Dietician visit

Monday was my appointment with a registered dietician. We met for an hour and covered a broad range of subjects. I am apparently not the typical diabetic patient he sees … my what a surprise.

We went over my history, what medications I am taking now, what I have taken in the past. He looked at my chart and my my recent labs, etc. Basically the whole of my healthy history on his screen.

Then we go down to the nutrition part.

First things first, I explained to him that I was not going to be weighing or measuring or tracking portions of food I consume. This was not me being difficult or uncooperative; this is me being real about future failure if this is some key to my ultimate success. This is Kaiser we’re talking about, and they have basic protocols of how to manage their diabetes patients. Thing is, I know all that. I know about basic food groups and general nutrition; I have met with RDs in the past and gone through diabetes education, suggested meal plans, foods I should eat and foods I should avoid. I explained that I want and I need something a little more specific and tailored to me and where I am right now, and hopefully he could help me with that.

So he went off-script and talked to me like a person with questions rather than a form to be completed and filed.

We talked about my activity levels. We discussed my recent forays into exercise land – that I do a little more than the recommended 30 minutes of walking 3 to 5 days per week. RD also lifts weights (he’s a bulky guy with no observable jiggly fat on him) and follows a pretty strict clean eating diet himself. I explained about working with a personal trainer for the last 6 months, but that in the last 3 months I had gotten very serious in my commitment and was at the gym 6 or 7 days per week, practicing what trainer J is teaching, so much so that I had to up sessions with him to twice weekly to stay fully engaged. I showed him all my lists and explained that I do at least 2 sets of 2 lists pretty much every day these days.

He particularly liked the dumbbell routine. He asked me about cardio and I explained that other than my warmups I rarely did dedicated cardio anymore, but since I was usually working 90 minutes to 2 hours daily, I felt okay about it. I could revisit that in the future.

Because I am new to Kaiser my records do not precisely disclose my medication history, so I explained to him about going completely off the insulin, the reduction in oral diabetes drug dosages, and how far my A1c had dropped in 3 months. THAT really got his attention.

Finally, when he understood that I’m not just there because my new endocrinologist insists upon it, I explained that I wanted him to help me figure out how to get more serious about my meal planning so I am more balanced and could perhaps hope for leaner.

Right now I’m not doing too terribly, but I am well aware that my portion control or carb intake is out of balance. Maybe both. We discussed food allergies (I don’t have any) and my picky eater factor. While I have done A LOT better with my eating along with my increased exercise, there is still room for improvement. I need the equivalent of a cue sheet for eating.

I don’t eat most fish. The vegetables I will eat are all green. I do not like legumes. While I cannot bring myself to put cottage cheese into my mouth, I like an occasional glass of skim milk or carton of Greek yogurt. Cheese is good when melted on food, and ranch dressing tastes really, really good on lots and lots of things. I love white potatoes, will gag or worse if forced to try yams or sweet potatoes. I love bread, but eat considerably less of it. Pasta used to be a staple and now is an occasional rare treat in restaurants. I eat A LOT of chicken, beef a couple of times per month, turkey only on sandwiches. I am fine eating the same things for weeks at a time.

He was familiar with Dr. Spencer Nadolsky and has read his book. He said the jump start diet plan is reasonable, but his concern is that with my level of activity it might not be enough calories to sustain me throughout the day and could cause low blood sugar events. That’s fair.

We talked about other diet systems and prepackaged meal plans – Paleo, Body for Life, Weight Watchers, Nutrisystems, Jenny Craig, Ideal Protein, Whole30 – some of which I am very generally familiar with and others (whole30?) I had never even heard of before he mentioned it. We also talked about Scott Abel and Georgie Fear – he said J did me good service by the titles provided thus far. From there we wandered to calorie counting and tracking apps – LoseIt, MyFitnessPal, a couple of others I’ve not heard of and have zero interest in exploring further.

Really, just a good general discussion of the marketing frenzy surrounding diets and nutrition out there.

When discussing my personal eating patterns, he immediately spotted the flaw in my routines, in that I do not eat at regular intervals. I have a protein shake before I go to the gym in the morning, and then maybe I have another after I get home or maybe I don’t, but when I don’t I also fail to eat any additional protein. Bad me. Lunch might be 6 or 7 hours later, at which time I’m starving and falling into an eating frenzy from hunger. Because I ate lunch so late dinner is a smaller to tiny meal and then I have middle of the night lows.

My eating timing is out of whack as well.

My former endocrinologist was breaking me of any snacking habits I have picked up, but we had not yet gotten to the eating at regular times portion of that equation.

So to get started, RD says Dr. Spencer is a reasonable kick start with a couple of modifications –

  • Protein shake before I go to the gym. He says the low blood sugar look or fainting during workouts would be bad. Suggested breakfast after is fine.
  • Lunch needs to be within 4 to 5 hours after breakfast, no exceptions. I get busy with work and forget to eat. Set my phone alarm and make it happen.
  • Dinner needs to be within 5 hours after lunch. Eat a midafternoon snack – piece of fruit or small portion of nuts – if I cannot make dinner happen within that timeline.
  • If my sugar is lower than 150 before bed, I should have a small snack before bed to stave of a low blood sugar event. (Endocrinologist also told me this and I am mostly keeping a close eye on it.)

