The Nutritionist Fiasco

As I explained in my last post, I lost my way for quite a while during 2016.  It didn’t much matter whether the culprit was medical, emotional, the weather, or just the universe working against me.  The result was the same:  weight gain. 

Just about everything in my life results in my gaining weight (happiness, sadness, anxiety, boredom, etc.).  When it comes to food, I have to be vigilant and disciplined 100% of the time.  It’s a daily struggle to do the right thing as it pertains to food and exercise because I like to eat and I hate exercising.  Staying on the right path is hard enough to do when I’m doing well emotionally and spiritually, impossible when I’m not.  The whole struggle is utterly exhausting!  

I watched the scale numbers climb steadily (and quickly) from 166 lbs. in late spring of 2016 to about 193 lbs. by early 2017.  Twenty-seven pounds in less than a year.  It takes no time at all for me to gain weight, but a lifetime to lose even a fraction of it.  Talk about frustrating, especially after all my hard work these last few years - not to mention the fact that I had already lost those pounds and now I’ve gotta do it again.  There’s that self-defeating vicious cycle again.  I know it’s inevitable that my weight will fluctuate for the rest of my life, but to gain a whopping 27 lbs. to me, personally, is a huge disappointment/failure.  What scares me most is not the numbers on the scale, but how I feel in my head.  The lack of control and loss of motivation is frightening.  When will it stop?  Will it stop at all?  Why do I make myself start all over from scratch time and time again?  Why do I always punish myself by making everything worse by overeating?  I’m letting everybody who is motivated by my success down, too.

People who don’t have an addiction (lucky them!) would never understand what it’s like to have no control over your actions, even when you KNOW with every fiber of your being that those actions are incredibly detrimental to you.  It’s fascinating to me that at our worst, instead of pursuing what is healthier for ourselves, instead of working harder to improve our lives and feel better, we immerse ourselves in our particular addiction which only compounds the problems at hand and only serves to make everything exponentionally worse.  In many ways, it’s just so much easier to give in to the addiction than to fight it.  I understand perfectly when people say they had to hit rock bottom before they started being smart and healthy for themselves, regardless of their specific addiction.  There’s a sense of giving up because you're too exhausted to fight it until you just can’t take it anymore.

In any case, last year I wasn’t doing well at all and gained weight.  I started wondering if I had forgotten how to eat properly because even when I was eating healthy foods, I was still gaining weight.  There were days when I was just fine and then I’d have episodes where I just couldn’t stop eating for weeks.  Some of it was binging (i.e., uncontrollable) but many times it was just hunger.  I can usually attribute the culprit of binging to a specific problem or negative situation/emotion.  Overeating out of hunger, however, is harder to understand.  Why am I so much hungrier these days when I was eating the same foods last year and I wasn’t hungry all the time?  That frustrated me and I got angry not only at myself but at food.  I actually found that I was getting angry at food.  Why couldn’t I eat pastries and cakes every day?  Why can some people eat whatever they want and be fine but I can’t?  Why is it that if I indulge frequently I gain weight in seconds but then it takes me months to lose even a fraction of that gain and only after a lot of hard work?  After all I've accomplished these last few years, why can’t I indulge whenever I want?  It was driving me mad.

During this journey to lose weight, I started researching foods here and there.  A subject that previously bored me to tears, now fascinated me.  Here I was, 52 years old in late 2012, learning what we should be eating and now at 56 in early 2017, I felt like I forgot how to eat properly.  Once again I started looking into foods, but this time I was more interested in those foods that increase feel-good chemicals in the brain, like serotonin and dopamine.  There’s a ton of information out there, as you can imagine, about foods and how they affect our bodies and brain.  Some of that information is contradicting though.  So in an effort to understand how to improve my relationship with food to get back on my weight-loss journey again, I contacted a nutritionist.  I was desperate to find the magic answer to my current issues before it got completely out of hand.  I wanted an experienced professional to explain to me what I didn’t know.

