My Doctor is an idiot!

I went to the doctors (OB/GYN) today to get my test results. The results were perfect. I asked him what he would reccomend for diet. I was being tested for PCOS, cysts, ect. He asked me what I was currently eating. I told him that I was eating 1500 calories a day, working out 5-6 days week. I assured him that I made sure I netted 1200 calories and that I recently dropped my carb intake to 100g sticking to mostly clean eating.

He then went on to tell me that I could easily eat 1000 calories and work out. I told him that I believed that would make me net 500-600 calories most days. He that was fine. He then went on to ask me how often I weigh myself. I told him probably 2x/week. He then reccommends that I weigh myself everyday to see the gains/losses. He told me that when he sees a gain from the day before he will not allow himself a treat such as ice cream that night.

What the eff!! I think I was just perscribed anorexia!! I have 40 pounds to lose, not that much. The medical student behind him was stunned and shaking her head, "no" to me as he was speaking.

I am horrifed. Not just for me, but what about a younger, less knowledgable girl? He just green lighted an eating disorder. I think I am going to call the office manager on Monday. I had just switched OB's as my private practice provider retired.
The search is on again.

Is this crazy? What would you do?

Okay, let me try and be constructive here. I am not an OBGYN but I am a physician and I have some nutrition background.
The only thing you should probably ask your OBGYN (who is not a registered dietician - do you know there was not one book on nutrition in an entire Medical Book Store I looked in) is what foods are off limits in PCOS (see below).

http://www.3fatchicks.com/living-with-pcos-4-foods-to-avoid/

Otherwise you should speak to a RD. I'm not going to get into the 1200 calorie limit (which is set mainly to make sure most people get the macro and micro nutrients they need). I have patients that will not lose weight unless they get a diet of 900 calories a day becasue their RMR (resting metabolic rate) is so slow (quadraplegic). You're RMR can slow to 30 percent of what it should be when you get your calorie counts down to 900 (in the average person) but you still lose weight, just at a much slower pace.

IF you don't have PCOS then I based on available knowledge and scientific study you are taking in too few carbs. There are specific requirements for the average athelete - women and men - but diet plans need to be taylored to your build (how much muscle you have, etc).

The general recommendations (see Sports Nutrition: A Manual for professionals 5th edition for a summary) as follows:

Protein 1.0 grams per kilo per day (kilo = 2.2 lbs - ie 22 lbs = 10 kilos), moderately active aerobic 1.2 - 1.4 grams per kilo, resistance training 1.4 - 1.7 grams per kilo per day with some bodybuilders doing 2.0 grams protein per kilo per day. There is no evidence that numbers over this amount are useful).

Carbs: Less than 60 min of activity a day - 2 grams per kilo per day.
60 minutes of moderate activity 3-5 grams of carbs per kilo per day
1-3 hours of exercise per day 5-7 grams of carbs per kilo per day
4-5 hours of exercise per day (ie training for tour de France) - 8-12 grams of carbs per kilo per day.

The problem with consuming less carbs than this is that you will not be able to optimize performance or endurance at lower levels. The "percentage" of your diet that is made up of carbs is not as important as the absolute number.

Having said this...you can see why dieting and exercising for prolonged periods can cause a perceived problem - especially amoung women atheletes trying to maintain lean body mass while gaining stength and stamina.

Remember: Eat too many carbs and you get fat stored. However, this is about optimizing the right amount of carb for you so that you can exercise hard, get stronger, but still lose weight. Muscular builds have higher requirements than lean. So keep this in mind. The reason your question is too vague to answer appropriately is I'd have to know a lot of specifics such as what your diet consists of, not just how many calories. I'd tell you to eat heart healthy fats high in Omega 3/low in omega 6 and after exercise make sure to take in carbs with both high and low GI (Glycemic Index / and glycemic loads). I'd also need to know what kind of exercise you do and how long.

It gets more complicated too. Just as an example...rebuilding glycogen stores is what helps you recover. To do that you need carbs and protein. Did you know that Fructose (sugar found in fruit) is the least effective at helping rebuilding glycogen stores? In addition it helps to have a mix (ie sucrose, maltose, fructose, glucose) because the "carriers" that help carry these building blocks into the cell are speciific for each type of sugar. So if you take in a lot of glucose you can't use it all because the carrier is full like too many people trying to get into the elevator. If you add three different sugars they get carried in by three different carriers and that helps get glycogen synthesis done quicker aiding in recovery.

Sports drinks that combine carbs and protein and different kinds of carb sugars are preferred and convienent...but not always necessary. If you are exercising less than 90 min a day you might not need to know any of this.

For the OP or any of you that might have questions, feel free to ask. If I don't know the answer, I'll try to find out from a licensed source. These are not specific recommendations for anyone out there....just general knowledge in sports medicine. You should ask your physician and a dietician for specific advice that pertains to you!








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Yes. I doubt you would hear most doctors ever use the term "net calories".

I agree. But if i tell him i am burning 500 calories on average every day and then he tells me to consume 1,000. Net or not, not healthy!

But you're not burning 500 calories per day. You're burning far more than that (your TDEE). For weight loss, the numbers that matter are your total burn and your total intake. What each component of your total burn is (BMR, exercise, etc.) isn't very relevant. Your body loses weight by using your stored calories in the form of body fat to fuel some portion of your total expenditure for the day. There is no reason you need to fuel today's workout (or "today's BMR") with today's calories. 1000 or 1200 calorie recommendations are more for nutrition purposes, not energy purposes. Your energy purposes will get met, as long as you have excess fat to burn. Burning excess fat calories IS healthy!