Case Study and a challenge for you
I’m going to outline a case study, and I’d love to get your feedback as to what you think is the problem and how we solve this weight (or rather FAT) loss problem.
This is a case study on a type, rather than one person. I have had a string of clients over the last 6 months who are so remarkably similar, I’m doing a kind of composit case study.
This client has a goal for fat loss, increased performance, better energy and sleep. Despite eating a low carb paleo diet and doing 5 – 6 sessions of CrossFit (or similar high intensity training) she is not the desired results in fat loss and performance.
Note: The following is all the information I collected from this client on her first consultation with me, she had put herself on a low carb diet because she had read and been told this is the best way to lose weight.
Client: Female
Age: 28
Weight: 68 kg (150lbs) Height 5’6″ BMI 24.1
Measurements: Waist at navel: 32″, smallest 30″ Hips at widest point: 40″ Shape: pear, waist to hip around .75
Body fat: looks high 20′s – 30%, would like to be closer to 20%, would like to lose about 8 kg fat, and retain strength
Here is a picture of a woman with similar measurements:
Woman 150lbs 5’6″ pear shape
Exercise: 5 – 6 sessions of CrossFit or bootcamp / boxing per week. Maybe some cardio as well, like running. Making slow progress, but feels a lack of energy when training, recovers fairly well after a session.
Reason for consultation: Failing to lose body fat despite eating a low carb paleo diet.
Typical complaints (For a list of questions I usually ask in a consultation – link to a simple version)
Cravings: Constantly craving usually sweet food, often immediately after a meal, worse on days with hard workouts – eating nuts between meals to stave of cravings, or more often give in to cravings and eat biscuits, chocolate, might binge then feel guilty.
Sleep: Disturbed sleep, difficulty getting to sleep or staying asleep. Sleeps 6 – 7 hours, has a busy job and social life
Feel fatigued / Tired in the afternoon
Gut: tends to get bloated on wheat / gluten, but no longer eating it so not an issue (except if gives in to biscuits)
Skin: prone to breakouts / pimples
Otherwise healthy, does not get sick easily.
Type of person: successful, driven, happy, motivated to succeed.
Weight loss: hit a plateau (for weeks or months)
Diet: Cut down carbs lower – below 50 g per day to try to lose weight, but feels tired in afternoon, not sleeping well, finds workout quality reduced.
Typical days food:
Breakfast: Eggs and non starch veggies plus coconut oil
Snack: nuts
Lunch: Salad plus chicken or tinned fish, avocado
Snack: nuts or paleo nut bar
Dinner: Meat / fish or chicken, selection of non starch vegetables, plenty of healthy fat
Weaknesses: Alcohol, (can’t stop at one, drinks a lot 1 – 2 times a week), biscuits, chocolate, chips (caves in at least 2 times a week)
Sugar: does not have sugar unless craving (chocolate) 1 diet coke day, no drinks with sugar in them
Caffeine: 1 -2 coffees plus 1 diet coke
Supplements: fish oil capsules, occasional magnesium. Gets sun on skin without block so Vitamin D levels likely to be okay.
By all accounts – this diet is the perfect low carb one to give weight loss, although this woman has been following it or months her weight has not budged.
If you were the nutritionist – what would you do?
New Blog Post: Low carb paleo crossfitter not losing weight: What do you think could be the problem? Please read post and comment! http://paleozonenutrition.com/2013/02/10/crossfit-and-low-carb-paleo-why-isnt-this-client-losing-weight/
[...] Paleo & Zone Nutrition Blog / Posted on: February 09, 2013Julianne’s Paleo & Zone Nutrition Blog – Case Study and a challenge for you I’m going to outline a case study, and I’d [...]
Seems too low carb for that much activity. I’d feel fatigued for sure. I would definitely add in a decent amount of starch post workout.
Agree with you, Ben. Carbs are fuel and an active person or athlete needs to have ready fuel available. Yes, the body can convert, but as he said, too low carb for the activity level stated.
That said, everyone’s metabolism differs, not everyone will respond to the same type of nutrition – in otherwords perhaps a Paleo diet does not suit her metabolism and activity level. As advisors we need to understand that advocating only one type of diet defeats our stated purpose.
Also, what suppliments is she taking? RDI’s are not enough for her stated activity level, review PDI’s instead. Has she had a vitamin D deficiency test? It could be a deficiency, or perhaps she is not adequately reporting her consumption levels.
Helen makes a good point too, stress could be a factor, stressors can be addressed with proper supplimentation, yoga, and/or some guided stress relieving meditation practice. Good luck! <3
I’m seeing some red lights with “driven” and “busy job and social life”. PLUS there’s a lot of HIT and not a lot of relaxing, fun, enjoyable movement. What is the busy job? Sitting in a windowless office under fluoro lights with a 40-minute commute? What happens before bedtime? TV/computer until 10PM? I’m thinking stress is a significant component here. I’d be advising some stress reduction methods like Heartmath or Yoga, try to make the social life involve a fun outdoors activity instead of a club or bar, and switch out a session or two of Crossfit for a walk or cycle in the park.
