Updated: Jan 18
People often tell me that one of the most frustrating things about having diabetes is being told different things about their condition by different people. Why does this happen and how do you know what the right thing to do is?
It’s understandable when it’s John down the pub telling you that he’s been told it’s fine to have chocolate, whereas your sister tells you that sugar is evil and the cause of all ill health. You can understand that they aren’t experts and might have their own different viewpoints.
But it is more confusing when health professionals tell you different things. Perhaps your doctor has told you to cut out all carbs, the practice nurse, who has started you on your new medication, has told you that you must have a portion of carbs at each meal, but the dietitian who you saw when you were first diagnosed told you that everything was fine in moderation, but choose the healthy versions (although to be quite honest, you’re not quite sure which they are). At the end of the day, you just want someone to tell you what you can and cannot eat (more about that in my next blog).
If I’m honest, it might be that none of them are entirely wrong (although perhaps chocolate isn’t quite the work of the devil, I’m quite partial to it myself). Here are 7 reasons you might hear different things from different people:
1. There isn’t necessarily only one way of doing things.
Weight loss is a very good example of this, where it really isn’t one size fits all. There are many different weight loss plans out there, and all will be able to give you great examples of what people who have successfully lost weight by doing them. Someone who has followed a plan themselves a found success, or seen a number of family, friends and patients find it useful, understandably might want to suggest it to someone else.
2. The lure of the new.
Most people with diabetes will have tried may different approaches to improve their diabetes control with varying success. Health professionals will also have seen many different approaches during their career. It is understandable that someone might feel that something new might be the answer.
There is a reason why we like drawn to new things. In fact scientists think that novelty triggers the reward centre in our brains, causing us to believe that something new will bring us greater rewards, even if we have been previously successful with something else.
Perhaps when our ancestors evolved out in the plains, part of their success was a desire to try new things. We wouldn’t be sitting in our comfortable homes now if our ancestors had decided that it wasn’t worth staying put and seeing if they could grow those nice tubers that they had previously walked so far to dig up.
People selling things exploit this sense of adventure, but perhaps also health professionals feel that they are more likely to be successful trying something new. They could be right if trying something new feels exciting and motivates you. But it also just might just feel like you’ve been told something different yet again.
3. Being an expert or a generalist.
Not everyone is an expert in everything. John down the pub might be a total whizz when it comes to 1984 Ford Cortina engines, but he has probably had less time to delve into all the latest scientific evidence for the best way to eat when you have diabetes.
Your Practice Nurse will know more, but will see people with diabetes, asthma wounds and many more conditions in a week, and do an amazing job managing all of them. They will have done training in good healthy eating for the general population or gone on a more specialist course into how to eat when taking different diabetes medications. But it is difficult to be an expert in everything and there is also another big issue that they face.
4. Time may be limited
Some things are be complicated and take time to explain. Your appointment with a GP might only be 10 minutes. Even a full 30-minute diabetes review will come with many other things to discuss in that time. So diet can get pushed to the back of the queue or covered in a very general, one size fits all way,
This basic advice isn’t necessarily wrong; most of us could improve our diet if we followed it to the letter. But what there often isn’t time for is to find out about your personal likes and dislikes, work, home life, or other medications or conditions you may have.
5. Simplifying the complicated
Sometimes the answer to a question might not be that straightforward. Take for example “how much fat should I eat?”
Again we come to one size not fitting all. That might depend upon, among other things, whether you need to gain or lose weight, how active you are, what medical conditions you have and what the level of different types of cholesterol you have in your blood. And it's not just about amounts. Some fats are healthier than others, in fact some have proven benefits to your health, but it also depends upon the foods they come from and the whole diet they make part of.
With a limited amount of time available, it might just be easier to advise someone to cut down on fat and particularly don’t eat tinned processed meat (which can be horribly high in unhealthy fats and salt). This could end up being in conflict with previous advice you have had had. For example that it was ok to occasionally have the corned beef hash you love, because it reminds you of happy scout/girl guides camps when you were a kid.
6. Scientific discoveries don’t stop.
There’s been remarkably little change in what we believe to be healthy eating since the research was done for rationing in the Second World War. But advice does change from time to time. The advice on cholesterol in foods is one example. When researchers discovered that high levels of cholesterol in the blood were linked to increased heart disease, it was understandable that they would advise people to cut down foods high in cholesterol such as prawns and eggs.
But it has since been discovered that the amount of cholesterol in these foods is very low compared to what the body makes itself. So, it’s now thought to be better to advise people to change things that cause the body to produce more of the unhealthy types of cholesterol in the blood. Which brings us to the final issue.
7. Opinions do sometimes differ.
Scientific studies into diet can be challenging. How do you know what people are eating? You can ask them, but they might tell you what the intend to eat instead of what they actually do eat on a Wednesday evening, when they had a horrible drive home from work, the kids are all hungry and there’s nothing in the fridge. So, it can be challenging to get enough evidence to be 100% sure whether something is unhealthy or not. One small study might show one thing, but then when you look at a lot of small studies all together the evidence might show something else.
In recent years, there has been a whole area of discussion, particularly online, about what is the best diet to change cholesterol levels in the blood, and what effect that might have on the risk of heart disease. There’s always the temptation for someone who has an interest in promoting a particular way of eating to just pick the small studies that agree with their point of view, while others might look at all the available evidence and come to a conclusion from that. Even as a health professional, It can be quite difficult to sort your way through all of the competing opinions and come to a conclusion.
How an appointment with a Diabetes Specialist Dietitian will help.
Diabetes Specialist Dietitians are experts in diet and diabetes. They complete a four-year dietetics degree with clinical placements before starting work in the NHS. They usually work for a period as a general dietitian, seeing patients with a range of different medical conditions before specialising in diabetes. I worked in general diabetes and weight management for 2 years before working as a Diabetes Specialist Dietitian for the last 11.
Dietitians are trained to look at all the scientific evidence on science and lifestyle and, in partnership with our colleagues working in research, translate it into straight forward, practical advice that works.
I am familiar with the different diet and lifestyle approaches for managing diabetes, and can explain the benefits and drawbacks to help you make your own mind up about what you want to try.
When you book an hour-long appointment with me, you will have more time to have all your questions about diet answered. I will also ask you about all the things that might affect your food choices such as likes and dislikes, medical history and medication, what your job and hobbies are. This will help me to support you to decide which changes to make that will fit in with your life and work for you.
I am currently offering Video Consultations allowing you to talk to me at a place and times that suits you. Appointments can be booked online from my website by clicking the book now button below, or click services for more information about what I offer.