As a doctor that focuses on the early detection of diabetes
and heart attack risk, I see risk where a lot of other doctors might not. It
comes back to that “ounce of prevention pound of cure” thing. It amazes me to
see how many patients come through my door that have been in a state of insulin
resistance for such a long time without knowing it and more importantly without
an action plan. See this study and this one if you don’t believe me.
Patients need to have something tangible they can leave my
office to change their lives (and get inspired). Unfortunately there is no “one
size fits all” solution. We can talk about metabolic flexibility in regards of
how the body uses energy; well how about diet flexibility for patients.
I offer an array of options for patients, like Robb Wolf"s Paleo Solution, Steven Gundry's Diet Evolution, or Dave Asprey's Bulletproof Diet. (can you tell I was an Anthropology-Zoology major in undergrad?)
Those struggling with their weight have to be in it for the
long haul or else it is just a set up for failure, both metabolically and
psychologically. This is something I see over and over again in the low
calorie, “Weight Watchers” mentality. Short term weight loss with long term
rebound weight gain.
For my patients with “metabolic risk”, a lower carbohydrate
approach is the starting point. Some are more eager than others to get on their
way. For those patients that want to grab the bull by the horns, my go to is
Kiefer’s plan/book: The Carb Nite Solution (CNS). It is the plan I
recommend to most of my diabetics who are looking for a way to improve how they
feel and get off that wheelbarrow full of medicine they are on.
One of the reasons I like the plan is that it offers
flexibility for patients. Knowing they can have one Carb Nite (CN) a week,
makes it easier for them to plan for that work party, family get together, or
special event. I believe also that psychologically,
there is not that constant denial of food you get with most standard low
calorie plans, not to mention it adds a little fun to making lifestyle changes.
I would like to share 2 patient stories, both are women (I
have their permission) who have struggled with diabetes for the last 7-10
years. One is on oral medications and the other is on oral medication plus
insulin. They both had hemoglobin A1C’s that were elevated (8.3 and 10.1
respectively) and have always struggled with there weight. Both went on CNS and
have now successfully have lost weight (15 lbs and 20 lbs respectively) and
have lowered their hemoglobin A1C at or under 7.0. That is as good as or better
than any multimillion dollar drug. Their
cost: about $20 investing in a book.
They are both a work in progress, but these changes have had a
big impact, both metabolically and psychologically for both women. Both
patients had improvement in markers of inflammation (i.e. hs-CRP, PLAC2). They
also now exude a bit of confidence in moving forward instead of previous desperation.
I have had many other patient success stories, but these two
stick out the most to me because it made such a large impact on both of their
lives.
There is a lot of “psychology” that goes along with making
changes, you know that little voice in your head that you have that constant
dialogue with (common, it’s not just me). So the following is what I talk to my
patients about:
1.
Throw your scale away, you don’t need it,
really.
2.
Relax, do not stress, especially when you fall
off the wagon (yes it is going to happen), just get back on. High cortisol is
bad, ummmkay (in the voice from the teacher on South Park)
3.
Go with the flow and do not over analyze things.
Enjoy the foods that you get to eat on ultra low carb days (ie bacon) and on
carb nites (ie cherry turnovers ;-) ).
4.
If the CNS is not right for you, than be
flexible and modify the program (ie initially start with lesser carb
restriction)
5.
Have a short and long term goal. Reward yourself
for every short-term goal you meet.
6.
Be prepared. Have your food options planned out
ahead of time and have a back up “emergency” plan in place.
7.
Don’t be afraid of eating fat
8.
Did I say relax?
9.
Manage your expectations. The weight did not
come on in 1 month and it will not all come off in 1 month.
10. Eat
real food. Avoid or limit shakes and smoothies (or at least only keep them to
post resistance training time only)
11. You
are in it for the long haul. If it is something that you do not think you can do,
then stop and let’s find something that will.
12. When
in doubt, rub some bacon on it.
If you want to learn more about Kiefer, check out his
website at www.athlete.io