I’m also not too sure about VLC. I find that I do better on moderate carbs.
Lastly the alcohol. It messes with sleep and (AFAIK, recalling info from heaven-knows-where) is metabolized preferentially so will mess up ketosis.
Finally, I question the need to get body fat too low. A little more maybe, but there’s this thing women have called estrogen…
oh and ditch the diet coke. Ugh!
If it was me I would introduce a bit more protein with midmirning and afternoon snacks and perhaps even after dinner before bed.
She could be overtraining and perhaps the body is holding on to fat to store energy. Perhaps introduce a slow long walk at low intensity as a change up or a birkam session .give the body time to recover.
This sounds remarkably like me too! It is worth looking deeper into hormonal imbalances that may be impacting the situation. For example if the adrenals are fatgued then you are likely to see a slowing of the all systems of the body, including thyroid being affected. It’s natural for the body to ‘resist’ in times of stress – whether mental, physical etc. So look at adrenal function especially DHEA and cortisol, thyroid function (not just labs), progesterone-oestrogen ratio, testosterone, insulin etc.There may be some clues there. DIM has helped with some pear shaped women I know who are oestrogen dominant. Other than that I would look at hidden food intolerances also. I still havent found my breakthrough but I’m working on it, and I think that hormonal balance is one of the keys to this.
In terms of the cravings perhaps Chromium is worth trying, as well as looking that she is getting enough fats at each meal. I think she may be one of those, like me, that have to be rigorous about staying away from ‘bad’ foods to really get rid of cravings.
I hope some of this sparks conversation!
Thanks
Charlotte
I agree with Ben except I think she needs to maybe add some starchy veg to some of her meals. Something like sweet potato. Find an alternate snack to the nuts ie; full fat yoghurt. It would be interesting to know what alcohol she binges on because that sounds like a lot of sugar to me as well as the diet coke ( which tells her brain sugar hit anyway ) and all the cravings she seems to give in to. Hope you do a followup on this case to give us all some insight……I’m going through a similar plateau so this is a wake-up post for me!
As a nutritionist, I see this with quite a few people, mostly women, who are working out regularly. This woman probably tends to hold some extra weight around her middle as well. This to me is a fairly classic example of someone who has put their body in continuous stress mode, taxing thèir adrenal glands and producing excess cortisol b/c their not giving their body enough of what it needs to properly refuel and recover well. I would highly recommend a few things: eat more starches like root veggies! Her body is starving of fuel…even efficient fat adapted folks who are athletic and workout at a high intensity need more starches then the typical low carb, moderate activity individual. This lack of dense carbs is greatly contributing to sugar cravings….including the alcohol which is after in large part a sugar addiction. I would also recommend she re-evaluate her training regimen….is she training for something or training to lose weight and change body comp? She will never do that if she continues to train like that and not allow for proper recovery by proper refueling. Many people think with methods like crossfit, it’s all about protein, but that is wrong. I consider doing crossfit 3-4 days a week and something like yoga the other 2 days or every 3 weeks drop from 5-6 sessions to nothing but yoga etc for one week then back to it. This is crucial for proper recovery, something all athletes or folks training hard need to do. I would also start taking some adaptogen herbs like rhodiola and Eleuthero to give her adrenals the support they need. If this continues she will end up with reproductive hormone issues as the adrenals and repro hormones are very connected. So wrap up: eat root veggies regularly, take adaptogen herbs and switch up her training routine, focus on recovery, recovery, recivery. i know for sure this will help.
drop the nuts. increase fatty ruminant meat. no snacking. limit one glass of wine per meal.
works for me and i’m old enough to be her mother.
You could be describing me! And that photo could be me too! And my occupation is a yoga teacher, so am active even when not working out. And yet, I cannot seem to shift the belly weight.
I am desperate to know the answer… Can you post that too?
Stop the excessive exercise. Cut crossfit and othe rtypes of strenuous working out to 2 and NEVER over 3 days/week. Take at least one full day off per week (no exercise.) Right now, two days off would be even better! Space the crossfit/strenuous workout days so she is never doing 2 in a row. In between Crossfit days, do gentle, regular walking outside in nature- no treadmills – for 30 min to a max of one hour. And we are not talking about racewalking here, but regular paced walking. She is not eating anything approaching a low carb diet for at least 3-4 days/wk as per your description of her cravings, binges and alcohol consumption. Stress needs to be looked into. Sleep hygiene and sleep promoting activities and rituals may help as well as relaxation work. Her breakfast may well be too lightweight and setting the entire day off on the wrong foot. Look at replacing breakfast veggies with some type of fatty breakfast meat. Some types of aerobic exercise (not high intensity stuff for her!) have been shown to very positively impact anxiety levels, depression and stress tolerance in general. And they can be helpful in burning fat. 20 to a MAX of 30 min a couple days a week of LOW IMPACT dancercise or other aerobic activity may be useful – but NOT 60 min and not high intensity stuff. So, ideally I’d like to see her doing only 2 crossfit days, 2 low impact aerobic days for 30 min max only, a walking in nature day for a max of 60min and taking two days off. She needs some good recovery. The first move here is to cut the way excessive intense exercise NOW.
