Posts Tagged ‘Diet’

Phat and Fat: Dr. Cadaver

April 22nd, 2012

In the series on my fat-control, here’s a last set of comments on BMI, using the closely related height/weight charts doctors had as a gimmick before BMI. We can’t even estimate how many of us become sick, sicker or dead from physicians not listening, not believing.

Although they tend to say their anecdotal and experiential knowledge is sound “medical science,” it is a very rare doctor who trusts patients’ self-reporting. I recently experienced that repeatedly from two nurses, my PCP, and a nutritionist. Shown two years of carefully measured, counted, weighed and machine-derived caloric intake and exercise expenditure, to a one, they denied it all. I was yet another patient who was confused, or dishonest, or inaccurate, or unaware of what I was eating.

Instead, logic could go for Occam’s razor, looking for the simplest explanation that fits the known facts. In this case, I came to them because the two nutrition/exercise recording programs I had been using clearly indicated that I should have lost considerable weight instead of continuing to edge up. The conclusion I drew and expected them to was not that I had to be a liar or fool when my experience did not fit their formulaic stereotype of calories-in/calories-out. Instead, my metabolism might be hosed, my body was too efficient during exercise, and the estimated basal metabolic rate was wildly off in my case.

With my conclusions, I could try to work in that frame and find solutions short of absolute starvation. The best my doc could say was maybe I could increase my aerobic exercise 10 minutes a day. I was already exercising one to two hours six or seven days a week. His way was just silly.

It took me back to decades before, when I dealt with the guy I think of as Dr. Cadaver. He was a partner of my favorite doctor and specialized in smoking cessation and weight control. He was so gaunt that he appeared to have been dead for quite some time. I think that was good for his anti-cigarette work.

About that x-ray…

In fact, he did scare me. After a battery of what was then called routine tests, he said he wanted to talk with me about my chest x-ray. I had smoked two packs of Camels a day for years and dreaded the skeleton’s revelation. He asked whether I lived in Manhattan (I did). He paused a long time, leaving me to stew. Then he said, “That’s odd. You have the clearest lungs I’ve ever seen in a city dweller.” That put the idea in my head to stop smoking, while I was ahead.

I had complained to my doctor that I wanted to lose some weight. At about 190 or so, I wasn’t fat, he said, but he sent me to Dr. Cadaver.

The first conflict came from the exam where he questioned my checking large bone structure on his form. Like so many doctors and nurses before and after, he laughed derisively and with a snort said that everyone claims to have big bones but almost no one does. Then as two other doctors have done since, he got out his calipers to prove me wrong.

He measured several times and had to admit that in fact I had the largest bone structure, from wrist measurements, he had seen and at the very top of the chart. He palpated my wrists and found them very broad and without any flab at all.

Next, he brought out ye olde height/weight chart. As I recall his finding, at six feet even, I should weigh no more than 173 pounds, ideally five pounds less.

I went off and to the Stillman diet, used by two girlfriends. That meant almost no carbs and extremely low fat. I got weak and a few times nearly passed out, but I lost pounds. When I returned, I was around 175 or maybe a little under and feeling very accomplished.

He examined me, making odd noises. When he finished, I recall very clearly that he fairly exclaimed, “What the hell did you do to yourself!”

He said I was way too thin, my ribs were sticking out and that I did not have adequate fat on my torso. Having done what he commanded, I was none too pleased. He said I needed to gain at least 10 pounds back, slowly if I could.

Add some science

Since then, I listen politely when a doctor pulls out weight or BMI numbers. It’s important for them to play expert here, even when observation and listening to me should be more productive. With my own doc, I have said plainly that I use body-fat measurements and have no use for BMI. As muscular as I am, pure poundage or BMI is almost worthless.

Fortunately for this matter I grew up to be a relentless researcher when called for. That has worked well for me as a newspaper and magazine writer, and on occasion for such personal matters as diagnosing myself when medical types fail.

