Tuesday, May 03, 2011

Wanna see what diabetic hospital patients get fed in Ontario?

(That pie represents the caloric macronutrient breakdown of a Rice Krispie.)

A reader of mine emailed me yesterday with a video she took of the diabetic breakfast she was served at an Ontario hospital.

What'd she get?

A refined flour based pancake, syrup, a bowl of Rice Krispies, a glass of apple juice, and a coffee.

The only diabetic consideration? She received an artificial sweetener for her coffee, rather than sugar. Basically, she received a breakfast full of refined carbohydrates that her body'll process nearly instantaneously into simple sugars. And for good measure I suppose, she was provided with a glass of sugar water to wash the carbs down.

I don't think her case was unique.

I know that when my grandmother-in-law, also a diabetic, was recently in hospital, she too was given highly refined carbohydrates and juice with virtually every meal.

RD readers - if any of you folks work in a hospital can you let me know if this is typical, and also if there's anything a patient can do about it?

How difficult would a breakfast inclusive of protein, and with only whole grain carbohydrates, be to prepare, and how is it that her hospital's doctors, dietitians, and other allied health care professionals are ok with this being served to their patients (diabetic or otherwise)?

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  1. Debra M7:41 am

    I don't work at a hospital but over the last few years I have been a patient several times... and I have to tell you that sad to say, each and every time and at every meal this is the case... I was suppose to be on a diabetic diet (one of the times I was there because my blood sugar was over 700) and served food that would never cross my lips if I was not in the hospital... each time I remarked on how they were giving me to many carbs... but it did not change anything. I was amazed, and would be there days longer because they could not get my blood sugar down to an acceptable level. I wonder why?

  2. Paulette8:05 am

    Pretty pathetic and totally typical of what was served to my husband during a hospital stay a few years ago when he had a heart attack, largely attributed to his diabetes as his angiogram showed very little plaque and there were no blockages. for much of the time he ate as little as possible, as he knew what the fruit juice, fruit and starch heavy diet would do to his readings. I know price point is paramount in hospitals with limited food budgets, but even so a creative RD should be able to come up with a more balanced meal plan. I don't believe that this is the best the experts can do.

  3. Anonymous9:57 am

    I recently had a session with an RD. I couldn't believe the industry supportive bumpf she was being paid to foist on me. I'm not diabetic, but I have the other industry shibboleth, high cholesterol. No cardio disease though. Hello.

    I was treated to the most ridiculous explanation of what causes cardio disease, what happens in your arteries when you eat cholesterol, and how my high cholesterol diet (3 percent milk, 1 cup per day; salmon, an egg) was causing my high cholesterol LDL. No one pays any attention to my HDL. Industry doesn't have a theory or pill for that yet.

    What really galls me is what these professions are billing the crashing healthcare system to push misinformation and potentially damaging info on us.

    Which, if I refuse, I am called non-compliant. Up is down.

  4. I saw it in Indiana just last month with my mother in the nursing homes. A typical family reaction is not to be concerned that they're feeding her the wrong thing; instead, you tend to think there's something "special" or non-sweet about the item they're serving. "Wow, they have diabetic cake here, how nice!"

  5. I have been a patient in two different hospitals and in both, we were given a printed menu each day and allowed to select what we wanted for our meals for the day. Being a diabetic, I received the diabetic menu choices and was advised how many carb options I could have per meal (usually 1 or 2).

    I was also a resident in a nursing home in a bariatric program for 4 years and there, we received a set of menus for the month and were expected to choose meal options that fit in with what we were being taught in our nutrition classes. One carb choice per meal (bread, rice, potatoes, corn, etc), one protein, salad and a vegetable. Dessert was a choice between a piece of fruit, sugar-free ice cream cup or sugar-free pudding.

    I learned on my own to avoid the carbs and just stick to the protein, salad and vegetables.

  6. Just this morning, my pregnant sister told me she is concerned about her blood glucose test tomorrow. If she were to be hospitalized with gestational diabetes the hospital is not equipped to feed her. A great concern to us given that she has triplets on board.

    I didn't believe it til now....