I searched online for nutritionists near me, preferring a female because I figured she’d know a woman’s body first hand.  The person I chose, Wendy, and I exchanged a few emails to set up our first appointment.  She requested certain information from me which I emailed to her before we met:  personal background (age, height, weight, etc.), blood work results (I get regular checkups so I sent her the latest report), and other medical information.

In one of my emails, I explained to her that I had lost a considerable amount of weight after overhauling my lifestyle a few years before and had been eating healthy foods and exercising since.  I told her that the way I lost the weight was by keeping track of my daily calories, and that the reason I wanted to meet with her was to better understand the correlation of food and feel-good chemicals in our brains, particularly serotonin.

I can’t go into a lot detail here about serotonin because the subject is diverse and too complicated for this forum.  Plus my knowledge is narrow and I don’t want to pass on incorrect information.  With that said, this is a brief summary of what I understand about serotonin.  My disclaimer here is that I’m not trained in this topic so I urge everyone to do their own research, talk to their own doctors, and not take what I’m saying at face value:

Serotonin is a chemical in our bodies (a neurotransmitter) that exists in our brains and in our guts.  It is dubbed the “happy molecule.”  Serotonin deficiencies have been linked to depression, sleep disorders, mood swings, memory loss, hoarding, anxiety, ADHD, OCD, eating disorders, and other negative conditions.

So what is the treatment if a person is suspected of having a serotonin deficiency?   I say "suspected" because no medical test exists that can test serotonin levels in the brain so doctors have to look at the overall symptoms of a person to determine whether that patient may be experiencing a serotonin deficiency.  If they do suspect this to be true, doctors prescribe antidepressants, like Prozac or Zoloft which are selective serotonin reuptake inhibitors (SSRIs).  Unfortunately, no "serotonin pill" exists that you can take to fix a serotonin deficiency. 

If there was a way to test for serotonin levels and I proved to be truly deficient, I don't know that I would agree to take dangerous drugs to fix the problem.  I’m not fond of taking any medication in the first place, let alone these SSRIs.  There is an over-the-counter supplement called St. John's Wort that is not as powerful as prescribed medications, but it is used to treat serotonin deficiencies.  This supplement takes a lot longer to take effect, but it's safer.  Unfortunately, one of my doctors told me I can't take St. John's Wort because it affects my other medications.  So my only option is to see if changing what or how I've been eating will improve my situation.  If possible, I would rather go the natural way, with food rather than pills.

Something I couldn't understand was why did I do so well in 2015, when I lost over 90 lbs. and my mood was great despite dealing with normal life problems and setbacks, yet in 2016 things fell apart for me despite the fact that the universe was doling out the same type of problems and setbacks at me as before.  I kept mulling these questions in my head all the time:  Why was 2015 so different?  Why was it so much better than 2016?  What happened to make things change to that degree?  

Well, here's a kicker to losing weight:  it turns out that losing weight lowers your estrogen by quite a lot.  In turn, estrogen affects serotonin, dopamine, and other neurotransmitters in the brain.  Could the very thing that was making me healthier (i.e., losing the weight which is linked to everything from cancer to heart disease, not to mention depression about how you look and feel) actually be making me miserable mood-wise?  Complicating matters even more, I had an ulcer in early 2016 and my thyroid was underperforming, each having its own negative effects on a person's well being.  Food cannot solve an ulcer (it was always believed that certain foods cause/aggravate an ulcer, but my gastroenterologist told me that new findings show that’s not true) nor can it fix a thyroid not performing normally.  In both cases, medication is required.  But perhaps serotonin can be increased with food.

This is exactly why I wanted to talk to a nutritionist, a trained professional in the topic of food and how it affects our body and brain.  Maybe losing over 90 lbs. in one year plummeted my estrogen which, in turn, lowered my serotonin levels which, in turn, made my body crave more food – especially bad foods - that would increase serotonin which, in turn, made me gain weight.  Added to that, I had vitamin deficiencies and an underperforming thyroid to boot.  Good grief, it's enough to make your head spin!  It's any wonder I was able to get out of bed every day!

