Calling Health Care Professionals

(Barbara Greenwood) #1

I’m not one myself.

I’m curious.

If you’re here, you are presumably eating keto yourself. Do you advise it to your patients? If not, why not? Are you fearful of being hauled over the coals by your professional organisation… or have you specifically been told what you have to have to advise to patients?

Here in the UK, there are a number of GP’s and other HCP’s advising low carb especially to people with diabetes… and in some cases being very public about it as well. But I’ve also just seen from a nurse in the UK that she’s not allowed to advise low carb to patients. So I’m wondering what the rules are, and what people are doing…

(AnnaLeeThal) #2

As a cardiothoracic surgery clinical nurse I advise my patients to eat whole food, avoid packaged processed foods, and choose healthy fats. I usually say “build your plate with your protein and lots of veggies” or something like that. I also tell my diabetics to do whatever it takes with their diet to keep their blood sugar controlled.

I never say “eat a Ketogenic diet” for fear of being accused of practicing out of my scope. I have to follow what my doctors order, which is “heart healthy” low cholesterol, low fat, no added salt.

While this is frustrating I do still feel like I can have good conversations with my patients about dietary changes without specifically recommending Keto. Even if I can get people to choose whole food over processed carbage it will help.

(James storie) #3

I understand the restrictions, but this sucks! How can you not tell everybody the truth. It must be very difficult. I wish our medical system would wake up and catch up. I wish you luck in dealing with the system.

(Barbara Greenwood) #4

So, whose scope is it? Dietitians? Or doctors?

(AnnaLeeThal) #5

The doctor orders the diet, we follow those orders.

(Barbara Greenwood) #6

It must be really tough :frowning:

(Bacon for the Win) #7

I am a nurse on a busy inpatient surgical unit. I also work nights so I am not there for any meal times. When the subject does come up I speak of my experiences with unprocessed, whole foods without mentioning keto or any other specific WOE. I advise them to stay away from sugar and maybe give a quick lesson in how sugar is disguised.

Then I go get the Coke they asked for :frowning2:

(Brian ) #8

Thank you for the question Anna Lee. I am an internal medicine doctor and do recommend the ketogenic diet and intermittent fasting to my patients. I have read the research and now understand the devastating effects of insulin resistance and hyperglycemia. I typically advise patients to do the research themselves because it sounds crazy for a doctor did tell them to increase their fat and salt intake. I have had 7 people come off of insulin in the past 3 months (they did it themselves by changing their diet). I typically refer them to videos by Jason Fung, DietDoctor.com, and many of the researchers in the field such as Ivor Cummins and Dom D’Agostino.

I think the easy starting point for all of us is to advise people to cut back or eliminate “processed foods and empty calories.” It has become easy for me to discuss this because I have lost over 40 lbs since Feb 2017 and my patients ask me how I did it. That opens the door and most patients are receptive.

I do get into discussions with my partners and specialists in the area and they are starting to get the concept. I believe that we have to educate ourselves and be able to have an intelligent conversation with those around us to let them know this isn’t a fad diet. Now I have specialists in the area asking “Can you tell me more about that crazy diet you are telling people about?”

#9

This is a very interesting and insightful post, @BrianL. I like your measured/thoughtful (and non-pushy) approach, which is in the leadership style of example-setting and encouraging others if they express interest in following. Pulling others through example is always more effective than pushing against their inertia or lack of interest or receptivity.

Your post reminded me of my experiences when I discuss the ketogenic lifestyle. Let’s call them Approaches A and B:

APPROACH A:

Them: “Wow, you’ve lost weight!”

Me: “Thanks!”

Them: “How’d you do it?”

Me: “I’ve been eating a low carb, high and healthy fat diet with alot of emphasis on meats, non-starchy vegetables. Also, I fast every now and then for periods of 20 to 48 hours.”

Them: “Oh. That sounds really unhealthy!”

APPROACH B:

Them: “Wow, you’ve lost weight!”

Me: “Thanks!”

Them: “How’d you do it?”

Me: “I’ve cut out all sugars and refined packaged products, and have been trying to keep my carbs as low as I’m able to. I also don’t eat when I’m not hungry, which, on this way of eating, is pretty common (i.e., not hungry).”

Them: “Cool! Great work!”

