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    Type 2 diabetic: 320 reasons to avoid dietitians

    graham64
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    Post by graham64 on Wed Nov 09 2016, 22:29

    Dietitians' practice in giving carbohydrate advice in the management of type 2 diabetes: a mixed methods study

    Abstract

    Background

    Carbohydrate is accepted as the principal nutrient affecting blood glucose in diabetes; however, current guidelines are unable to specify the optimal quantity of carbohydrate for glycaemic control. No studies exist that describe current practice amongst healthcare professionals giving carbohydrate advice in type 2 diabetes. The present study aims to improve understanding of the degree of variation in the current practice of UK registered dietitians (RDs) by describing how RDs advise patients.


    Methods

    UK RDs were contacted through national networks and asked to complete an online survey, which was analysed using stata, version 12 (StataCorp, College Station, TX, USA). Three consultations between dietitians and patients with type 2 diabetes were observed, followed by semi-structured interviews with the dietitians.


    Results

    In total, 320 complete survey responses were received. Dietitians' advice varied according to expertise, training and confidence, and the complexity of the patient's blood glucose treatment. Some 48% (n = 154) of respondents advised patients to restrict carbohydrate intake either occasionally or frequently, with 35.6% (n = 114) considering 30–39% of total energy from carbohydrate to be a realistic expectation. The overall theme from the interviews was ‘Conflicting Priorities’, with three sub-themes: (i) how treatment decisions are made; (ii) the difference between empowerment and advice; and (iii) contradictory advice. A disparity existed between what was observed and interview data on how dietitians rationalise the type of carbohydrate advice provided.


    Conclusions

    Dietitians' advice varies for a number of reasons. Consensus exists in some areas (e.g. carbohydrate awareness advice); however, clear definitions of such terms are lacking. Clarification of interventions may improve the consistency of approach and improve patient outcomes.


    http://onlinelibrary.wiley.com/doi/10.1111/jhn.12436/abstract


    Sorry for the exaggeration in the title  Wink it should read 319, Zoe Harcombe who has accessed the full text found that one dietitian was advising a keto diet   Cool


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    Post by chris c on Fri Nov 11 2016, 21:16

    So more than half of them did NOT recommend carbohydrate reduction.

    Who put the tit in dietitian?
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    Post by graham64 on Fri Nov 11 2016, 22:15

    @chris c wrote:So more than half of them did NOT recommend carbohydrate reduction.

    Who put the tit in dietitian?

    Probably the same tit who put die in dietitian  Laughing

    The BDA have a diabetes specialist group of tits  Shocked  http://www.diabetesdietitians.org.uk/

    On a serious note we are always told BDA advice is evidence based 


    No studies exist that describe current practice amongst healthcare professionals giving carbohydrate advice in type 2 diabetes. 

    Given that, our anecdotal evidence and that of other diabetics carries far more credence than non existent evidence touted by the BDA


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    Proving the LowCarb sceptics wrong for over ten years

    Not all cherubs are Angels  Wink nor all diabetics Bonkers  Rolling Eyes
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    Post by chris c on Fri Nov 11 2016, 22:19

    I typoed "deitician" on someone's blog, then decided I'd leave it.

    Frankly thousands of anecdotes way way outnumber a study of 30 diabetics bought and paid for by the Sugar Bureau and published by DUK.
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    Post by graham64 on Mon Nov 14 2016, 22:31

    Zoe Harcombe has done a review of the study some interesting figures and quotes  including the following:

     “So, people who are wanting to control their weight they know that it’s the carbs that they need to inject for so, for example, if they want to have any carbs at lunch time, because sometimes you know, people, patients, have said to me that the insulin puts weight on and we keep saying that well actually insulin is non calories, its (sic) what you’re eating that would put the weight on…”

    http://www.zoeharcombe.com/2016/11/dietitians-diabetes-carbohydrates/


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    Proving the LowCarb sceptics wrong for over ten years

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    Post by chris c on Mon Nov 14 2016, 23:16

    Go Zoe! Nice to be able to read that in full for free.

    One thing that struck me was their ages. Most dieticians will NEVER have experienced a time when there were no "epidemics" of obesity, diabetes and all the other "diseases of civilisation". Nor will an increasing percentage of doctors.
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    Post by graham64 on Tue Nov 15 2016, 22:26

    wtf

    Type 2 diabetic: 320 reasons to avoid dietitians  Capture%2Bcollins2
    No nutrition training for doctors has got to be better than the BDA's high carb low fat dogma  


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    I'm a skinny T2 diagnosed 4/4/2008, a high calorie LCHF diet and one metformin a day A1c 6.2 and no complications.

