Quick question RE: minimum calories

iAMaPhoenix

Im disappointed with your doctor. The fact is, many many medical professionals really do not have knowledge about nutrition and diet and just say what they think is right without really knowing the truth.

As a nurse practitioner and clinical lipid specialist I would have to disagree with your doctor ... any "diet" that has you eating under your basal metabolic rate in the end is just gonig to result in weight loss from muscle loss, and needing to eat significant lower calories in order to maintain your weight...

Its really quite a shame..

Are you serious? Really? Do you know this patient? Have you examined her like her doctor has? Do you have her lab results? As a NP and clinical lipid specialist, you should know better than this. I am absolutely appaled at your statement and think you should retract it. As mid-levels, we are not allowed to overrule a finding by a qualified MD about his patient that he has knowledge of.

The shame is in your answer, not in his medical opinion and practice of his patient.

Well said, I don't see how anyone can say that someone's doctor is wrong when they know nothing about the patient.

She has yet to retract her statement or respond in defense of it. I am not confrontional on here, but this really is wrong and borderline malpractice, in my opinion. I hope the OP has enough knowledge to listen to HER doctor and not to advice from some stranger on an internet forum.

JustMichelleB

If you re-read the OP, the nutritionist made the "rules" regarding caloric intake, not the doctor.
Is this an RD or a "nutritonist" (anyone can claim they are a nutritionist).

And doctors are not often trained in nutrition. IT really depends on what type of doc is giving out this advice. Doctors do NOT know everything, even for their own patients. hell, some docs prescribe HCG....

And people give out opionions and recommendations on here every second. I don't think the NP is practicing "malpractice", that's a bit strongly worded.

And i'm a PA, fwiw.

mrsc86

I will of course be listening to my doctor - I just wanted to check there were no long term negative impacts of going lower than 1200 for a short period of time

Are there any foods you would suggest I include to improve metabolism? The diet I have been given is balanced (with higher iron as I am low in that) but anything I can do would be great

This is not a long term thing - I love my food!

iAMaPhoenix

If you re-read the OP, the nutritionist made the "rules" regarding caloric intake, not the doctor.
Is this an RD or a "nutritonist" (anyone can claim they are a nutritionist).

And doctors are not often trained in nutrition. IT really depends on what type of doc is giving out this advice. Doctors do NOT know everything, even for their own patients. hell, some docs prescribe HCG....

And people give out opionions and recommendations on here every second. I don't think the NP is practicing "malpractice", that's a bit strongly worded.

And i'm a PA, fwiw.

I did read the OP and the NP did not say she is disappointed in the nutritionist. She said she was disappointed in the doctor. As mid-levels, we all should know our limitations, and have been trained in that model. To say that statement as a medical professional without having all the background information is not only mis-leading, but not very good practice, hence in my opinion, can be viewed as malpractice. And yes, all doctors are not trained in nutrition, but I would venture to say that their limited training is vastly more than any mid-level I know.

crmhaske

Im disappointed with your doctor. The fact is, many many medical professionals really do not have knowledge about nutrition and diet and just say what they think is right without really knowing the truth.

As a nurse practitioner and clinical lipid specialist I would have to disagree with your doctor ... any "diet" that has you eating under your basal metabolic rate in the end is just gonig to result in weight loss from muscle loss, and needing to eat significant lower calories in order to maintain your weight...

Its really quite a shame..

I doubt it's a long term recommendation. If it is... then I'd tend to agree with you. But if calories are that low and protein intake is jacked up.... say 2 grams per pound.... at least temporarily... I doubt there'd be appreciable muscle loss. Look at the success of protein sparing fasts and such in acute settings.

I agree. There are some fighters at my dojang that do ridiculous things to make weight for tournaments. The only part of them that suffers for it is giving up the foods they love. They typically go on high protein low everything else diets until after the tournament. At the same time they crank up the training, training 8-10 hours a day. They are alive. They are healthy. MFP is just a website, not the end all be all of fitness and nutrition.

joejccva71

I completely agree with EmmaLeigh 110%.

Here is why alot of you are not only misinformed but you rely too much on internal medicine doctors.

1. You can't just go by someone's BMR without also looking at their ACTIVITY LEVEL throughout an ENTIRE day, not just inside the gym. You have to take everything into account to find out what you burn in a 24 hour period.

2. In order to effectively lose weight for long term success you should be eating a caloric deficit of no more than 1000 calories under what the maintenance level is. You can also use 20-40% to determine your deficit if you have a low activity level throughout the day.