During my recent research of food, I learned that tryptophan is an essential amino acid needed to synthesize serotonin in our bodies.  Tryptophan is one of the eight essential amino acids found in the human diet.  Essential amino acids are those that can't be made in the body and therefore must be obtained from food or supplements.  The best sources of tryptophan are animal products: meat, seafood (which also contain Omegas, important fatty acids), poultry, eggs, and dairy.  You’d think the answer would be to eat more foods rich in tryptophan to increase serotonin, but that’s actually not true.  In fact, eating foods high in protein causes both tryptophan and serotonin to drop after eating a meal containing protein.  Paradoxically, protein blocks the synthesis of tryptophan into serotonin.  That’s where carbohydrates come in.

When you consume sugars and starches (i.e., carboyhydrates), your pancreas releases insulin which is responsible for transporting sugar from your bloodstream into cells.  Insulin also lowers the amount of amino acids in your blood except for tryptophan, which avoids insulin’s influence because it tends to bind with the protein albumin.  As a result, the concentration of tryptophan increases and more transports across the blood-brain barrier.

The type of carbohydrate you consume is important.  Simple carbohydrates (sugars, like the white stuff we add to everything from coffee to baked goods) offer the fastest and strongest serotonin increases which is why it’s said that sugar can be as addictive as, if not more than, cocaine.  I noticed that when I’m emotionally unstable, I instinctively crave foods high in sugar.  It’s like my body is telling me that it needs to feel good NOW.  But the boost is short lived and if you consume simple carbohydrates often, you will need higher doses to reach the same levels of the happy molecule.  It’s the same thing with drug addiction, you need more and more of the same drug to reach the same highs as you did before.  Simple carbohydrates are detrimental to our health in every way, including weight control.  The optimum carbohydrates to consume are complex carbohydrates.  A few examples of these are brown rice, sweet potatoes, beans, and vegetables.

Complex carbohydrates consist of multiple sugar molecules (versus simple carbohydrates which only contain a single sugar molecule) bonded together which make it more difficult for your body to break them down. The slower breakdown results in less of a blood sugar spike, keeping you fuller longer.

One of the things I wanted the nutritionist's opinion about is that some schools of thought say that it is best to eat tryptophan-rich foods with complex carbohydrates at the same meal while other schools of thought say that no, you should eat them at separate meals with a lapse of a few hours inbetween those meals. 

After exchanging a few emails with Wendy, we set up an appointment for one week later, on a Friday in December 2016.  I found myself feeling excited about this meeting and I sat down and wrote out a questionnaire of things I wanted to know about or clarifications I needed on contradicting information I had found.  I also grabbed a couple of cookbooks I often use to ask about specific ingredients/recipes.  I was so excited about our first appointment that I was almost giddy as I got to her office with my cookbooks and questionnaire in tow.

Wendy turned out to be an attractive woman in her 40s and she was physically fit.  My first impression was disappointment at her behavior/personality though.  She was not very personable, kind of boring almost.  I wanted her to have the same enthusiasm about our discussion as I felt.   After a few minutes of talking to her, I decided I was being unfair.  How can I expect her to feel the same way about the topic at hand when it was new to me whereas she’s probably been doing this for years and had gotten into a rut, as we all do when doing the same job day in and day out.  I also thought maybe she’s just tired today, a Friday, after a long week.  I told myself that it didn’t matter what her personality was that day, I was there to learn from her.

Initially, she asked me a bunch of questions about my eating habits:  how often do I eat breakfast every week?   Every single day.   Do I ever skip meals?  No, in fact I usually add one or two snacks daily as well.  Do I eat fast foods?   No.   Do I drink sodas?   No.   Do I drink alcohol?  Yes, but not every day and when I do drink, it’s normally just one glass of wine (5 ounces).  These are the types of questions she asked me during the first 15 minutes of our meeting.  She also asked me some medical questions that I didn’t cover in my previous emails, and she commented on my blood work which showed me she had read the report I had sent her earlier.

So far so good.

