Using education to deliver the real food message - Dr Trudi Deakin PhD

[Music] [Applause] education is not very sexy is it you know should we all go home now how can I keep you all stimulated in the next hour well one good thing on my side is that you all had a real food lunch so you're not gonna fall asleep on me are you and and so I still like the challenge of keeping you engaged and education should be informative and it should be fun and so we've tried to make the education that we delivered to patients fun and engaging and we're pleased to report we're having eighty-two percent completion rate on the six-week programs that people attend so I think you know and those people who can't attend the procession it's tough and down to work or illness or holidays so we think we're doing it we can always improve we're always reevaluating and we're always striving striving to do better but education just working it helps if you turn it on I suppose right education it's a riotous intere as some said I started out in the 1990s as a dietician in the NHS I'm now I left the NHS in 2008 and set up a registered charity called expert health so I could further develop and evaluate and test out different models of delivering education so my journey started in 1990s and a quite shortly specialised in diabetes and it was like a conveyor belt I was doing nine clinics a week and people coming in seeing the consulting the dietician the nurses getting clips of information and they were saying to me things like but I don't eat sugar so why my blood Sugar's high and I thought they don't understand what diabetes is they don't understand what happens to food when they eat it it's not just sugar that impacts on blood glucose levels it's carbohydrate so I started to do some active listening started to us hold focus groups and say to people what information would help you better manage your diabetes how do you like that information delivered and what they said to me very loud and clear is that we don't want to be talked at we don't want to be just given well a leaflet and be told to go away and just follow the leaflet we want to understand how our bodies work so that started my journey to try and help people to self manage their condition and now we've got three programs the prevention of diabetes type 2 program for people the expert diabetes program for type twos and the expert insulin program for type 1 and type 2 and this summer we're launching the expert weight management program and we're piloting with the National Grid so it's going to be four employees working with the National Grid people don't want a degree in nutrition they don't want a degree in physiology but what they want to do is put the jigsaw pieces together and understand their bodies better so we see as collaboration it's about us as educators working together with members of the public to help that kind of desirable of people making informed decisions so our education isn't dick toriel it's not prescriptive it's all about people learning the information and then making informed decisions so we deliver the education if you like to drive you don't just take one learning one driving blessing you take a series of driving lessons and we've explored and found out that fifteen hours is about the right amount of Education that people need to start to really understand their bodies better and the education and the current programs is over six weeks so it's two and a half hour sessions for six consecutive weeks but the wait program will allow people to come at lunchtime so it's short sessions over twelve weeks so at the end we use Discovery learning but at the end of every week it's been our people setting goals you know from listening to the topic this week what's my biggest concern right now now we know behavior isn't often the problem it's the things that cause the behavior so if you think of behavior as the iceberg sticking after the water what's causing the behavior like they you know evening snacking or something like that it's the things that underpin that behavior things hitting on way underneath the murky waters like values and beliefs and past experiences so most people have explored that it's thinking about what's the way forward what could I do to tackle this concern but if people try everything how to end up feeling overwhelmed so the next bit is well well I leave this session today what am I going to try out and experimenting experiment is a big word because we don't always get it right we're human beings but by experimenting we can find out what works for us because what works for me doesn't necessarily work for anybody else and people need to evaluate you know what do I want to happen after making this girl when do I want it to happen and how will I know if it has happened so it's all about that constant evaluation as well we're creatures of habit so if you do what you've always done you'll always get what you always got and so it's about sometimes stopping and thinking and thinking okay what could I do differently what are my health goals everything in life there's good choices and bad choices and if we make more of the better choices then the consequences will improve so there's this you know exercise so in the handbook there's every week the specialist goal-setting forms them to complete if they want to do so some people would rather just work things out in the head some people like to write everything down again we're all different so those people came to the workshop this afternoon I was using a tablet and doing drag-and-drop and we had to do it that way or we use magnetic boards and magnetic labels the reason why we don't use powerpoints is that if you use PowerPoint you have to do it in a certain order and therefore you can't follow the conversations that your group wish to have you have to say no we're doing it this way in this way only so by using either drag