Have you ever consulted with a private dietitian?

[Mars27]

Have you ever had a meal plan tailored for you?

I'm thinking of seeing someone and having a meal plan tailor made for me taking into consideration my health issues. I'm thinking of someone who could order blood and other tests and have a clear picture of what's needed.

This is the situation: I'm 51, 5'6" and 13 stone. Classic Apple shape, weight all in my belly. Fully menopausal and not taking HRT (don't want to as I have thyroid issues and take levothyroxin, also take antidepressants and Pregabalin for another issue and don't want to add yet another thing in the mix). Pre diabetic with a fatty liver.

Because of multiple factors (mental health included) I never wanted to go on a diet as diets are linked to trauma in my past. Also the bother of having to cook two different meals, one for me another for the family. But needs must and changes have to be made.

There isn't anything like that in the NHS. My GP said so and all she could do was refer me to one of those "change your mindset" plans. I learned to read labels, make substitutions and all of that but what I actually need is a tailored meal plan.

There's a person on social media who calls themselves the Menopause Dietitian and I have to say I'm feeling tempted to go and see them 🙃

Apologies for the long post but didn't want to drip feed. I'd be grateful if you have any experience of something similar.

Anyone?

If you can afford it, being under the supervision of a dietician is great.

The issue with Instagram influencers is that they fit you into a program more than being on 1:1 support. Ideally you want to find someone near you that you can go and see in person, instead of zoom. I looked her page up. She has helped 10.000 clients. There is no way she has the time to do a personalised meal plan, fine tuned to your needs, like/dislike and medication. You don't want someone that will print a template or use an algorithm to create one by ticking a few lines.

Oh you found a she? I was talking about a he

No, certainly not happy to be seen by zoom and put on a generic diet. I'd like to have a f2f consultation and have a program made for me, otherwise I'd just go to WW or Slimming World. Nothing against them as I'm sure both are effective but I really want something that works for me based on my needs. What works for me is certainly different from what would work for a 25 year old. But it's hard to find someone with a good reputation.

No, but I absolutely would do if I had unlimited means! Along with cosmetic surgery, botox, gym membership and many other luxuries. Why not, if it's affordable for you?

Not her? https://www.instagram.com/lauraclarknutrition/?hl=en#
Laura Clark - The Menopause Dietitian
@menopause.dietitian.

I guess it is a popular label !

Haha, popular label indeed:

instagram.com/menopause_dietitian?igshid=MmJiY2I4NDBkZg==

I consulted a registered dietician when I was diagnosed with PCOS, as I wanted to change my eating habits to tackle insulin resistance and balance my hormones. She was absolutely shite. She basically just went through the motions of what she previously did for NHS patients, with loads of outdated advice and a very generic plan that took no account of my PCOS at all.

I think part of the problem is registered dieticians are obliged to stick with the NHS guidance, which hasn’t really changed for decades and isn’t personalised to individuals. Next time I’d go with a nutritionalist, who often have less well recognised qualifications but do seem to specialise in certain conditions and seem to filter through scientific advances more.

Oh interesting, tell me more about them!

@Secondwindplease what was the outdated advice?

@AnIntrovert just gone back to look, it was eat three meals a day (always have), only have snacks if you’re hungry, eat slowly and chew food, stop eating when you are full, stay hydrated, plan meals, watch portion sizes, eat a ‘healthy eating diet’ based on that NHS plate I’ve been seeing since I was 11 in bloody food science.

I mean, none of it is problematic advice but what woman who has been watching their weight for twenty years doesn’t know that already? It was generic to the point that I actually felt fleeced. I wanted focused advice on insulin resistance (low GI, intermittent fasting maybe), hormones and possibly also disordered/intuitive eating. It seemed to epitomise everything that is wrong with the factory approach of the NHS, except i’d bloody paid 🤣

@Secondwindplease I understand your disappointment.

But you paid a medical professional and they provided medical advice based on science and not internet trends.

The insulin model has no scientific ground. Intermittent fasting without calories reduction doesn't work and intuitive eating isn't possible in an environment dominated by processed food.

We are constantly bombarder by claims that we are being mislead by .... whoever the bad guy is... be it the government .... sugar industry.... whatever and that we are fat by not fault of our own, but just lies and doctors who ignore insulin and other rubbish. Those YouTube videos are very convincing especially when we failed.

Truth is, it is very hard to lose weight and not gain weight. What was true when you were at school is still true today. There was no discovery that is kept from the masses. It just very hard to eat right.

Sorry to hear that, so disappointing.

I second your post. We all know those points, ie, drink water not fizzy sugary drinks, watch your portions, read your labels, etc, etc. I'm really past that now, that's why I wanted to see someone to tailor a plan for me but if this is what's on offer it's hard to part with your cash for that kind of advice

@Mars27 a dietician will make you a meal plan based on accurate calories need not some random inaccurate online calculator, and if you stick with it, and you have their support and accountability, you will lose weight. So don't discard it.
Three meals a day, and only snacking if you are really starving if not bad advice.Eating slowly and chewing is needed to activate the satiety hormones. How can healthy eating be wrong?