  7. Amanda1:42 pm

    I am an RD in an Alberta hospital and unfortunately that probably is typical. I know with many hospitals dietitians actually have very little to do with the menu despite what is often the public perception. When I tell people that I work in the hospital they automatically assume that my main job would be to make up the menu. Sadly this is not the case. Menu decisions are often made by untrained food services supervisors or managers with often little or no input from an actual dietitian. This is also the case in long term care or assisted living facilities. A dietitian has to compare the menu to Canada's Food Guide in Alberta to make sure that it meets the minimum servings of each Food Group, but I of course know your opinion on CFG :)

    I suppose we're lucky in Alberta now that "we're all one" as they say under Alberta Health Services because there's committees of dietitians who are deciding what should or should not be allowed on every single type of diet you can think of. AHS is also becoming quite strict in terms of things like sodium, which you would be disgusted to know is very high in hospital diets (even a low sodium in our hospital is allowed to have 3 to 5 grams per day!)

  8. Anonymous1:48 pm

    Are we really surprised that hospital food is crappy food? The dietitians probably have little say in what is served. Big batch institutional cooking with the cheapest ingredients available. It all comes down to dollars. Sad. I am an RD, and like in any profession, there are a wide range of beliefs and practices. Some of the things my patients tell me their doctors tell them to do is downright scary. And I have to toe the line to not offend the doctor, because heaven knows, the doctor knows everything and I'm just a lowly dietitian.
    In my job, I accept no sponsorship from food industry. I do not use food industry resources. I had to ask to have my contact info removed from third party mailings from the Dietitians of Canada to stop getting crap from the likes of Pepsi, mcdonalds and the sugar institute.
    I recommend real, whole foods to my patients. It is an uphill battle. Food industry has way too much power and advertising clout. Too many subsidies go to produce cheap 'food like substances'.
    Now I must go and eat my real strawberris and 3% plain yogurt with a sprinkle of ground flaxseed.
    My word verification just made me laugh (good to dispell the frustration I feel right now!) It is 'scaries'...hahaha...food companies are indeed scaries!

  9. Anonymous1:52 pm

    Dear muchabout

    I'll bet my ice cream budget that your dietary choices were only available to a segment of the nursing home residents. American owned for-profit care centres here which charge $5000 a month do not offer choice or amenities to a segment of their residents who are a partial subsidy, from Canada's universal health care or maybe HMO type healthcare in the U.S.?

    People don't see this wing of the building, aren't allowed to enter it, it's kept locked and the residents do not join you in the dining room, hair salon, around the piano and pool table in the recreation area, will not be included in the Xmas concert. They are people with dementia, Alzheimer's or people who are just plain POOR. The for-profit care centres make a pile of money off them, taking almost the same fee, but giving back nothing.

    And don't under any circumstances have a stroke that leaves you cognitively challenged. That's where they'll move you, and if your family doesn't like it, they will be told to take you home and care for you themselves.

  10. Anonymous2:06 pm

    Strawberries, which Alberta city are you in? :)

  11. A. Tobias2:26 pm

    I have just been diagnosed with gestational diabetes. I've also been appalled at my experience thusfar. The main diabetic education center in town gave me grossly erroneous and vastly over-simplified carb counting education, without once making an attempt to assess the knowledge that I come to the table with and go from there, even though they knew I was a physician.

    And this weekend I had to be hospitalized for a pregnancy complication. I had to have steroids, so my sugars were running higher than normal, but the dietary choices I was offered match with everyone else's experience. Pancakes for breakfast! At least without juice on the side. Mashed potatoes and gravy! Animal crackers for a bedtime snack (un-asked-for, BTW). Definitely an area that could use some attention from a medical standpoint.

  12. Did you forget that Diabetes is all about the FAT? I have been climbing this slippery wall for more than a decade with dietitians, doctors and patients, trying to reverse the fear of fat myth. At least your readers are brighter than most, and actually read the science and expect better.

  13. Anonymous5:49 pm

    I am diabetic, and was recently in the hospital in Edmonton, recovering from Knee Replacement surgery. I was also given the same kind of diet as you mentioned here. When I asked why, they said, oh, sorry. Want some fruit??
    They were happy to give me Metformin and test my blood. But the food was tragic.