3. To ensure long term success without plateau'ing you need to hit your macros every single day depending on your goals and your training. 8 times out of 10 people that plateau don't have their macro's correct so they change their eating habits and eat a little more which in turn alters their macro intake which starts the weight loss again.

There are alot of doctors that are knowledgeable, but there are also many that are so clueless when it comes to nutrition and losing weight that it's mind boggling.

Any doctor that tells someone to eat below their BMR level without first calculating exactly what their BMR is + their activity level is a recipe for disaster. I bet most of those doctors would tell a patient to make sure they eat 5-6 meals a day, don't eat past 7pm, and eat a low-fat diet which is all completely wrong and based on not only broscience but completely outdated research.

So before you start throwing Emmaleigh under the bus, please take a step back and go read some real studies from the NIH regarding this very topic.

Please read the links in my sig for more information.

iAMaPhoenix

I completely agree with EmmaLeigh 110%.

Here is why alot of you are not only misinformed but you rely too much on internal medicine doctors.

So before you start throwing Emmaleigh under the bus, please take a step back and go read some real studies from the NIH regarding this very topic.

Please read the links in my sig for more information.

So are you agreeing with EmmaLeigh that a patient should not listen to her doctor who has knowledge about her. I am not in disagreement with what she is saying except for one thing. The statement that she disagreed with this patient's doctor. That is wrong on every level, unless you have conclusive evidence based medicine(not internet links or some random study), that that doctor is wrong. While NIH studies are great, I use them every day, they are not specific to each patient. This person's doctor has knowledge of her condition, not me, you, or EmmaLeigh. We cannot as health care professional advise someone to dis-regard medical advice unless we have evidence based proof that contradicts that advice---for that patient. That is the only point I am trying to make. I know we can all have opinions, but in the medical field, our opinion can end up costing us a lot of money, and in some cases, our careers.

joejccva71

I completely agree with EmmaLeigh 110%.

Here is why alot of you are not only misinformed but you rely too much on internal medicine doctors.

So before you start throwing Emmaleigh under the bus, please take a step back and go read some real studies from the NIH regarding this very topic.

Please read the links in my sig for more information.

So are you agreeing with EmmaLeigh that a patient should not listen to her doctor who has knowledge about her. I am not in disagreement with what she is saying except for one thing. The statement that she disagreed with this patient's doctor. That is wrong on every level, unless you have conclusive evidence based medicine(not internet links or some random study), that that doctor is wrong. While NIH studies are great, I use them every day, they are not specific to each patient. This person's doctor has knowledge of her condition, not me, you, or EmmaLeigh. We cannot as health care professional advise someone to dis-regard medical advice unless we have evidence based proof that contradicts that advice---for that patient. That is the only point I am trying to make. I know we can all have opinions, but in the medical field, our opinion can end up costing us a lot of money, and in some cases, our careers.

Her doctor has knowledge about her from a MEDICAL standpoint but not from a NUTRITION and DIET standpoint. There is a huge difference there when it comes to losing weight. He's telling her to eat below her BMR level without first knowing what their daily 24 hour activity is inclusive to her BMR. THAT is a recipe for disaster.

I once had a doctor tell me to not eat whole eggs as they cause your LDL blood cholesterol levels to skyrocket and will eventually cause me heart failure regardless of how much I exercise, stay at the proper weight and eat healthy.

I walked out of his office immediately.

emmaleigh47

I completely agree with EmmaLeigh 110%.

Here is why alot of you are not only misinformed but you rely too much on internal medicine doctors.

So before you start throwing Emmaleigh under the bus, please take a step back and go read some real studies from the NIH regarding this very topic.

Please read the links in my sig for more information.

So are you agreeing with EmmaLeigh that a patient should not listen to her doctor who has knowledge about her. I am not in disagreement with what she is saying except for one thing. The statement that she disagreed with this patient's doctor. That is wrong on every level, unless you have conclusive evidence based medicine(not internet links or some random study), that that doctor is wrong. While NIH studies are great, I use them every day, they are not specific to each patient. This person's doctor has knowledge of her condition, not me, you, or EmmaLeigh. We cannot as health care professional advise someone to dis-regard medical advice unless we have evidence based proof that contradicts that advice---for that patient. That is the only point I am trying to make. I know we can all have opinions, but in the medical field, our opinion can end up costing us a lot of money, and in some cases, our careers.