    Proving the LowCarb sceptics wrong for over ten years

    Not all cherubs are Angels  Wink nor all diabetics Bonkers  Rolling Eyes
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    Post by Derek on Wed Nov 16 2016, 14:24

    You have to sympathize. If you take out a food group you would need less than half the number of dieticians. 2 squared is four and 3 squared is nine! Smile
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    Post by chris c on Wed Nov 16 2016, 21:42

    You're not supposed to be able to do maths like that, didn't you know low carb causes brain damage???
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    Post by graham64 on Mon Dec 05 2016, 22:52

    Perhaps I'm being a bit harsh on the BDA Wink  because they do mention this on their fact sheet

    A lower carbohydrate diet could be an option for you but talk to a healthcare professional first, preferably a dietitian, as it may not be suitable or your medication may need adjusting.

    Finding a dietitian that actually knows what a LC diet entails could be difficult though 

    Type 2 diabetic: 320 reasons to avoid dietitians  Capture%2Bmacardle





    _________________
    I'm a skinny T2 diagnosed 4/4/2008, a high calorie LCHF diet and one metformin a day A1c 6.2 and no complications.

    Proving the LowCarb sceptics wrong for over ten years

    Not all cherubs are Angels  Wink nor all diabetics Bonkers  Rolling Eyes
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    Post by chris c on Wed Dec 07 2016, 21:34

    Well that's half an hour of my life I'll never get back.

    They have noodle apps on their phones? They just can't keep away from the carbs, can they?

    Complacent twerp, 0.8% - 1% reduction in A1c is the best they can do? Much like the ADA under John Buse, completely ignore what patients themselves actually achieve, more like 5 - 8% and sometimes over 10%. He should have speaks with David Unwin, Joanne McCormack. Jay Wortman, Eric Westman, etc. etc.


    Last edited by chris c on Wed Dec 07 2016, 21:35; edited 1 time in total (Reason for editing : added a bit)
    graham64
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    Post by graham64 on Wed Dec 07 2016, 22:02

    @chris c wrote:Well that's half an hour of my life I'll never get back.

    They have noodle apps on their phones? They just can't keep away from the carbs, can they?

    Complacent twerp, 0.8% - 1% reduction in A1c is the best they can do? Much like the ADA under John Buse, completely ignore what patients themselves actually achieve, more like 5 - 8% and sometimes over 10%. He should have speaks with David Unwin, Joanne McCormack. Jay Wortman, Eric Westman, etc. etc.

    Yes carbs but don't forget the all important calorie reduction, I doubt they have a clue when it comes to those like you and me or any other T2 that follow or need above the RDI of 2,500kcal 

    But hey look they are still researching carbs  Rolling Eyes

    Type 2 diabetic: 320 reasons to avoid dietitians  CzEin27XEAAgoWQ

    So they need to bribe dietitians to take part Sad when what they really need is a diabetic with a meter then they might fully understand the effects of carbs on BG simples


    _________________
    I'm a skinny T2 diagnosed 4/4/2008, a high calorie LCHF diet and one metformin a day A1c 6.2 and no complications.

    Proving the LowCarb sceptics wrong for over ten years

    Not all cherubs are Angels  Wink nor all diabetics Bonkers  Rolling Eyes
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    Post by chris c on Wed Dec 07 2016, 23:19

    Oh but they already know that all diabetics who improve their health are secretly lying about their low fat diet. And anyway they are all Eddie who is online 24 hours a day busily posting to forums and blogs in all countries, often several at once, in all time zones.
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    Post by Eddie on Thu Dec 08 2016, 10:18

    @graham64 wrote:
    @chris c wrote:Well that's half an hour of my life I'll never get back.

    They have noodle apps on their phones? They just can't keep away from the carbs, can they?

    Complacent twerp, 0.8% - 1% reduction in A1c is the best they can do? Much like the ADA under John Buse, completely ignore what patients themselves actually achieve, more like 5 - 8% and sometimes over 10%. He should have speaks with David Unwin, Joanne McCormack. Jay Wortman, Eric Westman, etc. etc.

