Leah:
Hello and welcome to the Ideal Nutrition Podcast. I’m Leah Higl and I’m here with my co-host Aidan Muir. And today we’re doing something a little bit different. We’re going to talk about some interesting experiences we’ve had with clients over the years. Aidan has definitely prompted this particular episode with a post that he did on Instagram a while back. So I’m going to swing over to him to kind of discuss why we’re doing this and what kind of value we might get from it.
Aidan:
Cool. So this podcast was prompted by the Instagram post and somebody commented that we should get together the team and do a full podcast on stories. Unfortunately, the team thing fell through due to a variety of reasons, particularly scheduling, but I still want to do one anyway. So we’re going to go through a few stories. One of the things I did want to put at the start of this is a bit of a criteria of what we’ve tried to include in these stories. So the first thing is that obviously we really value working with our clients and stating the obvious, but our goal is to genuinely help as much as possible.
When I posted these stories on Instagram, 99% of the feedback was positive. But one person touched on something which is why I rarely have ever shared stories or anything like that. Basically the commenter said, these people are humans who have come to you when they are vulnerable. They are people, not curiosities. If I’m being honest, I do actually feel like I had navigated that very well on that Instagram post. My perspective is that we can try to help people as much as possible. Respect that they’ve come to us for help and be fascinated by that case as well.
We can share that case in a de -identified way without it being done in a disrespectful way. So that’s kind of the goal. And while I do believe I navigated that well on Instagram, that’s what we’re gonna try and do today as well. Because obviously we’re taking the fly and that’s the goal. We’re gonna try and keep that kind of concept in mind. The first story I’m going to share was prompted by one of the stories I shared on that post. So a bit of a recap was I shared a story about a boy or I suppose a 21 year old who had Prader -Willi syndrome, there is a few key features with Prader -Willi syndrome.
One of the reasons why you heard me slip up and say, boy, is that they don’t go through puberty. There’s like a very delayed puberty. So even at 21, there’s some very childlike features still. There is a slightly lower IQ. On average, it’s about 30 points slower than standard. And the big thing where a dietician comes into play is that there’s like this insatiable appetite. It’s like never ending appetite.
So I’ll share a story about that, but I’m going to share my second story on this now, which is part of the thing that really prompted me to go all in on my own business. When I had left a prior job, I decided I wanted to chill a little bit and work super hard. So I was going to do like 10 hours per week just in my own business, just seeing clients who would come to see me and then 10 hours in a different allied health clinic to continue gaining experience. Cause I was probably two and a half to three years out as a dietician at that stage. I really wanted to continue building experience and as part of the experience in the allied Health Clinic, a person came through with Prader -Willi syndrome, so he would have been about 20 -something as well, and his father was with him for the first session.
It was an NDIS consult, and my understanding, particularly at that time, was that I had to spend an hour in the consult because that’s how NDIS funding kind of worked. The insatiable appetite’s a really, really, really hard thing because as a dietician, I typically use some techniques like motivational interviewing, which basically, it’s very hard to describe what motivational interviewing is. But basically it’s a bit of a concept of like, when you tell people what to do, it often makes them want to do it less, not more.
They get some barriers up and stuff like that, unless it’s a really good idea that they actually have genuinely never thought of before. That’s the one exception to that. Often, like, you can kind of ask them guiding questions being like, why would eating more vegetables be good for you? And then when the patient or client comes to their own conclusion, it kind of moves them a little bit up the spectrum of readiness to change in a way. With Prader -Willi syndrome, that’s probably never gonna work.
Leah:
It’s not a willpower or like a coming to a conclusion thing.
Aidan:
No, no. When you go on Google, literally is like one of the tips is literally for parents to put a lock on the cupboards because it’s just so hard to control that appetite and everything like that. The previous story that I told on Instagram, I was sharing about how the parents had locked his bank account and he started doing return and earn. He was just walking around, was Wagga Wagga at that time. He was like walking around Wagga Wagga picking up cans to return and earn so he could buy chocolate. So going back to this one in Brisbane, the most recent one that I worked with, that was session one. I tried everything I could, particularly drawing on my previous experience. I don’t think it was helping that much, but I like, I really want to give this a proper crack.
