Juliana’s weight loss is stalled. We made it through the holidays eating low carb pretty easily–we had some sticky cauliflower latkes; and many low carb desserts that Juliana invented. She has a real talent for baking and she will be posting her recipes. She has maintained her weight, and continues to feel good, but she has stopped losing even though she is not yet in the healthy weight range for her height and age.
What to do? I spent more time poring over my collection of low carb resources and looking at other blogs and forums. It is striking that although there is a lot of discussion of overcoming obstacles for low carb eating adults, there is none that I have seen for children. The few resources out there report 100% success in achieving a healthy weight with low carb eating. Juliana’s situation seems particularly unusual, and I think will be very instructive to other parents when we finally figure it all out.
Children aren’t just little adults. The ranges of what’s considered healthy for a 14-year old’s complete blood panel, for instance, are not the same as for an 18 year old. The BMI charts are different. On an adult BMI chart, Juliana would be considered a healthy weight today. On the child/adolescent chart, she is about 10% above the maximum healthy weight.
The adult literature tries to inform about how to tweak standard medical practice so that it is meaningful (and not harmful) to the low carb eater. A simple example is the measurement of LDL cholesterol (the bad one). It turns out that in a standard cholesterol panel, the LDL amount is calculated, not directly measured. The calculation is known (at least in the low carb community, if not the medical establishment) to be completely inaccurate for someone following a low carb eating plan. Furthermore, there is more than one type of LDL–big fluffy LDL, which is not harmful, and tiny LDL, which is. Guess which kind low carb eaters have more of? The big fluffy LDL. And thirdly, sometimes cholesterol levels go way up as you are losing weight, because the fat lipids are being released into the blood stream from fat cells. This is a good thing, but will look like a bad thing on a cholesterol test. So a standard cholesterol test could indicate high levels of LDL where none actually exist. Or you might have high levels, but the LDL is the non-harmful fluffy kind. Or you have high levels, but it’s a temporary situation because you are losing weight. In any of those cases your cholesterol is not a problem but your doctor might well think it is and might suggest cholesterol-lowering drugs. For the low carb eater to get an accurate and useful measure of their cholesterol requires a completely different cholesterol panel.
I was not comfortable trying to be Juliana’s ersatz doctor by asking for special tests or re-interpreting the results of standard tests in light of her low carb eating style. But I failed in finding a standard medical practitioner who could help us. It occurred to me that if Dr. Atkins were still alive I would fly Juliana to his clinic. However, I think I’ve found something closer to home.
Last week, Juliana and I went to a naturopathic physician. She does not specialize in low carb per se. We related the whole history of Juliana, that you can read about in all the posts on this blog. Dr. Hopewell is the first medical professional I have ever spoken with about this topic who did not think I was making all this up and that Juliana’s weight was simply a consequence of her eating too much. She listened, she commented that the fact that Juliana was so sensitive to carbs at such a young age is unusual, and she ordered a bunch of tests. More than half of the tests that she ordered are not check off boxes on the lab form. She had to write them in by hand on the bottom.
She ordered a fasting insulin test–not a glucose tolerance test, like you may have done if you were ever pregnant. A glucose tolerance test is done in pregnancy to test for gestational diabetes. It is (just like the standard cholesterol test) not meaningful for a low carb eater AND will make them feel particularly sick from the slug of straight glucose that has to be drunk. Did you even know you could do an insulin test to see if your fasting insulin levels are elevated above normal? I’ve been looking for mention of one, and asking doctor friends about one, but had found nothing. She ordered a special thyroid panel (a malfunctioning thyroid can prevent weight loss), special cholesterol test, cortisol test (excess cortisol can interfere with weight loss), and a food allergy panel (food allergies can also interfere with weight loss), and a few more of which I don’t yet know the significance. She agreed with me that Poly Cystic Ovarian Disease (PCOD) should be ruled out, even though Juliana doesn’t have all the classic markers. She said she has seen PCOD in pretty much every body type–not just the classic one. PCOD interferes with weight loss. That’s at least 5 things she is directly measuring or checking for (you can’t measure for PCOD, it’s an observational diagnosis based on a number of indicators) that could be interfering with Juliana’s weight loss and that a standard medical doctor would not investigate.
I did not prompt her to do any of these tests. This kind of investigation is her usual practice. That’s when it dawned on me that naturopaths are the closest thing we have to low carb savvy doctors. Naturopathic Physicians, NDs, rather than MDs, have medical training similar to MDs, but they have a lot more too. Here’s a description of the professional training from the American Association of Naturopathic Physicians website:
“A licensed naturopathic physician (ND) attends a four-year, graduate-level naturopathic medical school and is educated in all of the same basic sciences as an MD, but also studies holistic and nontoxic approaches to therapy with a strong emphasis on disease prevention and optimizing wellness. In addition to a standard medical curriculum, the naturopathic physician is required to complete four years of training in clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, psychology, and counseling (to encourage people to make lifestyle changes in support of their personal health). A naturopathic physician takes rigorous professional board exams so that he or she may be licensed by a state or jurisdiction as a primary care general practice physician.”
Standard Western medicine cannot be beat in some situations. Broken arm? No problem. Stroke? Nowhere you’d rather be than a standard Emergency Room. They will minimize damage to your brain and keep you alive. But the model doesn’t work very well, often, for non-injury and chronic health problems. It doesn’t even know how to look for what is now preventing Juliana’s weight loss. I am very optimistic about the naturopathic model.