Should I trust my nutritionist's advice- more carbs?
February 18, 2017 12:03 PM   Subscribe

I saw a nutritionist (registered dietician) yesterday. I have prediabetes (5.7) and she told me to add cereal to my morning yogurt and eat carbs at dinner. This is along with a balanced diet with fruit, veggies and proteins. Should I trust her advice? It seems that I should be limiting my carbs not adding them if I'm trying to keep my blood sugar steady and lose weight.
posted by starlybri to Health & Fitness (21 answers total) 3 users marked this as a favorite
 
What's your normal carb intake?
posted by bunderful at 12:10 PM on February 18, 2017


I don't really track it.
posted by starlybri at 12:13 PM on February 18, 2017


Yogurt has carbs but no fiber. Did she say any cereal or a decent fiber cereal? The fiber helps with carb intake.

When I did weight watchers they said use a 5:1 or better carbs to fiber ratio when making food choices.
posted by tilde at 12:16 PM on February 18, 2017


Did she explain why?
posted by bq at 12:16 PM on February 18, 2017 [1 favorite]


She said it would probably keep me fuller.
posted by starlybri at 12:18 PM on February 18, 2017


Adding carbs in the morning can end up lowering your blood glucose over the course of the day, paradoxically. So that advice isn't necessarily bonkers.

Do you have a blood glucose meter? Unfortunately everyone's biochemistry varies, so while the dietician can give you general advice the only way to know if things are really working is through trial and error. If you get a meter and gather some data, you can go back to the dietician and they'll be able to give you advice that's tailored for you specifically.
posted by asterix at 12:18 PM on February 18, 2017 [1 favorite]


You (or your insurance) paid for you to see and be evaluated by a trained and certified medical professional who specializes in nutrition. Why do you trust her advice less than advice from random strangers on the internet?

Try adding the carbs she suggests for a month and then reevaluate. If it's working for you, great; if not, she can suggest something different.
posted by Lexica at 12:44 PM on February 18, 2017 [35 favorites]


I mean I get that she's a registered nutritionist and we're not, but in my experience nutritionists' advice when it comes to diabetes just plain sucks. The current American (and really worldwide) paradigm for diabetes seems to involve little fat, some protein and lots of carbs, and then medication to take care of the effects. I've seen my grandmother die of diabetes related complications by following the standard advice, and I've reversed my own prediabetes through a low-carb, high-fat, moderate-protein diet. Trust your instincts.
posted by peacheater at 1:08 PM on February 18, 2017 [35 favorites]


Nthing contact and ask her. On the one hand sometimes professionals make mistakes and maybe she wasn't considering it. But she is also being paid for this, and is a real dietician, not a bunch of random people behind a computer. Call and ask for clarification before you decide whether she's has good reasons, or things feel wrong. And if things feel wrong, find a new dietician and stop paying this one for advice you don't feel comfortable taking.
posted by Caravantea at 1:11 PM on February 18, 2017 [4 favorites]


Seconding peacheater. My experience has been that paradoxically, nutritionists/dietitians don't seem to know much about actual healthy eating. And if you need proof, just look at the food they give you in hospitals - which is theoretically planned by dietitians.

I've had blood sugar issues since I was in my teens. I'm 56 now, and I've kept it under control all these years by eating low carb in terms of grains and sugar such. I eat fruit, veggies, protein, and a little fat.

My mother, on the other hand, follows the dietitians advice, and her health is such a mess that all her doctors are horrified (all 9 or so specialists), and they are referring her to the Mayo Clinic. Not one of them has asked her to keep a food diary.
posted by MexicanYenta at 2:01 PM on February 18, 2017 [13 favorites]


Just another anecdote, but I have a family member who's diabetic and their dietician told them to eat more rice/bread despite being shown the blood sugar data (finger prick) that demonstrated that's absolutely the wrong thing to do.

When it comes to diet, the advice from medical professionals can be horribly out of date because they're following the "official guidelines" which are based on old/biased studies.