    Yes carbs but don't forget the all important calorie reduction, I doubt they have a clue when it comes to those like you and me or any other T2 that follow or need above the RDI of 2,500kcal 

    But hey look they are still researching carbs  Rolling Eyes

    Type 2 diabetic: 320 reasons to avoid dietitians  CzEin27XEAAgoWQ

    So they need to bribe dietitians to take part Sad when what they really need is a diabetic with a meter then they might fully understand the effects of carbs on BG simples



    More on this nonsense here. http://www.hra.nhs.uk/news/research-summaries/carbohydrate-awareness-advice/

    Type 2 diabetic: 320 reasons to avoid dietitians  BDA%2BRD%2Bcarbs

    So the BDA member in question clearly knows the effect of carbs on a diabetic, yet the BDA and most of it's RD's push the carbs with every meal lunacy.


    _________________
    Type two diabetic-low carb diet (50 carbs per day) and two 500mg Metformin pills per day. Apart from diagnosis HbA1c almost 12-all HbA1c results none diabetic. For over eight years my diabetes medication has not changed. My weight has remained stable, I have suffered no ill effects from my diet whatsoever. Every blood test has proved, I took the right road to my diabetic salvation. For almost seven years, I have asked medical professionals and naysayers, how do I maintain non diabetic BG levels on two Metformin other than low carb ? The silence has been deafening !
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    Post by Derek on Thu Dec 08 2016, 15:07

    @Eddie wrote:
    @graham64 wrote:
    @chris c wrote:Well that's half an hour of my life I'll never get back.

    They have noodle apps on their phones? They just can't keep away from the carbs, can they?

    Complacent twerp, 0.8% - 1% reduction in A1c is the best they can do? Much like the ADA under John Buse, completely ignore what patients themselves actually achieve, more like 5 - 8% and sometimes over 10%. He should have speaks with David Unwin, Joanne McCormack. Jay Wortman, Eric Westman, etc. etc.

    Yes carbs but don't forget the all important calorie reduction, I doubt they have a clue when it comes to those like you and me or any other T2 that follow or need above the RDI of 2,500kcal 

    But hey look they are still researching carbs  Rolling Eyes

    Type 2 diabetic: 320 reasons to avoid dietitians  CzEin27XEAAgoWQ

    So they need to bribe dietitians to take part Sad when what they really need is a diabetic with a meter then they might fully understand the effects of carbs on BG simples




    More on this nonsense here. http://www.hra.nhs.uk/news/research-summaries/carbohydrate-awareness-advice/

    Type 2 diabetic: 320 reasons to avoid dietitians  BDA%2BRD%2Bcarbs

    So the BDA member in question clearly knows the effect of carbs on a diabetic, yet the BDA and most of it's RD's push the carbs with every meal lunacy.



    Surely you don't want them to get into trouble by telling the truth. Look what's happened to poor old Boris!
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    Post by chris c on Fri Dec 09 2016, 22:09

    A glucometer will soon tell them! Mine originally told me less than 15g at breakfast on a sliding scale to 30g in the evening.

    After a while when I had kicked my IR into touch and kept it there for nearly twelve years now, it's around 10g at breakfast but more like 50 - 80g and sometimes 100g by evening.

    I keep that as a party trick for eating out though, if I did it with any regularity the IR would return.

    Mainly I stick around 50g/day, that gives me a VERY wide choice of nutritious foods and near-normal BG, BP and lipids, and energy all day.

    Most of the well controlled diabetics I've known in numerous forums and newsgroups are in the 20 - 150g range, the latter end mostly active Type 1s on insulin, the vast majority are probably 20 - 60g

    and none of them are dead yet.

    I was going to ask Catherine Collins (I'm not fat, just big boned) which of my nutritious foods I should not have eaten in order to fit in my 230 - 300g carbs including 70 - 90g sugar, the Government's recommendation, but she went away. I know of not one diabetic who remains healthy and eats more than half that many carbs. Not one.
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    Post by graham64 on Fri Dec 09 2016, 22:47

    @chris c wrote:I was going to ask Catherine Collins (I'm not fat, just big boned) which of my nutritious foods I should not have eaten in order to fit in my 230 - 300g carbs including 70 - 90g sugar, the Government's recommendation, but she went away. I know of not one diabetic who remains healthy and eats more than half that many carbs. Not one.

    Careful what you say about Collins  bitenails

    Type 2 diabetic: 320 reasons to avoid dietitians  Capture%2Blibel


    Have you seen the latest: The BDA has today revealed its annual list of the Top 5 worst celeb diets to avoid in 2017


    I don't have any issues with four of the five but number one in the list is Clean Eating: The idea is to avoid all processed foods and eat only ‘clean’ foods, by eliminating refined sugar, cooking from scratch, and choosing foods in their natural state.  Cool

    The BDA of course will be upset this diet will not include Belvita junk biscuits and the Sugar Bureau  won't be happy either 

    9)      The British Dietetic Assoctaion flatly DENIES that eating too much sugar causes Diabetes. This is stated clearly on their Sugar Factsheet. Their sugar fact sheet suggests that the only health issues with too much sugar is tooth decay. It is nothing short of shocking.