  14. Anonymous6:42 pm

    I am also an RD and also work in Alberta hospitals. I find it difficult and frustrating when I provide education to patients in hospital. Many patients think that what they are served in hospital is an example of what a healthy diet should look like.

    I don't really know why the menus are so terrible. Technically, as long as they meet CFG, they "pass". Of course cost is also an issue - whatever is fast and cheap will likely end up on the tray... as long as it meets CFG, of course. ;)

  15. Kristie8:38 pm

    I have to say that I take offense to the statements, " Menu decisions are often made by untrained food services supervisors or managers with often little or no input from an actual dietitian." and "The for-profit care centres make a pile of money off them, taking almost the same fee, but giving back nothing" in the comments.

    I am a Nutrition Manager in Ontario who has been trained in developing and providing healthy menus. While not a dietitian, I am in charge of the nutritional program (assessments, production, menu planning, clinical care) for 120 people each and every day. I work for a for-profit long term care and retirement company whose priority is "residents first." As a company, we try very hard to provide a healthy menu by serving whole grains (in cereal and the breads to make sandwiches), fresh fruit (on our snack carts three times per day), and seasonal fare when available. The problem lies in the amount of money the government provides us to feed each person per day: $7.33. That amount is way less than the $11-$12 given to the criminals in prison. With rising food costs and a fixed amount of money, it is extremely difficult to provide what we'd like to provide. Wouldn't it be wonderful if we could provide our residents (and hospital patients) with a 100-mile menu?

    On another note, I too was appalled at what I was given to eat in hospital last year when I gave birth to my daughter. Being a diabetic, I was given a huge white bagel and rice krispies for breakfast. I made a complaint to the food services department of the hospital but I doubt that things have changed. They too are managed by the almighty dollar.

  16. Ceci V10:14 pm

    I can vouch for the comments being made re: Alberta hospitals. Clinical Nutrition and Food Services are two separate departments (though Alberta Health Services is trying to put us together as one), and often as dietitians we just put the order in and cross our fingers and hope the diet is ok! When I do counsel patients I often hear frustrated patients that feel that they aren't receiving what's appropriate, and I can't do very much about it except direct them to Food Services staff.

    To make matters worse, they recently made a move to lay off all the Dietary Technicians in Calgary (and all of Alberta?) and replace them with "Managers" who may or may not have any nutrition credentials. Did you know that there aren't even any Dietary Technician programs in Alberta anymore? The message is clear: when it comes to patient food services, it's more about trying to offer it at the lowest cost possible when in reality, poor nutrition is sometimes the one thing that's keeping some people from being discharged!

  17. Anonymous1:26 am

    The problem lies in the amount of money the government provides us to feed each person per day: $7.33. That amount is way less than the $11-$12 given to the criminals in prison.


    Yet the health insurance will pay $6 and up for one medication which has been heavily marketed and little tested, leaving you to be the lab rat. It is one of five medications costing similar which you are taking twice a day ($60) and likely NONE of them treats any disease but treats the side-effects of the previous one in the list, which was given to prevent disease, when what should have been done was prescribing and monitoring healing diet and exercise.

    Alberta Health would rather give you drugs. They've signed contracts with pharmaceutical companies which bankroll their political parties.

    And Alberta votes them in again and again and again. Right up until yesterday, when only ONE riding in this whole province had the integrity to vote something other than the politicians who are in the pharmas pockets.

  18. Over the past seven years of practice I have found Hospital-Fare to be an embarrassing open secret. Every doctor can see what's on their patients tray, they just pretend not to notice, or pretend the patient won't be in hospital long enough for the diet to matter. This is wrong in several ways...

  19. Very interesting topic. It's sad that many newly diagnosed diabetic patients leave the hospital with absolutely no idea how to manage (or in some cases reverse) their diabetes by eating a healthy diet.

    It's difficult to narrow down the root of the problem.

    In my experience, a huge problem is that food trays are often put together using the carbohydrate exchange method. So basically anything that has 15 grams of carbohydrates is considered a carbohydrate exchange -- fruit, milk, starches, desserts, etc.

    Diabetic menus typically allow for 3 carbohydrate exchanges per meal, sometimes more, sometimes, less, depending on gender, weight, height, weight history, etc.