Thank you for your post. I am 41 and experiencing a similar pattern to this client. I have been doing Crossfit 3 days in a row for 4 months and have gained weight. My clothes are tight as well. I’ve noticed an increase of fat in my midsection despite doing intense abdominal/core training. This has happened during periods of intense stress. After researching exercise and hypothyroidism, I learned that intense exercise with hypothyroidism can be counterproductive as intense exercise lowers thyroid hormone levels. I will be following a regime similar to the one you described above. Thank you.
How long ago did she cut back below 50 g carbs/day? It can take several weeks for that to get better (energy back) and if you cheat during that time it takes longer…
I’m fairly similar, except a little shorter. What has worked for me lately is to add additional weight training (powerlifting specifically). This hasn’t changed my weight, but has helped change my body composition. For diet, I’ve condensed my eat window to a 9 hour/day window (typically twi meals) and I train Crossfit a fasted state, have coffee afterwards with coconut milk and don’t eat until lunch. This has made my otherwise stuck scale finally move.
Too much cardio exercise, for a start. I’d reduce to maybe twice a week, and introduce heavy lifting twice a week. Then eliminate the nuts, take out the cheats, and reduce the alcohol. I’d also be interested to know what ‘plenty of healthy fat’ really is, and the consider increasing the fat a bit to achieve satiety.
She needs to match her carb intake to her activity level. To meet her goals, I would advise her to increase the former and decrease the latter.
Haha, this used to be me, therefore I can hopefully get away with saying that she won’t get anywhere until she can exercise some self control in the alcohol dept. She has to want it bad enough to do that. If you want the killer bod, you do have to make some sacrifices, unfortunately.
Alcohol messed with sleep, and bad sleep leads to all the rest, including metabolic problems and sugar cravings. She needs to make sleep a priority – get off that computer at nighttime.
I’d recommend:
*Weaning off the alcohol and (I assume) caffeine. Make a schedule. She is probably addicted to both and a slower approach is less shocking. Get it down to say, 1-2 glasses alcohol a week and 1 coffee a day. This is a behavioural change, requiring embracing new habits (like.. soda water, not so bad once you get used to it!).
*Addressing stress through time management
*going easy on the nuts, not only are they high fat, but she could have a problem with the anti-nutrients in them.
*Look carefully at portion sizes. With high fat foods like avocado, it is easy to get too many calories. I know calories are a secondary concern, but they do count for something.
*If she needs treats, try and get them into the post workout window (30-60mins after the workout – best time for carbs). It might be good to try a carby postworkout snack as well, to see if this reduces sugar cravings at other times.
* Cut back volume of training (you don’t say how long a crossfit class is, but I get better results with 3-4 x 20 minute higher intensity sessions a week. Less is more).
*Glutamine. There is a fair body of work on glutamine being of benefit for both sugar and alcohol cravings. I know it helped me, a lot.
*Run the diet through a tracker and see if she is low in B3 or B5 – these are the biggies for bad skin. Or just try and B3/B5 supplement and see what happens.
*Smaller goals. Aiming for 20% bf may be unrealistic for her body type. Take it a little at a time and see how she feels.
* Try to gently assess whether there is a binge eating problem. If the ‘caving in’ involves a packet of biscuits, there might be an underlying issue that needs addressing, and a hardcore, low-carb diet is not the best to suggest to someone with binge eating disorder (they will just rebel.. with binges). The criteria for BED is: 2+ binges a week / feeling that they can’t control it / feeling of self-loathing and shame afterward. If there is BED, you might need to involve a psych. BED is stupidly common in people that have tried, and failed to lose weight over a long period of time.
That’s all I got. It’s certainly interesting. AND frustrating for both yourself and the client.
The performance issues and craving sweet foods while crossfitting 5-6 times per week and eating 50 grams of carbs all point towards the need to increase carbs.
Nuts, alcohol, the 6-7 hours of sleep, the cheats, the diet coke probably don’t help either.
(It seems like nuts are supplying a considerable portion of her total calories, because without them it doesn’t look like she’s eating much.)
The minor acne suggests a minor resolved issue, which could be related to any the problems above, but otherwise suggests some minor immune dysfunction/GI problems
If she wants to do 5-6 lots of crossfit per week she would need to get more like 8-10 hours of sleep and eat something like 150+ carbs per day.
But then I think the answer Julianne
*but then I think you already know the answer Julianne*
They have tanked endocrine systems. Way too much exercise and in need of a lot more carbs. These woman need to heal their systems with herbs and vitamins, gentle exercise like yoga and walking, and eat some starch. After a few months to a year or two, slowly go back to Crossfit.
I also had a friend lose significant weight on GAPS when nothing else has worked.
I would recommend Chinese medicine to help get their systems under control faster. (I’m biased as it is my future profession. It helped me heal from many things.)
I’m not an expert by any stretch and I’m still trying to work on getting myself 100% paleo but I really don’t think she’s been strict enough on that. It looks like her binge activities with alcohol and carbs that include not only massively high amounts of refined sugar but also wheat and gluten would be screwing with her hormones, sleep and energy levels in a big way- not to mention the HIT that has been discussed, which it seems she might be overdoing while attempting LC very intemittently. It sounds like she’s saying “yeah, I’m totally paleo except for this, this, this, this oh and then that”.. I don’t think you can say that the paleo regime isn’t working for her b/c she’s not really giving it a good go. You’ve said it sounds like the perfect low carb diet and I’m sorry but it just doesn’t.
Perhaps she would benefit from dropping down to 3 crossfit sessions per week and doing a bit of a strict 30 day paleo month where she doesn’t cheat or drink alcohol or any of that other crap. Maybe a whole 30 approach for a month and then she can get into the high fat, mod protein, low carb ways with some more success.
Maybe exercise a bit less so she doesn’t need to snack or have too many carbs, resting the body from the hormonal load in some way? I just finished Whole 30 with no snacking, 3 meals a day, and leaving 3 hours between dinner and bed with no food. I adapted fairly quickly (there were a few evenings of cravings before things settled down) The 3 meals need to be pretty good to last you to the next comfortably. Lost 5kg I’d regained after a hip problem last year. I still have weight to lose though. I had a read a funny book called Mastering Leptin by Byron J Richards and wanted to try the no snacking thing,
i wonder if the diet supplies enough micronutrients to allow the metabolic flexibility she needs to burn stores in place of snacking. I’d suggest red meat instead of chicken, hard cheese and tart fruit instead of nuts, and I’d try 200mcg chromium as piccolinate for the sugar cravings (worked for me).
I received this from Tom as a personal email and he has given permission to post:
Hi Julianne,
I’m not a nutritionist, I was trained as a biologist, so I don’t have “the answers” but believe some of the info below might be helpful:
see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892765/ on informative documentation of how diet coke and “sugar-free” drinks actually exacerbate sugar cravings and lead to weight gain.
see article copied below re why “intense (crossfit) cardio” is actually bad for your heart and bones (as well as your joints) and a reasonable alternative (assuming your clients do not have neck or back problems).
Disturbed sleep could be due to a host of factors – can’t help without knowing more about individuals’ lifestyles, stressors, etc.
“Weaknesses: Alcohol, (can’t stop at one, drinks a lot 1 – 2 times a week), biscuits, chocolate, chips (caves in at least 2 times a week).” Since she “drinks a lot” there are obviously a lot of extra calories being added to her intake without any real nutrients making it more difficult to lose weight. Same scenario re caving in to sugar (and high calorie) sweets.
Supplements: What about supplements to cover a wide spectrum of micronutrients like boron, iodine, etc? A deficiency in micronutrients may be contributing to her cravings. I believe our bodies are innately programmed to recognize micronutrient deficiencies thus stimulating us to eat more in an effort to satisfy the need for these micronutrients. Obviously processed foods. alcohol and even many paleo foods may still be deficient in certain micronutrients. Seaweed products should be helpful as long as an excess of iodine isn’t ingested.
Hope some of this helps,
Tom Lang
Put Money In Your Heart’s Bank Account
If going to the gym for hours on end to do the same thing over and over doesn’t feel right, you’re on to something. Because it isn’t natural.
Forcing your body to perform the same continuous cardiovascular exercise by repeating the same movement, at the same rate, thousands of times over, without variation, without rest, is unnatural.
This type of demand does not exist in nature. You never see animals moving that way. Our ancient ancestors never moved like that – unless they were under great stress.
Yet endless moderate exercise is what you’re told will be the only way to make your heart “healthy.” In fact, this is “National Heart Month” and you’ll see endless advice like this for the next few weeks. Just today I read an article advising that “2 hours and 30 minutes of moderate aerobic activity is recommended each week.”
But moderate aerobic activity for long periods of time is the opposite of what your heart needs for top performance.
Today I’ll show you what I mean, and how you can easily boost your heart’s power by using a simple alternative.
You see, your body adapts to whatever you throw at it. And so, when you do “cardio” at the gym, your body adapts… but in the wrong direction.
