Monday, June 09, 2008

Gluten Dr Briffa link

Not sure if this sort of thing has ever happened in the UK before, perhaps the parents and child discussed by Dr Briffa live in Nottingham. The case is highly complex, but here's the summary:


No wheat=no diarrhoea

Now, to assemble this Apollo 13 rocket, first remove all contents from packaging and make sure all pieces are present, locate an appropriately sized launch pad, take the first nut and an appropriately sized spanner (not supplied)...

The question is whether the dietitian and gastroenterologist can hide behind a negative coeliac antibody test (in a wheat avoiding, currently digestively normal coeliac) to justify their execrable behaviour.

I'm not much of a clinician nowadays, I'm pretty well ruined as far as belief structure in the marvels of the latest anti inflammatory drug or chemo protocol goes, but the one thing that I do still try very hard to do is to listen to my patient's owners. In their own way, from articulate to incoherent, these people are trying to tell you what the problem is. Relying on a set of bloods (normal) and an abdominal ultrasound (inconclusive) will miss you the opportunity to sort out an awful lot of problems.

Luckily the child's problems were limited to the superficial and highly responsive problem of diarrhoea in response to gluten. What if the presenting symptom had been gluten ataxia, hypothyroidism or systemic lupus. Scary.

Anyway, skip's arrived, time to shift some rubble!



Chris said...

It is quite interesing to read the comments on that post.....various dieticians getting quite defensive!

Anna said...

Yes, the bickering (on all sides) is a bit much after some of his posts, especially the past few. That part is a real turnoff. There were some similar commentaries a few months back that degenerated into a bickering competition.

I really appreciate the thoughtful, informative (if sometimes over my understanding level) commentary on Hyperlipid.

Peter said...

Certainly Dr Briffa attracts quite a lot of defensive comments from NHS dietitians. Perhaps some of it is because he is a combination of being "in the system", being moderately "altie" and being mostly right.

Where as an NHS dietitian has a mountain of garbage advice to be VERY defensive about.

As for the medics, I'm glad I'm not in a position to be berated for failing to report Toxic's gastroenterologists to the GMC.

I'd also like to add that my own GP seems pretty clued up. He has been pretty good with the problems we've run in to where we've needed specific items best obtained from the NHS, rather than anywhere else!


Anonymous said...

"I really appreciate the thoughtful, informative (if sometimes over my understanding level) commentary on Hyperlipid."

I second that. Only a few comments here go over my understanding, but they are usually thought-provoking and informative.

frank said...

Thanks Peter for that link - quite entertaining. I share Dr Briffa's generally very low opinion of dietitians having worked with many over the years. "Got cancer? Here have some more sugar!" Or, "have this soy bean emulsion TPN intravenously - you'll soon be feeling better".
A study (I can't immediately put my hands on)demonstrated that nurses were just as effective as dietitians in preventing diabetes complications, despite little or no "formal" nutritional training (most likely because of).
One dietitian harridan attacked me at a work dinner - she eavesdropped on a private conversation - she grabbed me by the arm and screeched "there's no such thing as good cholesterol" in a thoroughly disturbing manner.
The British Dietetic Manual states that trans fatty acids are metabolised in the same way as saturated fats and that wheat is pretty much essential to life! Catherine Collins RD is full of poop. She's now chief dietitian of St George's (where I trained) - be very afraid!

Peter said...

Hi Frank,

When you get immersed in nutrition the answers become so blindingly obvious that I often feel that blogs like Hyperlipid are about to become irrelevant. Most of the answers are in Pubmed. The causes and managements of so many diseases are written on the supermarket walls in letters 5 feet high. Someone with macular degeneration could read them if they have any of their peripheral vision available. But while we have registered dietitians of this calibre Hyperlipid is probably safe from redundancy.

Re the obstipatory aspects of a certain person's bowel habits. I would agree, it does seem to show in her personality. Ah, whole grain opioids, a bit like a self retaining methadone suppository, back to Trainspotting again.


Dr. B G said...

OMG... you guys KILL me (more than whole grains) *he hee*


Melodie said...

Interesting, give a special kind of diet for epileptics (not the purified stuff), give a special diet for both diabetes types, give a special diet for cealiac disease, give a special diet for high performance athletes...give a special diet to the average person: HF/LC is the way to go!

The fact that something can help the pathological as well as the healthy, indicates the naturalness of such woe.

raphi said...

Hi Peter,

Just came across this old post of yours while commenting on the more recent ones.

In case you maintained a peripheral interest in the gluten question, here's my breakdown ( of a 2013 double-blind cross-over study on gluten's effects whilst controlling for FODMAPs.
In a nutshell, the nocebo effect is VERY strong; gluten always has some measure of guilt although it seems highly context dependent.
I still don't think anybody should eat gluten but certainly, many people can do so with little (known) impact.