Wednesday, January 6, 2016
Thursday, July 10, 2014
Eric: A house divided
One of the difficulties that we have encountered in our home is that the different approaches to the exchange system sometimes clash. For example, every time that Callie has been home and on an eating plan, I have cooked to meet her exchanges and the family ate what she ate. And we all gained weight.
Now; however, I have to follow my own exchanges and so I have been cooking lighter dinners to meet my needs with low carbohydrate selections. We recently discovered that despite the fact that I was telling Callie that the meals were no longer meeting all of her exchanges, she was not eating enough and was also losing weight.
Eating is a very social time for our family, and quite frankly, it is very difficult to not eat what everyone else is eating. I know I get a certain satisfaction from sharing a meal with my family. And, it doesn't feel good to me when I have to eat less or another person is not eating all that the rest of us are eating. We are learning how to adjust the family norms so that we can all have our needs met, but this has not been easy.
Another interesting difference that we have noticed is that we both tend to estimate calories differently. This became apparent when we both got Fitbits and started logging our meals and sharing the information with each other. Here's a recent example: We each had a kimichi egg roll for dinner. If you look this item up in an online food calorie guide there is likely to be a spectrum of possibilities. The range that I saw was 120 to 320 calories. I estimated that it was 180 calories. Callie estimated that it was 280 calories. Isn't it interesting how these estimates just happened to meet our true desires? I am restricting but don't really want to and Callie is eating more than she wants to while wanting to restrict!
We now double check each other on calorie estimates, and when I cook I make a starch for others to eat even if I choose not to eat it at that meal. I feel hopeful that with a few minor adjustments we can find a balanced middle ground that will lead to good health for us all.
Now; however, I have to follow my own exchanges and so I have been cooking lighter dinners to meet my needs with low carbohydrate selections. We recently discovered that despite the fact that I was telling Callie that the meals were no longer meeting all of her exchanges, she was not eating enough and was also losing weight.
Eating is a very social time for our family, and quite frankly, it is very difficult to not eat what everyone else is eating. I know I get a certain satisfaction from sharing a meal with my family. And, it doesn't feel good to me when I have to eat less or another person is not eating all that the rest of us are eating. We are learning how to adjust the family norms so that we can all have our needs met, but this has not been easy.
Another interesting difference that we have noticed is that we both tend to estimate calories differently. This became apparent when we both got Fitbits and started logging our meals and sharing the information with each other. Here's a recent example: We each had a kimichi egg roll for dinner. If you look this item up in an online food calorie guide there is likely to be a spectrum of possibilities. The range that I saw was 120 to 320 calories. I estimated that it was 180 calories. Callie estimated that it was 280 calories. Isn't it interesting how these estimates just happened to meet our true desires? I am restricting but don't really want to and Callie is eating more than she wants to while wanting to restrict!
We now double check each other on calorie estimates, and when I cook I make a starch for others to eat even if I choose not to eat it at that meal. I feel hopeful that with a few minor adjustments we can find a balanced middle ground that will lead to good health for us all.
Tuesday, July 1, 2014
Eric: Exchanges from My Perspective
I learned about the exchange system when Callie was in treatment for her eating disorder. We were given the responsibility of planning her exchanges for each of her meals. I hated the idea of it at first, but after a little experience with this system it became clear that it is an effective method for monitoring and maintaining a balanced diet.
Now, as a diabetic, I am using this system to manage balanced nutrition while losing weight and reducing my intake of carbohydrates. The meal plan below is for approximately 1800 calories and limits carbohydrates to 225 grams.
What I have found to be the most difficult with reducing carbohydrates is that it is really easy to replace them with fats, which I am trying to avoid. However, this approach is working. Along with a minimum of 300 minutes of exercise a week and following this plan, I have gone from 262 to 239 pounds in about 8 weeks.
Now, as a diabetic, I am using this system to manage balanced nutrition while losing weight and reducing my intake of carbohydrates. The meal plan below is for approximately 1800 calories and limits carbohydrates to 225 grams.
