Wasting away again in ketogenic-ville

Leptic... you're right... I was ranting about giving people a chance to do their thing and then didn't respect your right to do it! Really sorry, and now that I see what you wrote line for line, I'll take it back or shut up, whichever you want. Should not get so carried away with my brilliance .

Julie wrote:Leptic... you're right... I was ranting about giving people a chance to do their thing and then didn't respect your right to do it! Really sorry, and now that I see what you wrote line for line, I'll take it back or shut up, whichever you want. Should not get so carried away with my brilliance .

No worries - I think there is a lot of wisdom in what you've been saying. I act like a know-it-all sometimes (occupational hazard for university professors) and you could totally be forgiven for thinking I might act as you'd feared.

There's no telling a closed-minded dietitian his or her business no matter what kind of peer reviewed, high standard evidence you present. .

Personally, I would never subject myself to a dietitian unless:

1) The dietitian has a reputation for being supportive of low carb/ keto diets and I believe he or she may be able to offer me some help or guidance; OR

2) I was forced to for one of those evil insurance situations, i.e. "we are not going to cover X unless you have a consultation with a dietitian."

My daughter works for a company with one of those wellness plans, and she can save significant money on her insurance if she gets lifestyle counseling. She is far out of the BMI limits, so they are all tying themselves in knots to get her on some sort of program. But she is off the BMI charts because she is 4'11" and only weighs 90 lbs. What are they going to do, tell her to live on Cheetos and ice cream (she already does! )??? Fortunately, for now I'm self employed and don't have to play stupid insurance games. And tomorrow is her last day at this job--she quit before the deadline to do the lifestyle counseling.

leptic wrote:One other question -

If I were to bring some literature to my appointment with the dietician, what would the low-carb/ketosis advocates here consider to be the most compelling documentation of the safety and efficacy of these approaches? I am talking about articles in peer-reviewed journals, not consumer-oriented books.

Thanks for any suggestions!

The book by Gary Taubes "Why we get Fat" - I just got it from the library and finished it in a day. It has lots of references for low carb studies - by major American universities.

I have worked with a dietitian but that was to help me with Mother who had problems swallowing and had to eat mush. She was surprisingly helpful. She knew all the secret sources for food replacements and helped me with diary (Lactose) replacement issues. She pointed out to me that Almond milk was a total scam - just flavoured water with none of the protein found in actual almonds. She was very much for the high fat/protein low carb for mom's diabetic diet - "Pour butter over it all" was her suggestion for the tasteless mush.

Janknitz wrote:There's no telling a closed-minded dietitian his or her business no matter what kind of peer reviewed, high standard evidence you present. .

Personally, I would never subject myself to a dietitian unless:

1) The dietitian has a reputation for being supportive of low carb/ keto diets and I believe he or she may be able to offer me some help or guidance; OR

2) I was forced to for one of those evil insurance situations, i.e. "we are not going to cover X unless you have a consultation with a dietitian."

My daughter works for a company with one of those wellness plans, and she can save significant money on her insurance if she gets lifestyle counseling. She is far out of the BMI limits, so they are all tying themselves in knots to get her on some sort of program. But she is off the BMI charts because she is 4'11" and only weighs 90 lbs. What are they going to do, tell her to live on Cheetos and ice cream (she already does! )??? Fortunately, for now I'm self employed and don't have to play stupid insurance games. And tomorrow is her last day at this job--she quit before the deadline to do the lifestyle counseling.

I am more worried about my wife than the dietician . You will never meet a bigger 'calories in, calories out' adherent. My wife is blessed with iron discipline and is not much interested in food - for her, an inability to lose weight through portion reduction is to be despised as weakness. I grew up in a family of rail-thin boys (with ever-present admonishments to 'eat more'), and did competitive sports for several decades (during the era of 'carbo loading' no less). Unfortunately I developed very bad, wolf-like eating habits that have been hard to shake even though I no longer do anywhere near enough activity to justify it (sleep deprivation is not helping).

Whatever the dietician recommends/supports, it will lend a lot of weight to any concerted effort I might make at home.

Thanks again for all the discussion on this thread - it has been really helpful and I very much appreciate the support.

Janknitz wrote:There's no telling a closed-minded dietitian his or her business no matter what kind of peer reviewed, high standard evidence you present. .

Personally, I would never subject myself to a dietitian unless:

1) The dietitian has a reputation for being supportive of low carb/ keto diets and I believe he or she may be able to offer me some help or guidance; OR

PS the clinic I chose is a private clinic that seems very attuned to consumer demand. I suspect that they are very aware of the interest in low carb/keto diets, and recognize the business value in catering to this. There are two dieticians at the clinic - I opted for the one I will see tomorrow in part because she co-authored a food guide for bariatric surgery that discusses a low-carb diet (no, I am not going for bariatric surgery).

