I'm a Dietitian - ask me anything

[doesthisseemright]

This one may be a bit dull but ask away.

Do you often refer people for counselling? My weights fluctuated between 5stone. I know how to eat well, diet and what puts the weight back on. It's more over eating for comfort, life isn't going well, submerge myself in buying preparing food ect. Life going well I eat well ect

I guess you could lower glycaemic index of foods with ACV. No evidence for IBS though. you also need to watch your teeth if you take it every day!

Moominfan yes I do and work with MI and intuitive eating myself. a lot of us work this way now and are "anti diet".

I’m peri and 51 about 20 lbs over where I’d like to be so you think BS diet 800 cals and strength training is a good start

My friend is lifelong anorexic, she's in her midforties and has been sectioned for it in the past. Last time she was discharged, part of her recovery programme was a referral to a dietician. Unfortunately said dietician seemed to have little to no experience with such an ingrained illness, issued her with worksheets aimed at teenagers and basically told her to go away and eat more. (I was present at this appointment so I know she didn't lie about that.) I realise that her illness is unusual in duration, but is there any kind of training to address it?

Also this dietitian was obviously overweight herself, and my friend felt she was in no position to be advising anyone on healthy eating. While her illness would naturally make her hostile anyway, do you think she has a point? Would teenage anorexics not feel the same?

parsley1234 I would not attempt to give anything specific without a proper assessment but can say that 800 KCals would be very low, especially with weight training as you are trying to build up. This is a hard one as there is some evidence it works and is a good motivator but the evidence also suggests that "weight loss diets don't work" meaning that the long term successes are low and rates of regain are huge.
I'm not going to lie, I think I need to read up more on the evidence around 800BS and will do!

Thank you it’s so blooming hard it seems So much conflicting advice my head is exploding !

HirplesWithHaggis I think AN can only be treated in a team approach and dont think Dietitians have much or a role unless the person is in recovery (or in calculating EN if needed).
I worked with some AN clients many years ago and they had the same attitude to "normal" weight Dietitians.
To answer the overweight Dietitian question - I think that it should be no impact at all but I do know that when I was heavier for a while, it affected my confidence in being able to advise rather than my ability.

Thanks for your reply. My friend was "in recovery" at the time in as much as she had just been discharged from another section, but still very unwell. (She relapsed and was NG feeding at home soon after.) She had a full team behind her, including a consultant psychiatrist and regular CPN support, so the dietician was a fairly small part. I don't feel she was at all helpful, though I absolutely understand her frustration at a seemingly intractable problem she really needed training in the psychiatric issues involved in anorexia. "Go home and eat more" isn't a helpful response, and nor is it professional. And I worry that teenagers would get the same response.

Its dreadful advice hirples So sad to hear that people are being told stuff like that :(

This thread is fascinating, thank you!

My kids are aged 3-9. I often get confused as to what is good for them. A rough day inc
Eggs for breakfast
Plain biscuits and a babybel for school snack
Lunch (kids come home here) often pasta/quiche/sandwich
Fruit snack after school
Meat/2veg of some sorts, like cottage pie, savoury rice, etc.

We bake bread/cake/cookies from scratch (and I make lots of things like pancakes/waffles with my sourdough starter)

(My Asd child will only eat processed meat so sausages/meatballs/hams are eaten 4-5 days a week, other times he just has what we have without the meat).

They only drink water or milk at home.

How am I doing? I do worry like crazy that they aren't getting the right foods.

themonkeymummy if they are all growing well, you are doing fine! I hear your challenges with ASD and textures and can understand you are doing your best with these limitations. As long as you are offering them a good range of wholegrains (maybe add some at breakfast, and also a drink), fruit and vegetables (2 fruit a day would be good), lean meats..maybe add fish now and then, dairy (all good) and healthy fats (this may be through your cooking unless nuts, seeds and avocados are on the menu) then you are doing fine! (Im a big fan of adding vegetables to all meals so maybe add some at lunch unless already there).

I just enjoyed a chocolate coin. Does that make anyone think less of me?

Ooh Op, this is not a dull AMA at all. Over the years I've realised I know so little about food and have spent the last 5 years trying to educate myself. Fascinating reading, thank you. How you all keep up with it I don't know?!

I've been considering seeing a dietitian (or excellent nutritionist) for a while. Ever since I contracted a virus and was diagnosed with 'ME/CFS' and become mainly bedbound, my nutritional interest has intensified. Problem is my guts 'broke' at the same time. Maybe IBS, Coeliac, something auto-immune etc Out of money at the moment to confirm.

The last 6 months on Keto has been brilliant for improving my cognitive abilities but guts are still poorly. Have cut out wheat, gluten, now dairy, which seems to have improved things.

I've seen so many specialists for so many things ( & on LONG waiting lists) I'm hoping to sort it out myself. What would your advice be if I came to your clinic? FODMAP maybe? How do I monitor best?

Oh and this you linked to earlier is great!

www.monashfodmap.com/about-fodmap-and-ibs/

What do you think about sweets? My youngest (6)clamours for them and I dont want to make them into a forbiddwn fruit.

At the moment she gets 50p pocket money which she spends on sweets on a saturday but she will ask everytime we are in a shop or go swimming....

Ketome I would have to look at your whole diet with a focus on the type of vegetables you are eating (and what type of IBS symptoms you have ). FODMAPs are a group of carbohydrates including fructans, galactooligosaccharides GOS), fructose, lactose, polyols.....so I imagine you may already have cut quite a bit out anyway. There may be some high fodmap vegetables in there but in enough quantities? Not sure.

I am glad that you have some symptom relief with keto but at the same time am sad as some of the non-gluten containing, lower GO carb foods would have been good overall.

I think you may have disrupted your gut environment (even low fodmap after 4 weeks does this) so try a good probiotic for a while and keep a food/.symptom diary.

adventuresRus, not much to say about sweets except that you are at a tricky stage where your child is learning about choice and also at the stage where you can make her life with food amazing by ridding the concepts of "good" and "bad" food from her life. Yes, they are best avoided but you are right to remove the tabu.
I'm a big fan of the ellyn satter approach
www.ellynsatterinstitute.org/family-meals-focus/39-using-forbidden-food/

Always remembering I am just one Dietitian.

thank you for replying - how do I go about doing a challenge diet? Is this something my GP could help with?

@doesthisseemright thank you!

GingerOClock sorry, it's a Dietitians area, that one.

Thank you for answering doesthisseemright

Been happy on dairy kefir since last year but I think you're right about disrupting the gut environment. Kept a food diary for months but can never pinpoint which is the trigger despite all the cutting out, grrrrr.

Will keep at it. Best wishes to you in your work!

Oh & I live in hope that I'll get back to a normal 'balanced' diet as you mentioned, but until they discover what causes this inflammation & associated neurological symptoms, I'll have to stay away from the carbs & fruits.

Sorry can you explain more for me on how you work for yourself. I think I’m being thick, I just don’t get it Do you just advertise (where? how?) as a dietician and people pay you per session because they want to lose weight / have diabetes/ibs/allergies etc etc. So basically they aren’t getting the support they need via the NHS? So they pay to see you privately? I would trust an NHS-referred dietician more than one I found on fb/google/yellow pages. I guess I would feel more confident in the abilities/knowledge/access to stuff via the NHS.

(I know you could in theory extrapolate this to any profession where someone goes freelance/independent, but for this area, even if I saw your certificates/qualifications, I think it would somehow lack credibility. Really not trying to attack op, more hoping you can open my eyes to this please!!)