Visiting the dietician

I had my latest appointment with the dietician today to discuss my 5 day eating recap for for him to provide me with some recommendations for improvement. Or so I thought. Apparently we had more than I anticipated to discuss.

The more appointments I have with the RD, the more I like him. I recognize that the Kaiser protocol is constraining, but he is doing his level best to work with me and find some happy medium to work together. This time, it was actually like we are normal people having a consultation instead of him giving me the Kaiser standard spiel and me rebelling against the machine. This time, we had some basis for our conversation and a jumping-off point for him to see where I am and how he can help me more efficiently.

As agreed, I had done my 5 days of food lists with best guess estimates of quantities consumed and the actual time I started eating meals and snacks. When I remembered I would take pictures of food so he could see. I did not cheat, even going so far as to take pictures of the single piece of dark chocolate I eat on 3 of the 5 nights I ate them (thankfully that bag will be empty soon). It was not much fun, but I got it done and got through it.

It was curious that I do eat a pretty narrow variety of foods, day after day, as represented by the 5 days of pretty much the same meals. Same rotation of 2 or 3 different meals or variations of combinations of the same vegetables, proteins, carbs at each meal, same snacks over and over again. Really boring eater.

Surprisingly, dietician says I eat pretty well, pretty balanced meals, and if I have been doing this for awhile as well as exercising consistently it is no surprise my blood sugar has come down and stabilized in the normal range without insulin and with the low dose of oral medications. But because he is a health professional, there must always be at least one area that requires improvement. In my case it was a few things: (1) I need more protein, (2) I need to time meals better so I do not go longer than 5 hours without food, and (3) I may not be consistently consuming enough calories.

I actually laughed out loud at the last one. Me, not eating enough? Too funny. He explained how he had done a rough calculation from my food list of how many calories I had consumed and on 2 of the 5 days it was between 1150 to 1450 calories, which could be inadequate when subtracting the calories burned with exercise. Between that and the type of calories I am consuming, it would be of concern if it goes on for extended periods.

Which brought us back to the more protein and timing of meals.

Because I exercise every day consistently I need to step up my protein intake. He’s not a huge fan of supplementing, but the protein powder before and immediately after workouts is the best place for its use. It would also be good if I would eat more fish and wider variety of vegetables. Salads are good, especially spinach and kale (ummm … YUCK on the kale!), and to add some chicken or tuna or tofu (ummm … YUCK!) or other protein source to it. Basically eat more protein, eat more protein, eat more protein. I believe I now know he wants me eating A LOT more protein.

Meal timing, there are a lot of days when I go from lunch to dinner and it’s an 8 to 9 hour stretch. Yes I have a small snack in there – usually almonds or a piece of fruit. While a regular meal every 5 hours is preferable, a snack with some protein is better that completely skipping meals for that long. While reviewing my almost daily almond intake, he also said to be careful and watch the sodium.

Which segued into dairy. I was alarmed for a minute – I really did not think 1/2 cup of skim milk and/or a single serving carton of greek yogurt a couple times per week was a big deal. But he thought I might be adding milk to the protein shakes. Nope, not me. Ice and ice water or ice and coffee is all I ever use with them. Once that was cleared up, I am good on the amount of dairy I eat.

And finally the calories thing again. I am apparently not massively overeating, but there is an imbalance in the carbohydrates to protein. Eating more protein will help even it out, but he would like me to consider trying for more of my carbohydrate load from plant based sources rather than my daily breads and cereals. While I feel like I eat more than the average person in vegetables and fruits, I can apparently eat more and do better for myself. So we discussed alternatives for that – apparently it’s not enough that I have cut back pretty dramatically on pasta and completely given up french fries and most other forms of potatoes I must now cut back on my sandwiches and cereal as well, too. And whatever bread and cereal I do consume, it should be whole grain. Le sigh.

Obviously this guy has a mission in life to suck any and all joy out of eating.

That said, it was actually a very positive meeting for both of us. He said because I was/am so resistant to counting calories and food tracking he was expecting to see that I have some bad food habits lurking. He is now understanding that I am just nut-ball crazy about monitoring too closely and given the basic tools I can usually stick with a program. So my new marching orders for the next 3 weeks until we meet again:

  1. Eat more protein, preferably with every meal and before/after workouts.
  2. Primarily plant-based carbs.
  3. Try to plan and consume meals at maximum 5 hours intervals. Protein shake or bar as snack if necessary.

I actually thought I was doing pretty well, until he shows me all his charts and calculations of my nutritional intake, which made a lot of sense. So I will step up my game and become more single-minded about the protein.

But as I told trainer J, it could have been so much worse. I was actually prepared for so much worse.

