Meeting with the hospital dietician

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I met with the hospital dietician and the endocrinologist on Friday. The two could not be more different!

The dietician discussed my diagnosis with me. I told her that I'd been on a low-carb diet for two months, and that my A1c was initially 13.1% but, after 40 days, had dropped to 8.8%. While I'm concerned that my post-meal BG takes hours to return to normal levels, it has dropped significantly in general. I think these are positive points. She didn't agree. While she would admit that what she called an “Atkins” diet does produce results, she believes that they're only short-term and no one can continue to live on the diet. She predicts that I will become tired of not eating bread, cake and sugary foods and that I will stop following the diet and go on a long, long binge. She said that the level of protein and fat in the Atkins diet inevitably leads to poor health.

I don't tolerate gluten at all well and haven't eaten much of it for years. The dietician informed me that it was unwise to eliminate gluten from my diet without a biopsy that confirmed that I have celiac disease. If I don't have it, but am simply sensitive, there are ways to “work with that” diagnosis. She wanted me to ask my family doctor to order the test. I can't see why I should have an invasive test when eliminating the things I'm sensitive to works beautifully. Many people with celiac have far more unpleasant symptoms than I do–and my heart goes out to them. She pointed out that a lot of gluten is hidden in the ingredients used in commercially prepared food. I agree. However, I don't buy or eat such things. I cook what we eat, myself, from scratch. I know the ingredients that go into everything I serve. It's possible that there are trace amounts of gluten in some food, occasionally, if only from contact with things like crumbs from homemade bread, but I have never needed to be that meticulous about avoiding them.

We also disagreed about the amount of protein I'm eating. She thinks I should cut it back, drastically. I think I need to eat more of it, particularly once we figure out how to keep my BG from spiking alarmingly after meals and while I exercise. I know I'm not eating enough protein to help repair muscle tissue at the moment and I would like to get into some weight resistance training.

Ultimately, she challenged me to eat the Diabetes Association diet–high carb, low fat, lower protein–for at least four to six months. Even if I feel good with the diet I'm following now, she's sure I would feel even better on the “correct” diet. She wanted me to agree to eat 30-45 grams of carbohydrate at every meal, and about another 15 g. in an afternoon snack. I didn't agree. I would be the size of a barn in six months, and I said so. For me, at least, the high-carb diet will raise my BG dramatically. The dietician agreed that it would, but she predicted it would only do so for “a few months.” After that, it would “settle down,” she said, and if it didn't, there was medication that would help.

I asked her if she realized what she'd just said. That she wanted me to change my diet from one that is obviously working very well for me to one that she knows won't work well at all for months, if ever; she knows it will be bad for my health for awhile, but I should also be ready to take drugs to lower my BG. I don't need those drugs right now. My health will not benefit. I would lose the successes I've achieved so far, and, in the end, I would end up paying a drug company. This makes no sense.

I told her that I could point to many long-term studies of the benefits of low-carb diets for people with diabetics and that I'm confident that this will continue to work for me.

The dietician also said I need to come to terms with the “fact” that “nearly all diabetics also have heart disease,” and that low-carb diets contribute to coronary problems. Well, in fact, that's not true, either. I've read several good studies. I have no indications of heart disease and nothing pointed to being diabetic before September this year. Before then, my A1c and my lipids were all normal.

It wasn't exactly an argument. It was a very civilized, polite discussion. I don't plan to see her again.

In my next post, I'll describe the meeting with the endocrinologist.

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Hi Ann. I would avoid this dietician like the plague! I hope you didn't have to pay for such ridiculous advice.

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I had a similar experience with a dietician a couple of months ago. Due to hormone fluctuations with menopause, my blood sugars were all out of whack. I started with a Dexcom and decided to go back to basics with my diet and logging to get things straightened out.

The dietician I saw was so young that she couldn't answer any questions - she kept leaving the room to go ask the CDE and the endo. I really wanted to ask if we could just all sit in the same room since she kept going down the hall.

She told me emphatically that I should be eating 40-60 grams of carb per meal. When I told her that I basically eat to my meter and I don't eat when my blood sugar is high, her response was "Why? You're going to cover it with insulin anyway." Silly me, because it's just so easy like that.

