Case Study: Low Carb Diet Gone Bad

How many of you city girls and city guys have lost weight on a really low carb diet? But eventually you got bored and found you were unable to stick to it? Or perhaps life just got in the way? You have unsuccessfully tried to get back on board with the diet, but just can’t seem to do it. You are upset with your lack of discipline.  You know carbs are bad – right? After all, you lost the weight bycutting them out. Sound familar? Read on for a real life case study from my private practice….

Sue’s story (name changed of course)
Sue was a 41 year old female who had been overweight for most of her life. She was 5’5 and weighed 185 pounds. She tried numerous diets without success. Sue was a type A personality and tended to have an “all or nothing approach”. Four years ago, she started the Atkins diet and found the weight came off rather quickly. She was very diligent in avoiding all carbs (except the small amounts allowed). She liked the fact that she didn’t have to count calories. Sue had always been a carb-a-holic, but found she could avoid them because they were “off limits” on this diet. As far as exercise goes, she added in jogging on the treadmill for 45 minutes 6 days a week. In a matter of time, Sue lost 50 pounds and felt great. She managed to maintain her weight loss  for 2 years. Considering the fact she was “all or nothing”, she was able to handle this rigid diet/exercise program. But here is what happened when life gots in the way: Unfortunately, Sue got a stress fractures from running that wouldn’t seem to heal. Her doctors strongly advised her to to refrain from jogging. She also had several major stressful incidents in her personal life. Sue ended up regaining all the weight back (and even more) because she was unable to adhere 100% to her “successful routine”.  She came to my office seeking help because she felt desperate and out of control.

Black or white mentality:
Sue’s story is not uncommon. I actually see it quite frequently in my practice. Many people have a difficult time being flexible or in the “gray zone” (as compared to black or white) when it comes to diet and/or exercise. If they can’t do it 100%, then they don’t do it at all. This pertains to both diet and exercise. Here is the problem – being extremely rigid when it comes to diet and/or exercise will only lead to failure in the end because it is not sustainable.

I don’t believe in a “one diet fits all” approach and feel some people do better on lower carb diets while others do great on lower fat diets. Sue obviously did better on the lower carb regimen. However Sue took it to the extreme. The result? She is now carb phobic. As soon as she eats anything that contains carbs, she feels she is being “bad” and so the eating continues on and on. Very rigid diet and/or exercise regimens tend not to work for the majority of people in the long run. As you see by Sue’s story, an unbalanced exercise program can also lead to injury. If Sue had been flexible enough to allow herself to cross train versus having to run on the treadmill every day, she could have avoided injury – or at least allowed her body to heal properly when she was injured. Now she can barely work out at all.

Here is what Sue ate on a typical  day:
Breakfast: nothing (in attempts to compensate from her overeating episodes the day before)

Lunch: minimal. She would often stand at the refriderator and eat slices of turkey. That’s it!

Afternoon: She would feel absolutely famished. The trouble began… Sue would eat anything that wasn’t nailed down. Usually it was large portions of some type of carb (cracker, cookie, ice cream, etc.). Then large portions of other “appropriate” snacks – in her mind – such as nuts and cheese.

Dinner: Usually a high protein low carb dinner with her husband. She felt dinners were on the boring side. All of her dinners were ordered in ( a typical citygirl/guy). Portions tended to be jumbo sized.

Exercise: Despite her doctor’s recommendation, Sue was trying to use the treadmill midmorning a few times a week… and was experiencing leg pain.

My assessment of Sue’s diet:
She had many problem areas in her diet. Here is my list:

1. No breakfast. This will only set her up for trouble later on. While I don’t force breakfast on people, I feel that she should at least have something small midmorning.
2. Lunch was inadequate in carbs, fat, fiber and not enough protein. A few slices of turkey will not hold her for long . This contributed to her out of control eating later in the day.
3. Uncontrolled afternoon snacks. There were several reasons as to why this could be occuring including: 1. her inadaquate food intake for breakfast and lunch, 2. the notion that carbs were bad and that once she gave in and ate something with carbs, she might as well continue eating inability to control her intake once she started in on these foods and  3. keeping trigger foods in her house.
5. Sue often felt bored and unsatisified at dinner.
6. Sue was so focused on limiting carbs at meals that she forgot about calories. Many of her dinner were over 1200 calories.
7. Inappropriate exercise program.
8. Problem foods were being kept in the house
9. Overall diet was very unbalanced nutritionally

My goals for Sue:
I tried to give Sue a little education regarding her nutritional needs. We discussed how skipping meals would lead to cravings and how it would slow the metabolism. We also discussed how she needed more protein to help stablilize her blood sugar. This could help control carb cravings. I also think it would be best for Sue at this time to get the problem foods out of her house. Sue will also need to understand that carbs are not “bad” (especially if she focuses on the healthier carbs and is able to implement portion control). We will focus more on this later as I didn’t want overwhelm her in the first session.

Sue obviously had many problem areas in her diet, therefore we had to start by making very small changes. Here is a list of the goals I wanted her to work on for this first counseling session:

1. Keep a food record. Record what you eat and drink, what you did for exercise as well as how you feel physically
2. Add in something small for breakfast such as a yogurt or 1/2 cup cottage cheese or a fruit and hard boiled egg.
3. Get problem foods out of the house. Of course, this needed to be discussed with her husband.
4. Eat a real lunch! Sit down, don’t eat out of the refrigerator. I recommended an veggie omelet or salad with ~ 4 ounces of protein and 2 T. dressing. Eat a fruit with lunch (as she was still afraid of bread)
5. Plan a healthy afternoon snack. Ideally a snack that contained some protein and a carb. Example: string cheese and an apple. Or 1 T. peanut butter on high fiber crackers. Sue felt she could control her portions of these crackers because they didn’t taste that good.

 We would set more goals at her next session with me in 2 weeks. Stay tuned! (Understandably, Sue did not want her picture taken for my blog)

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MEET MARTHA

I especially love problem-solving, whether it’s helping women defeat issues plaguing them for years, helping a busy executive find practical ways to get heart healthy, or providing tips to help you reverse diabetes. That’s why I’m on a constant quest to expand my knowledge by staying on top of the latest research.

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