Session two, the father didn’t come in and like the honest reasons, I think the father had come to terms with the fact that it probably just wasn’t going to help if I’m being honest. Once again, I was sitting there doing my best. I’d Googled, I’d been doing all these things to try and figure out how to help. But the thing that kind of crushed me a little bit was that I had to be in there for an hour because I was in somebody else’s business. And I had to stay in there. Another bit of a symptom of Prader-Willi syndrome is often they like pick at their own skin. He was like bleeding in like this is a terrific story to start with, I know.
Leah:
That would be quite an uncomfortable situation, I think, as a practitioner. Especially if that’s not something you’re used to dealing with.
Aidan:
Yeah. And the reason why I’m sharing this story in a way is like the reason why I this made me go all in on my own business is, I do think there are people who could help that family. I don’t think I was the person who could help that family.
Leah:
So ultimately you probably would have referred out to another business or another practitioner.
Aidan:
If it was my own business, I was like, there’s no way that I’m staying here for an hour because I don’t think I’m helping. It was so tough just staying in there for that hour. I did another session after that because it was somebody else’s business and I felt that I kind of had to stay in there. And that was the thing that drove me to just be like, nah, I’m kind of done. I’m kind of done working for other people. I want to do my own thing so that I feel like I’m making a positive impact where I can. And if I don’t feel like I’m making that impact it’s time to move on.
Leah:
Yeah. And I think that actually that leads into my first story quite well, because I think it it veered me to like a very similar conclusion in that I knew I didn’t want to be seeing clients that I ultimately felt like I couldn’t help and feeling just as a bit lost as a dietitian. Yet you feel like you have to continue to see this client, even though you feel like you’re probably not the best practitioner for them or maybe not what they need at the time.
So for me, like my first, I have to preface with my stories are not as interesting as yours. I think yours are really interesting because you’ve probably had a lot more time in medical centers and working for other businesses that are not sports related. Where I kind of felt like I went into sports quite early. But there was a period of time where I was working at a medical center. A lot of those clients that I was seeing were like my own sports specific clients, I was also being referred clients from a nearby aged care facility.
A lot a of those were really cool people and I got to do some interesting cases. But one of the interesting stories is having this 90 year old woman come to see me who had pretty severely progressed dementia. She was sent in by herself to see me, no age, no nurses or anything like that.
She had no idea where she was, had no idea who I was, what her medical conditions were. I was basically sent in with a bit of a doctor’s letter describing the client and a client that had no idea what the hell was going on. So after that first session, I was like, okay, was nice to chat with this older lady. She was quite interesting, but I really felt like I couldn’t, how do you do a medical history? How do you know what they eat? Like it was impossible. Like she had no idea what was happening, the poor thing.
After this initial session, I was like, well, that was probably a waste of both of our times other than a nice little chat that maybe she wouldn’t have had otherwise. So I remember, you know, trying to have a chat with her doctor, trying to go into the aged care facility and being like, like basically trying to figure how the hell I could help this person.
I don’t know if I mentioned, but she did have diabetes and some weight management issues. And that’s why she was referred to me in the first place. But I was at such a loss because when I went into the aged care facility, no one wanted to talk to me. Like the nurses were like, just write us a letter. So I was like, okay, I’d like to talk a little bit more about this client, but fine, whatever. Wrote them letters, I contacted the doctor.
No one wanted to have that kind of like combined approach of like actually helping this client. To be fair, that aged care facility wasn’t very, wasn’t very well run. Like no one really cared about the clients or their nutrition, which, which was a bit sad, but essentially like this person kept being brought into the clinic to see me every couple of weeks for a number of sessions. And I just felt I couldn’t do a single thing to help her.
She didn’t know what was going on. The doctors, the nurses didn’t want to help me out. Just nothing. So eventually she did stop coming to see me when I was like, I don’t think this is worth anybody’s time. Like we’re wasting everybody’s time and money here. Cause she was also paying slightly out of pocket for this as well and like, she also has no understanding of what she’s paying for. And whilst I think someone else was taking care of her funds, I think her sister. I was like, but she’s not even consenting to this spending of her funds. I just didn’t feel good about the situation at all. was like, yeah. So eventually I stopped seeing her. I was pretty upset that I couldn’t find a way to help her.
