Wednesday, November 14, 2012

On Being Metabolically and Psychologically Flexible

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