Reality Check: Nutritionist Advice

So I saw a nutritionist today (actually an RD) at the recommendation of my new primary care. I've been trying to lose weight and have been stuck despite eating a pretty healthy diet and having a regular exercise habit. I'm wondering if I found the wrong person (or if I've just had a lot of misconceptions over the years). Here are the changes she wants me to make that have be scratching my head (there are others I agree with like playing with my meal timing):

1) Halve my veggies. I'm not eating crap - but I'm now pretty severely limited. We're taking about less salad, broccoli, cabbage, etc. Not the starchy stuff.
2) Reduce my protein to a total of 5 ounces a DAY. So - with my 2 egg lunch, I get 3 ounces for dinner (with no cheese, tofu, beans, etc.). Assuming I didn't have any for breakfast.
3) Increase my grains - she doesn't care what kind. So - more bread (her recommendation is English muffins or bagels), more oats (I can live with that), more pasta, more rice.
4) Never, ever replace any calories burned in exercise. No matter what. I'm not talking about supplementing after an hour on the trainer (I don't - but I do try to eat part of the next meal so I'm not starving). I get 1800 calories a day even if I'm on my bike the entire day. Yes, I double checked. I told her that (if the stars align and my hamstring starts behaving - a big if), I want to train for a 200 mile ride. 1800 calories a day.

This sounds completely nuts to me - and contrary to what my research has uncovered. On the other hand, I haven't managed to lose weight on my own - so maybe I'm not in a position to be questioning it. Thoughts? Am I crazy or is she?

This sounds like pretty much the opposite of what I'm doing and I've lost 12#s since 1/1 (have been in a water weight stall for a couple of weeks, thanks to TOM/AF). Is she super old-school, or what? FEWER veggies, MORE nutritional-desert refined carbs...seriously? Potentially eating WAY under 1200 net calories/day (which is the realm of the female athlete triad of eating disorders). Lemme guess...all fat is evil, better make that 5oz of protein in the form of egg whites and skinless chicken breast. :rolleyes:

I would be firing this "nutritionist" STAT and finding someone who actually is versed in the dietary needs of endurance athletes. Check out the Feed Zone books.

Hey friend -

Ok yeah that sounds completely insane. Completely.

WTF about not eating veggies????? And starchy "grains" like bagels and muffins - those are completely empty calories! I wouldn't even consider them grains! FWIW, I'm not eating much bread at all anymore EXCEPT during long rides (long for me = 200k and above right now). Which brings me to the subject of not replacing calories burned. That's crazy too!! You shouldn't go out and eat a whole pizza because you rode 2 days ago (I used to have that mind set), but if you don't replace some of what you are bringing there is no way you are going to be properly fuelled to do ANYTHING.

And lower protein? Weird.

Honestly that whole eating "plan" is completely the opposite of what I have been doing since about August of last year. And during that time, I've lost 20 pounds (gained while being moderately depressed/in pain/inactive before my hip surgery) and my athletic performance is about the best it has ever been.

I don't get that at all. Could you ask her for studies or theories substantiating these particular recommendations?

Sarah

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Originally Posted by maillotpois

I don't get that at all. Could you ask her for studies or theories substantiating these particular recommendations?

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Seriously, call her to the table. Pretty much ALL of her recommendations go against modern sports nutrition and actually sound pretty dangerous. No woman should dip below 1200 net calories/day.

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Originally Posted by zoom-zoom

Seriously, call her to the table. Pretty much ALL of her recommendations go against modern sports nutrition and actually sound pretty dangerous. No woman should dip below 1200 net calories/day.

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+1

If she's got research to back it up, she should be happy to share. Otherwise ... it just sounds really, really wrong to me.

FWIW, I've read recently that endurance athletes shouldn't go full low-carb, because our bodies will learn not to burn carbs during competitions when we need quick energy. But grains are the most acidifying component of most people's diets, and I can't imagine increasing grains. I feel *so* much better since I reduced my grain intake. My weight's reasonably stable and has been for a while, but since I reduced grains, my mostly sedentary DH has followed along to a lesser extent and spontaneously lost like 15# without making any other changes.


Also FWIW, you might search for a nutritionist who's a member of Dietitians for Professional Integrity. I certainly would make sure I'm taking advice from someone who's more interested in health than corporate sponsorship ...

Thanks, ladies. I thought my gut was correct on this one, and you're definitely confirming that. I suspect I need to balance my meals better (move more calories earlier in the day), but that *what* I'm eating isn't fundamentally incorrect (when I eat carbs, it's things like sweet potato for the most part). I should have known I was in trouble when she asked what "subclinical hypothyroidism" meant.:rolleyes::confused::eek:

*If* I go to the second appointment, I'll definitely ask her for sources. When I pushed a little today, and responded in a "if you want to lose weight, you will do what I say" manner. She also said (when I pushed on compensating some for exercise) that we could talk about that when I stopped wanting to lose weight. Not before.