Overall, he was very pleased with my overall eating habits. With the amount and type of exercise I am pursuing, he said I am off to a great start and we now need to refine my food intake so I continue to gain muscle and lose fat and stay in the well controlled diabetic range. It’s going to be an adjustment, but I have overcome much worse. I do not eat a lot of sugar or junk food anymore, so it should not be that difficult to implement small adjustments (read: eat more protein) that will reap bigger dividends.

While he knows I am completely against the idea of food tracking and calorie counting, RD would like me to consider it as an educational process, so I can get a better feel for how many calories I am consuming and when I may be going over and why. He set a do-not-drop-below calorie budget of 1850 calories per day because of my daily exercise expenditure. Since I am the farthest thing in the world from an extreme dieter, I feel pretty safe in assuring him that I will not drop below that, but I did commit to at least thinking about tracking for a short period. And I did not run from his office screaming, tearing my hair out, or feeling frustrated about lack of progress. Progress right?

And I am still laughing about the idea of me and not eating enough.

But when I mentioned this morning and the low of 49, his eyes widened and he immediately asked if I had reported it to my endocrinologist. Ummm, no, not yet, but since it was the second low in a week I wanted to ask his advice as to what else I might do to keep it from happening in the future.

Like M, he was protein right after workouts, packed in my gym bag if I can manage it, or consumed immediately after I got home. Since I dislike most protein bars, I will figure out some system to mix and cart my shake and shaker. He also suggested I check blood sugar at the gym before leaving. I explained I felt fine when I left the gym, felt fine up until I got to the point where I didn’t feel so fine but am now familiar enough with the signs to recognize them when they occur.

So I have emailed my endocrinologist about this latest turn in my low blood sugar events and will figure out some system to pack my little protein shaker thing in my bag. I recognize it’s a serious issue, but we have cut my meds back so severely and I hadn’t had an event in awhile so I thought myself well past that point. Until I wasn’t.

Doc got back to me right away in complete agreement about testing after exercise and protein shake or equivalent as soon as possible after I am done with practices or training sessions. If it happens again I have to report for blood work and make an appointment to see him. It is part of my new mission statement to not let it happen again. On the bright side, it does make that serving of protein one less to be worried about.

10 thoughts on “Visiting the dietician

  1. Glad to hear the RD appointment went well – looks like he will be a valuable member of your team! Even knowing the signs/feelings when you are low – I think you should test before leaving the gym. Just in case. And on tracking (yuck) – maybe just track protein intake? Not meals or all calories but just that one areas. May be easier.
    BTW – from my restaurant days as a teenager – Kale is a salad bar garnish – it is not meant to be actually consumed. IMO anyway. Kale = yucky

    • So far beyond yucky! I cannot figure out how its become so fashionable to eat it. That’s a really good idea about the protein tracking. It should be easier to keep track of protein consumed and bread-type carbs not being consumed that trying to track everything.

  2. I am one of those who loves kale :). That said, it’s only really good when you grow it in your own garden, leave it in the ground until it gets hit with a few good frosts (which we get lots of here in eastern Canada!), and then you steam it. The frost/cold turns the bland starchy kale into amazing sweetness. That’s why store-bought and most restaurant served kale is yucky, it was picked before turning sweet :).

    • That could be the issue. I’ve also never heard of cooked kale, other than kale chips. Everyone I know who actually eats the stuff either pulverizes it into smoothies or eats it like salad. Do you grow other things as well as kale?

      • Oh, kale in a smoothie does not sound very good! Why would someone do that? :). Even store-bought kale is worth cooking (with some soy sauce and sunflower seeds). I don’t usually eat it raw.

        Yes, lots of other things in my vegetable garden. Tomatoes, peas, potatoes, squash, broccoli, swiss chard, more that I’m forgetting. Last year was a horrible garden year as I was pregnant and couldn’t get much work done there. I’m hoping this year will be much better. I can set up the jolly jumper on the fence door frame and baby can jump away while I weed!

      • I am so not a gardener, but your harvest sounds divine. I’m trying to expand my list of vegetables to eat, or it’s going to be an insanely long rest of my life eating the same things day in, day out.

      • Also wanted to say I’m glad that your meeting with RD was much better than you were anticipating. Hopefully he continues to be a good ally. I’m a bit confused though – you mention he’s part of the “Kaiser” system – I’m not sure what that is.

      • Kaiser is a health maintenance organization/insurance corporation of doctors, hospitals, and other medical services. It’s sort of one-stop shopping for all healthcare needs. Doctors are all employees of the corporation, versus private groups or sole proprietorships. People either love it or hate it, and I’m still learning to work but so far it’s going pretty well.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s