Weight Loss Support - Do GPs have a clue how macronutrients work?

07-06-2011, 02:14 PM
I went to the GP two days ago about recurring episodes of very nasty stomach pain. He listed three possibilities, but the top one was gallstones, and he's sending me for an ultrasound. I said rather proudly that I was eating 27% of my calories from fat, and he said that it was very high and I should be eating 10% instead, along with a high-protein diet. I was a bit too doped from painkillers to ask how exactly I should do this on a vegan diet, but once I got home and started tinkering in FitDay I realised that this was a pretty tall order.

Nevertheless, I tried. I added extra protein powder to my morning porridge, experimented with sautéing in broth instead of a teaspoon of olive oil, replaced half the soya milk in my morning porridge with water, found the fatfreevegan.com website, and had to add huge quantities of pulses and extra veg in order to get up past 1000 calories. My insides have been completely unimpressed with this new regime, with constant gurgling, noises and smells so bad I honestly don't know what I'll do when my partner gets home from work tonight. After two days of this I thought I'd check, so I rang and spoke to another GP. I mentioned that 10% is very low and basically means no added fats, no nuts or seeds, no tofu, no avocado, very little soya milk, no EFA supplements. She was surprised and said that they always recommend 10% fat for healthy eating, that I should be fine with my usual diet (which is blindingly healthy, quite frankly), and that her colleague had meant that I shouldn't be living on fried and greasy foods, something I'm very far from doing. Then she muttered something about saturated fat, and I got the impression that the 10% figure may have been about saturated fat, not total fat intake. After describing my diet a bit more, she ended up telling me to eat what I do normally, though we compromised on 20% fat, to be lowered if I get suspected gallstone attacks again. (I had actually had a couple of higher-fat meals before the last attack, I'd had a big block of tofu to use up.) I asked what proportion of protein I should get and she said she didn't know about that sort of thing.

She also recommended the British Dietetic Association (http://www.bda.uk.com/foodfacts/index.html) website for general guidelines. Once the phone call was over, I moseyed over to have a look. Guess what, they recommend 70g fat daily for a woman on a 2000 calorie diet. I'm on 1100 (sensible for my height and low activity levels, and okayed by my usual GP who's currently on holiday), and for me the equivalent would be 39g fat, whereas I've been averaging about 33g. How exactly have I been eating a high-fat diet?! Not to mention that I've looked up gallstones, and apparently they can be caused by insufficient fat in the diet, although they can also be caused by a host of things from genetics (don't think mine are great there) to high cholesterol, including rapid weight loss (they mention crash dieting) and hormonal disruption. I don't think 1lb/week counts as rapid, even at my height, but I have experienced hormonal disruption since starting dieting and the CFIDS/ME always complicates matters, so maybe that set something off.

Anyway, I am relieved that I can get back to a normal diet, just with slightly lower fat levels. (There goes that nice avocado that's probably overripened by today anyway.) Meanwhile, I am still rather confused by the whole thing. It's generally an excellent practice, my local GP surgery. Should I just assume that GPs may not know the first thing about nutrition?

07-06-2011, 02:17 PM
GPs learn very little about nutrition. They learn about sick people and how to treat them. Not so much on how to keep people healthy. A nutritionist is better for that.

Plus, too high a protein diet is hard on the kidneys. Fat is not as evil as people think and not all fats are created equal, as you know.

07-06-2011, 02:23 PM
From what I've read (a good bit) 10% is really low. Maybe they were confusing total fat and saturated fat.

I agree with berry that doctors don't learn much about nutrition. I wouldn't necessarily go by what any one doctor said.

07-06-2011, 02:30 PM
I mentioned that I've been following the usual guidelines of 20-35% calories from fat and she sounded surprised. I also mentioned that I'd heard that gallstones can be caused by not having enough fat in the diet. And yes, I know all about good fats, I am thoroughly in favour of them in the appropriate quantities.

I'm not a fan of madly high-protein diets, and they're well-nigh impossible as a vegan anyway. But it's entirely possible that I'd benefit from bumping my protein levels up from an average 17% to, say, 19% or so. Of course, the foods which are high in protein tend to be high in fat as well. I was racking my brains trying to work out how to combine high-protein with low-fat short of living on protein powder. I might increase the protein powder in my porridge anyway, just to see how I fare on it. Does anyone have an opinion on rice protein powder vs. soy protein powder? I have the latter, am not too keen on the flavour, plus I think that a bit of soya milk and tofu is probably the optimal amount of soy in my diet and don't want to overdo it.

