Answers
to your questions

These are common questions from practice. We work daily with people who start/follow a new diet. Our diets sometimes differ from current dietary standards, so questions are logical and more than welcome.


If you have a question that you don't see here, please don't hesitate to contact us!

General

1What is reimbursed?
3 hours per year under the basic insurance. Keep your own risk in mind, this will be addressed first. Outside the 3 hours you may be reimbursed through your additional insurance. You can find out how many hours are reimbursed under your supplementary insurance in the policy conditions of your health insurer.
2No deductible
If you are in the chain of care for diabetes, cardiovascular disorders and no deductible. This also applies to children under the age of 18.
3What does the first consultation entail?
The reason/reference is key. Based on this, we will discuss the diet and eventually adjust it with advice. You will always receive a sample daily menu in which personal advice is described. Depending on the advice, you will receive additional information about the diet. The first consultation lasts 60 minutes.
4Is the dietary advice tax deductible?
Yes, various diets are tax deductible, such as lactose intolerance, low FODMaP diet, etc.. This overview can be found on the website of the tax authorities under diet confirmation. This can be signed by the attending physician or dietitian.

Carbohydrate restriction

1Why are carbohydrates converted to fat?
Suppose you eat a sandwich or plate of potatoes with a lot of carbohydrates and little fat. Carbohydrates are quickly absorbed from the gastrointestinal tract as glucose (sugar) into the bloodstream, after which the glucose concentration in your blood (blood sugar level) will rise. Your pancreas will then (provided you do not have type I diabetes) produce insulin to normalize the glucose concentration in your blood. When you can no longer use or store carbohydrates, the liver will convert the "excess" carbohydrates into fat to replenish the body fat stock. In prehistoric times this was meant to survive a hunger period and the fat was also broken down again in a period of eating less.

On our nutritional advice page we have explained the process with images and short text.
2Why is sugar addictive?
Sugar enters through the mouth. The taste buds recognize the sweet taste and send a signal to the brain. This produces dopamine, a neurotransmitter that is responsible for happiness, sexuality, a good immune system and nervous system. Dopamine is needed and is produced automatically. It gives a euphoric "kick". However, if a lot of sugar is consumed (think of soft drinks, fruit juices, candy, biscuits and sugar additives), this kick will become less and less high. This can eventually lead to a low dopamine level which can cause an unpleasant feeling.

A person then automatically wants more, this can be done by consuming sugar again. However, the effect is short-term and will never be as strong as it was in the beginning. The demand for more sugar then increases!
3What is the glycemic index?
This is an index that indicates how quickly the sugars in a certain food product are absorbed into the blood on an empty stomach. This is indicated on a scale from 0 to 100. Here 0 means that the sugars in the product are not absorbed or are absorbed very slowly and 100 that the sugars in the product are absorbed very quickly into the blood. The glycemic index is used to influence and understand the blood sugar level in your body.

However, there is a major disadvantage of the glycemic index, namely: it shows what one single product on an empty stomach has on the blood sugar level. In most cases, you eat a combination of products, making the glycemic index inaccurate. For example, yogurt with nuts and honey for breakfast, spaghetti with minced meat or fries with mayonnaise. Fats and fibers affect the rate at which a product is digested and absorbed.

The glycemic index is often used in people with diabetes, an overview of products can be found on the website of the Diabetes Fonds: Glycemische index.
4What is ketosis?
Ketosis is a metabolic process in the body in which there is a high concentration of ketones in the blood. These ketones are an energy product for the body when no more carbohydrates are available. In this way, the body will burn fat to provide the body with energy.
5When will my body burn more fat?
The body and especially the brain cannot switch from one moment to the next from (glucose) sugar burning to fat burning. It takes your body about two to three weeks to make certain proteins that can transport water-soluble fat bodies (ketones) from your blood to the brain to provide it with energy. During this transition period from glucose burning to fat burning, it is not uncommon for people to feel a little more tired than usual.
6Does a high-fat diet not raise cholesterol?
Although scientific research in studies with huge numbers of subjects has shown that there is no relationship between the amount of saturated fat eaten and the risk of cardiovascular disease and death, we still learn that saturated fat is bad, which makes us afraid for certain products such as cheese. Unfortunately, because cheese is a delicious and very healthy! People are afraid of a rise in cholesterol in their blood if they eat a lot of fat. The truth about cholesterol and fats in your bloodstream is more nuanced than certain commercials would have us believe. In particular, triglyceride is a 'bad' fat and its value generally drops sharply with a low-carbohydrate/high-fat diet. LDL is a bad fat. However, LDL is not about the amount of LDL cholesterol in your blood, but the number of LDL particles! A high number of LDL particles increases the risk of cardiovascular disease. Unfortunately, doctors in the Netherlands almost always measure the amount of LDL cholesterol and not the number of LDL particles.

Therefore, ask your doctor to measure the Apo-B (a measure of the number of LDL particles) in your blood instead of the LDL cholesterol. Why the total cholesterol in your blood is still being measured is completely unclear to us, it says absolutely nothing about your risk of cardiovascular disease and determining it is a complete waste of money.
7How much fruit is needed daily?
The Voedingscentrum in the Netherlands advises to eat at least 2 servings of fruit of 100 grams each per day. This is good advice to meet the need for vitamins, minerals and fiber. To limit the carbohydrates, fruit can be replaced with vegetables to still meet this need.
8How long should/may I keep this diet?
We also call the low-carbohydrate diet a lifestyle, because the diet can also be used to maintain or gain weight. There are no restrictions to continue this lifestyle. Most importantly, what feels good? Have you reached your goal?