And just for how lacking in care that she actually was, that no one, they were just ticking boxes. At that point, they would just like send it to a dietitian, tick the box, but no one was actually helping her situation. So I think that’s just interesting from the perspective of like, in those situations, what do you even do as a dietitian when you feel like such at a loss?
Aidan:
Yeah. And I also feel like, like I try to make this podcast targeted to non dietitians, but there’s a ton of dietitians or student dietitians who listen to this, who like, this is part of it in a lot of cases as well. I’ve had heaps of similar experiences. There was government funded type situation that I was working in where I remember I kept rocking up, I was doing home visits in a nursing home to certain people who didn’t remember me. And I’m like, I’ve been like five times. And I was seeking feedback from other dieticians. I’m like, how do I help this person? And they’re like, I’ll just write their meal plan on the fridge so that it’s in front of them. So even if they don’t remember you, their meal plan’s there. I’m like, okay.
Leah:
Is that actually helpful?
Aidan:
Yeah. And like, I don’t know, I really struggled with that as well. I don’t But those early days, feel like a lot of Digitins in early days have these stories in some way, or form. My next story is a little bit more recent. This is actually the only one through my own business. I can’t recall how the family kind of got onto me. It might’ve been a Google ad or something like that, because it’s very different to my normal type of client. But it was a mother and the person who I was seeing was her son who was 14.
He was a Chinese boy with autism and food aversion. So that was what I was seeing him for. They, I believe he was kind of nonverbal as well. I don’t know if like whether that was, I believe he could speak Mandarin, but I don’t think he was speaking English at all. The mother had like decent English. The thing that was tough was I did actually do a decent amount of sessions with her, like six sessions. So was like trying to have proper crack of helping, but there’s a few things that were really tough.
So firstly, prior to coming to see me, he had gained 10 to 20 kilos quite quickly. So he was about 90 kilos at 14 years old or 10 years old? I think it was around 14 years old. But he was a bit larger and his mother was really concerned. And I think that was partly due to like the Asian background and everything like that was part of why she was so concerned. Like, obviously I think anyone would be a little bit concerned at that stage.
Leah:
Yeah, such a rapid weight gain in a child.
Aidan:
I don’t know how many people listening to this are quite familiar with the food aversions associated with autism or anything like that, but one of the most common ones, and I don’t want to butcher this because I’m not an expert in this space, but one of the most common things is a only eats white foods type situation. Whereas like he would eat potato and pasta and white bread and stuff like that, but would really struggle with vegetables and everything like that. There was quite limited variety in diet.
And a story that I often tell in relation to autism is that with food aversions is if you get somebody without these really, really strong food aversions, say a regular picky eater as a child, wouldn’t recommend doing this, but just as a hypothetical experiment. And you give them food that they don’t like and you leave them locked in a room and they’ll starve if they don’t eat the food. They will eat the food eventually. I’m not saying that’s a strategy or anything you should ever do. That’s a bad idea, right? But like the point I’m making is that they will eventually eat the food if it keeps getting offered to them and their other option is starving.
With have autism and these food aversions they won’t eat that food, which as you can imagine makes this a far more complicated situation than just regular fussy eating. Other parts of the story, huge intake of sugar, love of baking and also soft drink. Like when we met, a massive percentage of his calories were coming from added sugar.
That was part of where I was like, I think I can help you. Like there’s a of things that I know I’ll struggle with, but I do think I can help with a few of these things. The mother was very, very passionate, very committed. She had him exercising on a treadmill most days, which was like, I can’t even imagine how hard that would have been to do. She was trying so hard to help and every decision she made was coming from a place of love. The most complex part of this story and the killer for me was that baking was his biggest joy.