After we cleared through her questions about my eating habits, I was ready to get to the nitty gritty of what I wanted to discuss, the relationship of food and feel-good chemicals in our bodies, specifically serotonin.  I told her that I had been researching foods for the last couple of years and although I was not an expert by any means, I was no longer a novice about the topic.  That’s what I wanted.  This is what I got:

She told me that her practice was to implement portion control rather than calories (something she never mentioned in her emails) and she handed me the same food chart I’ve been handed since I was a kid:  how many portions per day of fruit, whole grains, dairy products, vegetables, meat/protein, etc.   It used to be presented as a food pyramid for decades, then at some point it became a pie chart on a plate, and now she handed me the same type of list that never worked for me - EVER.  

I’ve explained before in my blog that these food charts are useless to me, regardless of whether they’re presented in a pyramid, circle, or other shape.   It’s too overwhelming for me to figure out how many servings of veggies, fruits, dairy, etc. I need to have every single day of my life.  I don’t like having to cram the required food groups into what I want to eat on any particular day.   Often, the two don’t mesh.   Sometimes I’m not in the mood for fruit but the chart says I need to eat so many servings a day so I just failed in eating right.  Sometimes all I want to eat is vegetables so I just failed in not meeting the other requirements.   There are times I only want to eat protein and you know what that means:  another failure.   Also, these charts never told you what constitutes one serving, especially when it comes to fruits and vegetables.  Do 5 carrots make a serving or do 8?   How many strawberries constitute a serving?   How about lettuce?   Since I was 10 years old, people have shoved these charts at me, not only in school but doctors and other people trying to “help” me lose weight, as if these charts held the answer to becoming “normal.”   The only thing these charts proved to me was that I was out of my league in terms of being normal and healthy as it pertained to food.  I used to berate myself, “Why is it that everybody else can follow these charts and I can’t?”  It didn’t dawn on me until many years later that few people, if any, really follow these stupid charts.  And if they do, there's no way they're perfect at it all the time.

So once again, here I am presented with another stupid chart that I know is useless to me.  They might work for everybody else, but not for me.   During this particular weight-loss journey, one of my epiphanies was to do what works for ME rather than what people tell me I should do.  Sometimes what works for the entire population of the world won’t work for me specifically and instead of feeling abnormal and like a failure, I go with my personal needs.   The only caveat is that whatever I'm doing is healthy.

As I looked at the chart Wendy handed me and as my disappointment returned, she began to discuss portion control.   At this point she started pulling out rubber foods to show me what a portion looks like in various foods.  I’m a very visual person so this type of presentation works better for me than just verbally being told something.   What I couldn’t believe though was when she took my hand and plopped each rubber food in my hand, one after the other, so I could feel what a portion of each food is.   I was thinking, “What am I, 7 years old?”   First she plopped a burger patty in my hand that constituted one portion.  This brown rubber patty reminded me of the dehydrated, tasteless patties I used to get at fast food joints.   Then a small chicken breast that made me wonder how emaciated the rubber chicken this came from must have been.  Followed by some sad looking strawberries that were globbed together to form a rubber pile of fruit.   The one thing this presentation proved to me though is how little food constitutes a portion.   We definitely overeat at every meal.  If I went to a restaurant and was served an actual portion of whatever food I ordered, I’d feel ripped off and would never return.  Plus I would probably still be hungry after that meal.  That's why I prefer to work with calories rather than portions.  As long as I stay within my allotted calories per day, I can eat whatever I want in whatever quantities I want, within reason.  For example, I recently had for lunch a 12-ounce steak (one portion is about 4 ounces) which was a lot of calories.  So what I did was work my calories around that meal for the rest of the day, like having a smaller afternoon snack and a vegetarian dinner.

It became clear soon enough that our first meeting was not going to be what I wanted.  However, I can't put all the blame on Wendy.  The failure of this meeting was partly my fault, too.  I realized while sitting in her office that I had erred in not asking her during our intial email exchanges what her specific practices are.  It never occurred to me to ask what I could expect from our first meeting nor whether she used calories or portion control.  I just assumed that nutritionists were trained in the diverse topic of foods and that I could pick her brain about anything I wanted to know about the subject.  That's where I went wrong. 