It’s amazing how that different approach (by focusing on what I eliminated versus what I actually eat) has such a difference in their perceptions and reactions.

(Brian ) #10

Absolutely agree, Brian. Thanks for the kind words. The hard thing for us to overcome is the “just give me a magic pill” mentality. When I was nearly 250 lbs patients would ask me if there was a pill for weight loss. My answer: “Don’t you think I would be taking it if I knew of it?” I have diabetics who say “I could never give up sweets or bread, just give me more medication.” It is the classic, pass me the cake and I’ll take more insulin and Lipitor mentality. When people understand that they can change their destiny through lifestyle changes, they are typically excited to do so…especially when they see and feel results.

I am so happy that I found this community!

#11

This is so sad. I’ve heard the following analogy lately on some podcasts, which might resonate with them:

“Suppose your child had a severe but non-deadly nut allergy. Would you permit them to eat peanut butter as long as they took a squirt from their epi-pen to counteract the effects of the peanut butter? Of course not! This is sort of what we’re doing by managing diabetes by eating the wrong things and then compensating by taking insulin and other drugs.”

(Bacon, Not Stirred) #12

I am working with a “nutritionist”, who is actually an internist that specializes in weight management. I find it interesting that the only doctors that I know of that recommend keto are internists. Apparently, you’re more advanced. :slight_smile:

(A ham loving ham! - VA6KD) #13

A few weeks ago I was supporting a friend at an Endocrinologist’s office who specialises in diabetic patients. Sitting on a shelf in the waiting room was a selection of free samples of “liquid lunch” products with a sign asking patients take a few to help loose weight which ultimately would be beneficial for their diabetes. Looking at the product label, it was over 60g of carbs and over 30g of straight sugar per serving! I said out loud “Isn’t this just like throwing gasoline on a fire?”…and I was loudly shushed by my friend… oh well…

#14

Wow. Geesh! I think the conventional approach is so concerned at avoiding hypoglycemic events (e.g., car crashes, falls, accidents, etc.) that the medical community feels safer with elevated sugars that then get managed through medication and other interventions.

Or, it could be because treating diabetes is a multi-billion dollar a year industry??? :thinking:

#15

Yes, as an RN this is exactly how it “works” for us. It can be so frustrating, but at least helping people to choose real food is something. However, I feel like it is malpractice when I have to “go along with” the AHA and ADA dietary guidelines for my patients. I pray things will change sooner rather than later!

(Brian ) #16

Unfortunately, it took me 13 years of medical practice to figure it out! I had to try it for myself before I could recommend it to patients. I think a lot of doctors will seeing the light. We are now starting to get great research. The sad part is that it will be at least 20 years before this becomes the “standard of care.” Until then, we will be considered a fad diet.

(Carpe salata!) #17

I think the biggest problem is the concept of compliance. It’s hard work for the practitioner to take the client through the educational process of ketogenic diet - what to unlearn and what to learn. The average client is not considered reliable enough to ‘get it’ and do it right. We on this board are a small exception. Yes, we are exceptional :slight_smile:

Just take one of these pills every day.

#18

This is a huge issue. Many patients want a pill they don’t want to not eat bread. It’s hard to overcome the “pill for every problem” and personal responsibility issues.

(Brian ) #19

I agree, Peter, but I know it is worth the effort. I see the results in my patients. I am a huge fan of Jason Fung and typically steer my patients to his book The Obesity Code and his Youtube videos especially “Intermittent Fasting for Weight Loss.” There are so many excellent sources as well including 2 Keto Dudes (my favorite Podcast). For those with resources Dr. Fung and Megan Ramos have the IDM program for more intensive dietary recommendations at a cost of 1K annually. The Ketogenic Bible just came out and is an excellent resource also.

We all have to do our small part. This is a truly amazing community!

(You've tried everything else; why not try bacon?) #20

Well, I certainly didn’t want to not-eat bread, either, when I eliminated sweets from my diet. I thought I could get away with brown rice and oats instead of potatoes, and whole grain bread instead of the spongy “whole wheat” I had been eating. Interestingly, however, I found myself feeling so much better without sugar that the rest of the carbs started tasting too sweet and they just sort of fell out of my diet.

You still have to keep an eye on me anywhere within five miles of a Dunkin Donuts, however, lol! Fortunately, bacon is a wonderful substitute! :bacon: