[Daytona]

After a few months of whimping out, I finally found another doctor to replace my endo (after having a total falling out earlier). I'm in this annoying state of not having any doctor who can help adjust the stupid blood pressure meds she left me on, prescribe test strips, run an A1c, etc.

After all the drama with the previous doctor's office about how I am killing myself with my diet, refusing to help me get off of my blood pressure medication, etc the possibility of having another doctor yell at me makes is hard for me to even think about going to another.

But we persevere! This doctor was found on Jimmy Moore's low carb physician network page so I sure hope they are willing to work with me. Frankly since they aren't covered by insurance, they better be because I'm not wasting any more more money on unhelpful doctors. If I had known I would be switching insurance 3x in 1 year (restarting that damn deductible each time!) I would have gotten one of those health savings accounts...

Sorry for the venting. I'll report back on Saturday with how the visit went and if I am going to break in this new doc or not. Wish me luck!

 

[tony0611]

Best of luck. Hope this goes well !

Tell us about it.

 

[jwags]

Good luck with the new doc. Basically I don't care what my doctor says about my LC diet. I know by my bg meter that it works and my HbA1c shows it. He can yell at me about my lack of carbs, I just don't listen. I am the one who manages my diabetes not him. I just need him to write the Rx's for the drugs I want.

 

[Miss_Blue]

Good luck! I'm still trying to find a doctor I don't hate. They all try to send me to nutritionists or diabetes classes or tell me my A1c is too low. The doctor is the gatekeeper of my Metformin and lab work, so I have no other choice but to go. This is why I'd love to get off medication one day - to not be so beholden to my physician's view on how I should manage my diabetes.

 

[d33na]

I think a good doctor is as important as a good hairdresser..it's always worth shopping for one that is prepared to listen...good luck!

 

[Daytona]

Oh boy oh boy! I think I won the doctor lotto. The appointment was 2 hours and included a physical, EKG, body composition and initial diet advice / QA. I came prepared to battle if necessary over low carb, high fat, LDL, etc. Instead I was bowled over by the amount of current scientific knowledge this doctor has.

* He thinks LDL is meaningless unless you do a VAP/NMR to measure particle size, and said if anything he cares about HDL/Triglycerides ratios, the total amount not so much.
* We discussed gluconeogenesis for 15 minutes and he even changed my mind on a point or two.
* Wasn't phased at ALL by LCHF, and he uses the term without fear.
* Is 100% down with gluten/grain free, avoiding starches, etc to control BG. He also had some easy to remember ticks to calculate GI (carbs / fiber > 6 is too high).
* Recommended that I get enough sodium and other electrolytes like magnesium and potassium because of the diuretic effect of the ketogenic diet.
* Dealt with my white coat hypertension like a champ. The nurse took it when I first arrived, saw it hit 170+ and stopped immediately saying "let's do this after you see the doc". He then quietly redid it after the physical, without discussing it beforehand so that I wouldn't get anxious. 134/74 yay!

I was ready to call and cancel an hour before the appointment and was almost skipping out of the room afterwards. I'm glad that I didn't lose my nerve.

I'll report back with my progress; he's going to help me lose the last 40 lbs since after losing the first 60 I have hit a brick wall.

 

[Shanny]

HALLELUJAH!

 

[Miss_Blue]

Wow! I'm in Chicago, too. Now I want to see this doctor!

 

[moon]

* We discussed gluconeogenesis for 15 minutes and he even changed my mind on a point or two.

Daytona! Now, you can't drop a comment like that without sharing. Next time please take a recorder and upload the audio - he sounds incredible!

You deserve a doc like this. We all do, we just don't happen to live in Chicago <checking airfares>

 

[Daytona]

Wow! I'm in Chicago, too. Now I want to see this doctor!

I wasn't sure if it was allowed to post the name? I'll PM it to you.

They specialize in weight loss so I'm not sure if they are willing to serve as a general doc but they are all MD's (often with multiple specialties like cardiology + bariatrics or gynecology + bariatrics) and can prescribe any meds that I need, run tests etc.

 

[Daytona]

Daytona! Now, you can't drop a comment like that without sharing. Next time please take a recorder and upload the audio - he sounds incredible!

Next time I will unabashedly take notes. I was tempted to do so today but didn't have paper handy.