Cardiovascular endurance exercise “downsizes” your heart. Your output shrinks, and what you get is efficiency. That means you economize your heart’s power so you can go long distances.
The problem is, no one ever stopped to think if training like this – building endurance – was the right thing to do.
And as it turns out, you give up something much more valuable by training for endurance with cardio.
The first question you’re probably asking is, what’s wrong with increasing your endurance?
The problem with it is, instead of building heart strength, it robs your heart of vital reserve capacity. Your heart’s reserve capacity is that portion of its highest possible output that you don’t use during usual activity.
Think of it as money in the bank. If you have $50,000 in your checking account, you won’t be bothered by a $1,500 repair you didn’t expect. But if you only have a tiny amount in reserve, any surprise could mean disaster.
Your heart works the same way. If your heart is in good shape and you only use 40 percent of its capacity during your normal daily routine, you’ll have enough reserve power to help you when you need it. But if you give up your reserve power by running and doing long-duration cardio, a sudden stressful event can trigger a heart attack.
Heart attacks don’t occur because you lack endurance. They occur when there’s a sudden increase in demand that exceeds your heart’s capacity to handle it.
Giving up your heart’s reserve capacity to adapt to unnatural bouts of continuous, prolonged, durational exercise only increases your risk of sudden cardiac death.
And endurance exercise doesn’t just weaken your heart, it mimics the effects of stress, poor diet, and aging.
A groundbreaking study of long-distance runners showed that after a workout, the blood levels and oxidation of LDL cholesterol and triglycerides increase. And as I read further into the study I found that prolonged running disrupts the balance of blood thinners and thickeners. This has the effect of increasing inflammation and blood clotting – both signs of heart distress.1
Cardiovascular endurance exercise is bad for your bones, too. A study published in the Journal of Clinical Endocrinology & Metabolism found that long-distance runners had reduced bone mass. This is true for both men and women – and women had an increased risk for osteoporosis, as well.2
So, instead, if you want a heart that’s ready for action at a moment’s notice, with the extra capacity to deal with stress, you can use a simple alternative to endurance exercise.
Think “cardiopulmonary exertion.” This means that in place of exercising for longer and longer, you make your workouts brief but “progressive.”
What do I mean by progressive? You start off easy at a level that’s comfortable for you, and then increase the difficulty (pick up the pace or increase the resistance).
The key is, don’t increase the time you spend exerting yourself. Just increase the challenge a little bit each time. In this way, you’ll be training your heart, lungs and muscles for strength and peak capacity but not endurance. This reprograms your body to cut fat, stay lean, prevent pain and build real heart strength.
In fact, here’s a capacity-building movement you can try right at home. It’s straight from myPACE Express DVD Program and it’s called a Jack Knife. The trick to getting the most out of the Jack Knife is to keep your legs and arms completely straight through the entire period of exertion.
1. First, lie with your back on the ground or floor. Lay your arms and your legs flat so that your body forms a straight line.
2. Lift your arms, with your palms facing the ceiling, and your legs off the ground 12 inches.
3. Inhale as you lift your straight arms and straight legs up so that your hands touch your shins, and your body looks like a closed folding knife.
4. Exhale as you lower your limbs back down quickly – but don’t let your arms and legs touch the floor. This is very important to work your muscles enough to deplete their glycogen and enter the supra-aerobic zone.
5. Lift again, keeping your arms and legs straight. Do this for as many repetitions as you can, for three sets. Remember to recover fully between each set.
If you’ve never done a Jack Knife before, start with just a few. Vary how fast you do them and how many you can do for a true cardiopulmonary workout.
To Your Good Health,
Al Sears, MD
Al Sears, MD
1. Liu M, Bergholm R, Makimattila, S, et al. “A marathon run increases the susceptibility of LDL to oxidation in vitro and modifies plasma antioxidants.” Am J Physiol Endocrinol Metab.1999;276(6 pt 1): E1083-E1091.
2. Hetland ML, Haarbo J, Christiansen, C. “Low bone mass and high bone turnover in male long distance runners.” Journal of Clinical Endocrinology & Metabolism. 1993;77(3):770-775.
Where is the article on intense cardio?
1) Decrease workouts to twice weekly, three at most. The body needs rest and recovery time.
2) Limit alcohol to special occasions only, 1-2 times month. (For this hypothetical person, not necessarily everybody.)
3) Have her do a food diary for two weeks (including calorie counts) to convince her she’s eating more than she thinks, especially carbs.
-Steve
stop drinking DIET anything would be a great place to start
Alcohol: People who can’t stop at just one often find it easier to stop for a while rather than try to moderate. I recommend Allen Carrs Easy Way to Quit Drinking which may be available in your local library. Given her other cravings she might also consider Potatoes Not Prosac.
IMO she is also over exercising for her body type and diet.
Since you ask… crossfit less, eat more fat, no snack/pseudo-food-beverage… as everybody else suggests.
