lean meat, fish, veggies and fruit was arguably a lot better for patients than cheese sandwiches and potatoes, chips and jelly. She insisted that people in recovery from operations + illness needed the high (pasta, grain, potatoes, sugar) carb diet.

Her argument was constantly that she knew they needed it and that she had a degree on the topic thus qualifying her opinion. Just because somebody has letters after their name doesn't make them an expert on a topic.

Similarily I'm sure there are plenty of clued in dieticians that are hamstrung by professional indemnity and hospital policy!!!

Ya I can see where she was coming from though, with patients coming out of operations the intial treatment diet reccomendations wouldn't be much to do with what would be appropriate for a long term term diet and so long term health outcomes. High carb might be more suitable for tissue/scar recovery who knows! A dietician I know is always grumbling about the crap they have to give patients in her hospital because they're so underfunded and because they dont have control over what is ordered for or made in the kitchens.

EDIT: another thought, a high protein diet isn't necessarily suitable for everyone, especially the sick. For example someone with acute renal or liver failure will have extremely specific dietary requirements and can only eat very controlled amounts of minerals, vitamins and other food compounds to the extent that they can't eat certain fruits and veg, too much animal protein etc etc.. So the idea that dieticians are bad because they don't reccomend the diet you think is healthiest is flawed from the get go. The whole point of a dietician is that sick people have such different needs and they are trained to prescribe diets depending on the persons illness and any other number of parameters that might be complicating the situation.

columok

khrystyna100 wrote:

Ya I can see where she was coming from though, with patients coming out of operations the intial treatment diet reccomendations wouldn't be much to do with what would be appropriate for a long term term diet and so long term health outcomes. High carb might be more suitable for tissue/scar recovery who knows! A dietician I know is always grumbling about the crap they have to give patients in her hospital because they're so underfunded and because they dont have control over what is ordered for or made in the kitchens.

I think it was down to her pasta, bread rice at the bottom food pyramid education. (grains are an important and nutritious part of a healthy and balanced diet. Sure you can't just ignore a whole foodgroup).

Also she didn't argue (this was in a pub btw) that they had to go with easy food to make or that they had to go with comfort food to up people's calories. She argued that it was the appropriate and ultimate food for those people.

Besides, free range eggs, veggies and fruit are all cheap and easy to prepare. Meat and fish are more expensive but you can do wonders with cheap cuts and stew. Even if it wasn't high protein and just emphasised less of the bad carb crap and more of the veggies and fruits!

Sapsorrow

columok wrote: »

I think it was down to her pasta, bread rice at the bottom food pyramid education. (grains are an important and nutritious part of a healthy and balanced diet. Sure you can't just ignore a whole foodgroup).

Also she didn't argue (this was in a pub btw) that they had to go with easy food to make or that they had to go with comfort food to up people's calories. She argued that it was the appropriate and ultimate food for those people.

Besides, free range eggs, veggies and fruit are all cheap and easy to prepare. Meat and fish are more expensive but you can do wonders with cheap cuts and stew. Even if it wasn't high protein and just emphasised less of the bad carb crap and more of the veggies and fruits!

Ah ya I know what you mean there is a lot of people still promoting the pyramid, but tbh I think it can work perfectly well for some people as long as the right parts of it are chosen. A grain diet based on quality wholegrains, good meats and fish, fruit and veg and a tiny bit of sweet things as a treat can be ok for a lot of people.
Yes you can work wonders with cheap cuts but have you ever seen a hospital kitchen? They're just canteen workers same as anywhere. Again it's usually beyond the dieticians control, they don't even have real brown bread for example, and she's not in charge of ordering it and can't do anything about it.