Quick question RE: minimum calories

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!

DawnOf1969

Example: I went to a long-practicing Family Practice MD who I've been seeing for years, with knee pain. He diagnosed as tendonitis after a 2-view non-weight bearing knee x-ray. Gave me NSAIDS and pain meds. After no relief for 6 week or so, I went to a PA (mid-level practitioner) who specializes in Orthopedics for a second opinion. She performed an MRI, 4-view, weight bearing X-ray and thorough exam, therefore diagnosing me with a meniscal tear and cyst. I am scheduled for surgery on September 1st by her supervising doc. Had I trusted the advice of the long-practicing MD, I would still be walking (limping) around, taking Celebrex and Tramadol, with no hope in sight. Sometimes, the expertise of the "mid-level" exceeds the expertise of the MD.
Take from that what you want.

I work in a PA school btw.

kathyrice

I have to agree with Emmaleigh! Only because by experience, I have been to my doctor who has been my doctor for 13 years and still can't remember my name. A few years ago, I went to the doctor for a physical. I was of course obese (weighed 185 pounds at 5'.50") So he talked me into going on a diet plan with Phentermine. I did this and had to return every month for a check up and to get another prescription. Every month I went in, he didn't even know why I was there. His first question every time would be "So what can I help you with today?" Really? I've only been coming to him forever and monthly for the past 4 months?? At any rate, the number of patients these doctors see in a day is absolute madness and they barely spend any time with you to understand what your needs are. He even advised that if I wasn't hungry to not eat. He told me it was okay to only eat one meal a day! Now tell me should I have followed his advice just because he was a MD?

Amanda_Runs

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...

THIS is perfect. I know you are 100% correct with this and I am so proud of you EM!

HolleeERL

"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!!!

Read in the AMJ about a nurse who questioned several seasoned doctors about a little girl who had severe and unexplained blistering all over her body. Had that nurse not recognized the little girl was having a reaction to the medication she was taking, the little girl would have died.

Personal case: My son fell on his arm and I took him in to see a doctor because he was just crying all the time and holding it. My son doesn't normally carry on like that (he was 18mths). The doctor didn't x-ray it but determined it was nursemaid's elbow (usually caused from pulling, not from falling on) A week later my son was still crying about and holding his arm so I took him in again and this time I insisted on an x-ray (different doc). It revealed a broken arm. My son had to suffer that long in pain because I trusted one Dr.

I place a lot of trust in many nurses who are not too full of themselves and their own egos to know what they are doing. They see things the doctors sometimes feel they are "above" seeing and make a lot of generalizations. To put as much trust in one doctor even though it's questionable is not very smart to say the least. Yes, you are working under their direction, but most people who can think for themselves, know that sometimes doctors don't know it all and do make mistakes. To think you don't have the right to question that direction is wreckless.

We have to be our own advocates in medical care. If OP thinks the advice of her doctor is questionable, go back to that doctor and ask the questions she is asking here OR get a second opinion. You are allowed to question the doctor's advice. After all, you are paying THEM...not the other way around!

stroutman81

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.

I don't know all of the facts here and I've admittedly avoided reading everything in this thread. And as for your words I'm quoting above... I agree with you. I've heard more crazy crap from my client's doctors regarding weight loss than I've heard sane, sound advice.

However, just so we're clear, are you implying that going below a certain threshold of deficit relative to total daily energy expenditure can cause significant harm? And if so, in what context? Are we talking about below, normal, and over weight populations? Are we talking about chronic AND acute interventions?

I get it, I'm a huge advocate of moderate deficits for long term success when it comes to fat loss. And obviously it's quantity and quality of the diet that drives health and physique... not just quantity alone.

But for the sake of information integrity though, I'm hoping you'll explain your point a bit further.

Thanks for your time!