Do I listen to the doctor? Or...
Hey CC, I recently started seeing an endocrinologist for PCOS related insulin resistance. In addition to prescribing Metformin, the doctor put me on a diet that comes out to roughly 1,200 calories per day.
I realize that 1,200 calories is the absolute minimum any woman should consume, and it's not often recommended to go at all below 1,500. So, with the risk of starvation mode, plateaus, and hurting my body in mind, what should I do? Maintain the 1,200 calorie diet my doctor recommended, or up my calories to a more normal level? I know the question seems to have an obvious answer, but I honestly don't know how my body would react to such a restricted calorie diet--and of course, the idea of not following "doctor's orders" makes me hesitant to up my calories.
My stats:
Female
5'3"
20 years old
SW: 204
CW: 200
GW: 120ish
Note: As I'm currently on winter break from college, I'm basically sedentary, but when I return to school in a week or so my main mode of transportation is walking, and I hope to fit in exercise at the gym a few times per week.
You should always faollow what your MD says over what anyone here says.
1200 for a female is OK particularly when monitored by a MD.
However, studies have shown that low-carb diets are much more effective for people with type II diabetes. Chances are at 1200 calories his diet is low carb, but this may be something to ask him/her about.
1200 does sound like way too few for you. Your BMR, assuming no effect on your metabolism from your medial issues, is around 1725. Ordinarily it'd be a bad idea to eat less than that, but medical conditions can throw the standard estimates out of whack.
I'd suggest you ask your doctor how he/she feels about your eating better but consuming more calories. Probably they'll be cool with it, it just means you're losing weight a little slower. Definitely ask why he/she picked 1200 as a target, it might be for good reasons or it might just be because that's considered the absolute minimum for a woman.
Well, to be honest, I don't know how much consideration he put into creating a diet plan for me, based on my individual statistics, or if he just spits this out to everyone with my problem. He suggested that my three main meals be frozen meals (such as Healthy Choice and Lean Cuisine entrees), and the snacks are small portions of fruit and vegetables. He didn't mention anything about exercise or macronutrient breakdown--he was most interested in what the scale and tape measure said.
I guess, overall, his plan suggests a balanced diet since those frozen meals tend to be low in carbs and higher in vegetables and lean protein. However, I really can't see myself eating microwavable food long-term. I'm trying to teach myself healthy eating habits, and I don't want to lose the weight by keeping the training wheels on, as it were. So I've been eating nutritionally balanced (according to the breakdown on CC) meals that add up to 1,200 calories.
It's difficult to discern how my body is reacting to this level of calorie intake as I'm pretty inactive at home. I haven't had any problems so far, and the weight has started to come off, but the body isn't always quick to tell you it's not happy. I suppose the real test will come when I go back to school and and begin edge more towards "lightly active" than "sedentary."
As far as how my metabolic rate differs from the norm due to the insulin resistance...I really have no way of knowing, do I?
your doctor is probably telling you 1200 expecting that you'll eat 1600, because most people lie to their doctors about lifestyle stuff.
Original Post by jessifm:
Well, to be honest, I don't know how much consideration he put into creating a diet plan for me, based on my individual statistics, or if he just spits this out to everyone with my problem. He suggested that my three main meals be frozen meals (such as Healthy Choice and Lean Cuisine entrees), and the snacks are small portions of fruit and vegetables. He didn't mention anything about exercise or macronutrient breakdown--he was most interested in what the scale and tape measure said.
I guess, overall, his plan suggests a balanced diet since those frozen meals tend to be low in carbs and higher in vegetables and lean protein. However, I really can't see myself eating microwavable food long-term. I'm trying to teach myself healthy eating habits, and I don't want to lose the weight by keeping the training wheels on, as it were. So I've been eating nutritionally balanced (according to the breakdown on CC) meals that add up to 1,200 calories.
It's difficult to discern how my body is reacting to this level of calorie intake as I'm pretty inactive at home. I haven't had any problems so far, and the weight has started to come off, but the body isn't always quick to tell you it's not happy. I suppose the real test will come when I go back to school and and begin edge more towards "lightly active" than "sedentary."
As far as how my metabolic rate differs from the norm due to the insulin resistance...I really have no way of knowing, do I?
He's probably assuming you know nothing about nutrition which why he recommended the frozen dinners. The are pretty good and I eat them about 4 times per week for lunch and have been a quick easy way to eat relativley helathy. I wouldn't want to eat 3/day though.
According to this study, BMR is decreased significantly in women with PCOS and insulin resistance--by about 600-700 calories/day. Based on the numbers they were throwing around in there, eating 1,200 calories per day could actually be eating my BMR.
Thoughts? I realize it's only one study, but this worries me a little bit. Even if my BMR is not quite that low, chances are it's lower than the normal calculation would give me.
Original Post by jessifm:
As far as how my metabolic rate differs from the norm due to the insulin resistance...I really have no way of knowing, do I?