The other dietician at the clinic has worked at Nautilus Plus, a chain of fitness centres that is likely very well acquainted with low-carb diets.

I agree that if you see an institutional dietician who is 20 years out of school and is putting in time before retirement, he or she might not be so open minded (however even then, you never know). However, I'm cautiously optimistic that I will get open-minded and current professional advice from this clinic.

Did you dispose of your Encyclopedia Britannica once you discovered that you no longer needed them, due to your wife already knowing everything ?

Gasper62 wrote:Did you dispose of your Encyclopedia Britannica once you discovered that you no longer needed them, due to your wife already knowing everything ?

Yes it's in a landfill somewhere right beside my testicles

PS the clinic I chose is a private clinic that seems very attuned to consumer demand. I suspect that they are very aware of the interest in low carb/keto diets, and recognize the business value in catering to this. There are two dieticians at the clinic - I opted for the one I will see tomorrow in part because she co-authored a food guide for bariatric surgery that discusses a low-carb diet (no, I am not going for bariatric surgery).

But the diet they call "low carb, low calorie" is NOT low carb. It even says it follows the Canada food guide, which is NOT low carb. A good percentage of the calories at each stage come from cereal (corn flakes, special K, rice krispies, oatmeal), potato, fruit juice, skim milk, crackers. etc. The final diet recommends 2 servings of fruit, FIVE servings of whole grains, and up to 1 cup of legumes daily with Boost high protein which comes in at 15 g of carbs for the 125 ml. serving (the other protein drink doesn't have carbs, though). It recommends margarine instead of real butter. They may call it a low carb diet, but clearly it is not, since most of us on keto or LCHF strive for less than 20 g. a day, TOTAL.

Anyway, not meaning to argue, just to let you know what you may be up against. I'm interested to hear how it goes.

Janknitz wrote:

PS the clinic I chose is a private clinic that seems very attuned to consumer demand. I suspect that they are very aware of the interest in low carb/keto diets, and recognize the business value in catering to this. There are two dieticians at the clinic - I opted for the one I will see tomorrow in part because she co-authored a food guide for bariatric surgery that discusses a low-carb diet (no, I am not going for bariatric surgery).

But the diet they call "low carb, low calorie" is NOT low carb. It even says it follows the Canada food guide, which is NOT low carb. A good percentage of the calories at each stage come from cereal (corn flakes, special K, rice krispies, oatmeal), potato, fruit juice, skim milk, crackers. etc. The final diet recommends 2 servings of fruit, FIVE servings of whole grains, and up to 1 cup of legumes daily with Boost high protein which comes in at 15 g of carbs for the 125 ml. serving (the other protein drink doesn't have carbs, though). It recommends margarine instead of real butter. They may call it a low carb diet, but clearly it is not, since most of us on keto or LCHF strive for less than 20 g. a day, TOTAL.

Anyway, not meaning to argue, just to let you know what you may be up against. I'm interested to hear how it goes.

I hear you - thanks for actually reading it.

I'll be kind of surprised if a Canadian dietician at a fancy private clinic does not have a copy of Obesity Code on her bookshelf (given that Dr. Fung seems to be a pop sensation and he's just up the 401 from us). I have started reading it (Fung's book, not the Canada food guide), and it appears to be quite well researched. There are about 30 pages of references, many of them from reputable mainstream scientific journals (FWIW). Fung is a licensed MD in Canada - diabetes patients in Ontario can get a physician's referral to participate (for a fee) in his intensive dietary management program. Not sure if it's reimbursable by OHIP, but the College of Physicians lets him do it. None of this absolutely guarantees validity (and as far as I know I'm not a diabetes patient), but it seems a reasonable thing to ask a dietician about.

As I alluded to earlier, I have some personal experiences that make me think Fung is really onto something in blaming insulin. I've been involved in a few scientific studies of how exercise impacts cognition in aging, that started out under the hypothesis that the benefits were associated with mechanistic phenomena like CICO and/or improved cardiovascular function (better delivery of oxygen to the brain etc.) I have to say I never saw any evidence of such effects - I am much more inclined to believe that the benefits are indirect, in the form of endocrine changes (i.e. hormones like insulin) and the fact that people sleep better (which is probably also hormonal - and we all know here how important sleep is). I also have some (now-ancient) background in competitive sports, and with the onset of age/career/kids have gotten in and out 'of shape' more times than I can count. I've always felt improvements in cognition, alertness, and general feeling of wellbeing very rapidly after re-engaging in exercise - far too fast for the effects to be explained by 'fat burning' or any adaptive cardiovascular changes. The only things I can honestly think of that could account for this are changes in insulin resistance and improvements to sleep quality/quantity.