Gimme a break, seriously. The fact that you repeatedly use the term midlevel and feel that you would never diagree with a doctor means that you have bought into the society of medicine. Are there times that MDs know more than me, yep absolutely, but are there times that I know alot more than the MDs. Absolutely! I can apparently have an opinion as a normal person but as a nurse practitioner I cannot have an opinion.

Fine then... I am a completely uneducated person and I still think that the doctor and nutritionist are wrong. I agree 100% with the statements made by joejccva because even the most sedentary person should not be eating under their BMR. The physicians do not get that much education in nutrition and diet, unless they seek it out. And just like there are bad NP, there are bad physicians as well. As someone who has started and runs two lipid clinics, I see it every single day. Patients who were told bad dietary information, patients who are on medications that they shouldnt be on etc. You cannot trust the word of one person as gold, you need to practice evidence-based practice. And BTW if the original OP felt completely comfortable with the plan, she wouldnt be on MFP asking for opinions about whether it is safe. Something in her is questioning it, and that is a good thing. To throw around malpractice just because I give my opinion is poor practice... and if you believe the doctor is always right, that is also poor practice.

PS. Thanks to the PA who also chimed in as well.

JustMichelleB

"Gimme a break, seriously. The fact that you repeatedly use the term midlevel and feel that you would never diagree with a doctor means that you have bought into the society of medicine. Are there times that MDs know more than me, yep absolutely, but are there times that I know alot more than the MDs. Absolutely! I can apparently have an opinion as a normal person but as a nurse practitioner I cannot have an opinion. "


ITA. I have never met a PA or NP who reveres docs as much as the PA2b seems to. You are a PA student? Want to go to PA school? I'm curious, b/c you seem to think very little of the knowledge and capability of "midlevels", which is sad and inaccurate.

karensoxfan

The message I read into Emmaleigh's post is that the OP is right to be questioning the nutritionist's advice to eat only 1000 cal/day.

If that's an accurate interpretation, I'd translate it into a recommendation for the OP to seek out a second (medical) opinion. People get 2nd opinions all the time, and it's not a big deal. If the OP is unsure about the advice the Dr. or nutritionist gave, then that's what I'd do in that situation.

StaceyL76

Im disappointed with your doctor. The fact is, many many medical professionals really do not have knowledge about nutrition and diet and just say what they think is right without really knowing the truth.

As a nurse practitioner and clinical lipid specialist I would have to disagree with your doctor ... any "diet" that has you eating under your basal metabolic rate in the end is just gonig to result in weight loss from muscle loss, and needing to eat significant lower calories in order to maintain your weight...

Its really quite a shame..

Emma, you are a true gem. I agree with you 100%. Thanks for saying it, even when it won't be the most popular answer. Speaking from your base of knowledge and truth is best. Thanks Emma - wise woman.

End6ame

I completely agree with EmmaLeigh 110%.

Here is why alot of you are not only misinformed but you rely too much on internal medicine doctors.

So before you start throwing Emmaleigh under the bus, please take a step back and go read some real studies from the NIH regarding this very topic.

Please read the links in my sig for more information.

So are you agreeing with EmmaLeigh that a patient should not listen to her doctor who has knowledge about her. I am not in disagreement with what she is saying except for one thing. The statement that she disagreed with this patient's doctor. That is wrong on every level, unless you have conclusive evidence based medicine(not internet links or some random study), that that doctor is wrong. While NIH studies are great, I use them every day, they are not specific to each patient. This person's doctor has knowledge of her condition, not me, you, or EmmaLeigh. We cannot as health care professional advise someone to dis-regard medical advice unless we have evidence based proof that contradicts that advice---for that patient. That is the only point I am trying to make. I know we can all have opinions, but in the medical field, our opinion can end up costing us a lot of money, and in some cases, our careers.

Her doctor has knowledge about her from a MEDICAL standpoint but not from a NUTRITION and DIET standpoint. There is a huge difference there when it comes to losing weight. He's telling her to eat below her BMR level without first knowing what their daily 24 hour activity is inclusive to her BMR. THAT is a recipe for disaster.

I once had a doctor tell me to not eat whole eggs as they cause your LDL blood cholesterol levels to skyrocket and will eventually cause me heart failure regardless of how much I exercise, stay at the proper weight and eat healthy.

I walked out of his office immediately.

I agree whole heartedly. My doctor is great at diagnosing illnesses and injuries, but when it comes to nutrition and exercise, most doctors are not qualified enough to give that advice.