or drop or a magnetic board you're following the needs of your group so this is a put together kind of magnetic board after the what is diabetes activity which we do in week one and to give you a sense of the discussions that might take place we call this discovery learning we start off with the board almost blank and we talk about food you know when we eat this sandwich picture a sandwich up there when we at this sandwich what the three main nutrients that the sandwich breaks down into well its carbohydrate protein and fat which warmoth those nutrients breaks down and directly impacts on blood glucose levels a lot of people say fat because the program's believe that fat is bad for them so you know I can see where you're coming from as a common four but let's explore that further it's carbohydrate what's carbohydrate building blocks of glucose and fruits you go fructose and the milk sugar galactose and when we break it down the glucose goes into the blood and it raises blood glucose levels but well we like to use glucose for energy but can we use the glucose for energy when it's in the blood no we can't where does it go it's got to get into the body cells how does it get into the body cells that's where the insulin comes in so we produce insulin so getting it into the body cells will produce the insulin which acts like a key so if it's perfectly in the key hall of the cell wall unlocks a door and allows the glucose to enter the cell ideally we would leg want to use that for energy but if we don't need it for energy we stole his glycogen and if the glycogen stores are full we then convert it to fat so that's what should happen and in somebody who hasn't got diabetes are excellent diabetes control blood glucose levels tend to remain between 4 & 7 but we now know what 2/3 of the population are overweight what causes that what causes people to be overweight well we all know it's the high insulin levels so if people are producing too much insulin and they've got the insulin resistance the insulin causes the body's being fat storage mode so there's going to be storing more fat and creating the insulin resistance so then they can still get the blood glucose levels into the cell and produce some energy but not as much now type 2 diabetes as we know is a complete opposite condition to type 1 diabetes where they stop producing the insulin and so they're hype or is Lima Creveling hyper is lemic the symptoms the same he'll make the symptoms of both type 1 and type 2 diabetes are raised blood glucose levels the rise above Tang and the flush out in the kidneys out the urine so we have it here showing as a waterfall so that gives you an idea of how we educate people about what diabetes is now a common belief is that type 2 diabetes of people live long enough than I'll start making less insulin and they'll need insulin injections and this is a really good graph here that shows if you look at lying a it shows that it's working yeah oh yeah but yes you know the peak of insulin the first phase insulin response does reduce from somebody who's got impaired glucose tolerance who is obese to somebody with advanced type 2 diabetes but if you look at line B then the peak it's still higher than somebody who is normal and lean and the basal insulin levels are still much much higher than somebody who is normally or normal obese so type 2 diabetes is a condition of hyperinsulinemia so why then I will spent years giving people with type 2 diabetes insulin and we're just relaunching our insulin program and we use where the slogan is reduce or omit because it's the type 1 and type 2 diabetes well type ones we'll never be able to omit their insulin BIRT by changing their lifestyle and reducing their refined carbohydrate they can certainly to reduce their instant requirements type twos now we're hearing many many stories of people with type 2 diabetes being able to come off their insulin altogether and so we educate you to understand their health results so the metabolic syndrome then there's you know if people got three or more of these conditions that I'm out of target then they're going to have insulin resistance so we'll help to educate people to understand what the metabolic syndrome is and to be able to because you can't have a test in routine care around you know to test if your insulin resistant - have you got high insulin levels but if people have got three or more of these factors that are out of target then that suggests that they've got the insulin resistance and high insulin levels so this is the patient's handbook and on the last page of the handbook people can plot their health themselves we really encourage people to go to their GP and get the health results we do explain they want to have all of these done and so you know we say we all have the ones done that are required for you because last thing we want is get really unpopular with GP say why have you told my patient that they need all these health results so we're very clear that they may not have all these results done now this is we're just developing the expert wait wall and we actually remove total cholesterol because it's meaningless and LDL cholesterol because it's calculated and not actually measured from the expert weight health indicators monitoring health form and replaced it with visual fat because now with two nito's grain scales you can actually have a visceral fat so that's the fat in and around the organs can you actually measure that with the scales or getting an assessment and we've also replaced it with the waist height ratio because that's a really good monitor so if the waist height ratio is less a naught point five then that suggests that you are a healthy so it's much more around the waist circumference than it is around the actual body mass index so the clinical indicators of health indicators are explained in their handbook and so people can back up the