07-06-2011, 03:00 PM
GP's are just that - general. They know a lot about everything, but they are also human, and they simply can't keep up with research for every possible subject from a vegan diet to grandma's stubbed toe.

It sounds like your GP subscribes to the "fat makes you fat" fallacy that was once very commonly believed.

A higher protein (35-40%) diet IS possible when vegan but you really have to be creative and know what you're doing. At 4'11 and 120's, it's important to be getting a good amount of protein, you aren't going to have much lean mass to begin with and you'll want to preserve the lean mass you have while losing fat, rather than losing lean mass. This is a very common unfortunate trap that many vegans fall into when losing weight.

Lentils, seitan, those are your best bets for higher protein intake. Personally, I'd choose the rice protein powder or you can even explore hemp. Good luck!

07-06-2011, 03:08 PM
At least in the USA, gp's get almost no training in nutrition (and the good ones will admit it).

My doctor won't recommend anything that isn't supported by research published in reputable medical journals, and so I was a little surprised when he recommended low-carb (he said there was research suggesting that insulin-resistant and some diabetic folks did better on low-carb diets), but he warned "but not too low," and when I asked him what was too low, he admitted that he didn't have a clue (he's a little, just a little overweight himself, and struggling to lose it, so he's very empathetic).

I think it's insane that doctors don't get more nutrition education, especially since (in the US) insurance rarely covers visits to a dietitian (and when it does, it's usually only a few hours).

07-06-2011, 03:16 PM
Sacha - I tried hemp powder once, it was vile! Which is why I'm being cautious about other protein powders, as I haven't found anything smaller than a kilo for buying rice protein powder at a reasonable price. I am very fond of rice in its various incarnations, from using rice flour to make teriyaki tofu to rice milk going into dairy-free chocolate, so I'm hoping it's a safe bet.

I wasn't expecting huge amounts of knowledge about a vegan diet, but if he's actively recommending a fat intake, he should know what it means, really. 10% fat is 10% fat whatever your dietary type, and total fat is not remotely the same as saturated fat. Over the last two months, I have averaged 31g (26%) fat a day of which only 6g (5%) is saturated. Actually, it may be 6% saturated, since not all the foods in my FitDay database list the fat content broken down into saturated/monounsaturated/polyunsaturated, but my point is that it's nice and low.

I don't know how much protein he was thinking of, and he's not my usual GP so he doesn't know me personally. I doubt that he meant super-high protein, and to be honest, I think I'd struggle to do that while keeping my diet generally healthy. As you said, it's theoretically possible, but I think that an intensely high-protein vegan diet is unlikely to be a well-balanced one overall. For the time being I'll go for adding more protein powder and probably leave it at that, since I'm already making good use of pulses and such, and can't increase many of the other protein sources without increasing fat. Considering that I am frequently too ill to get out of bed and cook, just getting a decent balanced diet where I am peacefully losing weight at a sensible rate and feeling good on it is miracle enough.

There are five portions of a nice lentil and sweet potato soup in the freezer, and now that I'm off the hook about eating a practically fat-free diet I can stop worrying about the small amount of coconut milk we put in there. My frozen soups are generally lentil-based. Seitan doesn't seem to be readily available in this neck of the woods, for some reason. I did order some more dried pulses with my last health food shop order, so there may be further explorations of puy lentils and foul medames in the near future. Although even pulses contain fat, I was looking at the small-sized tin of chick peas I will cheerily throw into a salad and that had more fat than I expected.

Kaplods - glad to hear I'm not the only one with a generally good GP who suddenly falls down when it comes to macronutrients. I agree: surely a bit of basic training, the sort of thing a good dieter would learn in the first week, wouldn't be too much to ask?

I'll be curious to see what my regular GP says about all this when she gets back. She is generally fantastic and often knows more about certain medical conditions than the specialists do, and she's been holding my hand about this dieting business in general.

07-06-2011, 03:39 PM
GPs can be clueless but still throw out this kind of random, wrong 'advice' because they see themselves as more expert than the patient. Ain't necessarily so.

I seem to remember reading here that GPs (can't remember whether here or in the US) only had a day's training on nutrition in their 7-odd years. Something like that.

And I was pleased, really, when my GP said she didn't know anything about soft tissue and referred me to a physio. At least she did not blether pointlessly.

