Wednesday, January 16, 2013

Met with the dietitian today

I didn't know Kaiser moved so fast ... yesterday I went to see my primary care doctor and was told to call the nutrition services department on Thursday to make an appointment with a dietitian.  Instead, they called me late in the afternoon the same day, told me they had a cancellation and wanted me to come in this morning.  While I was there, my doctor wanted me to get a diabetic photo eye exam, the kind where they dilate your eyes.  Oh joy!  Guess kill two birds with one stone (what a horrible saying by the way). 

The meeting with the dietitian was pretty awesome.  She told me that she read up on me before I came in so she was very familiar with my whole journey and was impressed not only with where I have been, how much weight I've lost, but also my courage in walking forward through such a difficult time.  I could feel tears sort of sting my eyes when she said that and told myself, "No, Kathy, hold it together girl!  It's okay to cry, but you have got to be present to hear the advice she'll be giving you about nutrition." 

So I laid it all out on the table for her, especially my concerns on no longer being in the safety of the liquid program that Optifast provided and so deathly scared of gaining all the weight back.  I wanted to know how to do "real life" with the food so that I can not only continue losing weight but doing it in the healthiest and safest way possible, all the while trying to keep my low blood sugar at a normal level.  Not too much to ask, right?  Ha ha!  One of the best things she did was draw a chart for me on how the body reacts to the food that is put in it in terms of blood sugar.  For fast-acting carbs, like the food I was having to have to raise my low blood sugar (glucose tabs, orange juice, regular soda, etc.), it raises your blood sugar fast but then you crash in about two hours.  However, if you have protein, it takes four hours to lower your blood sugar and even takes fat five hours.  So, when I wake up in the morning, she does want my blood sugar to be around 80-120.  Then, with each meal, I should have a minimum of a high fiber carb, lean protein and healthy fat to keep the balance going throughout the day.

We talked in great detail about the food plan I was given from the Optifast clinic (which is part of Kaiser) versus the food plan in the diabetes education materials and where that leaves me.  Basically, I'm super confused. I explained to the dietitian that I track all of my food in the "Lose It" app on my phone and it tells me how many calories to consume based on my height and present weight.  And it's different than the other two plans.  The dietitian told me that she'd like to see me having about 1300-1500 calories per day since I'm tall (5ft 9.75 in).  However, when I exercise, I can add those calories that I burn back in.  So that's when I brought up a question that has been on my mind a lot:  If I'm told to have, say, 1400 calories in a day and then I burn 700 calories through exercise, is she suggesting that I am "allowed" to consume 2100 calories??  That seems like a lot to me.  She told me that, in fact, that's true.  However, I don't have to eat every calorie I burn, but that I could have up to that amount.  One thing she was adamant about, however, is that I should have no less than 1000 net calories per day.  She went on to explain that when we lose weight really fast, like on a fast or some sort of bariatric program, it really messes with the metabolism, so the weight loss is going to be a lot slower than what I've been used to.  At this point, in all honesty, I would be thrilled to be losing a healthy 2 pounds or so every week if I was doing it through regular diet and exercise.  The whole goal here was to be healthy, at least for me.

Given all the information she had on me and the questions that I had, she put together a program for me and gave me handouts as guidelines for what I should be eating.  I created a new page here on my blog with my current food plan, but didn't list specific foods.  I didn't want someone coming along and just following what I'm eating because everyone is individual.  However, I did put on that page the basics of what I'll be doing.  Here's my general food plan:

Breakfast:  1 protein, 3 carbs, 1 fat
Snack:  2 carbs
Lunch:  2 protein, 3 carbs, at least 1 veggie, 1 fat
Snack:  2 carbs (especially important for me before working out because I tend to dip really low with my blood sugar during exercise)
Dinner:  3 proteins, 2 carbs, at least 1 veggie, 2 fats

  Some other guidelines:

  • Non-starchy veggie quantities are unlimited
  • No more than 45g carbs per meal
  • Good idea to add a protein or veggie to each snack and adjust where needed
  • To keep blood sugar at an even level, aim to have  a high fiber carb, lean protein and healthy fat at each main meal
  • Carbs consist of starches, fruits, milk and sweets/other 
  • Don't skip meals
  • Eat every 3-4 hours
  • Choose fish two or more times per week
  • Keep a record of what you eat and drink
  • Weigh and measure your food as much as you can
It seems like a very simple and easy plan to follow.  I can meet with her again, but I also will be continuing in my Optifast support classes and seeing my regular doctor, too.  I'll continue monitoring my blood sugar like I have been doing, logging in my food and just taking this journey one day at a time.  After meeting with her, I felt really comfortable and it doesn't seem as daunting. 


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