What I have found to be the most difficult with reducing carbohydrates is that it is really easy to replace them with fats, which I am trying to avoid. However, this approach is working. Along with a minimum of 300 minutes of exercise a week and following this plan, I have gone from 262 to 239 pounds in about 8 weeks.
Daily Meal
Plan (~1800 calories for weight loss)
Breakfast:
385 cal
1 fruit 15
grams CHO
2 starches 30
grams CHO
1 fat
1 milk 15
grams CHO
Morning
Snack: 140 cal
1 starch 15
grams CHO
1 fruit 15
grams CHO
Lunch: 420
cal
2 starches 30
grams CHO
2 fats
1 vegetable
1 protein
1 milk 15
grams CHO
Afternoon
Snack: 155 cal
1 starch 15
grams CHO
1 protein
Dinner:
560 cal
2 proteins
1 fat
1 vegetable
2 starches 30
grams CHO
1 fruit 15
grams CHO
1 milk 15
grams CHO
Evening
Snack: 155 cal
1 starch 15
grams CHO
1 protein
So What Exactly is the Exchange System?
Most people are unfamiliar with the exchange system and they don't really know how it works. I used to be in the dark too, but hopefully through this blog, Eric and I will be able to explain and bring to light what a beneficial system it is.
While Eric and I are both using this system, we are each using it for opposite purposes. Eric is using it to lose weight and I am using it to gain weight, and eventually to maintain our new healthy weights.
You may wonder how this is possible. We are able to use it for differing purposes because the exchange system is unique to every individual who uses it, and can be modified as the individuals needs change.
A doctor or dietician will "prescribe" you a certain number of exchanges to eat in the day. Exchanges consist of a certain number of protein, dairy, fat, starch, veggie and fruit you are supposed to have in the day in order to maintain, gain, or lose weight. Each "exchange" has a caloric value, and certain nutritional criteria.
The exchanges are as follows; One protein would be 75 calories with 5g of fat, one dairy exchange is 120 calories with 8g of protein, one fat exchange is 45 calories and 5g of fat, one starch exchange is 80 calories with at least 15g of carbs, one veggie exchange is 45 calories with 5g of carbs, and one fruit exchange is 60 calories with 15g of carbs.
I like to break down my total number of exchanges by assigning a certain number to each meal. For example, I am supposed to have 3 milk exchanges in the whole day, so I assign one milk exchange to each meal. I am also supposed to have 6 protein exchanges, so I assign 3 of these exchanges to lunch and 3 to dinner. However, I am not rigid about making sure I meet each assigned exchange at each meal. For example, if I happen to crave a protein or two for breakfast I will have them and then simply adjust my lunch and dinner to account for the proteins I already had in the morning.
Along with my regular meal exchanges, I am also supposed to have 3-4 exchanges of my choice for an afternoon snack, as well as 3-4 exchanges for a night time snack. So as an example, I could have an apple with 1 TBS peanut butter, and 1 cup of soy milk.
Exchanges are fairly easy to follow once you are familiar with them, and once you know fair estimates of the nutritional values of basic foods. Exchanges don't have to be exact, they are just relative estimates. The challenge facing Eric and I is not only the fact that our exchanges differ greatly, and I don't know about Eric, but that I tend to manipulate the system.
By manipulate, I mean that I tend to go for the bare minimum, or even just under the minimum caloric values of the exchanges. It's very difficult for me to have full servings of exchanges and I convince myself that I've had a full exchange just because I had a certain food even if it doesn't meet the full nutritional value. For example, I will have a little bit of hummus, less than the 2 TBS serving, and I will still count it as a fat. Each time I do this, I shortchange myself and I convince myself and those around me that I am truly following my exchanges. I know that I am only hurting my recovery, but it feels so convincing in the moment, it is difficult for me to catch myself and admit that I am not in recovery mode. Now that I'm writing about it, my recovery voice is growing just a little bit louder, and I am already aware of how I can improve my day to meet my exchange needs.
