To succeed, maximize your failure rate…

I’m surprised to find I haven’t posted anything since February.  Not because we haven’t been busy, but because nothing we have tried recently has yet helped.  Juliana remains stuck at an unhealthy weight, and at risk for metabolic syndrome and type II diabetes.  Although the low carb eating plan has helped tremendously, I am convinced there is still something else going on that has been ameliorated but not eliminated by low carb eating.

In the next few posts, I will review things we’ve done that have failed.  I hope that our failures might be as informative for others as our successes.

 

Overcome obstacles with information

Every low carb eating book, article, and blog (including ours!) has a section on overcoming obstacles. Here is a sampling of some of the things that could be interfering with weight loss even when a low carb eating plan is being followed:

Food allergies or intolerances (especially dairy and wheat)
Stress or elevated cortisol levels even without stress
Poly Cystic Ovarian Disease
Yeast overgrowth
Thyroid issues
Not drinking enough water
Eating too few carbohydrates (paradoxically)
Eating too many calories overall, even if low carb calories
Medications (prescription and over-the-counter)
Inadequate nutrients to assist fat-burning (remedied by taking supplements, like l-carnitine)

In Juliana’s case, allergy medications and not drinking enough water were definite obstacles. But we’ve addressed those: she stopped taking allergy medication and instead we went to an alternative allergy practitioner who was able to clear up her mold and dust mite allergies without drugs, and she now fills and drinks several large water bottles a day, plus tea and low carb lemonade. But she is nonetheless stuck at her current weight. We tried some supplements, but didn’t notice a change. We tried eating no dairy, but didn’t notice a change. We honed in on overall calories, making sure she was eating appropriate protein and fat portions, but didn’t notice a change.

Rather than all this trial and error, wouldn’t it be great to have Information specific to your body to guide you? We just got the results of the tests Dr. Hopewell ordered for Juliana.

Lots of them were completely normal. Fasting insulin levels, cortisol levels, and thyroid function were all normal. Cholesterol was in range and most of the LDL cholesterol was the big fluffy kind. She did not show markers of Poly Cystic Ovarian Disease.

This was good and bad news. It’s good that she doesn’t have a hormonal imbalance or a thyroid problem. But it was bad because there was no smoking gun to explain her weight stall. However, there was one more set of results–the food allergy panel. Despite not having eaten gluten or wheat for 10 months, Juliana tested positive for wheat and gluten allergies. (Ordinarily food allergy reactions diminish over time when the food is not consumed). She tested positive for allergies to chicken and egg whites, and very positive for egg yolks. Since she has been eating 2 to 4 eggs every day, that could be a problem.

We are now trying an elimination eating plan where the offending foods are removed for a month. At the same time, Juliana is taking supplements to improve her gut health, since the wheat and gluten allergies may have caused leaky gut issues.

 

 

Naturopaths are “natural” low carb medical practitioners

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.

 

Advanced Low Carbing–Calories Do Count

Many low carb eating plans leave you with the impression that you can eat any amount of food, as long as you don’t exceed a certain number of carbs, and lose weight.  I suspect this is a conscious or unconscious counter-balance to the calories in/calories out model, where calories are ALL that matter.  The low carb plans want to make clear that what different foods DO in the body is more important than how many calories they contain.  Low carb plans in general suggest letting your appetite be your guide about how much to eat.  But the appetite of insulin-resistant children and teens may not automatically adjust on a low carb eating plan.

For children and teens who have suffered the gnawing hunger of insulin resistance combined with a high-carb, Standard American Diet, it’s worthwhile to pay attention to how much they eat as well as what they eat, even on a low carb eating plan.  Why?  Because they are afraid of being hungry.  They’ve been hungry a lot on the Standard American Diet, even if they were gaining weight all the while.

They can do fine, without hunger, on much less food if the carbohydrates are controlled.  The extra energy they need is made up, without hunger, by using up stored fat.  But they may not believe it at first.  They may think if they don’t eat a giant breakfast they’ll be starving, and stuck, in the middle of 2nd period math.  This is exactly what happened to Juliana on a low-calorie “balanced” eating plan.

So let’s compare a few approaches to limiting overall food intake.  How much is enough?  How much is too much?  If you are controlling your carbs, have tried all their other suggestions for getting weight loss going, and are still not losing weight, the Atkins eating plan suggests counting protein units.  The protein units come packaged with fat, without you having to count the fat.  For example, one egg is one unit.  It has approximately 7 grams of protein, and 5 grams of fat.  45 of 73 calories come from fat.  For a 5’4″ woman, the protein range for weight loss on the Atkins eating plan is 10 to 17 units.  That’s 3 to 4 units at 3 meals a day, and one or two 1 to 2 unit snacks.  Eat more if you are not satisfied at meals; less if you are satisfied. (And remember to wait 20 minutes to determine if you are or are not satisfied).

