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Wednesday, 14 December 2016

The loneliness of the newly qualified dietitian.

Much to my surprise, I find myself feeling great empathy, for the newly qualified dietitian. Imagine the typical scenario. After flogging through University to get your degree, and accepted as a member of the British Dietetic Association, you can't wait to get out into the real world and do good. Sounds wonderful and so it should be. However, and it’s very big however. Being very bright and bursting at the seams to learn more, you start to worry, big time. You start to realise much of the so called “evidenced based” science you have been taught, has been funded by junk food companies and big pharma. But it gets worse, much worse!

You can hardly believe your eyes, when you read the outfit you are paying your hard earned money into, the BDA, is being funded and accepting sponsorship from junk food outfits. Surely this cannot be, it’s all lying propaganda, from those gruesome people running blogs, not to mention those money grabbing, book writing, self styled nutritionists. You calm down, put the kettle on, and tuck into a large packet of Belvita biscuits. You chuckle to yourself, and feel a bit dumb, for even entertaining the idea, anyone other than a BDA dietitian, knows anything about a good healthy diet. But it gets worse, much worse!

While surfing around the Internet, between patient appointments, you suddenly begin to realise, much of what you learnt at Uni, is complete baloney. More akin to rants from the local Joo Joo man, and about as scientific, as throwing a pile of witch doctors bones on the floor and taking a guess. Then you wake up, in a cold sweat, good grief, what a horrific nightmare, and wonder why you keep dozing off at work. Maybe too many high carb biscuits for lunch. But it gets worse, much worse!

You start to discover, many of your more senior and more vocal colleagues, are flogging all sorts of junk on Youtube, and you start to ask yourself, why some of the more rubenesque RD’s of a certain vintage, only appear in tightly cropped head shot photographs. You also discover some of your colleagues, are hanging out on social media rubbishing others. Granted, badmouthing that deranged, geriatric reprobate Mitchell and his low carb crew is understandable, possibly acceptable, but A1 rated Science Professors, highly respected Cardiologist’s, GP’s, PhD Nutritionists and Orthopaedic Surgeons. Can it get much worse?

So, you are in a state of shock, how could nutritional science have become so polluted. What are you going to believe, importantly, who are you going to believe. You put on the kettle, bin the free sample Belvita biscuits and think. Being very bright and an independent thinker, you realise you have a very important decision to make, possibly the most important decision of your life. Do you perpetuate the old dogma, the standard totally failed dietary advice, and play it safe, or go out into the world, armed with the latest science and make a real difference. Decisions, decisions, decisions.



Anonymous said...

OMG! You have just described my experience to a T! Its as if you have delved deep into my mind and extracted all of my thoughts!

only slightly confused said...

For heavens sake, make the right decision...please....someone has to.

Francisco Manuel Carrajola Oliveira said...

Um artigo muito interessante.
Um abraço e continuação de boa semana.

Lowcarb team member said...

Francisco translation:
A very interesting article.
A hug and a good week continuation.

Anonymous said...

Asking an orthopedic surgeon for dietary advice? What is next, asking a Bushfella how to get to Alpha Centauri?

Anonymous said...

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.

Anonymous said...

Comment section would not allow my comment in full too many characters.

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.

Lowcarb team member said...

Good grief anon, far and above the longest comment this blog has ever received. I'm going on a flyer here, but are you the person that posted the comment "OMG! You have just described my experience to a T! Its as if you have delved deep into my mind and extracted all of my thoughts!" again on a flyer, I suspect you are dietitian or other medical professional. Be rest assured I know some great medical pros and you are far from being alone. It may surprise you to know, I get contacted privately by numerous medical pros, I even have a long term friend who works for the BDA. I can assure you the tide is turning regarding the low carb higher healthy fats tsunami of good news. Our time has come, and the genie is well and truly out of the bottle, and will never go back.

Respect and kind regards Eddie

Lowcarb team member said...

PS. BTW I am taking the liberty to post your entire comment as a new article. I believe it may be of some small comfort to others who may be in your position.


Lowcarb team member said...

Anonymous Anonymous said...

"Asking an orthopedic surgeon for dietary advice? What is next, asking a Bushfella how to get to Alpha Centauri?"

Thank you for your most valuable contribution to our humble blog. Tell me, why are the negative comments always made by an anon? Clearly, you are a most accomplished intellectual, feel free to come back anytime,and continue to thrill us with your acumen.

Merry Xmas Eddie

Anonymous said...

The surgeon in wuestion advised diebatic patients who's limbs he was about to shorten by removal of extremities to cut down on sugar and processed foods. Hardly rocket science and fot tgat he has been forbidden to advise them ever again.

Anonymous said...

The best anology I've seen is advsing a duabetic to eat high carb even "healthy" grains and using medication is like telling someone with a serious food allergy to eat it and use their epipen for the side effects. Good luck on your journey Ernie.

Anonymous said...

What is clear - one of you wrote that post it has your way of writing all over it .

Anonymous said...

this morning i read this and the new post in regard to diet and the loneliness of dietitians,
most interesting and sadly enlightening,
how will dietitians respond reading them,
will those who do care about the patients put them first,
or carry on down the path ignoring the signs that would lead many more to better health,

Lowcarb team member said...

Anonymous said...
"What is clear - one of you wrote that post it has your way of writing all over it ."

Dream on my friend, how you wish. Yes I wrote the post above, but not the post you are referring to,The loneliness of an experienced dietitian. The writer of that post is teaching me a great deal how so many RD's operate. May I suggest you cut down on the booze, and that Fortisip is doing you no favours at all.

Merry Xmas


Lowcarb team member said...

Anonymous said...
What is clear - one of you wrote that post it has your way of writing all over it .

No what is abundantly clear is your paranoia, the person who submitted the comment is caring and sincere which is obviously something you lack

Come to think of it you remind me of a member of the DCUK forum who claimed every new low carb member that joined was Eddie her name was Jopar a complete fruitcake, now I know your not her but you have the same mentality

Kind regards


chris c said...

If Gary Fettke had invented a way of cutting diabetics' feet off in half the time they would consider him a hero. Likewise if Aseem Malhotra invented a new cardiovascular surgical technique. Instead they are intent on putting themselves out of business by preventing the damage in the first place.