Not exactly NO way, there's always good old trial and error. Pick a certain calorie level, either the 1200 your doctor recommends or 1500 or 1725 if you want to try one of those, eat at that level for a longish while (say 6 weeks) and at the end calculate what your average weight loss rate is. From that you can back-calculate what your average daily burn rate was, and adjust your intake accordingly for the loss rate you want.
Original Post by jessifm:
According to this study, BMR is decreased significantly in women with PCOS and insulin resistance--by about 600-700 calories/day. Based on the numbers they were throwing around in there, eating 1,200 calories per day could actually be eating my BMR.
Thoughts? I realize it's only one study, but this worries me a little bit. Even if my BMR is not quite that low, chances are it's lower than the normal calculation would give me.
Yes, that's true, but eating low carb can mitigate a lot of that. Being insulin resitstant means your body won't react to glucose spikes (from carbs) as well as a normal person resulting in increased fat storage and decreased lipolysis. MD's seem to overpower the problem by just using a mass cut in calories.
Granted, most low carb diets are also low calorie but I suspect if you cut carbs significantly you'll get as good results on 1400-1500 as you would at 1200 with higher carbs.
I should also point out that the Mayo Clinic diet (the real one), if I remember correctly, suggest females start out at 1200 calories and males 1500.
Everyone, thank you for your input!
Based on all of the points that came up, I think I'll stick with the 1,200 calorie diet unless my body shows signs of needing more fuel, and if needed I'll try calculating my BMR by trial and error as jp5074139 suggested. It's true that such a low calorie diet is sort of inherently low carb, but beyond that I'll try to keep carbs to a minimum--especially simple carbs.
Original Post by jessifm:
Everyone, thank you for your input!
Based on all of the points that came up, I think I'll stick with the 1,200 calorie diet unless my body shows signs of needing more fuel, and if needed I'll try calculating my BMR by trial and error as jp5074139 suggested. It's true that such a low calorie diet is sort of inherently low carb, but beyond that I'll try to keep carbs to a minimum--especially simple carbs.
That makes sense. PCOS makes it a lot harder to lose weight, and if you're insulin resistant, it absolutely makes sense to limit carbs as this helps keep blood sugar stable and prevent drastic spikes. Some doctors put their diabetic patients on a low carb diet for this reason.
You have to work extra hard when you've got PCOS from everything I've read, so switching up your diet to change the way your body processes things is a good method.
I'm a 21 year old female, 5'1'' and I've been eating a 1,200 calorie diet for about four months now (except on cheat days ;)) and I feel great. 1,200 calories is doable, remember lots of lean protein, fruits, and veggies and you'll be in good shape I think. A doctor wouldn't recommend anything unsafe for you, it would be malpractice. I'd say at least try it and see how you feel.
Original Post by acer150:
I'm a 21 year old female, 5'1'' and I've been eating a 1,200 calorie diet for about four months now (except on cheat days ;)) and I feel great. 1,200 calories is doable, remember lots of lean protein, fruits, and veggies and you'll be in good shape I think. A doctor wouldn't recommend anything unsafe for you, it would be malpractice. I'd say at least try it and see how you feel.
A doctor wouldn't recommend anything that is provable that they know is unsafe for you, but I've seen plenty of posts where doctors don't have the full picture or don't have the specialized training or simply have a conflicting opinion. If you think that 1200 isn't enough (it does seem low to me, but 5'1" is on the shorter side and you do have the complication of diabetes so I really can't say for sure), it might be worth a call into the office to talk about it. It could be a genuine recommendation based on years of research. It could be based on information that other patients have given him about what worked for them. It could be based on a number published in a journal. It could be based on an expectation that you'll fudge your eating up to 1500.
What do you attribute your current 4lb loss to? Maybe you could get a referral to a nutritionist who specializes in diabetes?
I can't believe a doctor would suggest eating frozen meals like that that often. Have you seen the amount of sodium in those things? Guess he figures hypertension is better than the extra weight? Try the Kashi meals though over Healthy Choice and Lean Cuisine, they are also pretty low calorie but are made with real food, not filler and are much more satisfying.
First, let me say that doctors generally only take 1 nutrition course in their medical education. You doctor is highly trained to treat your specific disorder, but is probably not an expert in nutrition. I'm surprised your doctor did not schedule you to see a registered dietician considering the diabetes and PCOD.
I would call the office and see if you can see the dietician. There is also a metabolic rate test you can take, where you breathe in and out of a bag for xx number of minutes, and it measures your resting BMR. I had this done at a weight loss clinic (this was a Certified Bariatric Center of Excellence, not some fly-by-night diet pill-mill). Based on that, a RD gave me an eating plan. Part of the plan was first to discern my eating style, then the diet was custom made for my lifestyle; for example, if I was not used to eating 21 frozen meals a week, that was not in the plan.
Often when weight loss is part of the cure for your disease, your doctor will just give you a standard "diet" that s/he knows will cause weight loss if followed. But this can be anything, and may only be random. Examples: My endocrinologist told me to eat 1800 calories per day. My Gastroenterologist told me not to worry about calaories; instead just to fill up my plate with what I would normally eat, then dump half of it in the garbage before eating anything. My primary care told me to join Weight Watchers or Jenny Craig. So you see, medical recommendations can be all over the place.
