The loneliness of an experienced dietitian.

This came in as an anonymous comment today, posted on my 'The loneliness of the newly qualified dietitian' article posted here. Well worth an article in its own right I reckon. Pretty clear why the comment was from an anon. As we have seen, medical professionals who go against the flow of corruption and greed, can be given a very hard time indeed. Will it ever be thus? I think not.

The tsunami of new science, vindicating the much maligned healthy natural fats, and warning us of the perils of a high sugar, highly processed carbohydrate diet, increases by the day. I heard someone say a while ago "in the end it's people power that will win" Well, the people are wising up big time, and will not be fooled again. Eddie


The comment. 

"One beautiful, bright summer's morning, the golden letter of acceptance arrives through your letterbox. You eagerly await the start of your course, the universally accepted 'gold standard' in nutrition training. You're one of the few chosen few; on a quest to learn and promote the highest standards in nutritional care throughout your career.

You hurriedly slip on your best shoes, blow dry your hair to perfection, and arrive wide-eyed and full of excitement for your first day at school. Slowly, one by one, the most senior professionals begin to appear. They enter the room to welcome you; middle-aged, stern-faced and authoritarian; years of academia and experience oozes from their being with every stride they take. You look up in stark admiration and anticipation of things to come.

Surely enough, you swiftly begin to learn anatomy, physiology, fundamental concepts in nutrition. Both yourself and your colleagues are constantly reminded that you are the highest ranking experts in the field, and as time goes by, you begin to believe this. Your feelings of importance and superiority continue to grow, and all is confirmed the day you start to prescribe nasogastric feeding regimens, advise lightly on IV fluids and prescribe TPN on ITU. That's when you know you've hit the jackpot, you're almost akin to a doctor in nutrition, with super prescribing capabilities.

But as time goes by, you begin to realise that your role revolves around methodology that seems mediocre, non-evidence based and futile in comparison to the work of your fellow colleagues. You don't believe in all the rigmarole and palaver used to justify oral nutrition support to patients; especially working with incomplete food charts, weights that often don't seem to add up, and scraps of information from ward staff that have only just started a busy shift. Your heart sinks and stark realisation begins to set in, but you plod on regardless, unwilling to fully accept that your often impressive looking calculations sometimes feel like a deliberate smokescreen to guise unnecessary and unwarranted activities. Sometimes, you feel as if you may as well be plucking numbers out of thin air to produce a plan.

As the nights draw in, you notice that the ward seems to manage just fine without you at weekends, and that the pile of new referrals on a Monday morning seem more the result of wards following procedure, rather than the nurses actual inability to simply offer a supplement or two, or commence / increase the rate of a feed. You wonder whether it would be more efficient for nursing staff to take complete ownership of the role to avoid unnecessary delays, and deep down inside, you know that with just a couple of weeks additional training, this would be more than viable. You discuss this at length with nursing staff, and their frank and honest responses only confirm your worst fears.

One day, you head home to your husband, and he asks you "darling why do you insist on cooking with sunflower oil?". You annoyingly retort "I'm the dietitian, so don't question me on my choice of cooking oils!". The following week he sheepishly asks you to kindly explain why you continue to fill the fridge with tasteless low-fat margarine and buy only skimmed or semi-skimmed milk. Being questioned on your extensive knowledge base and superior food choices only fuels growing anger and resentment, so you quickly scurry to your dietetic folder and immediately present him with your 'gold standard' patient information leaflets. "Here you go!" you retort angrily, "now argue with that!". You immediately feel a sense of victory and relief.

As time goes by, you both agree not to discuss nutrition topics at the dinner table again. It isn't healthy for your relationship, after all, he is just an internet educated foodie - he hasn't had the privilege of attending dietetic school, like you. You almost feel sorry for him, he actually believes that margarine is harmful and that full-fat milk may somehow be healthier than skimmed milk! But you love him nonetheless, just as long as whole milk never makes it an inch past the front door.

So you continue on for years and years. In your superior bubble, believing and promoting all you have been taught to the masses. Never once stopping to question whether the most fundamental concepts taught at school was actually scientifically evidence-based. Meanwhile, hundreds of diabetics and heart patients pass through your door. You shun the low-carb movement as non-credible; with vague memories of your superiors scornful attitude towards Dr Atkins and the high-fat fallacy.

Years later, whilst attempting to lose some weight, your husband ignorantly suggests that you avoid carbohydrates at dinner time, most notably before bed. This comes as quite a shock to you, "I couldn't possibly avoid carbohydrates at mealtimes" you retort. This goes against the grain (quite literally) of dietary advice and is almost certainly not evidence-based advice. His subsequent suggestion of intermittent fasting really takes the conversation down a turn for the worst, and dialogue swiftly comes to an abrupt end.

But you're an honest soul at heart. And one day you have an epiphany. You remember that you were an inquisitive scientist long before this journey began, and you remember the words of your father when you were younger; reminding you to always stay humble and grounded. So you take a deep breath, sit down and begin to think objectively about the situation. You think about diabetes and what it means to actually be diabetic. The bodies inability to produce sufficient (if any) insulin in response to a glucose load, and insulin resistance. Then you start to think about where glucose comes from and the high carbohydrate diet prescribed to countless diabetics worldwide.

That's when you start to do a bit of researching on the internet. You soon discover a number of well-respected, highly experienced dietitians have already spoken out against the standard 'non-evidence based' dietary advice. You see the relentless ridiculing of doctors, professors, orthopaedic surgeons and the low-carb community on social media, and start to feel increasingly uncomfortable. You look at your husband regretfully and apologise profusely for the superior attitudes and ignorance you had displayed over the years. That's when you have a real decision to make. And you and your partner know deep down that you have already chosen the right one."