education between sessions by reading through the information and we really do focusing on waist circumference the importance of measuring the waist and also how to do it because it's something that people can quite easily do themselves at home and then we'll have pointers so if people want to lose weight reduce their triglycerides increase the HDL reduce their blood pressure then we give little tips or things that people could experiment with and try out to achieve their health care outcomes a lot of it really focuses on the seven lifestyle factors for optimum health so the running kind of theme throughout the program is talking about you know what is a healthy diet physical activity stopping smoking controlling stress and sleeping well and remembering to take ascribe medication if it's required and and wrinkle and moderation in session two then we really address limitations to do with energy balance they eat less more message and instead replace it by saying that obesity is a whole normal condition and you know if insulin levels are high that's just only one with the many hormones involved then that puts the body in fat storage mode if the body is storing energy around that energy being available to use that leaves the individual feeling tired and lethargic over the years the amount of patients I see who have tried really really hard with the eat less move more message and ended up just feeling completely miserable because they're tied all the time and the hungry all the time and this offers hope I know Jen talks about hope a lot this offers hope to a lot of patients who have tried to lose weight for many years and when they've done that they create an energy deficit so if they require 2000 calories and I'm just repeating now or Jason fund said this morning they require 2000 calories in a day and they drop it down to 1500 by eating less and moving more yes of course little lose weight in the short term all diets work in the short term so yes they will see it and then they'll feel really motivated then but then what happens the weight plateaus why does it plateau because the body responds to less food being taken in and so reduces the metabolic rate so the basal metabolic rate drops to 1,500 calories so what happens then the way it's plateaued and the person starts to lose her willpower they start to get fed up because I'm not seeing any further weight on the scales so they start to put back in their food their diet their favorite foods cuz the foods that they've been missing so what happens then they regain the weight that they've lost but because the basal metabolic rate still stays low they overshoot and put more weight on so they end up with a highest setpoint so they often end up at higher weight than what they were before so when you hear about all diets fail yes they all work in the short term but most people end up way more after a diet than they do before what happens to the willpower there believe that Dave done something wrong they believe often that they're a failure and so they'll say rat will do better next time so it becomes a vicious circle where they think right I'll try harder next time I'll do it better let's turn this around to be so much more motivating let's think about low carb intermittent fasting how will that do it so people can Britt base their food some real foods or miss out some meals they'll lose weight but there'll be no plateau because if you drive down these thing levels the body can use its own it's like taking the padlock off the fridge the body then can use its own fat stores as energy so the body is getting the energy so it doesn't need to slow down so there's no plateau so then people can continue to do the low carb the real food eating and the intermittent fasting so they can lose further weight so then they can reset their body weight at a lower level so the after after is a much better picture and what does that create confidence confidence to continue and adapt adopt the dietary approach as a sustainable lifelong approach so how do we teach people about nutrition well we've developed our own model nutrition for health model yes there are some similarities to the eat badly guide because there are five food groups but that's where the similarities stop so we encourage five to nine portions of fruits and vegetables two to three portions of good quality protein two to three portions of the milk and dairy but you'll see that the carbs and the fats merge into another and that's where patient choice and options coming because we're all unique and we all have different taste preferences so we offer four Dietary Approaches either low fat men swinging low carb or intermittent fasting people might have choice as adults would don't like to be told now many people have been programmed for decades that fat is bad they don't actually like the taste of fat in a longer and it's they're able to adopt a real food diet by keeping that restricted and having more carbohydrate that works for them and helps them to maintain their health goals or achieve their health goals who would knock that so we do support people in adopting all four Dietary Approaches so this is what we sure when we're looking at the low-fat dietary pros you'll see the line now strict in the fat and people consuming more carbohydrate but there's nothing in that process squaring there in the center a perhaps for the odds cereal bar or something like that so if people adopt a real food diet they're cutting out the biscuits the crisps the snacks and those things can actually help people to lose weight and lower their blood glucose levels most people even going on a low-fat real food diet are actually reducing their total amount of carbs in a day when we talk about the Mediterranean style of eating then people having a similar amount of carbohydrate as they're having fat so around 40 percent of the calories come from fat around 40 