If you have type 2 diabetes, this lifestyle may prevent you from having to switch to insulin injections instead of just oral tablets in the future.
9How do I know if the low-carb diet is right for me?
Any healthy person can apply the low-carbohydrate diet. Have a chronic illness or condition? Then the dietitian can check whether the low-carbohydrate diet is suitable. On our nutritional advice page we show how we use the diet, among other things. Such as type 2 diabetes, high cholesterol, sleep apnea and of course obesity.
10I am taking medication for diabetes, can I still use this diet?
All our nutritional advice for diabetes patients is discussed with your GP, diabetes nurse or your internist. We do not recommend using this diet without the guidance of a dietician or doctor.
11Does my doctor or internist agree with the low-carb diet?
We are in contact with many specialists, general practitioners and fellow paramedics. Our nutritional advice is based on well-conducted studies and we can also substantiate and justify this. Should your GP, specialist or internist have questions or are skeptical? Then we will be happy to contact them and answer their questions. So that you can come to us with a good feeling!
 

Irritable bowel syndrome

1How do you know if you have irritable bowel syndrome?
Irritable Bowel Syndrome is a diagnosis made by a general practitioner or internist. The diagnosis is made only if no structural or biochemical explanation can be found for the symptoms. In other words, they don't know what's going on.

Do you not yet have a diagnosis but have complaints that last longer than 6 months and are daily or weekly? Then you may have Irritable Bowel Syndrome. Complaints such as bloating, abdominal pain, cramps, flatulence, constipation or diarrhoea. IBS is about twice as common in women than in men.
2I do have the complaints, but no diagnosis from the doctor, can I go to you?
Yes, because in most cases the complaints such as bloating, abdominal pain, cramps, flatulence, constipation or diarrhea are food-related.

If the complaints do not diminish after the dietary advice, we always advise you to contact your doctor.
3What are the causes of IBS?
There are several causes of IBS; genetically such as lactose intolerance, physiologically a longer colon or delayed bowel function, but also external influences such as antibiotics, antacids, antidepressants and many more medications. Psychological factors also play a role, stress, sleep, rhythm, but also chewing behaviour; do you chew enough, do you eat quickly?
4What is the FODMaP diet?
FODMaP is an abbreviation and stands for: fermentable oligosaccharides, disaccharides, monosaccharides and polyols.

FODMaPs are small carbohydrates that are poorly or not absorbed in the small intestine and end up in the large intestine. There are many bacteria in the large intestine. These bacteria then ferment (=eat) the FODMaPs quickly and in very large quantities. This releases gas, causing symptoms such as bloating and flatulence. Symptoms such as diarrhea or disturbed bowel movements arise because more fluid is drawn into the small and large intestines. By limiting products with a lot of FODMaPs in the diet, fewer of these molecules reach the large intestine. Not everyone is equally sensitive source.
5Is the FODMaP diet the only solution?
No, the FODMap diet is one of the possible dietary recommendations for Irritable Bowel Syndrome. In practice we see that this does not always have an effect, in addition, it is a fairly strict diet, so we always first look at the wishes and possibilities of you to follow this diet.
6When will the complaints subside?
Our advice: after two weeks of following the dietary advice, the complaints should have decreased or have gone away. If this is not the case, another dietary advice will be drawn up.
7How long does it take before I am free of complaints?
This depends on the body/cause, it can sometimes be after a week, but it can also take weeks. Sometimes multiple dietary recommendations have to be tried to achieve the desired result.
8When is an elimination diet used?
Only when all other options have no effect and there are suspicions that this will make an effective contribution to the reduction of complaints, we opt for an elimination diet.
9Which aids can I use with IBS?
There are many aids available on the market, our advice is to first have a conversation with us to determine in which order we will use certain diets or aids. In particular, we strongly advise against the simultaneous use of substances and diets, this only produces noise and little clarity. Everything step by step.
10Can I have an allergy test done at the practice?
No, we do not offer these. We always refer to the GP for this.
11Are the allergy or intolerance tests online reliable?
We argue that these are not adequate and accurate, the test methodology is not satisfactory. Have a test taken at the doctor or hospital, these are reliable.
 

Children

1Compensation
There is no deductible for the treatments for children's dietetics. This applies up to the age of 18.
2From what age can we visit the practice?
We treat children from 1 year old
3Can the FODMaP diet be used in children?
- Yes you can. Recent research shows the benefits of the diet for intestinal complaints and also the safety. Especially at a young age it is important to have enough energy to grow and develop.
4What should I do if my child has a stomachache?
Our first advice for children is to discuss this with the GP. After the check-up, your GP may advise you to make an appointment with a dietitian.
5Is a carbohydrate restriction or ketogenic diet suitable for children?
Limiting carbohydrates can also be applied to children, of course we always look at the total picture such as growth, activity and need. In many cases, we see no reason to severely limit carbohydrates. We do not recommend a ketogenic diet for children who are still growing, unless there is a specific medical indication.
6Can I have an allergy test done at the practice?
No, we do not offer these. We always refer to the GP for this.
7Are the allergy or intolerance tests online reliable?
We argue that these are not adequate and accurate, the test method is not sufficient. Have a test taken at the doctor or hospital, these are reliable.
8Are sweeteners allowed for children?
Yes, but in moderation. Too little is known about the long-term effects of the use of sweeteners. An occasional glass of sugar-free lemonade is no problem. We always recommend drinking water, tea as a base, supplemented with dairy or vegetable drinks.
9Can a child outgrow an allergy?
Yes, but allergies can also come back. We see that people who have allergies have different moments in their life where a reaction to some products occurs.
10Do you work together with other parties for the guidance of children?
Ja, samen met IkBenIkDoe in Beuningen, psychotherapeute Babs de Wit en Integratief Kinder-, Jongeren- en Gezinstherapeut & coach Veronique Derksen in Nijmegen.