His recommendations were that I consume between 1500 and 2000 calories per day, and of that, at least 40% from protein, 30% to 35% primarily from plant-based carbohydrates, and not more than 30% from fat, preferably better fats. Avocados (sorry, I don’t eat those), nuts, etc. He broke it down for me in terms of how many grams of each just in case I want to look it up or keep track. I don’t have a problem looking up the nutritional value of things; I do have an issue with the OCD that overtakes me when trying to keep track of what I put into my mouth daily.

From there we got into clean eating and real food. I get where people are coming from on that front. I agree cutting back on processed food is a very good thing, buying organic is better whenever possible. But honestly, I work in an environmental field and have some skepticism about the certification process and how truly meaningful it is in the bigger picture. I also know I have no plans to find local ranchers or chicken farmers to buy our meat that way; I require the disconnect that comes with pretty cow in the field to steaks in the grocery store.

Since I cannot reinvent myself into a completely clean eating/real food preparing person this week it will have to be very much a slow work in progress. I am perfectly fine with frozen vegetables and berries. Fresh produce I do buy is limited to salad ingredients and fruit, and sometimes its organic.

So after this hour long appointment and conversation, my takeaway was eat more protein – A LOT more protein – and vegetables and better fats. I am going to have to further restrain myself with my beloved ranch dressing, as in even with my recently adopted salad dipping behaviors I have to limit how many servings I allow myself per month or test and adopt a vastly reduced calorie version of it.

Other than the holiday eating extravaganza, I have been a lot better about my diet, and the RD agreed my recent success with controlling my blood sugar is pretty phenomenal. However, since I am now sitting across the desk from him to discuss ways to get leaner (again the kinder, gentler way of saying please lose some weight), we have to talk about food and eating behavior modifications that are sustainable, not just quick fixes to help me drop enough weight to fit into something in a small dress size for an event. I am returning in 3 weeks to see how I did/am doing with the “eat more protein and vegetables” plan of attack.

Overall, I think the time was well spent. As an RD I think this guy is probably as good or even better than most I have consulted in the past. However, as a Kaiser employee, I truly believe there is a pretty canned formula applied to each of their diabetes patients and he has only so much leeway to step outside that program. The diabetes and weight management educational classes are not something that interest me right now, and reviewing 3 weeks of eating plans that I am unlikely to maintain that long seems a bit pointless at this juncture. I do not believe their program will work for me personally anymore, because I am no longer part of their target patient audience. I am okay with that; I feel as if I have stepped outside of the “most” in the “one size fits most” patient management model they use. It just reinforces for me that I will need to continue to read and study on my own to figure out what will work best for me.

So I will go forth with what I was planning on doing anyway and continue with my own diet and nutrition research. If when I get my labs done in February we find I am massively malnourished in some nutrients, I will have more reason to try and expand my food repertoire and attend more of the diabetes education classes Kaiser is already pushing me to enroll in. Until then, though, I will be back to reading and discussing eating and diet and such with J and other folks with an interest in nutrition and fitness. Between that and being more intentional in my application of new behaviors, hopefully there will be some success in the getting leaner advice.

As I have said before, I seem to have the exercise thing firmly in hand, and I am turning my attention and focus to refining and tightening up my eating habits.

2 thoughts on “Dietician visit

  1. Sounds like a good visit. But you are completely right about Kaiser having a standard program for diabetics. I was under Kaiser for a number of years and while it didn’t kill me – it actually came pretty close (not joking). Unless things have changed radically in the last couple of years – their formula is insulin and more of it. It sounds like you have a good endocrinologist (great that he knows your old one) but be aware that is what will get pushed if your numbers start to get out of whack.

    I’m with you on food except – I will eat things you won’t 😉 It really is about taking in all the information you can and then picking and choosing what works for you so you can build a sustainable life long eating style. The first 60 pounds I lost was all because of changes in eating and you are on the right track. Limited snacking – only if *really* hungry (not bored, depressed, stressed, etc), meals at regular intervals, low carb, high protein and veggies, drink water before eating. I’m not perfect – having some issues now – so when I do run into trouble I revert back to the very basic point – all bad stuff gets thrown out. No excuses. My cupboards look bare – but the only thing in the house is what I absolutely can eat. If things are going well I can a small thing of dark chocolate and have one a day or every other day. If not, no chocolate because I will not stop at one.

    You are doing all the right stuff and I love that you are honest and upfront about what you will and won’t do. They really aren’t used to that at Kaiser (or many places).

    • Thanks, SAK. I would love to be a compliant patient and log all my eating and weigh and measure and be accurate on my calorie and nutrient calculations … but it’s just not healthy for me. I cannot do that with any consistency without feeling anxious and stressed about what the data ultimately says about me and my habits, even if I am as close to perfect as is possible. If there is no other way to help me, then I guess we’re better off not wasting time together.
      Truthfully, I get more from the feedback here on the blog and in conversations with J and others who have been where I am presently sitting than anything else these days, and I am learning that I have to be my own advocate within the Kaiser system or what I want and need for my own health is going to go completely unmet. Kaiser is an experiment this year; I may be back to Anthem and happily handing over thousands of dollars more in premiums each month for the same level of services but with my own private providers.

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