This system can really work for anyone, but I don't recommend using it without the assistance of your doctor or dietician/nutritionist. This system takes some getting used to, and a lot of practice, but once you have a firm grasp of the types and amounts of foods that meet your nutritional needs, and are willing to follow your plan, it proves to be extremely effective.
While Eric and I are both using this system, we are each using it for opposite purposes. Eric is using it to lose weight and I am using it to gain weight, and eventually to maintain our new healthy weights.
You may wonder how this is possible. We are able to use it for differing purposes because the exchange system is unique to every individual who uses it, and can be modified as the individuals needs change.
A doctor or dietician will "prescribe" you a certain number of exchanges to eat in the day. Exchanges consist of a certain number of protein, dairy, fat, starch, veggie and fruit you are supposed to have in the day in order to maintain, gain, or lose weight. Each "exchange" has a caloric value, and certain nutritional criteria.
The exchanges are as follows; One protein would be 75 calories with 5g of fat, one dairy exchange is 120 calories with 8g of protein, one fat exchange is 45 calories and 5g of fat, one starch exchange is 80 calories with at least 15g of carbs, one veggie exchange is 45 calories with 5g of carbs, and one fruit exchange is 60 calories with 15g of carbs.
I like to break down my total number of exchanges by assigning a certain number to each meal. For example, I am supposed to have 3 milk exchanges in the whole day, so I assign one milk exchange to each meal. I am also supposed to have 6 protein exchanges, so I assign 3 of these exchanges to lunch and 3 to dinner. However, I am not rigid about making sure I meet each assigned exchange at each meal. For example, if I happen to crave a protein or two for breakfast I will have them and then simply adjust my lunch and dinner to account for the proteins I already had in the morning.
Along with my regular meal exchanges, I am also supposed to have 3-4 exchanges of my choice for an afternoon snack, as well as 3-4 exchanges for a night time snack. So as an example, I could have an apple with 1 TBS peanut butter, and 1 cup of soy milk.
Exchanges are fairly easy to follow once you are familiar with them, and once you know fair estimates of the nutritional values of basic foods. Exchanges don't have to be exact, they are just relative estimates. The challenge facing Eric and I is not only the fact that our exchanges differ greatly, and I don't know about Eric, but that I tend to manipulate the system.
By manipulate, I mean that I tend to go for the bare minimum, or even just under the minimum caloric values of the exchanges. It's very difficult for me to have full servings of exchanges and I convince myself that I've had a full exchange just because I had a certain food even if it doesn't meet the full nutritional value. For example, I will have a little bit of hummus, less than the 2 TBS serving, and I will still count it as a fat. Each time I do this, I shortchange myself and I convince myself and those around me that I am truly following my exchanges. I know that I am only hurting my recovery, but it feels so convincing in the moment, it is difficult for me to catch myself and admit that I am not in recovery mode. Now that I'm writing about it, my recovery voice is growing just a little bit louder, and I am already aware of how I can improve my day to meet my exchange needs.
This system can really work for anyone, but I don't recommend using it without the assistance of your doctor or dietician/nutritionist. This system takes some getting used to, and a lot of practice, but once you have a firm grasp of the types and amounts of foods that meet your nutritional needs, and are willing to follow your plan, it proves to be extremely effective.
Sunday, June 22, 2014
I Have an Eating Disorder...?
I believed myself to be a healthy eater and exerciser, doing everything in moderation. However, the healthy habits I thought I had, snowballed into a full blown eating disorder. It started with a regular sports physical when I was 17 years old. I was down a couple pounds and my doctor was concerned. I was already dealing with depression and the doctor thought it would be beneficial to send me to an eating disorder specialist...I thought she was crazy. I loved to eat and I didn't think I had a problem. Sure I had tried dieting and was very self-conscious about my body, but I didn't think I had an eating disorder. Even my parents were shocked at the suggestion of anorexia, but I proceeded in seeking therapy from an eating disorder specialist at UNC.