07-06-2011, 04:09 PM
I have just had supper. Jasmine brown rice (think it's my favourite brown rice so far), and a stir-fry of carrot, mushroom, snow-peas, spring onion, a few almonds, tamari, and of course sunflower oil to stir-fry in! Utter bliss. I'm still substantially under my calorie allowance for the day, and I've already had a 4g piece of chocolate earlier, so we may forage in search of strawberries later. *goes off happily humming "It ain't necessarily so"*

Do you know, I've been absolutely fine on this diet for the last three months. I haven't felt deprived or bored, I've found calorie-counting to be surprisingly fun, I've enjoyed the challenge of plotting the healthiest diet I can manage, and the weight has obediently dropped off at a predictable weight so I haven't needed to worry about it. Then this "you must only eat 10% fat" thing came along and I absolutely hated it. It probably didn't help that supper last night was a bit of a disaster, just one of those meals that go wrong, but I have really been sulking about this, indeed moping.

Since a lot of people in this forum have had their gall bladders removed, does anyone have advice on what is a good proportion of fat to shoot for at this stage, where we're not quite sure yet but it might be gallstones? The ultrasound may not be for a few weeks, between the referral time and my needing a week's notice to book a support worker to take me.

07-06-2011, 04:16 PM
I can only speak for my father's experience.

My father had to have his gallbladder removed. His doctor recommended a low fat diet for him. My father had to ask "How low fat is low fat?" The doctor told him about 30-35g. Which would be about half or a little less than half of what an average person should get.

Best of wishes figuring out what's going on! And I'm sorry that the GP seemed to throw out some advice that wasn't -really- all that good for you. I wish you a speedy diagnosis and recovery for whatever it is :)

07-07-2011, 06:10 AM
I wonder what 30-35g on a man (how big is he?) would equate to on a small woman? Less than what I'm eating most of the time, anyway. Do you think that was applied to the mythical 2500 for a man, or was intended to be relating to a higher or lower calorie number and should be adjusted accordingly? I think I'll shoot for 25g at the moment, but I'm still finding it really hard to calculate.

07-07-2011, 08:49 AM
I wonder what 30-35g on a man (how big is he?) would equate to on a small woman? Less than what I'm eating most of the time, anyway. Do you think that was applied to the mythical 2500 for a man, or was intended to be relating to a higher or lower calorie number and should be adjusted accordingly? I think I'll shoot for 25g at the moment, but I'm still finding it really hard to calculate.

My father is about 5'9" - 5'10" and weighed (at the time) around 225. (He actually lost weight after losing his gallbladder and needing to stick to a low fat diet for his health, but that's another story.)

Other than that. I have no idea where the doctor was picking the number from. I've heard via articles and nutrition courses that the average person needs about 70g of fat a day... that's on a 2,000 calorie a day typical western diet. I did some napkin math and 30g-35g is about 13-15% of his daily calories. If that is that case, and it very likely could be, then he was just going with half of a "usual" person's fat intake.

It doesn't look like you've been eating high-fat at all. But (if it is indeed a problem with your gallbladder) even one day of higher fat intake could've been what triggered the attack. In my humble, and very much so NOT a doctor opinion, at the moment, especially before a diagnosis the best you can probably do is what you're doing. Keep it a little lower, and monitor vigilantly. (Helpful that you've already been monitoring vigilantly so it's nothing new, just different things to watch for!)

07-07-2011, 09:24 AM
Your meals sound delicious :) I would just stick to what you are doing. Gather some fantastic vegan cookbbooks and go to town. Vegan diets, particularly ones that are based on Indian/Asian cuisine, are rich in nutrients/spices. You can't go wrong, IMO, as long as you are making sure to get some balance.

10% fat.. I would be ravenous. I prefer 30%.

07-07-2011, 11:32 AM
I know I may not be much help but my gallstones were discovered prior to being vegan. I did a pretty low fat diet and they didn't bother me. I went vegan and really don't watch my fats too much although I rarely eat fried foods. It has been over 4 years since my last gallbladder attack and I still have it.

If I were you, I'd look at the Engine 2 diet, Eat to live or possibly McDougall.

07-07-2011, 02:11 PM
Nelie - It's nice to know that someone has coped without surgery. How low fat was your diet? I've looked at McDougall and ETL and I wouldn't want to be on such low-fat diets long-term for health reasons, not to mention staying sane with cooking. I don't think that grains need to be limited that far, and I certainly don't think that nuts and seeds should be banned from a healthy diet. For the short term, I'm using them for ideas to make my cooking lower-fat than it was before, plus there are resources such as the Fat Free Vegan site.

