I'm a Dietitian - ask me anything

[doesthisseemright]

This one may be a bit dull but ask away.

DS2 (8) has a very limited diet. No veg at all and only apples and some brands of smoothie. Will he be ok???

I saw a nutritionist many years ago (no idea how qualified they were ) who put me on a completely sugar free diet for 6 weeks. Ever since then I have felt thirsty a lot, have to have water with me at all times etc. Should I be concerned?

What are the risks of following a very low calorie diet and if they are being supervised (by a dietician?) how would they monitor the person?

I struggle with weight loss because I have trouble with all the foods you are supposed to eat when restricting your intake, particularly fruit and vegetables (i.e fibre). I followed the FODMAP diet a few years back and I identified issues with quite a few fruits, and pretty much ALL green veg.

Considering I don't like eggs or fish either (previous stomach bug related), and that any kind of insoluble fibre sends my bowel into overdrive, my choices on a calorie restricted diet seem fairly limited. I have also noticed that when I up my fibre and water intake my IBS is a constant painful drain on me, but when I fall off the wagon face first into a trough of white bread, chocolate and cake, everything settles down again within 24 hours.

I've been a secret binge eater for 30 years, have I damaged myself irreparably?! I've already had my gallbladder out - I'm 45 and pre-menopausal. With a BMI of 36.

BonApp, no problem :)

There are many of us who are in private practice and, in fact, we are generally the most qualified as we spend our years in the Hospitals before going private. You can have a new grad Dietitian in the NHS with limited knowledge and experience. It takes quite a bit to be freelance and needs a lot of knowledge and expertise.
I am really glad you trust NHS Dietitians!!!!! That makes me so happy.
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I advertise on web pages such as nutritionist resource (which does both), the BDA (British Dietetic Association) freelance group webpage and via yell.com, word of mouth and my own website as well as on social media (twitter, facebook, insta). I have some awards from my association as well so get work from them and via them too.

Many of us choose this path because of the following reasons- (and more)-

• some love the media exposure (I don't)
• some always planned to be freelance and run private work
• flexibility in later years of if you have kids- leave and hours etc (me)
• room to work the way you want (me)
• lack of NHS jobs
• lack of NHS progression (me, I was at an 8 a and hit the ceiling in my area)
• just wanting to run their own ship
• it's rubbish working for large organisations
• some like a range of work - writing, some clients, recipe development, projects (you cant do this in the NHS)

Im sure there are many more reasons too.

For me, I feel like when I worked at the NHS, I wasn't really helping people as best I could. I feel I achieve more in freelance.

Reasons people use us

• tend to be more experienced
• you have pretty much no waiting time and don't have to wait another few months for a review
• you get an hour instead of TEN MINUTES (which is what I was doing in NHS)
• more personalised and bespoke service
• the broader range of treatments ( e.g in my area all they do is malnutrition and kids so wouldn't do something like ME, arthritis, CFS , women's health etc. Weight loss gets referred to weight watchers here) The limited staff numbers mean only certain conditions are seen.
• you don't need a referral so faster again and if you have a GP who doesn't support then can be a problem
• some people just like to have a private service , its a choice

I love it. My clients can email me any time, phone to book at any time, I can use naice handouts and interesting teaching tools, do the sort of stuff that people wouldn't get a chance to be seen for in the NHS and can run books around the kids. I can work from home!. I can also do project work such as articles or resources such as a huge project I did where I designed a massive nutrition teaching tool for nursing home staff.

The hardest part of the work in moving from the NHS to private is the money part. At first, I felt guilty that people were coming to me and felt the same - how dreadful these people couldn't get help in the NHS. In fact, I used to always mention at first contact that there was an NHS service available if needed and had they checked first. (How silly what a business woman lol !). Until one day a client told me off about it saying that she was CHOOSING to see me and not to feel bad about taking money for my work.
So now, I feel that people have the right to choose and if they choose me then I accept that and give them the best service possible. (If someone comes to me for something they need a medical team for or where I just think they were unaware they would get the help from the NHS , like undergoing cancer treatments, then, of course, I still tell them as that's the right thing to do.)