Try to see a Registered Dietician. A RD can balance your carbs to treat your insulin resistance, and help you choose natural foods that you are comfortable with. I don't mean to put your doctor down here, at all - one of the cures to your condition is weight loss, and that is what s/he is striving for. So the treatment is on target but the method may need some tweaking.
Good luck! I hope you are able to lose at a slow and steady pace. Exercise is also part of your treatment. Can you begin walking 30 minutes a day even while you are on your break?
Always follow your MD, but always get more than one opinion. PCOS is tricky, and sometimes your genes are your genes. My niece who is 12 has PCOS, takes Metformin, and weighs 190 lbs. She has done every nutrition test known to man, and been on many different eating plans. The one that works best for her is a healthy balanced diet, from 1200 to 2000 calories a day. This keeps the sugar in balance and the puffiness down.
I feel your pain, for every woman in my immediate family has PCOS. You need to learn your body and figure out what is best for you. Keep track of calories on the calorie counter, and see what combinations work for you. It can take a lifetime to figure out what is right for your body, but healthy, organic, veggie eating is a good way to go... I so wish you luck!! Remember to get that second opinion...
Hi Jessica,
I'm not here to comment on the calorie topic, but more on the PCOS and insulin resistance topic.
There is a lot of research out there that shows PCOS and insulin resistance can be alleviated by a nutrient called d-chiro-inositol. It's a form of the nutrient inositol that is already body-ready (like the concept of chelated minerals). The theory is that some people don't create d-chiro-inositol very well from the base inositol form and therefore develop health issues. There are supplement forms out there that are fairly pricey... but the good news is that there are plenty of foods that are tasty and good for you that have theraputic levels of d-chiro-inositol. For example, I love hummus, and chickpeas have really high levels! So, I make a big batch every weekend and eat on it all week. Fiber, protein, and d-chiro-inositol! No more ovarian cysts for me!
Here's a link to a list of foods high in d-chiro-inositol. Do some research when you have a little time... there's plenty of good information out there!
http://www.ehow.com/list_5960312_list-foods-h igh-d_chiro_inositol.html
Here's to your good health!
Stacey
Original Post by jessifm:
Well, to be honest, I don't know how much consideration he put into creating a diet plan for me, based on my individual statistics, or if he just spits this out to everyone with my problem. He suggested that my three main meals be frozen meals (such as Healthy Choice and Lean Cuisine entrees), and the snacks are small portions of fruit and vegetables. He didn't mention anything about exercise or macronutrient breakdown--he was most interested in what the scale and tape measure said.
I guess, overall, his plan suggests a balanced diet since those frozen meals tend to be low in carbs and higher in vegetables and lean protein. However, I really can't see myself eating microwavable food long-term. I'm trying to teach myself healthy eating habits, and I don't want to lose the weight by keeping the training wheels on, as it were. So I've been eating nutritionally balanced (according to the breakdown on CC) meals that add up to 1,200 calories.
It's difficult to discern how my body is reacting to this level of calorie intake as I'm pretty inactive at home. I haven't had any problems so far, and the weight has started to come off, but the body isn't always quick to tell you it's not happy. I suppose the real test will come when I go back to school and and begin edge more towards "lightly active" than "sedentary."
As far as how my metabolic rate differs from the norm due to the insulin resistance...I really have no way of knowing, do I?
Please listen to you doctor on the calorie intake. If he's monitoring it and you're hungry once you go back to school, leave him a detailed message about adjustments/problems/concerns/questions you have. None of us here is your doctor, and we don't know you well enough to make adjustments to a diet your doctor told you to stick to. If you don't agree with it, go back, walk in with a log of what you would normally eat (you can print your log here) and make adjustments together. At least he will have a better sense of how you eat under normal circumstances.
And yes, I do tend to agree that the frozen dinner diet is probably his quick go-to because teaching basic nutrition is generally time-consuming... plus you're a college student. There is nothing about that that generally screams "I want to cook nutritious meals!," its a common, though not always accurate, assumption. I lived off ramen and bagels in college, cooking was out my realm at that time.
Also, have you made a plan once you go back to school? How would you cook these nutritious alternatives to frozen dinners? Do you have access to a kitchen? Is the frozen dinner actually a more viable option while you're in school and this is maybe what he was getting at? Something you could actually do and really stick with? Frozen dinners are awful easy to pack and run with... it at least has a chance of keeping you out of the proverbial "bagel shop" or... that place that is so handy to get food but is so unhealthy.
I was diagnosed with pre-diabetes a little over a year and a half ago. My doctor immediately put me on metformin and didn't talk to me at all about diet or exercise. After I started educating myself, I chose to take myself off the metformin and focus on healthy eating and exercise instead. I haven't lost much weight (10lbs) but ALL of my numbers have improved.
The moral of my story is that I educated myself and also got second opinions (maybe talking to a nutritionist would be a good next step for you). Your doctor may be giving you good advice but if you're concerned about the advice being giving DEFINITELY get second opinions and educate yourself.