In any case, although she did answer a few of my questions, it became clear to me that she wasn't really interested in discussing what I wanted to discuss.  She had no interest at all in the two cookbooks I brought to ask her opinion about ingredients and recipes.  At this point, I put them aside and started watching the clock (which was on the wall in front of me) until my hour was up.

As my disappointment continued to grow and I couldn’t wait to get out of there, she committed a huge crime when I asked her about the conflicting information I had found regarding whether to eat tryptophan-rich foods and complex carbohydrates at the same meal or not.  She responded, “You didn’t understand what you read.”  First of all, my reading comprehension skills are pretty good.  Secondly, I’m a researcher. 

People who know me usually marvel about how much information I learned on any given subject that I didn’t know anything about before.  I didn’t say anything because there was no point, but I was thinking, “Well, Wendy, no, I did NOT misunderstand anything.   There ARE two schools of thought out there.”  Her response not only annoyed me, it told me she’s not as knowledgeable about research findings as she should be, particularly when this is her job. 

At one point when I was asking her about probiotics (the good bacteria in our gut that we all need for optimum digestion), she pulled out a bottle of pills from a cabinet and told me they were supplements that I could buy from her.  I politely declined the offer.   I was put off by the fact that she was trying to sell me a product, especially since I knew that probiotics from pills are not as effective as getting them from food.  When probiotics were becoming popular, supplement companies started putting out product in droves.  The problem is that not all supplements contain the right amount or the right type of probiotics that we need.  It is best to get probiotics from foods, like kefir or certain yogurts.   When I had the ulcer in January 2016, my gastroenterologist recommended that I start eating Activia yogurt every day.  He explained that it would take about 3 months for my gut to maintain the right type/amount of probiotics and I did notice a big difference in how I felt a couple of months after I started consuming probiotics.   I also consume kefir (a dairy product) frequently.  Many people don’t like kefir but I do.  On this subject, I'm going to go with my doctor's recommendation rather than trust a nutritionist whose competency I'm now questioning. 

By the time I got to my car to head home, I was completely disappointed, deflated, and felt I had wasted a whole week of excited anticipation for a meeting that was entirely useless to me. 

Later that day, I sat down and went through the multiple page list of foods she had given me.  Except for a few exceptions because I just don’t like those specific foods, I had already been eating everything on that list.  

Then I looked through the colorful booklet she gave me.  Imagine my disappointment when I realized the booklet was written for diabetic patients!!!   I have never been diabetic, it doesn’t run in my family, and even at my fattest, my sugar levels were always normal.   Some people become “pre-diabetic” as they gain weight and at some point they will get diabetes if they don’t lose the weight.  For me, I never had that problem even when I weighed 306 lbs. for over a decade.   I was lucky.   I realize that a diabetic’s diet is exceptional for anyone, but there are limits to what diabetics can eat.  I don’t want to be limited.  It's hard enough to stay within calories without being further limited from what I want to eat.  If I was never at risk of being a diabetic at my heaviest, I certainly was nowhere near it now, after having lost over 100 lbs. and permanently changing my eating habits. 

The food list, the food groups chart and the colorful book all ended up in the recycle bin that night.   These confirmed what I already suspected:  this woman gives the same presentation to every patient who walks in her door, regardless of what their specific needs are.   Since she’s associated with one of the local hospitals, they probably refer to her patients who are now where I was in 2012, clueless about what to eat for a healthy lifestyle.  I’m not that person anymore.  She gave me a beginner’s presentation whereas I’m in the intermediate class. 

Then there was the cost.  She initially told me when we were exchanging emails to set up our first appointment that she charged $150 for the first hour and $50 for subsequent half-hour follow ups.  I told her my medical insurance would cover it and whatever they didn’t pay, I would cover myself.  But she said I had to pay her when I met her and then she’d reimburse me whatever my insurance paid her.   Since I know my insurance is efficient at settling claims, I agreed.  After our first meeting, I handed her a check for $150 and we set up a follow up appointment for the following week.  I knew by the time I got to my car that I would be cancelling that second appointment.