Lovely - I think I'm better off looking at grams of fat compared to bodyweight than percentage of calories. Presumably we're talking about a certain level of fat for the body, and that level of fat would be the same whether someone was on a lower-calorie diet or not. So if I calculate it based on weight, my equivalent to your dad's weight comes to 20g fat/day. Eep. That's going to be hard, especially since I already take 2g fat from my EFA supplements (echium and borage oils). Oh well, I'll see what I can do.

Sacha - it wasn't so much ravenous as miserable. I didn't want to shock my poor body by going way under my calorie allowance, so I was desperately trying to make up the calories with fruit and veg, and feeling absolutely stuffed full of them. And you're quite right, time to fish out the cookbooks!

Meanwhile, I have finally decided to set up a blog here. I'm not going to use it to talk about how I feel about losing weight so much as a diety cookery blog. It's called Blissful Vegan Cooking (http://www.3fatchicks.com/diet-blogs/blissfulvegancooking/) and should be looking interesting before too long. I have a nasty feeling that this will mean logging out of 3FC as Esofia and in as the blog name every time I want to update, but hopefully not.

07-08-2011, 09:00 PM
isn't the Ornish Diet at about 10% fat? And it's considered super duper low fat, so I'm not sure where your doc was coming from. If 10 % fit into your life, that would be one thing, but I think it would be a ton of work to get there.

07-09-2011, 02:15 AM
Esofia - I eat about 15-20% fat but it varies. Some days may be slightly lower, other days higher. I actually started going vegan using ETL as a guideline but I am pretty flexible in my diet. I include nuts, olives, avocados, etc.

07-09-2011, 03:36 AM
Very, very few people can achieve 10% fat. Personally I do not find it a goal worth striving for or really anything lowfat at all.

I did have my gall bladder out a couple of years ago. I was probably eating about 35% fat when I had the attack. I had gallstones so elected to have it removed. It was a very easy procedure, and only took a couple of hours. Afterwards I was told that some people are sensitive to fatty foods, but I'm not at all. I really experienced no different reactions to food since then.

Right now I'm eating low carb and eating about 60% fat although as I go on that will probably drop to about 50%.

07-09-2011, 05:40 AM
It's probably too early to be getting a reaction of this sort to being on a lower-fat diet, but I'm noticing that my skin is drier today. I agree that 10% is extreme, and that any GP who says "we advise all our patients to go on a 10% fat diet" doesn't actually know what they have just said. I can't quite remember Ornish, but it's similar to McDougall, right? I looked up the latter, and while vegan diet plans are good to see and some of what he said was sense, his ranting about how all fats in any form are evil was quite bonkers.

18% fat is the level of "interesting challenge" rather than "making life unlivable", so I'm going to try to stick at around that until I have a diagnosis. It'll be a learning experience, if nothing else, and it basically just means skipping nuts and chocolate and not going too heavy on the soya milk or tofu. Oddly, the scales have been having another one of their little pauses over the last week, but I'm continuing to feel slimmer so I doubt there's any reason to worry. I'm just curious as to why I seem to get mini-plateaus after the episodes of this stomach pain.

Am I right in thinking that this is probably a good time to make extra effort with my nutrition? More protein powder than usual in my breakfast, for instance? And there's the question of multivitamins. I'm currently on the Seven Seas vegan multi, which is vaguely adequate but just about meets RDAs (bear in mind that with ME/CFIDS there could be malabsorption problems, though in my case this is theoretical and certainly not at major levels), and when the bottle ran out I planned to buy the Deva One-a-Day, which has a nice hefty dose of vitamins without going overboard, and more trace minerals too. Should I perhaps get the Deva now?

I'm also being really careful about pacing myself. The annoying thing about having CFIDS/ME is that a single trip out for something like an ultrasound can knock me out for weeks, and a hospital visit can knock me back for months. So for the time being, I am resisting any urges to nip to the shops or what have you on a better day. My priorities are the ultrasound in ten days, meeting my partner's dad and his family (first time in five years, and they don't even live that far away) when they come to visit in a month (thankfully it'll just be a nearby pub, I'll get a cab there), and possibly gall bladder surgery. Which means that I really need to get back to the hospital about the results of my complaint about the time I was there in December and they completely messed up getting me the vegan food they'd promised me, amongst other things. That's bad enough for the sort of thing where you're only in for a few hours, which with my state of health can mean keeling over from low blood sugar, but with an overnight stay it could be downright dangerous.