Like it was like the one thing in life that just brought him immense happiness. And like there’s a few easy wins we had in there and being like, maybe we switched from soft drink to diet soft drink. Like are there certain vegetables that you can have? Let’s get a multivitamin in here to like cover the gaps that are clearly like, there’s a few things that were very easy wins, but we halted it so that like he was no longer gaining like multiple kilos per week. So he kind of just stayed around 90, but we really struggled to get over that hump of actually going back down a little bit in the other way.
It got to the point where it’s like we’d implemented a lot of easy wins. I’m like, I kind of to do a little bit more. I’m like, do we restrict the baking? I hate to be the person to take away the one thing that he loves the most. That’s about all I’ve got on that. Like we didn’t like solve every problem kind of thing. Like that’s about where we got to. And like we did put a few things into place, but very challenging position, but I think it’s interesting as well.
Leah:
It’s definitely very interesting. And I’d hate to be that practitioner of okay, maybe you just stop him from baking so much if that’s the one thing he enjoys like you never want to be that person.
Aidan:
Yeah, we even we did play around with like healthier ingredients and stuff like that. it was still they’re still so tough.
Yeah, no hundred percent. I have a second client story. I know you have a third so I’ll I’ll go through this one, which I don’t think is like I guess as interesting like I said as yours but I think it’s interesting from the point of view of just being a complex client to manage. And I actually ended up having a lot of fun with this client. Cause I was like, it was something that I hadn’t seen before, like this combo of things that I’m about to speak about. And it really prompted my, I guess, like fascination with one of these conditions.
So at the time I was working with a lot of like ultra endurance athletes and endurance athletes in general. So this ultra endurance cyclist was sent to me. But that’s not the weird part of the story. The interesting part is he was also diagnosed with CSID, which is congenital sucrase isomaltase deficiency, which we would have just done an episode on like two or three episodes ago now, which is essentially a condition where you aren’t able to digest much sucrose and starch. So it can end up being a pretty low carbohydrate diet to manage the symptoms of CSID.
But then we think about what would be, I guess, optimal for an ultra -endurance cyclist is typically a very high carb diet, especially leading into competition, during training. So this particular client only had this recent diagnosis, but he’d always struggled with pretty much really bad diarrhoea for his whole life. He couldn’t get through a cycling session without having diarrhoea.
Aidan:
With ultra endurance cycling. How long are we talking in terms of like how many hours?
Leah:
So like here’s competitions were often 10 to 14 hours So like it was a long time and he actually wanted to do multi-day ones as well like that was his like ideal situation where it was it was quite a lot of quite a lot of time spent spent on the bike So the biggest conundrum that we had was okay. How do we fuel this appropriately and especially what do we do during competition when you really only have access to things that you can like fit in your backpack and usually things that we would use are like sports gels and sports drink and things like that which inevitably have sucrose in them.
So if he had these products, he would have diarrhoea within 20 to 30 minutes of consuming these. So they weren’t an ideal option. Even like the starchier foods like rice crackers and bread and pasta and all that stuff. He couldn’t really eat either. He had some tolerance to it, but nowhere near what we would need to fuel his training. We ended up going with basically being our own little chemist and making our own like sports drinks and chews and gels and things like that out of dextrose powder, which is glucose.
So people with CSID can digest that being a monosaccharide and not a disaccharide. So they don’t need that enzyme to break it down. So we ended up using dextrose with some fructose and like adding in electrolytes and flavourings. We played around with making our own like glucose gels and things like that. So from that perspective, it was quite fun for me to do, but I thought it was like an interesting client because he had this condition that completely was the opposite nutritional management to the sport he wanted to compete in.
Then he had this other layer of also wanting to be vegan or plant-based on top of it. I tell everyone I work with all the time that the clients I get can be pretty multi-layered in that way, which I love. But he ended up giving up the dream of being plant-based because it was far too hard to manage with everything else.
But yeah, we, didn’t solve every problem here. I don’t think like you can really optimise the training that he was doing with CSID. Like there’s only so much of that kind of homemade stuff we could use. But yeah, it was an interesting client. It was a fun experience. I think we solved it enough for him to at least compete in that stuff comfortably. And at the end of teh day that’s what he wanted.