In Living Low Carb, Jonny Bowden offers a formula:  if you don’t have a really large amount of weight to lose, try multiplying your goal weight times ten to get the number of calories you can consume per day and lose appreciable weight.  For Juliana, for a goal weight of 120, that would be 1200 calories per day.

So how would a typical day’s Atkins plan of counting protein units compare to Bowden’s equation in terms of total calories?  Imagine these meals and snacks:

Breakfast:   2 eggs, 1 ounce cooked bacon, cauliflower roasted with oil

Snack:  1 ounce peanuts

Lunch:  3 ounce hamburger with 1/2 ounce melted cheese, broccoli, roasted with oil

Snack:  1 deviled egg

Dinner:  3 ounces roasted chicken, 1 cup green beans with 1 teaspoon butter

That’s 11.5 units on the Atkins eating plan, and about 1300 calories on the Bowden formula.  Pretty close to the 1200 calories Bowden suggests for Juliana’s goal weight.  By the way, 63% of the day’s total calories come from fat.

Fat is satiating, and the carbs that create rampant hunger are controlled.  But a day’s meals and snacks are a much lower VOLUME of food than Juliana was used to eating before she started eating low carb.  In her head, she has to get comfortable with the fact that she can eat so much less food AND NOT BE HUNGRY.

Kids and teens have less control over their lives than adults.  They may overeat when the food is available in case it’s not available later.  I can remember as a child eating as fast as possible so that my brothers wouldn’t gobble it up and leave nothing for me–the amount I ate didn’t always have a lot to do with appetite.   And up until now, you may have been encouraging your child to limit her intake even if she was hungry.  On a low carb plan, she shouldn’t be hungry.  But now she’ll have to learn to recognize true hunger, and trust that if she is hungry, she can always eat.

 

 

 

 

 

The scale is a tool

What about the scale? Throughout her childhood, I had been afraid to put Juliana on a scale. I looked for “innocent” opportunities to check her weight. Doctor’s visits, obviously, but also the scales in the dressing room at the pool–I’d check my weight and ask all my kids if they wanted to check theirs. If I took in one kid to urgent care for an earache or something like that, all 3 of them came with me and we’d kill time by checking our height and weight while waiting for the doctor. But Juliana usually declined.

Since I didn’t check her weight regularly, I am guessing that she gained about 30 pounds in a year from the age of 12 to 13. By not checking her weight regularly, I also missed this steep weight gain as it was happening–more than half a pound a week.

Why was I afraid to put her on a scale? Eating disorders and self-esteem issues. I didn’t want her to tie her self-worth to a number on a scale. I didn’t want to create the impression that food was bad because it was making the number on the scale go up, or that it might be a good idea to starve herself to get to a lower number. When Juliana was 9, her BMI had spiked up again. I asked a family therapist about using a scale with a 9 year old, and she was emphatically against it, for the same sorts of reasons.

For some kids and teens not using a scale might be the right answer. But, the scale is a very valuable tool. Information from the scale allows you, as your child’s coach, to continually tweak what you are doing to help your child achieve a healthy weight. If your eating plan is effective, the numbers on the scale will demonstrate that by going down. If it isn’t, they won’t.

Yes, I know, muscle weighs more than fat and takes up less space. Your child could be adding muscle, staying the same weight, but slimming down. Could be. But unless he or she is on an exercise program that would justify a belief in added muscle, I would be wary of hoping that is happening, simply because the hope delays making tweaks to your eating plan to improve its effectiveness.

What about body composition measurements? We tried a home body fat monitor, but the numbers varied too much day to day to give useful information about the effectiveness of the eating plan. Unlike with a scale, there is far too much variation in the measurements of the body fat monitor from day to day to know if you are losing body fat. Juliana’s measurements bounced up and down between 25% and 35% from day to day.

We started with weekly weigh-ins, which was the procedure on the Packard pediatric weight control program. But now we weigh in daily, because we don’t want to waste time on a losing strategy. She feels great eating low carb, and she’ll eat this way the rest of her life, and yes, eventually she’ll reach her goal weight one way or the other; but she still wants to slim down without wasting time. I think everyone does. So if you can use the scale as a tool, and not obsess over the number, you should.  Juliana is doing well with the information from a daily weigh-in.  You have to judge for yourself whether using the scale is going to do more harm than good for your child.