I would add more practical advice for the alcohol, just like Dr. Briffa’s piece, and circadian regulation through (blue) light exposure only during the day, Dr. Kruse’s style.
I wouldn’t assume good levels of vitamin D without measuring. Simple tests, preassure on bones or questionaire, should give an approximate idea, though.
Infection?
Get bloodwork done and make sure the thyroid is working properly.
REST! It looks like the big thing that is not being addressed is sleep habits. Can she get her doctor to send her for a sleep study? If she is waking up feeling unrested there may be other problems to be addressed. Besides which, 6 hours sleep is just not enough, she will feel better if she allows herself more time for sleep. Remind her that it is not “sinful” or “indulgent” it is the body’s way of healing and recharging. Maybe a couple workouts could be ditched to get extra sleep, and one day a week used for resting.
Thanks everyone for your comments and suggestions. I do have a followup post coming and will go over what I recommended, and what the results were!
How much protein is she eating per meal?
There is some evidence to support targeting 30-40 grams per meal and 2.2 g/kg of lean body mass (LBM) per day. So assuming 48 KG of LBM she may consider consuming a little over 100 grams of protein per day. If she is only eating two eggs (12g) in the AM that may not be enough.
As others have said the Diet Coke could cause craving and there is anecdotal evidence that artificial sweeteners can blunt ketosis.
Is she consuming any sweetener in her coffee or her paleo nut bar?
She may be helped by consuming high glycemic carbs immediately post workout (white rice/potatoes) and again in the evening.
Has she considered having a couple squares of high quality dark chocolate as an end of day treat?
Also is she on birth control? That could also factor in.
Not on birth control. Yes – birth control pills can be a big issue and can increase leaky gut, weight and inflammation in my observation.
No sweeteners.
She is having decent amounts of protein.
Needs more carbohydrates. Cortisol and serotonin an issue. Needs gut repair and probiotics.
Non-compliance may be the issue. As a young woman I began to diet and found myself binging so went to a hypnotherapist which cured that behaviour. Things I’ve found helpful are bring snacks and lunch to work, being publicly gluten-free so colleagues know eating their stuff is not an option and an awareness of what certain foods do to me and how others serve my temple.
As an observation on compliance, I did a 54 day expedition in remote Fiordland, relying on food drops as the only source of food. My pal and I did the same exercise and ate the same rations. She, was a bit plump and lost a bit of weight – 8kg I think. I, who was lean lost no weight at all. People would explain my leanness as being due to a fast metabolism or being lucky but clearly this illustrates it was not the case.
I think she lost weight because she couldn’t pop down to the shop when she was feeling peckish or bake one of her lovely cakes.
As the philosopher Kaylee once said: Sometimes a thing gets broke can’t be fixed.
I remember that this is something that Wolfgang Lutz reported in the German edition of his book.
Personally I have hit a plateau and I can do what I want and nothing will lower my weight. Low Carb? Very low carb? Ketogenic diet? High Carb? Tried it all, does nothing for my weight.
Some things I would suggest:
- Drop the eggs. Potential health problems with the immunoglublins it contains (Robb Wolf’s autoimmune protocol comes to my mind).
- Maybe cut down on the nuts as well, for a while, see if it does something
- Try to increase carbs, try to use safe starches (mainly sweat potatoes, but normal ones might do as well)
- Try to reduce eating to one proper meal in the early afternoon, maybe drop the breakfast
- Use fruits for snacks
And if she keeps the weight on the diet, it is just the way it is.
For me, not gaining weight anymore is a big plus, and I think I am no longer making any new damage to my health – so I have to life with the damage that there is and be contempt…
And drop the fish oil capsules.
And skin breakouts / pimples? For me, I traced it mainly to milk/dairy, and to a lesser degree to eggs.
Test for candida overgrowth in her gut wouldn’t hurt…
She’s not really complying with the diet is she? All that bingeing on diet drinks, alcohol and chocolate would be adding masses of sugar, calories and antinutrients to her diet.
Way too much exercise, cut it down to a few sessions per week. I was the fittest I’ve ever been on just 2 x yoga sessions per week and a 5km, fast walk, round trip to each yoga session and a very good, alcohol free diet.
I’m not a nutrition or a fitness professional but personally I hit the leafy greens big time when I need to shift some weight. Massive salads with fish/chook/turkey proteins and some good salty foods like olives & fetta to get the tastebuds going and to find pleasure and enjoyment in the meals she’s actually eating. Chilli, garlic, ginger and fresh herbs make me excited about the food I get pleasure and enjoyment from planning and constructing my meals. Too much sensible eating and being on a ‘diet’ would lead me to engage in rebellious binge eating.
Just my personal observations, but I think I am quite familiar with her bodytype and lifestyle
Agree with Tess, nuts are a problem – much better off without them – from my personal experience. Snacks aren’t necessary of you eat proper meals with enough protein. Also, I have found alcohol will go straight to fat.