My first few appointments went smoothly, but as more and more focus was placed on my weight and how I felt about my body, I became very uncomfortable and actively began trying to lose weight. At first it was just a few pounds, but eventually my weight loss was so significant I was taken out of school and put into the partial hospitalization program for weight restoration, following a meal plan based on exchanges. This was only the first out of many stays in an eating disorder unit. With the help of treatment and my parents, I was restored to a healthy weight and allowed to finish my senior year of high school.
I did okay over the summer, I did lose a few pounds, however, I was still healthy enough to go to school in the fall. So I went off to college. I was able to almost make it the whole year, but at the end of my second semester I was too far into my eating disorder to finish my final exams. I was taken from school by my parents and put back into the UNC partial hospitalization program. Again I followed specific exchanges and was restored to a healthy weight and enjoyed most of the summer at an acceptable weight.
I went back to college and this time I only made it one semester before having to go to a new eating disorder program. I had been consulting with my school therapist and she was so concerned about me that she was mandating that I go to the ER. I refused, and she sent the cops to take me to the hospital. After this ordeal I swore I would get healthy, but this was a promise I was unable to keep and I was sent to treatment in an inpatient unit in New York. We could no longer afford treatment and the unit in New York was a free program if I participated in research. Now this would've seemed like a great deal for me, but I am a strict vegetarian and this program didn't allow me to exclude meat from my diet. For the first few days I couldn't force myself to get the meat down, and the doctors were threatening to kick me out of the program if I didn't start to finish my meals. This was by far one of the most difficult things I've ever had to do in my life, but eventually I was able to swallow the meat. I remember I couldn't bring myself to chew it, so I just got as small a piece as I could and I would swallow it whole, crying throughout the whole meal. This program gave me a calorie based meal plan, which overwhelmed me because I was on a plan of 3,200 calories and 4 Ensure Plus drinks. I lived in this program for about 3 months while I was weight restored and then maintaining my new healthy weight.
After I left New York I followed up in a new partial program called Renfrew. This program followed the exchange system as well and I was already a pro at using it. I maintained my new healthy weight and was doing very well for a few months, the longest I had ever gone without losing weight. I left this program feeling like there was no way I could ever go back to my anorexic self, but unfortunately my eating disorder voice was still present. I let it get back in my head and again I relapsed, this time reaching my lowest weight ever. I was slowly losing weight again when it was time for new school year, but I convinced my parents I could turn it around, and they supported me in going back to college. I returned and this time made it less than a semester. I was sent to the ER a few times and finally when my parents came to visit me they were so concerned and shocked at how thin I had become, they insisted I leave school (again) to get help. They were not going to support me in any way if I stayed at school, so I made the tough decision to seek treatment again.
This time I went to the inpatient unit at UNC for 2 months, then decided to move back in with my parents while I continued to gain weight at the Renfrew Center in Bethesda. I tried to gain weight in this program, again following a very specific exchange based meal plan. I was not gaining fast enough and I refused to fully follow my meal plan so I either had to go to a higher level of care or just leave Renfrew...I decided to just leave Renfrew, now on my own trying to restore myself to a healthy weight.
I currently have a meal plan based on exchanges, as does my step dad, newly diagnosed with diabetes. While we follow the same exchange system, the amount of exchanges we each have is very different. We are on opposite ends of the exchange spectrum with him trying to lose weight and me trying to gain, making for a very interesting household of eating. This blog will chronicle how the exchange system works for each of us individually and will provide an interesting juxtaposition of how the exchange system can be put to use.
My first few appointments went smoothly, but as more and more focus was placed on my weight and how I felt about my body, I became very uncomfortable and actively began trying to lose weight. At first it was just a few pounds, but eventually my weight loss was so significant I was taken out of school and put into the partial hospitalization program for weight restoration, following a meal plan based on exchanges. This was only the first out of many stays in an eating disorder unit. With the help of treatment and my parents, I was restored to a healthy weight and allowed to finish my senior year of high school.
