What the nutritionist said

So, I've owed readers his post for awhile. I'm not sure anyone is keeping track, or even reading me that closely, but I mentioned three weeks ago that I was referred to a dietician and said I would tell you all more about that and what I learned.

I'll be very honest - I went in with my guard up a little. I didn't want to be told I had to eat anything weird, or that I had to give up foods I liked forever. In my mind, it's not reality to never have pizza again. For instance, there is someone in my life who says, "I don't eat carbs. Ever. Even fruit." Except . . . he drinks, so he does imbibe carbs. I wanted advice on how to get the best results while still keeping in mind that my job requires I travel, a lot, and, I have to be able to go out and have fun sometimes too. I needed some help finding the land of moderation and figuring out how to put down roots there.

I'll also admit that my guard was up because people make assumptions about fat. People assume that when they see fat it means the person wearing it doesn't like vegetables, doesn't work out, has no concept of how to eat, etc. And frankly, my problems are not about knowledge or even about effort. My problems are biological and psychological. I have a lot of knowledge about the benefits of salad and protein and why it's important to eat breakfast and have a couple of well planned snacks. I'm not saying I know everything, I'm saying that my hypoglycemia and my years of dieting means I know more than the average person, regardless of my size.

I've had doctors in the past assume that I am unwilling to eat healthy, or a couch potato. I had one doc tell me if I was unwilling to work on my weight, he wouldn't take me as a patient in his asthma management practice. That's how he brought the topic up with me. He didn't ask what I had done in the past to address my weight - he assumed it was something he would have to convince me of. Ummm, hi. I look in the mirror every day. Do you think I dig sweating in the gym 4-8 hours a week to be this size? When I then told him how much I was working out and how healthy I was eating, he dismissed me and said, "Well, then you'd be smaller than this. You should think seriously about a 1200 calorie diet or getting your stomach stapled." I looked him straight in the eye and said, "I'm not unwilling to talk about my weight or even work on it. Do you have any constructive suggestions or are you just going to continue to assume I'm lazy and ignorant.?"

I lodged a serious complaint against him and found a new doctor, who, by the way did some tests to prove that in fact my lung capacity is not impacted by my weight. But it stuck with me that that doctor felt free to assume so much about me after having me in his office for 4 minutes, and felt free to recommend something medically dangerous for me. (If a doctor who is educated about the body and how it works could assume this, what does the person passing me on the street think?)

It was with this baggage I entered into the dieticians office. I know I'm overweight. I've known it since I was seven. I also know that I have medical conditions that make it impossible for me to ever be a size 2. I know those same medical issues make weight loss a very slow battle. And I know that my lifestyle and work don't do me any favors in that area either. And I know that when you add all of that together it makes it very, very hard for me to stay motivated. Perhaps most importantly, I also know that food is my drug of choice. I choose it over alcohol and caffeine every day and twice on Sundays. It's not just that I am someone who likes food or enjoys it and has somehow accidentally enjoyed too much of it recently. Food makes me feel better, but then it makes me feel worse. It's an abusive relationship. I mean, sometimes I can eat chicken and salad and not feel anything other than glad I ate lunch. But other times . . . mmmmm, all I can think of is unplugging myself with some snack of choice.

The dietician did some really awesome things for me. She confirmed that it's crazy to try and count calories all day long, and that people who do that are more likely to either struggle in the other direction, becoming obsessed with how few calories they can have, or to become someone who doesn't consider that not all calories are created equal (100 calories of brussel sprouts are always going to be better for you than 100 calories of soda). She gave me an opportunity to practice my working knowledge of serving sizes and good choices (1 cup = a tennis ball. 3 ounces of protein = a deck of cards, and so on). She took my RMR which told us how many calories I burn by breathing and doing nothing else. This gives us a baseline of how I should plan to exercise and eat to get the best results. We agreed on the following - 5 servings of bread, grains, or starchy vegetables, 2 servings of fruit (I can combine those for 7 overall servings of "carbs" but it's best for most of those to come from whole grains or vegetable sources rather than fruits), 3-5 servings of non starchy vegetables (tomatoes, broccoli, V8, asparagus, brussel sprouts, etc.), 3 servings of dairy and 7 of protein, 5 servings of fat (1 tsp of butter, 1 slice of bacon, 5 almonds, etc.). This left 180 discretionary calories a day (honey and granola in my Greek yogurt, 1 beer, a handful of chips, etc.) We calculated all of this based on aiming for an intake of 1850 calories a day and taking into account 2 hours of lifting and 3 of cardio a week.

The goal was to lose 1.25 pounds a week, and I'll be honest, that sounded like a lot to me in good and bad ways. Typically at my best if I eat perfectly and work out a LOT I might lose 3 pounds a month. But, she did the math and I wanted to believe in this. I paid for the appointment out of pocket, after all. 5 pounds a month sounded GREAT!

She didn't ask me to take any weird supplements or anything, and the only things she suggested I try were a particular kind of low-calorie organic bread and spaghetti squash as carbs. She suggested these because those two options allow me to have larger servings so she hoped it would mean my feeling more full and satisfied.

We discussed how someone with my medical issues has inherited a genetic predisposition to insulin resistance, and this means I have to have the right kind of carbs to "unlock the gates" and let food get let in to be converted to energy instead of being stored as fat. I'm lucky that with all of this going on that I never, never test as being pre-diabetic or as having even borderline issues with my thyroid. Still, that insulin resistance will make it tricky to find the right food combination for me for the rest of my life. It will often mean I eat but my body forgets it has energy and reacts to low blood-sugar. (Low-blood sugar crashes, are without a doubt, the worst feeling I've ever had. I prefer bone breaks and serious asthma attacks to that feeling)

As it turns out, it also means my dietician has some more work to do. After three weeks, I lost less than one pound. ARG! I know that her practice probably does see a lot of people who are making their first attempt to get healthy. But she's one of my last stops. After this I . . . well, I won't give up. But I may put more effort into dealing with myself rather than continuing to spend a lot of time and money on trying to be something I'm not or can't be. If I can't lose weight, maybe putting more effort into maintaining and being ok with that is wise. I know, I know, maybe I can lose weight just very, very slowly. Or maybe plugging all of my numbers into a formula doesn't capture the whole picture of how my body works. Maybe we just haven't found the answer yet.

I feel very, very tired when I think about how much work it is for me to do this, even with help, and still see minimal results. I do the workouts, I eat the salad, I take the meds . . . it seems like it's time for the pay off. She looked at my food logs and was stumped, because I have been eating a lot of yummy vegetables and doing a lot of exercise. In my heart of hearts I knew that 5 pounds a month was a lot to hope for - not for "normal" people maybe, but for me. I feel I've eared a break and it would be nice to have something work the way it's supposed to. It turns out doing the math right isn't enough.

In a way it was good to know I'm not the only one that my weight is mysterious to. It's good to know I'm not the only person who has to look at me and wonder why the things that work for everyone else don't work for me. It's good to know that someone else has to do extra work to make my diet and exercise give me the results I should have. It's also really discouraging that the things that work for everyone else don't work for me. It's disappointing that hard work isn't enough because I don't know what else to do. I hope the dietician does.

I will say, just as a chance for me to stick my tongue out to that awful doctor - the dietician also told me that less than 1600 calories and/or no-carbs would make my hormones worse. So there. Phhhhhttttttt!!!!