Nutritional Strategies News Summer 2009
Financial Upheaval
These past 5 months have been very difficult for many people. The financial pressures on individuals have caused much suffering and stress. Difficult choices are being made every day. Some people are going to lose their jobs or be manipulated into taking early retirement. Institutions we used to rely on are crumbling. We no longer can depend on the stability of our local banking system, the automobile industry and Wall Street. Everything is changing very rapidly. It is hard to know which way to turn. One day we had a stable job, and the next day the plant is closed.
The following is the story of Brett and how he found a way to deal with his changing circumstances.
Meeting Brett for the first time
Brett called because he had some trouble managing his weight. He didn't say much about it on the phone, but we agreed on a meeting day. As Brett entered the office, I noticed that he was morbidly obese. He was having trouble walking because he was short of breath and sweating profusely. During the interview process he mentioned that he had sleep apnea, blood sugar management problems, very low libido, depression and he was about to lose his job. With the possible loss of his job, it meant the loss of his employer-based health insurance. Without that he could not afford the expensive medicine, sleep apnea machine and his doctor visits. In fact he was unsure how he would be able to pay for my services.
Making the decision
Given the wide-ranging set of problems facing Brett, the first order of business was to find out from him what he wanted to change first. Brett was a former high school football player and a Veteran. After he left the military, he started eating like he was training for the super bowl. This time he became obese instead of the muscular athlete he was when he was a teenager. As we talked, it became apparent that Brett had been suffering from Post Traumatic Stress Syndrome. While he complained of being depressed and having a lack of libido, it hadn't occurred to him that he was suffering the consequences of surviving the rigors of combat. Brett was eligible for Veteran benefits, so if he lost his job he could obtain mental and health care services if he chose to do so. In any event, he was willing to visit a psychologist or social worker to be evaluated for his depression.
The depression was a not-so-subtle background player in his morbid obesity. At this point it was hard to know what came first: the morbid obesity or the depression. The greater the depression, the more one may turn to food for comfort. The morbid obesity, with its chronic disease and body image distortion, may in turn create the depression. In any event he was now able to make the decision to work toward improving his physical health by working toward becoming a healthy weighted person. In so doing he would be able to improve his sleep apnea and obtain blood sugar control.
Libido issues were also very important to him as they are with most men. It is important to note that the fat mass in the morbidly obese person is a hormone-producing organ. It will make lots of estrogen in men, which suppresses testosterone. As a result the voice my get higher, hair patterns may change, and the breasts may enlarge. Additionally, the libido is affected. Now that Brett was aware of this finding, he was highly motivated to get working on his nutritional recovery plan
The Plan
Our first strategy was to utilize so called protein smoothies or canned protein drinks to affect a liquid protein fast. Fortunately, Brett's physician was on board and he would provide potassium supplements for him as well as order monthly laboratory tests. By utilizing 4 protein smoothies or protein drinks with an additional solid meal each day, we were able to begin the effort. We agreed that Monday through Friday he would employ 4 'drinks' plus one carefully selected meal each day. On Saturday and Sunday he would use 2 protein drinks with two carefully selected meals each day. Aside from copious amounts of water, this would be the basic plan for the next three months. He would continue to measure his blood sugars 2 times a day, and call me if there were any concerns.
First Follow Up
During the first 3 months Brett was very good about coming in to be monitored and keeping in touch via email. It was very gratifying to see Brett improve. He wasn't able to see it as it happened, but change was in the air. After three months Brett had lost 45 pounds. He still weighed 320 pounds, but he was feeling hopeful as the improvements to his health were now manifested.
He was still using his C-Pap device and reported the settings were changing to accommodate the change in his weight. This is one important setting to keep changing while one is losing weight. He was in touch with the respiratory company, and they were helping him change the settings. His blood sugar readings were holding steady in a more normal range without the wide swings. He was no longer short of breath when he walked, and his skin was dry. He was no longer sweating profusely. After meeting with a mental health professional, Brett recognized that he needed treatment for his depression. His regular physician prescribed medication for him, and it was helping him regulate his depression. He continued to visit his mental health professional and was reaching out to his peers in the military. Sharing their common experience upon returning home was very helpful. In Brett's spare time he volunteered at the VA.
Now that he was able to get out more, he began a gentle walking program. Gradually he worked up his walking time (not distance) to an hour a day. He was't ready to take on the gym just yet, but he was feeling comfortable about wearing a swimming suit. With hot weather upon us, swimming is a great way to exercise.
Our food plan was now ready to undergo a change. The current plan of 4 protein drinks per day with one meal could be varied. Brett's lab tests were improving and his potassium levels where excellent thanks to his doctor who kept him in his potassium supplements. We would now utilize carefully constructed controlled carbohydrate meals, PRN protein drinks, and begin to add in much more protein.
The rest of the story.
While we are still working on Brett's transformation, it is important to note that for the moment he is still working at his job. His attitude is better, he has more energy, and he is beginning to see a female co-worker for an occasional date. He says that he feels as though he has come through a black hole. Acknowledging today he was feeling that he had a good future. He is requiring less medication now. Moreover he is saving money on food. He used to think that eating all kinds of protein was expensive, but he finds that in the long run he is saving money by eating at home. Avoiding soft drinks such as the 'big gulp,' he agrees they too were keeping him sick.
This story is not over. We are simply in a continuation of a very long effort. For Brett, the lesson is still unfolding for him. While it is true that we are in a period of social upheaval, it is important to look at the part of the dynamic that can be changed. For the part of the change that can be changed, determine what part of that change belongs to us as individuals or as a whole. Many years ago some wise words were spoken: 'change is inevitable, suffering is optional.'
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