I did okay over the summer, I did lose a few pounds, however, I was still healthy enough to go to school in the fall. So I went off to college. I was able to almost make it the whole year, but at the end of my second semester I was too far into my eating disorder to finish my final exams. I was taken from school by my parents and put back into the UNC partial hospitalization program. Again I followed specific exchanges and was restored to a healthy weight and enjoyed most of the summer at an acceptable weight.
I went back to college and this time I only made it one semester before having to go to a new eating disorder program. I had been consulting with my school therapist and she was so concerned about me that she was mandating that I go to the ER. I refused, and she sent the cops to take me to the hospital. After this ordeal I swore I would get healthy, but this was a promise I was unable to keep and I was sent to treatment in an inpatient unit in New York. We could no longer afford treatment and the unit in New York was a free program if I participated in research. Now this would've seemed like a great deal for me, but I am a strict vegetarian and this program didn't allow me to exclude meat from my diet. For the first few days I couldn't force myself to get the meat down, and the doctors were threatening to kick me out of the program if I didn't start to finish my meals. This was by far one of the most difficult things I've ever had to do in my life, but eventually I was able to swallow the meat. I remember I couldn't bring myself to chew it, so I just got as small a piece as I could and I would swallow it whole, crying throughout the whole meal. This program gave me a calorie based meal plan, which overwhelmed me because I was on a plan of 3,200 calories and 4 Ensure Plus drinks. I lived in this program for about 3 months while I was weight restored and then maintaining my new healthy weight.
After I left New York I followed up in a new partial program called Renfrew. This program followed the exchange system as well and I was already a pro at using it. I maintained my new healthy weight and was doing very well for a few months, the longest I had ever gone without losing weight. I left this program feeling like there was no way I could ever go back to my anorexic self, but unfortunately my eating disorder voice was still present. I let it get back in my head and again I relapsed, this time reaching my lowest weight ever. I was slowly losing weight again when it was time for new school year, but I convinced my parents I could turn it around, and they supported me in going back to college. I returned and this time made it less than a semester. I was sent to the ER a few times and finally when my parents came to visit me they were so concerned and shocked at how thin I had become, they insisted I leave school (again) to get help. They were not going to support me in any way if I stayed at school, so I made the tough decision to seek treatment again.
This time I went to the inpatient unit at UNC for 2 months, then decided to move back in with my parents while I continued to gain weight at the Renfrew Center in Bethesda. I tried to gain weight in this program, again following a very specific exchange based meal plan. I was not gaining fast enough and I refused to fully follow my meal plan so I either had to go to a higher level of care or just leave Renfrew...I decided to just leave Renfrew, now on my own trying to restore myself to a healthy weight.
I currently have a meal plan based on exchanges, as does my step dad, newly diagnosed with diabetes. While we follow the same exchange system, the amount of exchanges we each have is very different. We are on opposite ends of the exchange spectrum with him trying to lose weight and me trying to gain, making for a very interesting household of eating. This blog will chronicle how the exchange system works for each of us individually and will provide an interesting juxtaposition of how the exchange system can be put to use.
Saturday, June 21, 2014
Obese. Diabetic. Vegan. (Eric, diagnosed with diabetes)
Obese. Diabetic. Vegan.
What's wrong with this picture?
This was the news I got from my health care practitioner during my annual physical on May 23, 2014. Oh, and I was also diagnosed with benign essential hypertension, along with vitamin D and vitamin B12 deficiencies.
Okay, so none of this was especially surprising given my medical history, except for maybe the vitamin deficiencies and the fact that I had gone "mostly vegan" in September of 2013 to lose weight and improve my pending medical issues. About 15 years earlier a doctor told me that I had pre-diabetes and prehypertension and recommended that I lose weight. I have always been a large person, and at the time I was 310 pounds. I lost 50 pounds over the next several months and for the most part have kept 35-45 of those pounds off for 15 years. Along with that weight loss, my blood sugar and blood pressure returned to normal.