percent of the calories come from carbohydrate and so some people say yes really like that diet or approach that that works for me but other people who are perhaps more insulin resistant struggling to get their glycemic control or lose weight might decide to go for a little carb dietary approach if they're just going a little carved oh Michael listen 130 grams a day if they're going very low carb then they've going less than 50 grams a day it's personal choice the advantage of very low carb is they being in nutritional ketosis and that scares a lot of health care professionals especially when the working diabetes because they think of ketones as being deadly DK a diabetic ketoacidosis but the two conditions are completely separate if people achieve nutritional ketosis of levels between 0.5 and 3 when insulin levels are low blood glucose levels are low and they're not completely hi Paul Ince lemic then it's a healthy state to being babies are in a state of nutritional ketosis and that helps with the high fat breast milk and that helps the brain development and then with intermittent fasting then you know those last few decades we started eating five or six times a day and that's not the way that our ancestors ate that drives forward it drives openness and levels so the green is the good there so the agreeing on the top graph shows a very small period of time in a 24-hour period where somebody is able to use their own fat stores for energy whereas the bottom graph that person is just having lunch an evening meal so just see how much more time there there are where the green section is which means that the insulin levels has dropped and they're able to use their own fast doors for energy so that person was just having you know even somebody's cutting the snacks can achieve weight loss and improved glycemic control much better by reducing the frequency of which the ate let's look at this in an hormone level a reduced calorie diet drives up insulin levels and therefore drives up fat storage and Jason talked about the hunger hormone the gren in this morning so that stimulates the brain and so then people feel hungry and tired all the time long-term weight loss is not possible so in comparison to that their intermittent fasting their insulin levels low grain levels low and so you they increase more leptin which reduces hunger selecting these is released a chemical hormone that's released from our fat cells and that reduces hunger also a good home on a hormone that were producing the goat pyy that is released as well and that also reduces hunger and so that is one of the ways that people can succeed with losing and having a lower set point for their weight over a period of time the different types of gangue the so much choice pea might do time restricted eating and so they might fast for 14 hours in a day and eat for ten or they might fast for 20 hours a day and eat for four hours or they might fast for 24 hours and not eat anything they might do it once a week twice a week every day so so many options there for people to do when we're thinking about I mean when we talk about fasting people think about the five-two because that's very very popular but does it have to be 5 - no they could fast just one day and eat for 6 or they could fast for six days and eat for what there's so many options they're available and then there's alternate day fasting as well so people just test out and say well okay then what works for me now this miss isn't not and Jason did talk about some of these this morning so much go fly through them fasting you need to eat to keep your metabolic rate up that's nonsense so when you fast then you meta bitrate it's got keeps high because of the hormones but also because you're using your own fat stores the body doesn't feel it's being starved people that was a starvation diet no it's not a starvation diet because when you break the fast you eat well you eat to satiety I'm going to lose my muscle no the body will always use fat if it's available so you drive down the insulin levels the body will use fat in preference to muscle it will course disordered eating people start binging well if people have got an eating disorder already then yes but that's means they're already binging but what we find because it drives down hunger people often say I'm not as hungry any longer so when they break the fast they may have more calories in that meal and what they would have done if they hadn't have been fasting but it's not going to you know be excessive compared to what they were doing before he's nutrient deficient no it's not because people when they break the fast are eating real foods which are nutrient dense but breakfast isn't that the most important meal of the day no there's no evidence to support that at all breakfast is not the most important in the meal day especially if you're eating refined cereals so the top tips is keep hydrated have salt get some bone broth to keep the minerals in the natural mineral thing and stick with it because if we're programmed to have in breakfast snack lunch snack evening meal supper then you are going to feel like psychologically you will miss that eating at first but if people stick with it they often get used to it so when people experiment with say well you're giving time because we are creatures of habit and it takes time and don't try to do intermittent fasting with a low calorie don't count calories when you break the fast eat to satiety a true satiety truthfulness so we give people in their resource box information about different foods which food group it belonging and the reason why we do this is that people can assess the diets then of how many portions to having a different foods so we teach people to perform their own diet resettlement in the old-fashioned way people used to go to a dietitian and have their diet assessed and be told what to do so I've completely