Prime example: I injured my shoulder several months ago on bench press as a result of my own stupidity. I relaxed my form before I had the bar racked and screwed up my shoulder. I was diagnosed with an inflamed AC joint and bicep tendonitis. Because of the inflammation the joint was rubbing under everyday activities so I was given a cortisone injection and some NSAIDs to take as needed. I was also given advice from my doctor to eliminate barbell exercises from my routine and stick to machines. I blatantly told him that was not going to happen and laid out all of the benefits of barbell training over machines for him. He then conceded that I knew more than him on the subject and to just use my own judgment. Six months later and my shoulder is completely better. My flexibility and range of motion is back to (maybe even better) than it was before and I don’t even have stiffness in the mornings anymore. In addition my bench press and overhead press are higher than they were pre-injury. My doc was in complete disbelief of my recovery.

My doc is also in complete disbelief of my high saturated fat and cholesterol intake and my “amazingly” health LDL/HDL levels.

iAMaPhoenix

"Gimme a break, seriously. The fact that you repeatedly use the term midlevel and feel that you would never diagree with a doctor means that you have bought into the society of medicine. Are there times that MDs know more than me, yep absolutely, but are there times that I know alot more than the MDs. Absolutely! I can apparently have an opinion as a normal person but as a nurse practitioner I cannot have an opinion. "


ITA. I have never met a PA or NP who reveres docs as much as the PA2b seems to. You are a PA student? Want to go to PA school? I'm curious, b/c you seem to think very little of the knowledge and capability of "midlevels", which is sad and inaccurate.

Medical College of Georgia class of 1999 my dear. I know my role as a PA which is to work under their supervision. If your school taught you that you are better than them, or know more than them, you are sadly mistaken. And you are entitled to all the opinion you want, but I don't know of any doctor that would allow you to question their findings. If that is the case, why are they hiring you to assist them, or better yet, since you know so much, why are you working under their supervision. Just open up your own practice and have your name on the hinges. Oh, but you are not allowed to do that are you, because you need the signature of the doctor who you know more than...Give me a break!!!

emmaleigh47

"Gimme a break, seriously. The fact that you repeatedly use the term midlevel and feel that you would never diagree with a doctor means that you have bought into the society of medicine. Are there times that MDs know more than me, yep absolutely, but are there times that I know alot more than the MDs. Absolutely! I can apparently have an opinion as a normal person but as a nurse practitioner I cannot have an opinion. "


ITA. I have never met a PA or NP who reveres docs as much as the PA2b seems to. You are a PA student? Want to go to PA school? I'm curious, b/c you seem to think very little of the knowledge and capability of "midlevels", which is sad and inaccurate.

Medical College of Georgia class of 1999 my dear. I know my role as a PA which is to work under their supervision. If your school taught you that you are better than them, or know more than them, you are sadly mistaken. And you are entitled to all the opinion you want, but I don't know of any doctor that would allow you to question their findings. If that is the case, why are they hiring you to assist them, or better yet, since you know so much, why are you working under their supervision. Just open up your own practice and have your name on the hinges. Oh, but you are not allowed to do that are you, because you need the signature of the doctor who you know more than...Give me a break!!!

Haha well in this case you just showed your ignorance .... at least when it comes to NPs. I CAN have my own practice... I DO have my own practice ... and I DONT practice UNDER a physician... so I guess I AM allowed to have my opinion...

Flyntiggr

So are you agreeing with EmmaLeigh that a patient should not listen to her doctor who has knowledge about her. I am not in disagreement with what she is saying except for one thing. The statement that she disagreed with this patient's doctor. That is wrong on every level, unless you have conclusive evidence based medicine(not internet links or some random study), that that doctor is wrong. While NIH studies are great, I use them every day, they are not specific to each patient. This person's doctor has knowledge of her condition, not me, you, or EmmaLeigh. We cannot as health care professional advise someone to dis-regard medical advice unless we have evidence based proof that contradicts that advice---for that patient. That is the only point I am trying to make. I know we can all have opinions, but in the medical field, our opinion can end up costing us a lot of money, and in some cases, our careers.

Get a grip! In this day and age, people need to own their medical care. Most physicians see you for 15-20 minutes per visit, and don't really KNOW you that well either. To blindly follow a directive because it came from a Doctor is an outdated and dangerous practice. To the NPs, PAs and RNs that question orders that don't pass their 'litmus' test, THANK YOU! Emma didn't diagnose anything. She, as a medical professional, questioned the caloric recommondation from the doc. I think the OP SHOULD get a second opinion, preferably from an Internist that specializes in proper weight loss. My PC Physician is very proactive, but I, as an INFORMED patient, have questioned some what she's said to me, which in turn opened up a productive dialogue. Some of the best and most interactive care I've received has been at the hands of NPs.....