    So it's very easy to have a diabetic tray filled with refined carbohydrates because the people reviewing the menu are just looking at carbohydrate exchanges.

    Someone could easily get a tray with rice krispies, juice and a banana, with an artificial sugar packet for the coffee.

    Or refined white pasta, a refined white dinner roll, and non-fat milk.

    And if the people plating the food have not been adequately trained in portion sizes the patient could very easily end up with double portions.

    I could go on and on. It's definitely a big problem. It's not the RD's fault.

    Typically the RD's are doing patient educations all day long and are not sitting in the kitchen.

    There are exceptions like the previous commenter who is a Nutrition Manager in Ontario. We need more people like this in the kitchens who work hard to create healthy menus. Who make sure that whole-grains used instead of processed and refined grains.

  20. @Anonymous - The nursing home I was in ran a program for bariatric residents and the food choices were basically the same as what was offered to the other residents. Two main differences: we had salad at lunch and dinner each day which was not offered to the other residents; our choices of what to eat from the menu served and how much had to conform to what our dietitian dictated for us (and of course other food restrictions such as for those on a diabetic or renal diet).

    The dietitians were very involved, to the extent of being in the dining room during meals to oversee and answer questions from food service staff and program members about portions, whether one food item could be given up to allow another item (ie giving up a dessert in order to have another portion of something else).

    This nursing home is a private, for-profit institution that also had many residents on Social Security and Medicaid. The bariatric residents had their meals separately, only because it was easier for the staff to monitor what we ate if we were all together but otherwise, we were not housed in a separate wing and we participated in all the regular activities offered by the recreation department.

    Considering that I was able to lose 137lb in the four years I lived there, and was able to maintain the loss in the two plus years I've been out, I think they did a good job of teaching me what I needed to know about nutrition and weight management.

  21. Anonymous12:22 am

    No argument about what you must have learned there.

    The under $8 a day food budget for nursing homes, care centres and hospitals in Albert wouldn't be able to deliver the program you had. Someone has to pay for it.

  22. Anonymous3:40 pm

    Intramural conflicts of interest warrant scrutiny, too
    Matthew Movsesian
    University of Utah School of Medicine

    Pub in Nature Medicine

    Medical school faculty receiving remunerations from industry have financial incentives for promoting the
    products of the companies paying them. It's no surprise, then, that medical schools require disclosure and
    management of such relationships. Yet, despite their greater prevalence and more profound influence,
    the financial incentives offered by medical schools have gone largely unnoticed. A consistent standard for
    disclosure and management should be applied to both intramural and extramural financial relationships.

  23. To echo some of the above posts, I was hospitalized for a pregnancy complication. I had gestational diabetes, which at that point I was managing through diet. I was surprised when I was fed Cheerios and fruit juice for breakfast. I complained and the dietician came to see me, and said, yes they are frustrated with the food as well. I was then put on a 'choose your own' meal plan where I could select my food 2 days in advance. Then it was much easier to meet my diabetes diet requirements as there were some foods available that were not as processed/carb-filled, etc. This was in Alberta.

  24. Well, when someone pats themself on the back for serving "whole grains", it just goes to show that we have a long way to go before we can adequately care for diabetic patients in hospital. Unfortunately, a carb is a carb is a carb, and sandwiches and cereals, even if whole-grain, are going to land a diabetic in just as much trouble as refined carbs. Then add in an experience like mine, where they decided that, at age 62, I must be Type 2, and it's amazing they didn't kill me by withholding insulin except as an old-fashioned sliding-scale correction at mealtime. No basal, no bolus, and gee, I wonder why my BGs were going up and not down!
    Diabetics need to avoid hospitals as much as possible, because you take your life in your hands if you consent to be admitted -- if it's an emergency, get in and get out as soon as you can -- better to have a friend take care of you at home than be in a hospital!

  25. Breakfast yesterday at the nursing home I work at: Whole wheat toast with margarine, oatmeal bran porridge, orange juice or banana, live culture yogurt or cheddar cheese, coffee with milk. The menus are done by corporate dietitians. You can feed people healthy food on $7.32 a day alloted to Ontario nursing homes.