I *think* her theory is that my calories have been running below my base metabolic rate (from tables, which she believes to be accurate). Basically, I've been trying to lose weight for so long my body is quite used to starving. I don't see how giving it more grains and less "good stuff" helps that, though - and she didn't have a great response other than "it thinks it's starving."

Zoom - she's not absolutely against fat - but only 5 tsp a day total. Heavy on dairy (which, ironically, can be full fat). Basically, it's the freaking food pyramid that researchers have now fairly conclusively doesn't work. Will definitely check out the Feed Zone books. Assuming my hamstring calms down (and my PT approves), I might also consider a coach/personal trainer to help me safely ramp my activity back up. I expect that will help much more than following this plan.

This sounds really ***-backwards. That's the way I used to eat when I was in my thirties, teaching 7 aerobics classes a week. I weighed 92 and everyone thought I had a severe eating disorder. I would run, run, run away and find an RD who has a specialty in sports nutrition.

Oh sure - so if your body is in starvation mode then let's not compensate it for when it exercises. Makes SO much sense. NOT.

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Originally Posted by maillotpois

Oh sure - so if your body is in starvation mode then let's not compensate it for when it exercises. Makes SO much sense. NOT.

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RIGHT!!! I'd love to see this woman's license and where she received her training. I think any of us have a better handle on what is a healthy way to eat.

More of the same. I did my own research when the doctor told me I was headed toward becoming diabetic. I spoke to several diabetics about their diets. I used my fitness pal for calorie counting and for helping me keep my carbs, proteins, and fats balanced. I replaced my simple carbs with complex carbs. Reduced my alcohol intake. I began exercising for 2 hours a day mostly spinning but also trying to increase muscle. I ended up losing 35lbs from Jan 1- June. It was pretty easy to keep it off for the summer but fall and the holidays tripped me up and I put 10 back on so I'm trying to get back to it.

Good luck in dealing with your dietician.

She sounds disgraceful! I'd be running in the opposite direction.

Sounds like the advice I received - and took because I didn't know better - and wound up crossing over the line into Type 2 Diabetes. Not saying this would happen to you, but run for the hills. I wouldn't even give her a second chance. At the very least she has no idea how to address sports nutrition.

YIKES!! There are so many red flags in this persons suggestion, wonder what her basis is for this?

I agree with what others have said...sounds like bass-ackwards, bad advice and you should find someone else!

To be honest, it sounds like a stupid crash diet...about as sensical as eating nothing but popcorn every odd hour or 24/7 soup.

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Originally Posted by zoom-zoom

To be honest, it sounds like a stupid crash diet...about as sensical as eating nothing but popcorn every odd hour or 24/7 soup.

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But I love soup!!!


;)

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Originally Posted by maillotpois

But I love soup!!!


;)

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As do I, but I'd probably hate it if I was told I had to eat it for every meal.

There are certain vegetables that are better and worse when you have thyroid issues, but I certainly wouldn't limit the amount just change the type.

Thanks for the continued feedback! I do have subclinical hypothyroidism (said nutritionist wasn't sure what that was), but it's well controlled. I just had blood work checked by my primary care, and I'm happy with the numbers. The primary care said she wasn't sure what else to check medically - hence, the nutritionist. Not sure where else to look medically - since there's really not more blood work to check. I do need to get the knee resolves, so I can get back to my level of activity.

The veggie advice was in no way related to the thyroid issue. There are veggies that can interfere with thyroid hormone, but what my doc told me is that if I eat them consistently, my dosage will compensate (i.e., if they depress the levels, the dosage gets adjusted up, and we dose based on part of the dosage not being absorbed). I'm OK with that, and it mirrors my research. Soy, cabbage, and broccoli are all potentially problematic - but I eat them very consistently and my numbers are fine. I do try to add seaweed and other iodine rich foods as an added bonus.

Just off the top of my head, and with no idea how you're eating now, are you sure you're getting enough fat? You might try adding a tablespoon of Udo's Choice at breakfast and see what happens ...

talk to your primary care about your interaction with the rd.

Do you mind my asking, how much weight would you like to lose?

NY Biker - I'll message you. Here, I'll just say more than a little:) I have a long history of being overweight - I know why I have gained when I have - it is the losing that has perplexed me.

My diet now is heavy on protein, veggies, and fruit. I do eat plain, full fat Greek yogurt in small quantities and some whole grain carbohydrates (mostly oats and brown rice). Very little sugar or processed food.

I will talk to my primary care when next I see her. She is also new, as my old primary care relocated - and I haven't decided how I feel about her. I should have more contacts to find more appropriate providers when I start med school (at the latest). In the mean time, I will talk to my awesome physical therapist to see if she has people she would recommend. I have worked with her for a while, and she hasn't led me astray.

I went to a nutritionist a few years ago, not because of weight, but because I have borderline high cholesterol. I was pretty disappointed that the nutritionist recommended an extreme low-fat, high grain diet. That's pretty much been de-bunked for high cholestrol. Instead, I dropped all sugars (including most fruit) and all "white" foods except full-fat yogurt and half-and-half. Result: I lost 9 pounds the first month and felt amazing. My cholesterol also dropped to acceptable levels after 3 months.