Fast forward to September of 2013. Lets face it, I have kept off a lot of weight, but it has always been a struggle. I love food. I love to cook. I love to cook and eat really good food. My weight was creeping back up, so I thought I would join my wife and daughter Callie in going vegetarian, and actually mostly vegan. My rationale was simple. Less meat and dairy, fewer calories, better weight management.
Things went well at first. I was exercising regularly and eating mostly vegan and I started to loose a few pounds. I was probably around 270 when this experiment started. But, my downfall was a common trap. I assumed that eating vegan gave me free license to pretty much eat whatever non meat items I wanted and at unchecked quantities. A quick 8 pound weight loss seemed to support this notion.
In November, I caught a cold and did not exercise for the week that I was sick. After this cold, I was so tired and run down, I simply felt too exhausted to exercise. Then the holidays and a cold DC winter. Then the weight gain, followed by guilt and the promise to do better when I felt better. The new year brought new resolutions: 2014 will be the year that I enjoy the best shape of my life. Only if I weren't so exhausted.
February brought one of the scariest days of my life. My brain started popping on the inside. It literally felt like popcorn popping in the cortex or like someone was placing there fingers inside my skull and gently applying pressure for 3-5 seconds. This repeated for at least 50 episodes over 2 hours and then I was left with transient episodes of vertigo and even greater exhaustion. There were days that all I could do was go to work and then home to the couch.
This was finally enough to get me to the doctor. I received the diagnoses I mentioned above, and I think I have a pretty good understanding of what actually happened. Going mostly vegan without a solid plan is foolish. I pretty much replaced many of the protein sources in my previous diet with carbohydrates! Sure, I ate a lot of tofu and veggie burgers and fake meats, but I was not paying attention. Second, I was unaware of two potential vitamin deficiencies that vegans should be mindful of: vitamins D and B12. Both were low, my vitamin D levels was dangerously low at 7.63 ng/ml. Normal levels fall between 30.0 and 74.0 ng/mL. This probably contributed to my exhaustion and possibly to my popcorn brain experience.
And then there was the diagnoses of diabetes and benign essential hypertension. Now, I've got to tell, you that when the doctor first told me about these medical conditions, my first thought was: "Here we go again! I know how to make these things disappear! I'll lose some weight and things will normalize". That was pretty easy to do at 35, not so much so at 47. And my first wake up call came when I ate a very healthy low carb day and my blood sugar levels were still high. That was new. That was scary. That gave me an overwhelming sense of powerlessness. Maybe this disease had progressed to be beyond my control. Maybe good healthy living would not solve this problem. Those were scary thoughts.
However, I am not yet ready to accept the fact that I am a diabetic. I have been diagnosed with diabetes but I am not ready to throw in the towel. I am taking my medications, following my doctor's advice, and doing everything that I can to get my body in shape to function at its highest and best health. Is it too late to reverse the course of this disease? Time will tell. I will be chronicaling my plight on these pages.
Now, what's interesting, is that when my health care professional advised me to use exchanges, it was a familiar language. As it turns out, my daughter Callie, who is really my stepdaughter but in my heart she is my daughter just with a different last name, has been struggling with anorexia for a few years now and has been using the exchange system to gain weight. I had learned this system and had been using it for years to help her... it just never applied to me. Until now. I have been using the exchange system, still following a mostly vegetarian approach, since my diagnosis and to date, I have lost 18 pounds, have greatly reduced the amount of carbohydrates that I am consuming daily, and am feeling better every day. Moreover, the vitamin supplements I am taking in concert with the lost weight have vastly improved my activity level, and I am exercising every day.
So here is our story. We will both share about our experiences with overcoming our diseases, diseases that are vastly different and yet, somehow intimately connected.
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