I am pretty sure that the evolution of my sleep apnea has largely paralleled a particularly sedentary period in my life over the last three years, and it's now a vicious circle where I am too fatigued to exercise but experience intense food cravings that are probably linked to insulin levels and also the need to do something hedonic as a way to salve the dysphoria that comes with being wretchedly sleep deprived. Please understand that I have never exercised to 'burn fat'. I do it because I enjoy it and because it seems to make me feel good. If you compute the energy output associated with most reasonable workouts, it's tiny (like half a yoghurt). There's perhaps some boost to basal metabolic rate as well, but I think the real benefits come from indirect hormonal pathways.

Ok end of lecture (really just opinions supported mostly by anecdote) for now... I am also getting really tired so forgive the rambling sentences...

leptic wrote:
I am more worried about my wife than the dietician . You will never meet a bigger 'calories in, calories out' adherent. My wife is blessed with iron discipline and is not much interested in food - for her, an inability to lose weight through portion reduction is to be despised as weakness. I grew up in a family of rail-thin boys (with ever-present admonishments to 'eat more'), and did competitive sports for several decades (during the era of 'carbo loading' no less). Unfortunately I developed very bad, wolf-like eating habits that have been hard to shake even though I no longer do anywhere near enough activity to justify it (sleep deprivation is not helping).

You might point out to her that a lot of poor and very hard working people are over weight not due to lack of exercise or over eating but from WHAT they eat - lots of cheap carbs.

Wolf like eating habits are fine as long as you teeth are tearing into meat not bread. And even better if you ran to take down that prey.

ETA: This came across my FB feed today

My husband and I have agreed to disagree on the matter of carbs in the diet. About 5 years before me he "got religion" and began his own exercise and healthy diet regimen. He lost weight and went from very sedentary to fit and active. He walks several miles a day, does intense kettlebell exercises and yoga. His body composition has changed dramatically.

We agree on basic diet premises. Real, whole and organic food, real fats, cooking from scratch. He does the cooking and shopping--he's a great cook. He doesn't agree with my low carb approach (despite watching me lose 75 lbs and regain my health doing it) but he is supportive of ME, so he does not criticize my efforts and he makes sure there are always good things for me to eat on the table.

That's what I'd ask your wife. She does not have to agree with your dietary choice, but married people support each other. Tell her what you need from her--love, support, and encouragement and work out how to get the diet you want to follow without making it inconvenient for her.

In our case I usually eat the protein and we have 2 or 3 veggies with dinner, at least 2 are non starchy that I can eat. We have one kid who is a "pastatarian" so there's often a carby side for her. When they want a carby meal like pasta or chicken pot pie (husband makes from scratch!) I get just the protein part (a meatball or the chicken filling without sauce and crust). When I really can't eat the main course I cook up an omelet or frittata for myself.

We have a committment to sit down together as a family for a leisurely dinner EVERY night. So while I IF, skipping dinner is not an option (and not something I want to model for my kids). So generally I do only dinner to dinner fasts.

You have to work it out in a way that works for you and your family. The key is to start from a place of mutual respect and love, and tak it out. Share your needs and wants and be clear on what compromises you can and will make. Let this strengthen not only your body but your marriage.

Ok - I had the appointment.

Believe it or not, I started pretty much verbatim with the script below:

leptic wrote:
Dietician: so, Mr. Leptic, what brings you here today:

Me: I was recently diagnosed with sleep apnea, and I gather that losing some weight might be beneficial in terms of the apnea and for my health in general. I tend to be especially tired after meals, and have pretty intense cravings for food during the day. A number of people have suggested I look into a low-carbohydrate diet, because it can apparently reduce insulin fluctuations and there seems to be some evidence that it can be a safe and effective means of weight-loss. I thought it would be a good idea to discuss this with a professional though, to get your thoughts on whether such a diet could be appropriate for me and whether there are alternatives you think I should consider.

I will paraphrase the rest of the conversation, but she was basically aware of the ketotic diet and appeared to take it seriously as a means of weight loss and health improvement. She also felt that, while there is definitely evidence of its efficacy, it takes a while for the evidence to reach the consensus level typically required for professional bodies to recommend a new diet or treatment. For this reason, it's still not something she would normally promote as the 'standard of care' for somebody in my situation. She was clear that she would not necessarily discourage a ketotic diet, but suggested that a significant reduction in carbohydrates and avoiding all highly refined carbs (which cause insulin to spike more dramatically) would be a good first step.

She was very helpful in providing specific recommendations for foods and portion sizes, based on stores and brands that are available in our area. The general diet plan she proposed does not actually preclude reducing carbs to below 20g/day, although it is not required.

She is doing a graduate degree part time, and seems quite interested in research - overall my impression was that she was pretty open minded but didn't want to start by promoting something she will need to research herself (although she seemed quite familiar with the physiology of ketosis). I thought it was worthwhile, and an important part of taking my health seriously. Thanks to Julie for suggesting this - will let you all know how it goes.

Sounds like a good start.

It will at least make your wife happy, in that you can wave the approved diet chart at her.