While your concerns are different than mine were, I wonder if upping your fat intake and reducing your sugar (fruit/juice) and dropping grains completely would be effective. Have you tried doing that? Don't count calories, just don't eat fruit (sugar) or grains (turns into sugar) and increase fats and proteins.

You also might want to investigate soy, including tofu. I understand there are questions around soy and particularly women's health. It would not surprise me if a high-soy diet might effect the metabolism.

Thanks, Tulip! I actually have tried that - for some pretty extended periods of time. There is so much conflicting research out there on soy - but I definitely agree there are questions! Most of what I use is fermented (miso, tempeh), with some unfermented (tofu - 1-2 times a week on average). When I have done periods of veggie/protein, the soy gets completely cut out - and it didn't make a difference.

To say I'm heavy on fruit now is probably a bit of a stretch. I'm eating 1-2 servings of berries a day (either fresh or unsweetened frozen mixed in yogurt). Not much other fruit, and the only juice is cranberry when I feel like I'm getting a UTI. I have been playing with adding grains back in over the last 1-2 months because I was feeling really tired all the time. It has helped some. I feel like my energy levels have stayed more constant (which is ironic, I know, since usually protein/veggie should be better for that).

Back to a thread I started I while ago - this could *all* be my frigging birth control pills - as you all have told me. Trying to psych myself up to taking those out of the equation and seeing what happens (yes, I have been a spoiled happy person taking them continuously - but it might be causing problems).

Oh BC pills can really screw up a body. I took them briefly decades ago and was heavy(ish) and my cholesterol spiked. I went off them and I lost the weight quickly and my cholesterol decreased (it is genetically high but was in the 300s when I was on BC pills).

Have you tried going off BC pills? I'm no doctor but I just cannot see how they would NOT affect all sorts of things that are connected to hormones. Metabolism is on top of that list.

Not yet. I went on them because of horrifically heavy periods - and hence have been reluctant to get off of them. My docs keep *swearing* they couldn't be the cause of the weight issues. I have been more carefully watching my portions, and I think getting off them is my next step.

I would not listen to this dietician or go back for a second visit. I would try a very low carb ketogenic diet. I highly recommend the book The Art and Science of Low Carbohydrate Performance by Phinney and Volek. Real science by scientists that study this stuff: http://www.amazon.com/Art-Science-Lo...tephen+phinney

Its what I teach medical students to control weight, especially for type ii diabetics and insulin resistant patients. It puts your body in a hormonal state that favors fat burning. Once u become fat adapted, u will burn you body fat stores when u cycle.

This article is interesting in relation to the subject - and positively mentions Phinney cites above: http://www.timeslive.co.za/lifestyle...many-questions

OTOH, I've been doing a teensy bit of poking around, and with the huge caveat that I haven't even bothered to investigate how rigorous the studies or the journals might be, I've run across several studies that say a low-carb diet can depress thyroid function in susceptible individuals. So - especially considering that your hypothyroidism is more subtle and thus possibly more reactive to environmental factors - maybe increasing your carbs somewhat isn't such a crazy idea.

I know nothing about it - but it's possible that's some of what she's going for.

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Originally Posted by OakLeaf

OTOH, I've been doing a teensy bit of poking around, and with the huge caveat that I haven't even bothered to investigate how rigorous the studies or the journals might be, I've run across several studies that say a low-carb diet can depress thyroid function in susceptible individuals. So - especially considering that your hypothyroidism is more subtle and thus possibly more reactive to environmental factors - maybe increasing your carbs somewhat isn't such a crazy idea.

I know nothing about it - but it's possible that's some of what she's going for.

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For some women, very low carb doesn't work well (nor does intermittent fasting), and by low carb I mean <60 grams per day. There are other good nutrition-dense carb vegetable sources than grains however, so those are worthy of exploring if you want to avoid them. I don't eat grains of any kind, and I've no problem consuming enough carbs to fuel my energy needs for my activities. I no longer do endurance cycling however, I don't know how well that would have worked for me.

That's what I was wondering, if you couldn't just eat carbs other than grains.

Ketogenic diets are definitely good for weight loss, but they give you horribly bad breath. Just something to keep in mind if you try it. It can't be brushed away as it comes from your gut, not your mouth.

Emily is correct. You also don't need to go into ketosis for this. Indeed, research has shown that women's bodies are, usually, have fewer positive responses to ketosis than men. Paleo/Primal/whatever you wish to call a way of eating that focuses on no grains, no processed foods, and on well-sourced animal protein, a wide range of nutritionally-dense veggies and some fruit does not automatically mean either very low carb, low carb or ketosis.

Just saw this blog post from Nancy Clark. There's a link to a site you can use to find a sports dietician. It might be helpful.

http://www.sportingnews.com/sport/st...-biggest-loser

Btw for folks on Twitter, she posts links to lots of articles there. @nclarkrd is her name there.