I'm a Dietitian - ask me anything

[doesthisseemright]

This one may be a bit dull but ask away.

I take quetiapine for bipolar and have piled on 1.5 stone, I just feel more hungry though I'm trying to control it. Any tips?
I have always been slim so this is a shock.

I had severe vit d deficiency for a long time. My advice was to eat margarine and cereal - neither of those I ever touch as I dislike them greatly. Funnily enough i was able to do it without eating either of those crappy (to me) things!

Thank you for your advice.
Great thread- don't know why you thought it might be dull!

Just popping in between clients so answeering easiest ones first :)

Allergy/intolerance testing - no the york test is not accurate so I wouldn't. No food intolerance tests (blood ones) are validated - the gold standard is elimination and challenge diets assisted by a dietitian.

In my job, I do cover clinical work- kinds of things include - food intolerance, IBS, other gut issues- Crohns, ulcerative colitis diabetes (all), malnutrition (nursing home and home visits elderly), autoimmune conditions, weight, arthritis/gout etc..a broad range to be honest. Some freelance dietitians can cover private hospitals so can and still will do acute work.

Vitamin d - govt recommendations are for 10 mcg/day supplements everyone over the age of 4 between sept and march.

Have you seen an increase in issues or since the fashion for ‘clean eating’ and instagram/youtube gurus starting spouting forth misinformation and dodgy ‘recipes’? Do you think these things contribute to/normalise eating disorders such as orthorexia, especially in young people?

Yes, I think there is actually some evidence to support this too...would have to look.There have always been people peddling dodgy diet info but its the searchability and accessibility as well as the faux glamour lifestyles of instagram that has expanded horizons.

What do you think about the NHS taking so long to “catch up” on its advice.

For example, my FIL with type 2 diabetes was placed on a diet full of carbs. Good fats still demonised. Non celiac gluten problems. Dairy issues.

Do you follow NHS advice still or try to move faster?

I feel like well trained nutritionists are much better informed. The dietician that i saw for my baby’s dairy gave me advice including orange juice and Cheerios. Absolutely zero in terms of properly made home cooked food. The nutritionist I saw for mild IBS was fabulous - on top of the game.

slippereel that is so hard, isn't it. Usually, we would try to teach people to listen to hunger cues and determine if it is actually real hunger or not that you are feeling. (Do this by a body scan and rating hunger on a scale). With the meds, though, this can be a hard one to pinpoint so, in this case, I actually do recommend having a good amount of protein at meals and if you are hungry for snacks, eating very low-calorie foods like carrot/celery sticks, vegetable soup, etc. (or smoothie with protein powder but not overly calorific) This would not usually be my suggestion but you are in a tricky situation.

*What do you think about the NHS taking so long to “catch up” on its advice.

For example, my FIL with type 2 diabetes was placed on a diet full of carbs. Good fats still demonised. Non celiac gluten problems. Dairy issues.*

This makes me so very sad. Its lazy dietetics in my opinion. Happy for any other Dietitian to disagree.

I think the issues are rooted deep within the NHS rather than the actual profession if that makes sense.

By the way, NHS advice will vary from trust to trust too. It just depends on the department and staff within.

Just read the question on Lacto-ovo vegetarians. Ridiculous that people feel the need to criticise and you can balance your diet very well. I am astonished that with lacto and ovo, you still get this. I would probably just let them know they will be getting plenty of good high biological value protein and that they are growing well. Mad. (not you of course). Anyone else got any tips to shut people up?

Slippery - it’s scary to rock the boat when/if mood is stable but would your psych consider a switch to latuda or something more sort of weight neutral?

Calledyoulastnightfromglasgow Diabetes UK has developed an award winning diet that is moderate/low carb. It's been approved by the NHS. Maybe your Fil can have a look and show it to his dietician if he feels like doing it?( My parents are both diabetic and would never do it!) My DBro is diabetic too. He's giving it a go. Im not sure if hes spoken to his diabetic nurse about it though or if hes just doing it himself.

With regards to NHS ‘catching up’. Do you think that’s down to organisational aspects of Change in the NHS? The process of changing guidelines and policymaking in the NHS and NICE takes so long due to the length of time it takes to gather, assimilate and analyse good quality, reliable data, then look at the affordability and risk/safety, factors, not to mention the complexities of implementation.

I’m a nurse and don’t think that people realise the amount of complex ‘red tape’ and work that goes into this stuff. So much so that by the time these things are launched/implemented some of the original evidence is quite elderly and the new, shiny, guideline is almost out of date, evidence base wise. The public at large, seems to think that ‘surely we know this stuff, so it can just be standard?’ Well, no, it has to be tested and go through a rigorous, long winded process first. Whether that process can be slimmed down, I don’t know.

What are some of the most nutritionally dense foods per serving?For example should we choose an orange or a banana or an apple? Spinach or broccoli? Almonds or hazelnuts. That sort of thing, I know a bit of everything is best but I wondered if there was a Top Ten of great things to eat?

I'm a true believer in making sure there is a variety of foods in your diet, including lots of colour.

You can measure nutrient density using an equation (INQ) but its a bit of a pain. The most nutrient dense are whole foods and all are as good as each other. Green leafy vegetables always make a top 10 list :)

That’s kind - sadly he is dead now but not from diabetes! This was 2 years ago and he proudly showed me his eating plan of cereal for breakfast and sandwich for lunch bla bla and avoiding butter and eggs and I just groaned. And of course he was adamant it was right as the lovely nurse said so....

Good call whydidieatthat

Oh Sorry to hear that Calledyoulastnight

sporkinthetoaster I absolutely believe its the organisation rather than the profession.
For example, we used to have to go through a 6 month long process just to change a diet handout. Through patient information groups, panels etc. Then when the thing comes out, its out of date!

I've tried the low fodmap diet two years ago,it was very hard work given that I had to cook different meals for the rest of the family. I found out I'm intolerant to onions, garlic, honey and apples. Is there any other common foods that you find people are intolerant to in this diet or people with ibs? I didn't finish the diet but would love to when I have time!
Thanks.

I have also never had the luxury of being able to continue my education, read up on things and to try different ways of working as i have in freelance. When I worked for the NHS , I didn't even have time to wee!. Ten minutes per patient, double bookings, triplicate paperwork etc.

choccybiscuit we tend to group the fodmaps. I can see you have an issue with the fructans and fructose, for example. You really do need to do the whole elimination and challenge diet as the whole thing is about the groups of fodmaps rather than individual foods. You could also download the MOnash University Fodmaps app as it has a database of foods.

Thanks for the advice. My mood is really stable on quetiapine and I don't want to risk it. I will try more protein!

I just want to clarify that there are some really good, dedicated and up to date dietitians working in the NHS. Just trying to demonstrate the issues we face trying to be "sparkly" and fresh like everyone expects si to be.

Thanks. I see the same sort of thing in my area of work, re patient info leaflets.

There is a current thread in chat about apple cider vinegar. I suspect it is total faddy guff and there is no good evidence for the benefits of it, am I wrong?

I think all HCP’s face similar issues with regards to the need to practice within the current best available evidence. Staying ‘up to date’ is incredibly difficult (if not impossible when you actually look at the number of articles published every week!).