Definitely go back and challenge your dietician's advice, and also collect data - get a blood sugar monitor and actually track your blood sugar and keep a food log (and sleep, exercise, water, and stress) so you can correlate what you eat with your body's reaction.

Ultimately, type 2 diabetes can be "cured" through diet and is all about managing insulin sensitivity.
posted by jpeacock at 2:25 PM on February 18, 2017 [6 favorites]


I lost weight and got out of prediabetes (I was being treated with medication for it, so it was close to becoming diabetes) with a very low carb, moderate protein, high fat diet. My doctors are thrilled. I got nowhere with a conventional approach that sounds similar to what was suggested to you. YMMV, but it's good to be aware that many nutritionists are still peddling very outdated advice.
posted by quince at 3:15 PM on February 18, 2017 [6 favorites]


Possibilities for reasons (other than just "outdated ADA guidelines") why she might have suggested it:
The idea of adding fiber, mentioned above, makes some sense to me, for fullness and maybe for digestive health if you've been having issues in that arena. Does that sound like anything she said? Did she say what kind of carbs to eat?

Is there some reason why you need to keep your carbs constant throughout the day, like are you taking some medication that relies on that? I could sort of imagine suggesting that -- if your daily carbs were previously all happening in one big meal, you'd have a big blood sugar spike and then tend to go low, then spreading that intake throughout the day instead would keep your blood sugars more constant, rather than having one big spike-then-low with the big meal. (?)


But basically I agree with others that adding carbs to your diet sounds like very strange advice, and that the nutrition advice given for diabetes is often totally outdated and wrong. The story I've heard is that the American Diabetes Association (ADA) has for a long time promulgated guidelines that are inappropriately high-carb, and people who are employed as diabetes educators are (often?) required to follow the ADA's guidelines. It's certainly true that most of the educational materials mass-produced for diabetics talk about how you should do stuff like "cut back" to a fairly high level of carb intake, rather than anything about cutting out carbs completely. I assume this is on the assumption that most people are starting from astronomically high carb intake and will have a hard time cutting carbs more severely. (So they say things like "eat one slice of toast instead of two" or "order a half-portion of pasta", rather than saying "don't eat bread or pasta".)

If you're interested in a low-carb approach to controlling prediabetes -- Dr Bernstein's Diabetes Solution is a good place to start (he's super strict, but the book is still useful reading even if you don't end up going as strict as he does). This page: Blood Sugar 101 is also a good resource.

And this page has a good summary of what people are suggesting when they talk about self-monitoring blood sugars.... basically, you can get a finger-stick glucose meter at the drug store and use it to test your blood, and that will give you the best, most personalized, immediate information about what foods actually raise your blood sugars, and whether you're in the danger zone in terms of diabetic complications.
posted by LobsterMitten at 3:51 PM on February 18, 2017 [4 favorites]


Adding fiber, protein or fat to yogurt would slow the effect of yogurt on your blood sugar. She probably recommended cereal because dietary advice from the US FDA, AMA, American Heart Association and their surrogates (dieticians) seems intentionally designed to be easy to understand, easy to do and something most people would eat voluntarily. I'd ask (or just do it) about substituting something which would have the same effect as cereal, but with less carbs and more nutrition. I put chia seeds on yogurt.

Saying to add carbs at dinner... maybe she saw no significant sources of B vitamins in your diet.

That said, I agree the evidence about how FDA, AMA and AHA recommending high carb diets to prevent obesity which, instead, increased both it and diabetes.
posted by Homer42 at 5:44 PM on February 18, 2017 [2 favorites]


Just as an aside, check the sugar content of your yogurt. Flavoured yogurt has a stupendous amount of added sugar in it. We've been eating plain (unsweetened) Greek yogurt, usually with fresh fruit cut up into it. One gets used to the sour flavour eventually. :)
posted by heatherlogan at 6:04 PM on February 18, 2017 [2 favorites]


Oh dude no, I second what everyone above is saying re unhelpful nutritionists. I had pre-diabetes and was sent to a nutritionist, who told me to eat more quinoa and chick peas and things (I'm a vegetarian), and I had no idea those things all have tons of carbs, plus she refused to talk about keeping track of what I was eating or offering me any good recipes, and I ended up being diagnosed as diabetic a few months later, at whcih point I was sent to a diabetes education class where I learned about carb counting and was given a very helpful pamphlet, and when my A1c was tested 3 months later, it was back down to 5.7.