I would love to find a nutrition/exercise program with heuristics. I wish I had one as I assiduously tracked all food and liquid I consumed and all exercise I performed over several years. Then with the weekly entry of weight and body fat, I’d like that program to adjust the basal metabolism rate and perhaps rationalize the true exercise calories burned. I’d like to be able to trust the result so that at the end of each day if it says I lost .2 pound or whatever, it would be right.

Someone must be working on that. There are a lot of software applications that do learn.

Short of that, I researched to find out what I should be eating and perhaps why my metabolism doesn’t follow the estimates medical sorts use as gospel.

This series includes:

Call it Lifestyle on the intellectual and emotional commitment to low-carb
Watching the Struggle on my grandmothers diet woes
Wrestling with Fat on overcoming fear of dietary fats
Hunger? do you starve on a low-carb diet?
Low-Carb Eats on what’s on the menu in the regimen
How Much of What Food on calories-in/calories-out cliché
Dr. Cadaver on mindless trust in group averages
Who’s Counting on body fast v. weight
Part 1 on pants don’t lie

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Phat and Fat, Part 1

April 20th, 2012

Striding the aisles of the new Hyde Park Stop & Shop, I was aware how loose my trousers were. That’s smirk making.

Consider yourself warned. Self-absorption follows in this and related posts. Already, chum John experienced that in our recent four-day trip to Manhattan. I had started a low-carb regimen and talked about it. I tried not to harp, but it was everywhere. We’re drinking buddies, usually concentrating on ale. Beer is very expensive in carbs, ale less so, wine even less so and bourbon is free. So I’m sure he got bored suggesting brews and hearing me dither or pull out the carb counter and see if I could afford it.

So what brought me to my own modified Atkins world, you may ask?

The answer relates to that self-absorption we bloggers seem to epitomize but also transcends it. The more salient response is the incompetence and ignorance of health professionals. Therein lies the justification for this series.

I’m tired of being trim for a little bit and chubby for quite awhile. I’m also well beyond the teens and 20s when I could cast aside poundage and excess fat in a few weeks with modest changes in exercise or food choices. Way back in those days, I recall a woman with whom I kept company. She is about 10 years older and even then, in her 30s, has trouble paring a single pound off when I could drop 5 or 10 in a week or two.


Who Ya Gonna Call?


Well, we either age or die. Aging isn’t terrible, considering the only alternative. With that process comes a slower metabolism for nearly all of us. We as a nation then end up late or soon consumed with consumption of food and drink.

We care, we whine, we compare, we plot, we despair.

Of course, there are the tiny subset of exceptions. There are ectomorphic somatotypes. Those skinny men and women with neither visible fat nor apparent muscle mass, women with no breasts or hips to hold and men with no shoulders and wee, wee thighs. These freakish folk tend to have permanently high metabolic rates, as most of us did in puberty. They also tend to disdain the struggles of the 90-some percent of us who discover tighter pants when we have changed nothing about our activity, food or drink.

Being a pretty pure mesomorph with arms and legs like oak-tree limbs, but a tendency to tuck extra fat on the torso, I figured the medical world might give me some advice in my personal struggle. That was naive.

I’m no newcomer to diet/exercise/weight and fat control. Yet, not getting results, I went to the pros. I has used a damned good program, CrossTrainer, to track my intake and exercise. Also, being a pretty type-A tech writer, I backed that up with Lose It! Fastidiously, I plugged in each bit and every step. I counted grapes, measured yogurt, weighed cheese, and used the report of the elliptical machines as well as putting in the distance and duration of each bike ride.

Both programs had me losing lots of weight. I put in serious exercise time, yielding rated 1,000 to 1,600 calories burned six and sometimes seven days a week. Moreover, I wasn’t cheating in the slightest. Every morsel and motion went in accurately. That is my wont. The programs reported I should be losing half a pound to .8 pounds per day.