Cycle the carbs and overall go much higher carb from fruit. Switch the fish oil out (it slows the metabolism and is pro stress) out for coconut oil. Reduce PUFAs to a few eggs per week. Increase salt and add an aspirin. Reduce workouts to a few per week under 30 minutes. Add a daily one hour walk. Do something like Atkins Fat Fast for a week to jump start weight loss, then go to moderate carb diet with plenty of protein (50-80 grams a day) including sources of protein. Have 20-30 grams of protein within 30 minutes of getting up.
Is this for real? You’re a registered nurse and nutritionist and this is what you are prescribing your clients for sustainable weight loss?
50g a day carbs and 6+ sessions of high intensity exercise per week?
High-stress busy lifestyles, combined with the social pressure to let loose on the weekends, (or even on some weeknights) results in poor nutrition choices, masked by a bunch of generic excuses like ‘I don’t have time to prepare proper meals for the whole week’
I guarantee that several high sodium, nutrient-sparse snacks had whilst out drinking haven’t made their way conveniently onto the food log; often these get ‘forgotten about’, making the nutritionists job difficult.
Combine this with poor conditioning, alcohol, caffeine, sugary binges, and lack of sleep, you are adding additional stressors in the form of :
1. An intermediate to advanced HIIT exercise (Crossfit and running) for 6+ sessions a week
2. A drastically reduced carbohydrate intake, well outside of a healthy maintenance range
Your clients are not suprisingly all exhibiting the telltale signs of glycogen depletion,malnutrition, overtraining and physical exhaustion:
Not sleeping satisfactorily, despite getting 6 + HIIT sessions per week
Not having sufficient energy to get through workouts
A feeling of lethargy and extreme tiredness in the afternoons.
A seemingly unstoppable craving for sugary snacks
The next direction this heads is either injury or illness.
You say body fat ‘ looks ‘ like it’s in the high 20′s to 30′s; has this actually been calculated?
Is sugar taken in the coffees?
Reducing refined sugars and stabilising the blood sugars is most important right now to get over this spike crash setup that will ruin any chance of properly sustaining healthy weight loss and activity.
If blood sugars are balanced, and workouts start becoming completed and the client feels good, instead of listless, enthusiasm for working out will increase, reduction in harmful behaviours will naturally follow (as a product of wanting to feel better more of the time) and the feeling that ‘i don’t have the energy to exercise’ will vanish. Proper sleep will return, stress levels will drop as a result, capacity to cope with work, life , exercise will snowball.
Anyways, the straight forward recommendations:
1. Convince client to cut alcohol , if possible see if you can convince her to do a month off to show them the benefits. Play on the driven, motivated to succeed psychology these people display
2. <50g a day carbohydrate intake targets are a joke. Adjust intake of carbohydrates to support the demands of 3-4 training sessions per week. (and cut current training in half). 3-4 properly completed intense workouts are infinitely more worthwhile than 6+ partially completed workouts without sufficient intensity.
3. Dehydration can contribute to lethargy. Increase water intake. target at least 2 litres per day. Alcohol, caffeine, high sodium snacks all contribute to diuretic processes so this may even need to be more than 2lt. Try and limit caffeine intake if possible as this can be very powerful appetite suppressant ; the last thing required here to maintain stable blood sugars is missing meals.
Change the meal plan as such:
Breakfast :
2 eggs, boiled or poached alternatively if breakfast is blended, 2 egg whites
1 cup oatmeal lowGI carbs to balance blood sugars through til nearly lunchtime
1 high quality protein (80% plus) low carb scoop/shake in 2% milk
This can be all done as a shake if required. soak the oats in hot water to increase their solubility
A Substantial breakfast containing sufficient protein and some low GI carbohydrate is important to regulate blood sugar after the rest period and throughout the day.
WATER
Snack:
1 serve of greek yoghurt + tsp of jam, small handful of dry unroasted almonds
(The Jam here is a psychological boost and will help stave off the cravings, and won't introduce too much of a spike in blood sugar)
WATER
lunch
Chicken burrito, or chicken salad ; 1tbsp of dressing or sauce maximum.
Her Lunch actually looks ok but she needs to get a little carbs in here to contribute to a realistic daily target in the form of wrap breads or similar that are lighter on gluten to avoid upsets
Protein shake in water
WATER
Snack:
shake in water, almonds, berries. or repeat snacks above (important psychological 'pick me up' required in afternoon to prep for evening train.
WATER
After workout: or before retiring:
protein shake with water
Dinner: steamed or grilled meats plus steamed or stir fried veg
WATER
Before retiring:
small glass of fruit juice. Studies have shown that a moderate carbohydrate intake before bed can improve sleep quality by increasing the availability of melatonin and serotonin and increased insulin levels, which improves the uptake of tryptophan.