So, the range is great. This week I have had clients for - diabetes, fatty liver, weight management (and non-diet approach which takes 90 mins), arthritis, IBS , constipation, nursing home visits for underweight, fertility and have also written a few blogs and articles. I also do talks, which I love).

I guess the main thing is- why should Dietitians be stuck in the NHS? There is no reason why they should be bonded into that one single organisation. (There is no bursary now and I didnt have one). It is just one employer, not our master.

BishopstonFaffing It's not ideal. Obviously, I wouldn't see what else he is eating and have no information about any medical issues which may be there but from what you say, he definitely needs to be getting his vegetables in and increasing the range of fruit. I am not that keen on smoothies but if they are vegetable based then I suppose there is something. I'd avoid fruit ones as the sugar is so high. I would really try to broaden the range there - you could do this very slowly with a one at a time process; or if you don't mind then hide vegetables. There are pros and cons to this obviously.

RiverTam I'm not sure if a low sugar diet years ago would impact anything. Are you still low sugar? If you are concerned, and it does sound like you are suggesting a worry about possible Diabetes, then see your GP or Practice Nurse just to check and for your peace of mind xx

HopelesslydevotedtoGu The funny thing is that you would have less monitoring in the NHS as times are limited.
Very low-calorie diets can bring risks such as low blood pressure, fatigue, gallstones, loss of muscle, I think from memory there is evidence that cholesterol can be raised? heart issues (I had a boxer once who had bad heart issues due to the stripping down phase prior to fights). The risks also include constipation and bowel issues.

The first thing is that a VLCD should not be started without an "all clear" from a GP and without a full and frank discussion with a client about the risks and what to expect. Then, these diets should be done in association with the GP or Practice Nurse, to monitor blood pressure particularly and the recommended is not past 12 weeks before a med review.

Really interesting thread. I've ordered the intuitive eating book.

OP can you tell us what you eat on a typical weekday and on a typical weekend day?

Radiodorothy I would actually take a step back from weight loss, if you came to see me, and address the IBS first. You need a clearer and broader picture of what you can manage and of how you can adapt your tolerance. The thing with IBS, and fodmap diets is that you constantly need to rechallenge in order to broaden your tolerance. There is also a huge mind/gut link so stressing about both a weight issue and IBS at the same time leads to more issues.
If you do the IBS investigations, you may find you have a broader range of foods that you though, If you cam to see me, I'd go that way, I think.
The bingeing didn't help, that's true. I would recommend the intuitive eating book for you too xxYou ant to get off that rollercoaster before you do anything.

Have you heard of - and what do you think of - the Whole30 programme?

hellohello12345 I'm quite boring really and, apologies for the cliche, do love salad and vegetables.

I am also a Dietitian who just eats normal food rather than all the "superfoods". My weekends don't range much from weekdays and we rarely eat out. (No reason, we are just a bit antisocial)

Breakfast would be granary toast with an egg (this morning) or porridge with cinnamon or eggs with some sort of vegetable (spinach, mushroom, peppers), I do eat cereal sometimes - granola mostly. I also sometimes have nut butter on toast but I'm not a big bread fan so just have one granary slice

Lunch would be soup (really often now I think of it), grain bowl - grains(I am lazy and use the 2 min micro packs of quinoa/mixed rice and grains etc), with vegetables (obsessed with rocket) and tuna or hummus with crackers and tomato. (I hate sandwiches- blah).

Dinner would be normal family meals - last night thai prawn curry and rice with vegetables, salads galore lately. We do eat meat but not often - mostly chicken and fish and vege dishes such as bean chillis.

I do eat fruit, mostly berries, melon and apples, cherries today.

I had a chocolate coin yesterday and do admit I'm rubbish at getting my dairy in. :(

Trying to think what else I eat :/ I'm quite boring and don't eat a lot of snack foods to be honest

Oh yes, I do eat a lot of avocado but they arent good at the moment!

Do you have any tips for me? I am currently trying to lose about a stone in weight but I am medicated hyperthyroid (currently levels are normal) and even with a reduced calorie intake and exercise I am not managing to lose any weight.