Sorry but I completely disagree that ‘what was true at school is still true today’. We know so much more now about hunger hormones and how insulin resistance interferes with these. The connections between insulin resistance and metabolic diseases such as PCOS, diabetes, dementia, heart disease etc is indisputable now. We also know about how ultra processed foods make us fatter even when they are matched in calories and nutrition with unprocessed foods (see last week’s Panorama if you are UK based). So much work is currently taking place in this field - see Tim Spector, Giles Yeo, Andrew Jenkinson and many others. I have learned so much more from their books and I see why the shite I was told at school was never going to be enough - not then and not now. All that low fat bullshit that I followed for decades was government approved and it’s part of the story of why I am where I am.

@Mars27 I am now doing Zoe and it’s brilliant. They have given me information based on how my own body responds to blood sugar and blood fat, and an insight into my gut health. I fully recommend it for personalised service and cutting edge research. The podcast is also great if you want to dip your toe in first.

Insulin resistance is absolutely linked to disease. As is processed foods. No argument there.

It is great you are doing Zoe, and you will probably start eating better and fresher food, the healthy eating part I was saying was right.

A deconstructed food will be better absorbed than a food in its natural matrix with an increased calories input. Even healthy food such as raw almonds vs almond flour. The amount of calories one's body is able to extract differs between the two even if calories on label are identical.

That is not what you were saying in your previous post. You talked about insulin (not insulin resistance which is a metabolic disorder) , fasting, intuitive eating.

I’ve just gone back through my posts and I don’t think I’ve mentioned insulin other than as insulin resistance? Perhaps we have been at cross purposes occasionally.

I do think there is some evidence base for intermittent fasting but I am not as familiar with it and I haven’t actually tried it. It was recommended by my GP after my PCOS diagnosis so I was curious. I would have liked someone to walk me through it and explain why it was/was not a good idea rather than just ignore my curiosity altogether.

On the intuitive eating, I was curious about this because at the time I was living rurally, it was lockdown, and I was depressed about my upcoming wedding (body image, shit family dynamics and sensory overload). I was in a pattern of comfort eating and I knew I needed to address the psychological elements to my overeating alongside improving my diet. I did not expect a dietician to unpack this but thought she may have been able to encourage me/signpost to a counsellor perhaps, or explain how I could integrate both elements into a plan or advise whether I should start with one aspect before the other etc.

I went to a dietician specially because I was sceptical of nutritionists, so I was definitely open to being told what might be faddish/unsubstantiated. I did want tailored advice though and some expertise in managing the actual conditions I was approaching her about.

My bad, yes it was insulin resistance which a metabolic disorder.

Fasting without calories restriction does not cause weight loss. The hype is going down. Even Peter Attia , the founder of the most famous fasting app Zero, doesn't believe in it anymore. You just eat less calories. Intuitive eating might work in a naive body never exposed to processed food. Even home staples are processed. From the plain flour (refined) , baked beans (sweetened), even a wholemeal loaf of bread is actually a combination of plain flour and added fibres, and several additives, the deconstructed food I was talking about. Intuitive eating can't work in UK in 2023

I am sorry you were struggling mentally. In Western medicine, most of the time, it is as if head and body are separated. One more source of disappointment. What you eat affects your thoughts and mental health and vice versa, again body and head are linked.

None of this however proves that not eating junk, not eating too much is wrong. If you go for calorie counting, and these calories are made of fresh vegetables, a little fresh fruit, whole grains, a bit of meat and fish, low saturated fat and pulses several times a week, you will lose weight if calories are below maintenance.
It is boring, old and unsexy advice, but sound advice. Bloody hard work as well.

Anything else, when tested in a controlled setting, fails miserably.

I am pleased the hype is reducing with IF because I was too scared to try it - after decades of restricting food the idea of banning things outright makes me panicky.

Totally agree on the western medicine head and body thing. It’s so shortsighted, especially with food intake which is influenced by social norms, family culture, environment etc as much as physical hunger.

I don’t think I would have done with calorie counting given my chequered history with food, but I definitely could have created other feedback loops. I could have kept a food diary with photos etc to look at portion control. I would have happily weighed ingredients. Presumably there are other strategies I just don’t know about. But we never really got into the weeds on any of this - I’ve had a more specialised discussion with you this evening, for which I’m grateful! Thanks for taking the time.

I have a couple of times but it was a bit pointless really. I know what I should eat and that I should eat less of it.,fancy blood tests neither here nor there.

I know you said you tried a mindset type app, but could you see someone more focused on behavioural change? I think that might be better bang for buck.