    10)  The Sponsors of the British Dietetic Association are kept securely under wraps and this information is only available to its members. However we do know that one of them is the Sugar Bureau. Of course it is.

    11)    The BDA annual report Profit and Loss Accounts showed a turnover of just under £2.5 million and profits of just under £2 million without detailing the sources of this revenue. This information is only available to its members.

    http://blog.bitingfit.co.uk/?p=183


    _________________
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    Proving the LowCarb sceptics wrong for over ten years

    Not all cherubs are Angels  Wink nor all diabetics Bonkers  Rolling Eyes
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    Post by chris c on Fri Dec 09 2016, 23:30

    Catherine Collins is a clueless plank. If they never let her near a diabetic ever again it would be too soon. Notice she said bugger all when directly asked if she endorsed Chris Cashin appearing on John Briffa's blog as Ally, and Chris, and probably a male identity too, she turned up and backed her up though. You may remember the two interminable threads there about the extreme dangers of low carb diets for diabetics and the threats to pull Briffa's licence, though I think the latter occurred on another doctor's blog which has not only disappeared by also gone from the Wayback machine.

    I saw a Medscape CME recently where the importance of NOT avoiding gluten unless you were actually diagnosed celiac was pushed. Maybe their grain-based foodlike substance manufacturers are hurting in the pocket.

    Hey Catherine, guess what all the fit healthy old folks around these parts eat? Meat, poultry, game, fish and vegetables mostly. Unlike people like me whose metabolism has already been broken, they can get away with bread and even jam too. My gran lived to 90 and in her day there wasn't much processed food so she must have been "clean eating". Yeah it did her a lot of harm, eh?

    And while we're on the subject, instead of insisting that diabetics must eat more fruit "to avoid amputations" why not suggest alternative sources of vitamin C which don't spike their blood glucose, I'm sure you could think of a few if you wanted to. I'll start you off, how about peppers? Greens? Berries? Oh but you couldn't eat enough high nutrition foods like that if you have to fit in all the starchy carbs and all the pills.
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    Post by graham64 on Sat Dec 10 2016, 00:01

    @chris c wrote:A glucometer will soon tell them! Mine originally told me less than 15g at breakfast on a sliding scale to 30g in the evening.

    After a while when I had kicked my IR into touch and kept it there for nearly twelve years now, it's around 10g at breakfast but more like 50 - 80g and sometimes 100g by evening.

    I keep that as a party trick for eating out though, if I did it with any regularity the IR would return.

    Mainly I stick around 50g/day, that gives me a VERY wide choice of nutritious foods and near-normal BG, BP and lipids, and energy all day.

    Most of the well controlled diabetics I've known in numerous forums and newsgroups are in the 20 - 150g range, the latter end mostly active Type 1s on insulin, the vast majority are probably 20 - 60g

    and none of them are dead yet.

    I was going to ask Catherine Collins (I'm not fat, just big boned) which of my nutritious foods I should not have eaten in order to fit in my 230 - 300g carbs including 70 - 90g sugar, the Government's recommendation, but she went away. I know of not one diabetic who remains healthy and eats more than half that many carbs. Not one.

    Sadly a glucometer is not standard kit for T2's  most are unaware of the benefits of BG testing or actively discouraged by their HCP's, these are the poor vulnerable souls who suffer the consequences of the BDA/DUK dietary guidelines  Sad


    _________________
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    Proving the LowCarb sceptics wrong for over ten years

    Not all cherubs are Angels  Wink nor all diabetics Bonkers  Rolling Eyes
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    Post by chris c on Sun Dec 11 2016, 22:46

    Yes I was specifically told by my GP, the "diabetes specialist" that "we don't like out patients testing their blood", well of course not or they would see the harm the HCLF diet does (she gave me the typical I think Takeda leaflet with the "Diabetic Breakfast"

    a bowl of oatmeal with a banana and low fat milk

    a slice of toast with low fat spread and no-sugar-added marmalade

    a glass of no-sugar-added orange juice

    Guaranteed insulin sales for Takeda a few years down the line eh?

    I'd preempted her by buying this house from a pharmacist who sold me a meter and the rest is history

    "By now we would have expected you to be on two or three diabetes drugs"

    instead I'm only on 5 unprofitable mg of amlodipine

    and I still have most of my feet

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