turned you around so assess your own diet we've got a simple model here and it's how you do it plot a typical day of how many portions you're having a fruit and veg protein milk and dairy fats and carbs so then you can see what your starting point is what dietary approach are you currently having how many foods are in that process square and how many foods are outside it and so people cannot determine what a portion is because a lot of people say oh I've had two banana that's the passion fruit with that banana the edible part of that banana weighs 160 grams which is very very easy that's two portions of fruit not one portion of fruit so you know people portion that especially fruit portion size they've got so much bigger so it's allowing people to really understand what a portion is and so they can look at the present diet and plot that and say okay then yes I'm currently having a low-fat diet or approach what do I want to do what is my aims and how I'm going to achieve that and then looking ask themselves questions about you know I'm having the right amount of carbohydrate for my dietary approach etc etc so we then have to go on those people are being repetitive for those people attended the workshop this afternoon on fad awareness but what we found is that if people are going to adopt a real food dietary approach whether it's low government training or whatever they have to get over their fear of having healthy fats so we do fetch awareness so in our blood we have glucose that's a healthy level we have a small amount of insulin we have some tribus ride so triglycerides of Wong is healthy we have hopefully a large buoyant LDL so we've got three in there we don't want any small dense LDL but we do want some HDL so we pop them in there we shown there was transporters because our blood vessel is a bit like a motorway system and cholesterol is essential to life and the trucks the LDL character where it's needed and the HDL the Rose Reaper picks up the bits that excess and takes it back to the liver where can we package it so they only talk about fat awareness that's a healthy picture how do we get that we get that healthy picture from eating real foods so food rudia keep on pressing the wrong thing so foods that they both to the egg so the natural saturated fat and cholesterol in real foods as well as the oily fish and the monounsaturated fats like the oil like the olive oil so that is not going to create unhealthy picture in our blood vessels that this is a different story and this person is at increased risk of cardiovascular disease because what are they diet doing they're having the junk food diet they're having the processed foods with the trans fats and excess carbohydrates and a lot of the omega-6 processed we find oils as well and so their body's going to be in state inflammation and high insulin levels which will go drive forward high triglyceride levels fatty liver tribes' rag rich transporters cause the truck to shrink two cars and if you want an explanation I haven't got time to give it to you now but I do have written a paper on that which explains the processes involved how they smoke a large buoyant LDLs shrink small dense ones if there's too much triglyceride in the blood so as information for the participants in the handbooks to back up all that education and in week 3 then we do the carbohydrate awareness as well because people have kind of proven especially when the diagnosed with diabetes think it's sugar that's all bad and forget the rest of the carbohydrates so we show here that a slice of bread 3 teaspoons of sugar small apple and a glass of milk all have the same amount of carbohydrate around 15 grams of carbohydrate and the amount of carbohydrate is important but then the way that the impact from the blood glucose levels are slightly different and that's based on the building blocks so you can seem to the bread there you have building blocks of the bread it's glucose and so all that glucose goes directly into the blood so that's got the highest GI so a lot the starchy staples in our diet have got higher gi's than sugar so why has sugar got a lower GI that's because sugar is half glucose and half fructose the fructose goes to the liver where it's either stored as glycogen but the glycogen stores are full it's converted to triglycerides de novo lipogenesis making new fat oh my goodness right blue blue blue I'll start speaking very quickly and so so yes you know sugary foods might not have the same direct stimulation on blood glucose levels Bert they do have a direct impact on the fat that's in there in the liver and they can still impact on blood glucose levels later if it's converted to glycogen so that is somebody who's eating beyond their carbohydrate their personal carbohydrate threshold and so we all have our own personal carbohydrate threshold we all know people can have a huge amount of carbs and keep slim and healthy with all their blood results in the right sections whereas other people just respond badly to carbohydrates so how do people know what their personal carbohydrate threshold is they learn about the source of carbohydrate in the diet and we play a quiz which is the winning team gets a prize to help people to come more carbohydrate aware and also we look at the impact of those carbohydrate foods on insulin levels and so said to people okay then one of the ways that you know if you eat in the carbs the right amount if you're eating too much then it's likely blood glucose levels gonna be raised you go struggle maintaining or losing weight you might be feeling tired and hungry all the time and you might have an indication that you've got fatty liver and so we help people who've got diabetes we help people go through a flowchart to identify if they what their carbohydrate threshold is they haven't got diabetes and they want to do it through weight management then that's another flowchart