When I sent her an email a couple of days later thanking her for her time and informing her I would not be returning for a follow up, she wanted to know why. 

Although I was very honest, I wasn’t mean about it (even though in my head I felt ripped off and cheated).  She wrote back telling me that the first meeting is to “get to know” the patient and that subsequent meetings are to build on that.  I didn’t respond but, seriously, what would have been the point of having subsequent meetings?  I specifically told her those food charts don’t work for me and although I do practice some form of portion control, my priority is working with calories.   Watching my calories forces me to eat healthy.  I imagined that our second meeting would have gone like this:  how did the food chart/portion control model/booklet I gave you work out?   It didn’t.   Oh, that’s too bad.  Now what?   Oh, yeah, here’s my check for $50 and let’s set up another appointment for me to pay you another $50 after the information you gave me didn’t work for me for another week.

Regarding the reimbursement?   It took me about 3 months to get my money back and only because I kept pursuing the issue.  Six weeks after we met, I still hadn't received a statement from my insurance company which I thought was odd since they're quite fast at settling claims.  I suspected Wendy never submitted the claim, and this proved to be the case when I inquired.  I guess since she had my $150 already, there was no hurry on her part.  When I finally got my insurance statement over two months after meeting Wendy, I saw that she charged $280 for that one hour.  WOW!!!!!  After my insurance paid, it took me another month of asking for my refund before I was actually reimbursed.

The whole ordeal left me thoroughly disappointed and feeling a bit depressed.  I felt like NO ONE was helping me.   If you read my previous post, you know I was having medical issues as well and I felt my doctors were not paying attention to me.   So here the nutritionist I had hung my hopes on had not helped me either.  Not only that, the fiasco dragged on for 3 months until I got my refund.

After several days of feeling depressed about the whole thing (no one’s helping me, I can’t stop eating, I’m gaining weight, what do I do now?   I don’t know what to do!), it was then that the obvious hit me like a ton of bricks:   YOU lost 140 lbs.   YOU did it.   You KNOW what to do!   You’re looking for a magical answer to lose weight which is the same thing you did your entire life and that never worked for you.   There IS no magic answer to losing weight.  It’s all about the foods you eat and exercising regularly helps.   YOU already possess the knowledge of what you have to do, YOU just need to do it.   No one else can do it for you!  You did it before, you can do it again.  If you can lose over 100 lbs., you can certainly lose the 27 lbs. you recently gained.

As I’ve explained throughout my blog, the epiphanies I’ve had that led me to success were nothing earth shattering or new or inventive.  They were all things I didn’t see in the lines of “the forest for the trees” thing.  Here, once again, was an obvious epiphany I had forgotten. I already possess the knowledge of how to lose weight, I just need to apply it the way I did before.

So where am I today with this whole ordeal?   I’m feeling much better now that my medical issues have been resolved, but I’m still struggling when it comes to food.  I’ve been stuck between 185 lbs. and 190 lbs. on the scale for months, but I’m just grateful that I didn’t keep gaining beyond the 27 lbs.   I haven’t given up and I’ll continue to work on losing those extra pounds to get me back to 170 lbs. which was an ideal weight for me.  People tell me they can’t see the weight gain on me, but I sure notice it in my clothes because I have a closet full of new clothes I can’t fit into anymore and I refuse to buy bigger clothes beyond the few items I can wear now. 

As hard and miserable as it is to lose weight, keeping it off is even worse.  When you think about it, most difficult things in life have an end:  college leads to a degree, a job leads to retirement.   Not weight issues.  This fight never ends.   So…I will continue to fight it.   There’s no other choice.  I already proved to myself that I can do it, I just need to do it.  No one else will do it for me.  No one else can help me.  It’s all up to me. 

Sometimes when I feel down for getting off track, I need a reminder of how far I've come and my old elephant pants do that perfectly.  I pull them down from the top shelf in my closet, put them on, and stand in front of a mirror.  These pants that were too tight on me in 2010 now look like they belonged to an elephant.  It's the perfect visual confirmation of how much I've accomplished.   I just need to keep plugging along and get it done.