Aidan:
Yeah. So my final one, cause I really wanted to end on a positive note for this. This was one of my first ever clients. I would have started seeing him somewhere in my first three months in the first proper job that I had as a dietitian. I did about 20 sessions with him. So I was only in that specific city, in that role, for six months, but I did 20 sessions in the space of like 10 weeks or something with him before I had to move.
I didn’t have to move, I chose to move, I should say. But he had a recent diagnosis of stage 4 chronic kidney disease that was like the catalyst that just completely changed his life, right? So he had had type 2 diabetes for quite some time. He had continued going down that route and something that often comes alongside type 2 diabetes if it progresses is chronic kidney disease. One of the biggest caveats that could be hard to understand if you don’t understand this condition is that by the time you get stage four chronic kidney disease, it’s actually incredibly rare for it to improve back to normal function.
So even if you start like doing everything perfectly, it’s still very rare to like, like you can make a little bit of progress, but it’s pretty rare to go back the other way. There were a ton of logistical challenges based on everything, particularly in that phase of my life as a dietician, I was quite big on whenever I had a client, he also was looking to lose some weight as well, because that was going to help a bunch of things as well.
Particularly at that time in my life, I was quite big on like, I hate making people starve themselves to lose weight. Let’s give them some unlimited intake of two things, protein and vegetables. Let’s not even put a limit on those. Let’s just let them go for it and then put the limits on all the other things, right? That was part of my approach at that time. I’ve changed a few things, but that was part of what I was doing back then. They were my key moves.
One interesting thing or one part of the story is that he lost 10 kilos in the first six to 10 weeks. He was so motivated, like a stage four kidney disease thing. I’d like to think I helped, but it was really, he was super, super motivated. He monitored all of his intake and he created his own spreadsheet based off a lot of the stuff that I’d given him. So for chronic kidney disease stage four, there’s some guidelines around protein intake, electrolyte intake, a few other things like phosphorus and a few other things, right?
I’d kind of like given him the numbers, given him some suggestions and stuff like that. He went and created his own spreadsheet from that of all of the common foods that he eats. And the crazy thing about this is it was tough because like firstly, protein intake, like you could debate about how much protein intake matters for chronic kidney disease, but like there is some clear guidelines being like you should be above this amount and below this amount. And the amount isn’t super high or super low, but it also means it takes away my move of being like, let’s have unlimited here.
The next thing though is the electrolytes thing really has an issue for the vegetables thing because vegetables will contain potassium and he was limited on how much potassium and the logic there is just that the kidneys are filtering electrolytes including potassium which is why once things are at stage four there’s some limits on all of these things because the ability to filter these things is worse which therefore theoretically means if you have a lot of them coming in your levels in your blood could end up higher than desired and that could cause issues. So he’s like okay I cant eat a lot of meat. Can’t eat a lot of vegetables, can’t eat a lot of fruit, can’t eat a lot of whole grains. There’s also some carb limits on the diabetes as well, like some stuff that I put out around that.
And I was like, it was the first time I was like, this guy has to be quite hungry. But I don’t know, it’s quite impactful for me. Like one of the things, oversharing a little bit, but like in a truly non -judgmental way, one of the things that was super, super fascinating to me was I was like, really interesting that stage four chronic heat and disease, that was the moment everything changed.
Leah:
Yes, it got to that point and he’s like, now’s the time to be super motivated.
Aidan:
And like the hardest part for me, like in that moment and also upon reflection was like, man, if this, if he’d had this six months earlier, he wouldn’t have ever gotten stage four chronic kidney disease. He might’ve been able to reverse everything. Like there’s so many things that’s like, it’s always made me like want to be like, let’s get in as early as possible with all of these things. But so, so interesting for me, particularly like as a very early experience as a dietitian to be in that situation with somebody so motivated, also quite complex for me at the time and to have an experience like that. I thought that was cool, which is why I wanted to end on that one as well.
Leah:
So hopefully that was useful or at least interesting to some of our listeners, but this has been episode 132 of the Ideal Nutrition Podcast. Thanks for tuning in.