there which helps people to identify what a right level of carbohydrate may be for them might not be for them but it's a starting point that they can experiment with in week four we look at understanding food labeling now obviously if people are eating real food they're not going to buying a lot of food packages but they will still be buying some food in packages and they need to understand it now unfortunately our food labeling system it's based on a low-fat diet so Reference Intakes traffic like coding are all their support people having a low-fat diet so we've developed our own guidance to people who are adopt my training style or a low carb diet so it's instance it says there that a low carb food generally speaking rule of thumb is where the carbohydrate content is less than 10 grams per hundred grams people have laws and lots of questions can have coconut oil it can have full fat or fat milk and dairy what about chocolate so we've got nine pages of frequently asked questions that really help people you know and rather than getting on the phone or emailing your it gives them all those answers right there and then and people ask a lot of questions around alcohol as well and we call it cold - these with alcohol it's got you know virtually nil carbohydrate moderate amounts carbohydrate or large amount carbohydrate chocolate isn't interesting as the dark of the chocolate the carbs come down but also the fiber increases so 99% cocoa chocolate 20 grams of funny both 100 grams and 80% of that is sober fiber we discourage snacks but if people have to have a snap for a medical reason or them placing and replacing a meal with a snack they're not so by far they the healthiest choice and in diabetes they die a digestive biscuits often being thought of as being a suitable for people with diabetes and this just goes to show that not so by far the healthiest snack now if people aren't put off with a sheer amount of the omega-6 fatty acids in the seed of vegetable oils then so you can see at the bottom line there you can see that the sunflower oil and the corn oil much much higher in the omega-3s then it's not some people of having them the processing will because the seeds health that go into that processing but the end product is nothing healthy about it at all in fact when you use vegetable oils for cooking they are volatile add aldehydes are 20 times greater than what the World Health Organization stay that we should be having I'm going to really rush now I think there's information there or maybe these slides will become available or won't they so a lot of the information people ask questions about sweeteners and so you know we can say well Polly oils if you have to use one polyols are more natural and they can break down short chain fatty acids and help they got microbiome as well talk about physical activity the benefits frequency intensity time and type and encourage people like activity bracelets very very motivating for people to count steps and things like that and get apps on mobile phones as well and keeping activity log not just for aerobic but also resistance training as well and then in week 5 not causing anxiety but people really do want to know what the possible complications are now a day-to-day basis is fluctuations in Temple cause levels even people without diabetes and that can cause hunger and tightness mood changes and if people are taking medications drive down low glucose levels it can be also quite dangerous as well so if people make changes to their lifestyle they may have to come off that medication and they see their their blood glucose level fluctuations level out but you know dementia is classed as type 3 diabetes in T and I've just read a fantastic book by Amy Bergeron the Alzheimer's antidote and great book you know so some of the things we're learning about how our lifestyle can actually changing our lifestyle can reduce our risk of developing all of these possible complications there are 80 percent the diabetes budget in the NHS is spent on managing diabetes complications and they're all preventable so the given guidance of what the complications are on how to reduce them and we also go back to the 7 lifestyle factors to prevent and we focus more in on stress and sleep and I agree with Malcolm when he said earlier that we all come across stress every single day the problem is is when stress becomes a strain so it's all about yes we have stress in our lives but how can we deal with it better how can we have better sleep in week six this is right at the end to bring every two Gail education should be from so I've designed this game and it's bit like snakes and ladders you have six teams and they can only move down the board if the answer a multiple-choice question correctly and the multiple choice question is based on the content of the program and they might end up on a penalty squared such as heart a heart attack golf or cardiac rehab so they're going to the half cardio rehab Ollie might go on ask we're saying you've walked for 30 minutes a day shake again they start off as carbohydrate and if they go on a bonus square they digest into glucose and their insulin is released from the pancreas the end of the blood vessel they've got to dodge hyperglycemia hypoglycemia insulin resistance and they've got to get right in that bonus one at the end the answer the last question correctly there in team and they get surprised so it's really good for and people get awfully competitive but it's a great way to finish the program so that's me dog we believe that we should educate not medicate and let food be thy medicine so thank you very much for your attention [Music]

Channel: Public Health Collaboration

Views: 1,836

Rating: 4.878788 out of 5

Keywords: diabetes, diet, nutrition, health, public health, low carb, obesity

Id: S2mtYdr6uBM

Length: 39min 28sec (2368 seconds)

Published: Sun Jan 21 2018