JustMichelleB

Sorry the PA2b title threw me off.
I'm Yale, class of 99 grad myself. And the docs I work with trust me implicitly with my job. I am respected, and often they come to me with questions (I'm a hepatology PA and specialize in HCV, cirrhotic management, HCC and transplant). I do NOT assist any MD, and that is NOT what a PA does!!! The name is a misnomer in that manner. I practice medicine under the supervision of an MD, but I remain fairly autonomous in my every day practice. I'm always helping out MDs who have little knowledge in areas where I have a lot. It's a great, symbiotic relationship. But wow, I have never once thought of myself as an assistant to an MD (and no other PA i know views themselves as subservient to a doc either).

CardiacNP

First of All. I agree with the suggestion that the MD may be wrong.

I am a Nurse Practitioner Master's Prepared. Duel certified in Adult and Acute Care. I was the First NP in the World to become a FACCN-II ... What does that mean....I have minimum knowledge in my field. Does not make me an expert in anything. Just like an MD. Being a MD means you passed the Min level of a Standardized test.

Not only do I know what I know...But I know what I DON"T know. That is even more important.

I will put myself up along Many MD's. I actually practice along side a Cardiologist for over 16 years in private practice. I make Hospital rounds and take call for a group of 8 MD's. SO i think my skills and talents speak for themselves.

I never do anything just because the MD said so. Even when I was a Staff nurse in the ICU, ER and Cath Lab I only carried out an order because I agreed with it. Not just because some MD ordered it. That is dangerous thinking. If an MD writes an order to give a patient 20000 meq of Potasium would you do it????

I hate to burst your bubble....But not all DR's are right, Not all Layers are smart, not all teachers know how to teach & yes not all NP's or PA's correct all the time.

But to accuse someone of Malpractice is a joke.....How can it be Malpractice when like you siad she did not even have a patient/provider relationship?????

You my friend need to start thinking for yourself, become comfortable with your knowledge and become an indepenant thinker.

And I can Open my own Practice. I work with a MD as my choice.

So before you start making general statements about a profession. Get your facts right.

You may be a "mid Level" provider. I am a Proud Indepedant NP!!

Sorry to be critical and ****ty....but i just disagree with you on many points.

(Forgive spelling and typos,.....LOL was a bit spiritied)

Max HR 105 200 Cal burned typing post..LOL lighten up people

"Gimme a break, seriously. The fact that you repeatedly use the term midlevel and feel that you would never diagree with a doctor means that you have bought into the society of medicine. Are there times that MDs know more than me, yep absolutely, but are there times that I know alot more than the MDs. Absolutely! I can apparently have an opinion as a normal person but as a nurse practitioner I cannot have an opinion. "


ITA. I have never met a PA or NP who reveres docs as much as the PA2b seems to. You are a PA student? Want to go to PA school? I'm curious, b/c you seem to think very little of the knowledge and capability of "midlevels", which is sad and inaccurate.

Medical College of Georgia class of 1999 my dear. I know my role as a PA which is to work under their supervision. If your school taught you that you are better than them, or know more than them, you are sadly mistaken. And you are entitled to all the opinion you want, but I don't know of any doctor that would allow you to question their findings. If that is the case, why are they hiring you to assist them, or better yet, since you know so much, why are you working under their supervision. Just open up your own practice and have your name on the hinges. Oh, but you are not allowed to do that are you, because you need the signature of the doctor who you know more than...Give me a break!!!

joejccva71

Guys..while we're getting back on topic.....




The point of the matter is that all medical doctors are not ALL knowing when it comes to diet, nutrition, and weight loss. Some are accurate, but alot are incorrect in their judgement and advice. Simply telling someone that is having trouble losing weight to eat 1000 calories a day is just plain ignorant without actually knowing what their body burns daily in a 24 hour period. Not to mention what their macro intake is based on that daily calorie intake.

Period, end of story.

Flyntiggr

Guys..while we're getting back on topic.....




The point of the matter is that all medical doctors are not ALL knowing when it comes to diet, nutrition, and weight loss. Some are accurate, but alot are incorrect in their judgement and advice. Simply telling someone that is having trouble losing weight to eat 1000 calories a day is just plain ignorant without actually knowing what their body burns daily in a 24 hour period. Not to mention what their macro intake is based on that daily calorie intake.

Period, end of story.

^^^^^THIS!!!!! Good luck OP! You have loads of support (and opinions ) here!