This also may be why the client feels sleepy in the afternoons after a sugary binge.
My 2c, not qualified in any way, but most of this is common sense
Perhaps I didn’t make this clear – I obviously need to update my post! These clients come to me eating this way – I did not prescribe this diet.
I appreciate your response. I completely agree – the client is suffering glycogen depletion plus a whole lot of stress from unhealthy lifestyle choices, plus an exercise regime without adequate nutrition.
I have done a followup post – all these factors have been addressed with a good outcome.
http://paleozonenutrition.com/2013/02/20/low-carb-paleo-crossfit-not-losing-weight-my-recommendations/
I am neither a doctor nor a nutritionist, just a fat bloke who is now less fat thanks to a paleo diet, so my comments are purely from my own experience.
1. STOP the exercise. (well except perhaps for slow max65% HR for a couple hrs/wk)
2. Do a full-on “detox” “reset” whatever you want to call it Paleo diet (Whole9 worked for me, I am sure other variants are available)
3. Eat lots
4. Sleep lots
5. When the diet has changed habits only then think about reintroducing more vigorous exercise (slowly) and adjust diet to suit increased activity.
but then I am no expert in these matter
There is a tell tale sign of a problem with the sugar cravings between meals which, attempts with nuts to control doesn’t seem to work. This is an indication of the body being is a state of stress and possibly raised cortisol. This has to be due to the cross fit workouts.
Changes I would suggest are: reduce the cross fit and if possible cut them out all together and find alternatives such as, some heavy lifting (squats, dead lifts, cleans, chest press) and some sprints 1-2 times a week.
I’d also recommend intermittent fasting and cut out breakfast and have the first meal about 12-1pm and nothing after 8-9pm. The alcohol has to go during the week and then, maybe only 1-2 glasses on the weekend.
Simple: too much exercise at high intensity. She needs to scale that back considerably to maybe twice a week or less of crossfit. Cortisol is spiked from the stress. I see the same body ‘type’ with the athletes that do come 5 to 6x per week at my local crossfit affiliate. Those who religiously workout that hard, daily, are one of two body types:
a. Lean and ripped. But they were that way before Crossfit.
or
b. Fat. They’re strong, fit, etc. But fat.
I contend that if she scales back the crossfit to once a week, then mixes in low-level cardio on the other days (listening to her body) and maybe one day of weight training focused on core lifts (back squat, chest press, deadlift, press). She’ll drop 10lbs within a month.
Oh, and if that doesn’t work….then it’s the alcohol and diet cokes. She’s not eating “low carb paleo” if she’s binge drinking twice a week and eating potato chips.
Hi, I’ll make a few guesses:
In my experience caffeine can be pretty good with weight loss, as long as it doesn’t disrupt getting good sleep or cause weirdness with afternoon sugar levels. Maybe slowly cut down on coffee.
-Diet cola?! Colour made from burnt sugar – yum! And toxic sugar flavour? Swap it for a coffee.
-What kind of alcohol? If it’s beer or alcopops then there’s some hidden carbs in there, and maybe bloating from all the extra water. Red wine is less controversial.
-Coffee – if it’s 2 massive lattes then duh. The milk has lactose, that’s a sugar. Better to cut down on the milk and slow down the ‘caffeine hit’ by washing it down with extra water.
In general it looks like it might be a fluid problem, there’s no actual water on the list. So the skin then tries to help out the kidneys and she gets pimples.
Please dont take this the wrong way..
But this is EXACTLY whats wrong with the paleo (cross fit) community.
Do you actually think the above details are a
healthy and balanced approach to living life???
Slown down…. Eat a little more food that brings you joy… And stop obessing!
Start walking and making some love to your significant other ….
Again no dis respect meant…. But many are losing complete sight of the big picture,
Marc
Cero alcohol / Reduce nuts / Only chocolate with no sugar / No diet drinks / More HIT workout / More walking & playing / Less stress / Less worries at work / No TV or Computer before bedtime / Lot Lot Lot Lot of water & green Tea
Have you checked cortisol levels!!! I would not touch the nutrition until I control the sleep situation. I say adrenals could be the problem..or not!!!
Have her take L-theanine, and extra B-complex…see how that works
diet coke, artificial sweeteners, lack of sleep, caffiene, alcohol…. all signs of sugar addiction… been there. I cut out all sugar from my diet for a month, that is including fruit and even stevia, and I noticed a profound shift in being able to actually listen to my body and what it wanted. my cravings disappeared and i made better food choices at night.
I also think more carbs is in need here – more carbs, more energy, better workout, better result. Coconut oil is grand for energy, and that has no carbs!
I’d give it a rest and quit trying to force women into what men think is the acceptable porny body. She’s fine, except for her lack of energy, so she needs more carbs post workout. She should stop the alcohol though. And she should stop listening to the din of women hate from our male-centric culture.