You can eat carbs, but try not to eat too many, and be aware of how many carbs are in things! I am happy to talk about this more if you'd like.
posted by leesh at 6:42 PM on February 18, 2017 [2 favorites]


You might be interested in the Joe Rogan podcast with Gary Taubes (Available via podcast as well. The video is extraneous) Gary Taubes is a journalist who wrote the book "The Case Against Sugar" as well as several award winning articles on diet beliefs. He talks about the entrenched mistaken dogma of nutritionists and others as well as about is beliefs (based on his research) on how we should be eating.

It's a fascinating story I just listened to yesterday.
posted by bitdamaged at 9:16 PM on February 18, 2017 [1 favorite]


I'm T1, but I love my morning oatmeal. A couple of servings of high-fiber whole grains with a lower glycemic index are good for you, and I know they help keep my BG's steady.
posted by The Underpants Monster at 9:41 PM on February 18, 2017 [2 favorites]


Diabetic here, seconding this:

Do you have a blood glucose meter? Unfortunately everyone's biochemistry varies, so while the dietician can give you general advice the only way to know if things are really working is through trial and error.

The best way to get a handle on your situation is to gather your own data. Take some detailed notes about what you're eating, (both food type and quantity), and run some tests.
posted by mordax at 9:41 PM on February 18, 2017 [1 favorite]


Fire her ass.

She prescribed more carbs as a way to keep you fuller? She's either woefully uneducated or simply lazy. Anyone here with an ounce of nutritional knowledge would quickly spot the terrible advice in her suggestion.
posted by Tanzanite at 1:22 PM on February 19, 2017 [1 favorite]


She prescribed more carbs as a way to keep you fuller? She's either woefully uneducated or simply lazy. Anyone here with an ounce of nutritional knowledge would quickly spot the terrible advice in her suggestion.

Lot of armchair experts up in here.

Carbs ain't carbs. It's not like the nutritionist said 'go dump a cup of white sugar in there'. And cereal ain't cereal. There's a big difference between oatmeal or a homemade muesli and a bowl of Froot Loops.

Let's see what the peak diabetes body in Australia says about carbs, diabetes, fullness, and so on:
People with diabetes are advised to include carbohydrate foods at every meal as part of their daily eating plan. It is important to consider both the amount and the type of carbohydrate food eaten, as both of these affect blood glucose levels. The amount of carbohydrate includes both the sugars and starches in food, whereas the type of carbohydrate refers to the glycemic index.

...for optimal blood glucose management, it is important to have three regular meals each day, with each meal containing suitable amounts of carbohydrate foods depending on your energy needs. This will help prevent large rises and falls in your blood glucose levels throughout the day.

[recommended low GI] Breakfast cereals
Goodness Superfoods — Digestive 1st, Protein 1st
Kellogg’s — All Bran, Guardian, Sustain
Morning Sun — Apricot & Almond Muesli, Peach and Pecan Muesli
Sanitarium — Hi-Bran Weet-Bix, Up & Go
Woolworths Select — Bircher Muesli
Vogels — Ultra Bran
Unprocessed oats

Research has shown that by eating a diet with a lower GI, people with diabetes can reduce their average blood glucose levels and, as they become easier to manage, fluctuations in blood glucose levels may become less likely to occur. ... Low GI foods may also help improve satiety (feeling of fullness) which may help with weight management.
Have a question about advice from your qualified nutritionist? Ask your qualified nutritionist to explain. Still unsure? Get a second opinion from another qualified nutritionist, not people peddling personal anecdotes and this amazing award-winning article they totally read last week.

Edit: removed obscenities. But Jesus H Christ on a popsicle stick, you people sometimes.
posted by obiwanwasabi at 6:35 PM on February 19, 2017 [6 favorites]


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