Yet on the weekly weigh in and body-fat machine measures, I was chubbing up. My doctor’s scale showed that meager confirmation as well.

While I had read a lot about nutrition and weight control, I needed help. I turned to doctors and got a referral to a nutritionist.


DIY Health


Fuggedaboutit!

Docs, nurses, even nutritionists are ignoramuses about food and weight. With the flood of information and the myriad patients in their examining rooms, they remain ignorant, if not stupid. It reminds me of the many ministers I know who decry how little they learn of church management in divinity school, often a single course. Then when they get a parish, they are excepted suddenly to be or oversee the CEO, COO and CFO roles.

Unlike clerics, who look to board members, staff and others for help, medical professionals tend to feign competence and exhibit confidence. I have found they they deal instead in platitudes and formulaic responses.

The worst for my issue is calories-in/calories-out. “All you need to know is consume fewer calories than you burn up and you’ll lose weight,” they invariably say.  Elephant feathers!

Even telling my primary doc and nutritionist, even producing two years of weigh ins, with body-fat readings, and as much exercise and calorie intake printouts as they wanted to see, I got the same jive. It always came with the self-satisfied look of the ignorant. Calories-in/calories-out.

I can believe for some ectomorphs, that works. I can believe that those basal metabolic rate estimates and exercise expenditure estimates are reasonably accurate for a small percentage of people. Yet, I know far too many, including myself, for whom those don’t work, don’t work by a big factor.

In fact, I turned to my doc and a nutritionist precisely because I was assiduous in recording all, but did not get the expected result. My wife is fond of noting that I am an outlier. I am my mother’s son, the one who is precise, detailed, and honest. I do the scientific method.

So, provided with my proofs that the estimates of intake and expenditures did not work for me, what do you suppose the pros did? Of course, they doubled down. Calories-in/calories out.

The doctor was dumb enough to say things like, “Oh, I guess the calories are coming from the air.” The nutritionist had next to no quibble with my three-days of detailed consumption/exercise I printed out. She suggested adding more calories, specifically more fat in the form of olive oil, but had no answer for why I was not losing as the two programs reported I should be.


Medical Deafness


I thought of nutrition overlord/author Michael Prager. He has different issues leading to being fat, a self-defined food addiction. Yet, as a newspaper reporter for years, he had his own methodology. He tracked down a nutritionist west of Philly who didn’t do formula, who didn’t pull platitudes, and who did listen to his story to produce a custom plan.

Instead, my doc and nutritionist shoved the same hand of food cards across their desk to me, not hearing what didn’t work. In fact, at a party I ended up with three other people, all of whom had been to docs and nutritionists. One wanted to gain weight and muscle and we other three to lose. We all got identical diet advice. That’s craziness.

So I read. I went to libraries. I clicked around the internet to pop and academic sites. I went way back to William Banting’s 1864 booklet on who he dropped lots of flab. I did current research. I went so far as to find out that everything of value I wanted had been in Gary Taubes’ Good Calories, Bad Calories all along. I could have started and ended there, but given my anal-retentive nature, it’s better I found it after a lot of research so it had all the more credibility.

Part 2 of this series will go into what’s been working for me.

I have a food site I started in concept before my effort to lose some fat. It will have mostly food-enjoyment articles, recipes, videos and such. I remain a serious foodie. Yet, most of us adults are conflicted about food. I’ll address it all. Look here for the nutrition angle. I’ll announce the food site when I open it to the net.

This series includes:

Call it Lifestyle on the intellectual and emotional commitment to low-carb
Watching the Struggle on my grandmothers diet woes
Wrestling with Fat on overcoming fear of dietary fats
Hunger? do you starve on a low-carb diet?
Low-Carb Eats on what’s on the menu in the regimen
How Much of What Food on calories-in/calories-out cliché
Dr. Cadaver on mindless trust in group averages
Who’s Counting on body fast v. weight
Part 1 on pants don’t lie

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