Yes, I think I did a review of a whole 30 book once :/ It been a while.
I think the whole 30 eliminates grains and pulses. Any diet that rids beans and pulses dies in my book. Very keen on bowel health, I am.
I think it's a hard one to follow, like any elimination diet and not evidence-based. The benefits would be that people who follow it are focussing on diet and cutting down sugar and junk. That isnt bad but people might get similar benefits by just having an overhaul rather than being as extreme.Its not meant to be a forever diet, of course.

What are some of the most common misconceptions about food and eating, in your experience?

Can you still be shocked/surprised, or have you seen it all when it comes to people's diets?

My 9 year old offers with anxiety,esp around food being electrocuted (fear of dying etc). She is getting camh support but her weight is the same now as it was over 3 years ago. She is like a stick,and her height is being stunted now too. I'm offering her complan shakes to boost calories,is there anything else I can do?

han01uk I'm sorry if this sounds like a "palm off" but it's a genuine concern for which I would recommend getting a referral to a paediatric NHS Dietitian, (or using a private specialist). You need the full assessment, plan and support rather than a couple of suggestions.

QueenAravisOfArchenland the most common misconceptions are mostly around what the differences are between nutrition professionals, what Dietitians do and what we actually "tell" people. I guess things like "eat lots of carbs", which is rubbish.
The most common I see are around fear of dairy, fear of food groups (could be carbs or dairy), detoxing etc. I sometimes wonder how I have managed to make a living talking to people about food, especially when many think its "just common sense". I am reminded every day of just how little some people know about food and nutrition.
Nothing really shocks me, I've heard and seen quite a bit now. I am, occasionally, surprised by the absolute non-existence of cooking and food prep skills for some people. I used to have people in who had no clue how to prepare a lunch so I produced a "how to build a lunch" handout for one workplace. The ones that get me the most are families where each person has a different ready/micro meal to themselves each night for dinner.

examples of seen in NHS work over the years
-family with ready meal each
-cold pasta and milk for breakfast
-lady who ate 10 cornettos at each sitting
-men who don't eat anything all day and then have half a plate of mash and a big chop for their meal

• caffeine addictions (up to 6 L coke/day)

I have 4 year old ds. He was referred to a dietician over a very restricted diet. He is being assessed for Autism and has sensory issues around food. I have always kept with the attitude of I put it down he eats what eats. No stress no pushing. I give him options to try new food, we play with food, we play food games and we actually play with food itself.
The first dietician we saw told me to keep what I was do. Was more concerned about making sure he was getting the correct vitamins and minerals so gave me a diet plan of things he eats to make sure he gets what he needs. He isn't underweight he's on 99th centile for weight and 50th centile for height. Which are the centiles he was on at birth.
The second dietician we saw was only concerned over his weight. She wanted me to limit certain foods on his very limited food list and at times only offer at some meal times meals he won't eat.
Which in your professional opinion would you think is the best course of action? Just to add he is very much one of them children that would starve and get dehydrated rather than eat most food and drink water.

Ilovetrees , is that hypothyroidism or hyper? I would never give anything very specific without a full assessment, that would be bad practice, but I generally do recommend reducing carbs a bit for a couple of weeks and then adding back...you will need low GI carbs for that. Some people find gluten-free helps but that's not for weight, more for symptoms. The evidence is not 100% but emerging for that one. I would look at your whole diet before thinking about any supplementation which may help too. In general, as a blanker recommendation without being specific to your needs , I would usually say eat a diet based around vegetables, fruit and lean meats/fish with moderate amounts of grains (gluten free if this helps).

Oh and, to go back to the most important part!!!! Get your levels and medications looked atto make sure all ok!

Aspieparent, I have no idea if there is anything else we need to think about in terms of other medical or risks etc but, in general, I would agree with the first of your Dietitians. As mentioned above, I love the ellyn satter approach for kids...have a look at their website :)
The idea is that you provide healthy food and let kids choose, try and learn fullness cues etc. Restricting kids is not advisable.
Once again, very broad and without any information about history, medical issues etc so pleas take it as that .

Oh I wanted to ask about hyperthyroidism too - when we get it under control I gain weight, it’s not a great inducement to stick with carbimazole.

I did have to do a low iodine thing for a while to encourage uptake of 2nd round of radioactive iodine and I felt better but don’t know if that’s workable long term - is that something people do?