Basically, we started off discussing the Bernstein diet and limiting protein because it can contribute to blood sugar. He explained that your muscles and bones are constantly breaking down and building themselves back up again. As they do this they can either a) recycle the amino acids and keep them for their own use b) build up more muscle taking any available amino acids from your blood or c) send the amino acids back into the blood (i.e. muscle/bone loss).

He recommended eating a consistent amount of protein (based on your lean body mass) in each meal (instead of none for breakfast and a 1lb of steak for dinner) so that at any point in time your blood has a sufficient amount of amino acids to encourage your muscle and bones to use it to rebuild. Adequate protein (or protein sparing) diets should help prevent losing muscle and bone.

Specifically speaking to gluconeogenesis he had two points. First was that it is not a speedy process and usually is not the culprit when considering blood sugar spikes, though it may contribute to liver dumps the next morning. Second is that it usually isn't a problem for most people as long as they don't have excessive amounts of protein all at once. By spreading out your protein over the day, it will be used first for rebuilding and only the excess will be used in gluconeogensis (and then stored off in the liver to cause trouble later).

His recommendation to me was to calculate my lean body mass in pounds, multiply it by .8 and get that much protein in grams per day. So for me that ended up being about 90g / day or 30g/meal. The idea being that I am feeding my body just enough protein to rebuild but not enough to tempt my liver to convert and store for later.

 

[moon]

Thanks - that's very helpful. I'm guilty of seeing my diet more as a daily goal and will now be more mindful. Looks like I need to start writing things down until I get a better handle on my ratios and specific protein grams at meals. Ah, freedom from that was nice while it lasted ...

You really hit the jackpot.

 

[Daytona]

I found this doctor on Jimmy Moore's List of Low Carb Doctors . So you may be able to find someone on the list who is close to you. Or if you do have a good doctor who is willing to work with a low-carb diet, submit their information and he'll list them on the site.

 

[Daytona]

Thanks - that's very helpful. I'm guilty of seeing my diet more as a daily goal and will now be more mindful. Looks like I need to start writing things down until I get a better handle on my ratios and specific protein grams at meals. Ah, freedom from that was nice while it lasted ...

You really hit the jackpot.

Hehe I did didn't I? I hope I don't jinx it by boasting.

When I told him that I don't think in grams, he gave me the following formula to quick estimate the grams for a meal:

1 oz of meat = 7g protein (on average)

So a 4 oz serving of meat (deck of cards) is about 28 grams. That seems much easier for me to work with mentally. I'm not a huge fan of doing arithmetic before a meal but now I can eyeball it and come up with a reasonable estimation.

 

[moon]

There's a doc on the list close to me, listed as "Family Doctor/Psychiatrist" - now that's veering off from this specialized age. Talk about the body/mind connection. I dunno - still would rather fly to Chicago, though somehow first thought this was coincidental (LCHF supporter) from visiting a new Internist or Endo. Makes more sense now.

I'm eating too much protein I think. I know. I'm going to do a scale-back and cut out the side of beef snacks.

 

[Patdart]

The closest to me is 400 miles, so you guys will have to do it for me. However, my cardiologist is in favor, so maybe he can stand in. My PCP is a nice guy who will take my ideas, but knows nothing about it, IMHO.

 

[Shanny]

Two on the list are near to me - about 85 miles - but one's in reproductive endocrinology & the other is ob/gyn! Like they're gonna take a sixty-six year old fat lady!

My PCP is okay though - he's accepted my LC/HF and even recommended that old woodchopper stay on it too.

 

[Daytona]

Agreed the list is pretty thin in some areas! I really hope it grows over time.

The American Society of Bariatric Physicians lists a TON of certified bariatric physicians. The ABSP is actually quite progressive and you may have pretty good luck finding a low-carb friendly doctor on this list. In fact the doctor I just went to is listed on this site as well.

 

[moon]

Agreed the list is pretty thin in some areas! I really hope it grows over time.

There was another further away from me, but she was a woman internist, so I thought - maybe the drive would be worth it, after all, I don't go to the doc all that often...

So I check reviews and she's beloved! Terrific - I'm stoked. Then I check out the one-star negative one from someone who adores her, was a patient for years, but reported the doc had decided to cut back her practice, reduce hours, and go boutique. Her boutique fee? $2,000/yr.

I don't plan to be =that= sick!

 

[Daytona]

The whole boutique doctor thing is a funny topic. The doctor has a right to practice as they choose, and if you are a patient who can afford it, you probably get better care. However it does really leave everyone else in the dust...