I also enjoyed when she told me that she had worked diabetes camp for the kids for the first time last summer and was required to wear a pump with saline for a few days "so she knows what it's like". Please.

I won't be going back either.

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It is amazing that the dietician is so ill informed. You were right sticking by your guns. I think you should stay with what you are doing, as it certainly works for you. Maybe she works for a drug company on the side !!!!

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Thank you, folks. I appreciate your support. It's so very clear that we need to do our own learning and research, ourselves. It's also clear that it's not difficult to do it, if you have the time and patience to do the reading. Why a dietician would say the kinds of things this one says is beyond me. What do they learn in school, anyway?

I started out reading Jenny Ruhl's Bloodsugar 101 website. She, and her work, are an absolute blessing for all of us! I also like her sometimes wry sense of humour. She's a great interpreter of medical studies. I've done some of that kind of work in my professional life and I know how important it is to get things straight, be clear, and to question studies, experiments and parameters.

I have read Dr. Bernstein's book and I'm deeply impressed with him and grateful for his encouragement, clarity and openness. Whether someone wants to follow his somewhat rigid 6-12-12 carbohydrate meal schedule or not, the book is absolutely loaded with vital information.

No one reputable disagrees with Dr. Bernstein or Jenny Ruhl. The worst that anyone says is that it is difficult to achieve and maintain "normal" blood sugar levels and that some people won't be able to do it long-term. That may be true. But I think that many people will want to try and, however dedicated they are or aren't, everyone deserves to have accurate information! Most people are terrified of diabetes. Learning that it's in our power to avoid complications is critically important.

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Oh, and one of the great things about our health care system in Canada is that I don't pay to see the dietician!

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I hate it when a medical person insists you're going to fail because "everyone else does." In the first place, lots of people do NOT fail, they've done their research like you have and know what works for them. I have read veterinarian discussions about cat diabetes that show more of an understanding of the disease than a lot of doctors who treat humans.

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I think there's a kind of subtle hostility towards people with diabetes. We see it in the things people say when they assume that we've eaten our way into this illness: we have only ourselves to blame for it. On the assumption that we're out of control, hedonistic, neurotically self-indulgent and a drain on the healthcare system, some health care professionals appear to have taken on the responsibility for telling us what we're doing wrong. The message they give isn't just that we're doing things they don't like, but that there's something about us, as people, they don't respect. They may not be so concerned about our health as about our character. When their opinions aren't informed by accurate data, the whole combination is insulting.

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One of the basic issues is what's taught to dieticians in school. She's regurgitating what she learned. I was also told the one time I saw a dietician to eat 3 X 45g cho meals and 2 X 15 cho snacks a day. There's no way I could eat that much!

The other issue for people in the medical profession, methinks, is with those of us who are good at managing our own D. They are used to being the ones giving the information because they 'know', not having people manage on their own... never mind manage better!

I consider myself very lucky to have an endo, CDEs, and an endo nurse practitioner who pretty much leave me alone - they want me to let them know when I make changes. They very occasionally have a comment on what I've done in the form of... maybe consider doing this instead.

I suppose if I had really poor control it would be a different story!

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I agree with you, jrtpup. The medical profession is geared toward telling us what they think we need to know. I've no doubt that many who work in medicine want to give the best care possible to patients. What I don't really understand is why they don't pay attention to actual research! If they knew that the advice they give is genuinely harmful in the long run, they wouldn't give it, would they?

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I think, in regard to LC at least, what they've been taught overrides the evidence. After all, textbooks contain facts. Evidence is, well, just evidence!

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I fired my nutritionist the second week of my diagnosis. I have read soooo much about different diets and foods to eat. My sugars have been great!! I started July 25, 2011 with A1C 13.0..Last month I was 7.0 and I know it's even better since starting the pump. I stick to 1800 cal diet or less a day, 45-50g carbs with meals..4 oz prot and 1/2 my plate is veggies and I feel great. My endo said it was a good thing I got rid of my nutritionist who went to school in the stone age..Good luck and you know your body better than anyone...