|Greece, June 2014|
1. Sensational media reports based on a flawed interpretation of a journal article or on something made up by a journalist or a celebrity
"Did you see the TV programme last week about how eating saturated fat is good for you? I've switched back to butter."FACT: It's all rubbish, ignore it. If you are overweight and want to reduce your blood glucose and improve your diabetes control, then eat less carbohydrate and lose weight. If you want to lose weight, you need to eat less, and ideally move more. The dietitian's job is to help you find a successful way to do all this, not spend half a consultation explaining how journalists are perfectly free to MAKE STUFF UP and are paid handsomely for it.
"I read in a magazine about how you will lose weight if you eat nothing at all after 5 p.m."
"I cut this article out of the newspaper about kale smoothies reversing diabetes."
"This website says that chia seeds will melt fat."
"The Daily Mail says that eating blackberries brings your blood glucose down."
"It says there's a new cure for diabetes."
2. I can't possibly eat any less
The patient declares that there's no way they can eat any less than they already do. "I don't have any appetite," they say. "I eat like a bird. My two-year old grandson eats more than I do." The account they give of their daily diet consists of a small bowl of cereal for breakfast, half a tin of soup for lunch, and one slice of toast and a tin of sardines for supper. Between meals: black tea and coffee with sweetener. "I can't understand it," they say.
FACT: You are eating more than this, and you know it. Or maybe you don't know it. Either way, you're eating more than this or you wouldn't weigh 20 stone.
3. Artificial sweeteners
"Aren't they as bad as sugar? I read they cause cancer. They're full of chemicals, really bad for you. I wouldn't touch them."FACT: Artificial sweeteners are safe. They're calorie-free. They're carb-free. THEY ARE FINE, STOP BEING STUPID.
"I would lose all this weight if I could exercise, but I can't."FACT: exercise is incredibly good for us - it brings down high blood glucose levels, makes us feel good, strengthens muscles and helps stabilise joints - but the amount of calories burned by ordinary people who increase their activity level is about equivalent to a sandwich. If you're a typical overweight person you won't lose weight by exercise alone, and you'll probably reward yourself with more calories than you used up. But go out for a walk anyway, because the other benefits of activity are so worth it. And then start eating less.
"I'd love to go out for a walk, but my back/hip/knees are too painful."
"My dog died and I put on 10 pounds."
"I've cut out all sugar, I don't have any now. I put honey in my tea and on my porridge instead."FACT: Sugar is processed from plants by people; honey is processed from plants by bees and then people. Honey will have the same effect on your blood glucose and your waistline as sugar. Sorry to disappoint you, but YOU ARE DELUDING YOURSELF.
"Honey's natural so it must be better than sugar."
6. Fruit and fruit juice
"Fruit juice is healthy, isn't it? It's natural."FACT: fruit juice has more sugar in it than lemonade, and nearly as much as Coke or Pepsi. Why would a manufacturer need to add more sugar to a product that's already 10% sugar? Yes, whole fruit is better, but you're not helping your blood glucose levels if you have more than a handful at a time. And the 'five-a-day' message? Well, it's perfectly OK to have five portions of vegetables and no fruit at all.
"I buy the fruit juice labelled 'no added sugar.'"
"I've stopped snacking on biscuits, and I'm having lots and lots of fruit instead."
7. 'Full of sugar'
"I stopped having ketchup on my chips - it's full of sugar."FACT: There's far more 'sugar' in your chips than in your dollop of ketchup, more in your large bowl of pasta than in the couple of tablespoons of pasta sauce, and no less in your bowl of muesli than there was in your cornflakes. It's all about the carbs. Grapes and bananas are fine, but have a handful of grapes or a small banana, not the whole punnet or a banana the size of a baseball bat.
"Those pasta sauces are full of sugar."
"I don't eat grapes or bananas any more; the nurse told me they are full of sugar."
"I have muesli now - cornflakes are full of sugar."
8. The Menu Plan
"Just tell me what to eat."The lifestyle magazines are always printing "a menu plan for a week". We love them. I love them. If only we could just follow the plan to the letter, it would be so easy and we'd reap the promised benefit. But then we look through them - one muffin? Half a grapefruit? 300g kale? What do we do with the five other muffins that came in the pack of six, or the other half grapefruit, and I'm not allowed grapefruit anyway, and kale comes in 500g packs, and I don't like kale, and it's too expensive to eat all that fish, and I don't like fish except tinned tuna. What do I do in week 2 - just repeat week 1? My wife does all the cooking and we eat curry and chapatti not sausages and potatoes...
"Can you just give me a menu plan?"
FACT: Menu plans are useless, and I don't have one for you. You'll have to work it out for yourself. Sorry.
9. "You're telling me I can't have..."Honey. Rice. Sugar puffs. Fruit juice. Potatoes.
NO, I'M NOT TELLING YOU WHAT YOU CAN AND CAN'T HAVE. What I'm telling you is the effect that it will have on your weight, or your blood glucose. You can have whatever you like, whenever you like, because it isn't me that will put on weight or need to inject insulin, it's you. If you want to start the day with a Pepsi, that's fine, but if I were you, I wouldn't do it, like I wouldn't walk into the road without looking, or swim in the sea when there's a red flag flying. But if you want to, you go ahead.
9a. 'Good' and 'Bad' foodThere is no such thing as good or bad food - nothing is forbidden. It's good to eat a lot of some foods and a little of others, and hey! it's bad to eat a lot of some foods and a little of others. Eat what you like, it's your decision and you will have to live with the consequences. My job includes making sure you are aware of what those consequences might be.
10. Low blood sugar
"I had to have a sandwich because my blood sugar was low."FACT: if you 'need' a regular snack then your insulin needs adjusting down. If you're not on insulin (or gliclazide or another insulin-stimulating medication) then you don't 'need' a snack, you just want one - you will never have low blood sugar. Grow up, you're not a toddler any more.
"I can't sleep unless I have a glass of milk and a biscuit before bedtime."
"I need a snack to keep me going."