Working with a Sports Dietitian: It was Good and It Was Also Really Bad

 

This summer I did something that I've been thinking about doing for years: I worked with a sports dietitian for a month.  

So what was it like and how did it turn out?  Quite the mixed bag.  On the plus side, I solved my #1 food issue.  On the negative side, it's kind of a Thomas Edison thing where I discovered a few more of the 10,000 things that don't work, and feel like I still have 9,996 things that don't work left to discover. 

The Selection Process

I already talked about how I found the dietitian here, but to recap, the dietitian that I worked with is a sub-3 marathoner who has been a guest on several running podcasts that I've listened to.  I heard her say a number of things about food and nutrition that I strongly agreed with.  When I went to her website, her services were very clearly outlined and the prices were listed.

Let's contrast with another dietitian that I considered working with.  She had a great instagram, but her website had no detail on what her process was like or the cost.  The next step was a questionnaire and one of the questions was something like "Nutrition counseling is an investment and requires a financial commitment.  Are you prepared to make a financial commitment?" <==this is an example of someone who I would not be comfortable working with.  I also would not have been comfortable signing up for anything longer than one month without working with that person first.

And when I say "dietitian" yes that means a Registered Dietitian.  I do have some feelings about RD's (I had a previous bad experience) but I have stronger feelings about some of the nutrition advice that I've seen coming from folks without the credential.

The First Meeting

The process started with a one hour video meeting.  We introduced ourselves and got down to my problem, which is that three years ago I increased my running from 10-ish to 20-30-ish miles a week and I have been insanely hungry ever since.

She asked me to walk her through a typical day.  I told her that I get up between 5-6 and take a bit of time to have coffee and either a cereal bar or a Clif bar.  I run, and when I get home I'm usually pretty hungry.  I have breakfast, and then start work.  I usually don't think about food or feel hungry until lunch.  I have lunch, and then usually start to feel a little bit hungry afterwards but nothing too bad.  I take the dog for a walk, and usually feel like I need to eat something before I go back to work.

And that's when the problem starts, because no matter what I eat, I cannot get full.  I am full on starving and no matter what I eat it feels like tossing matches on a fire, I just get hungrier.  And then I'm stuffed and food is completely unappealing but I have a family so of course I eat dinner.  I almost always stop eating after dinner.  I tell her "I'm not saying this happens every day, just that it happens 3-4 times a week without fail".  I also tell her that for the longest time my weight held steady but I've just been through a really stressful time at work and over the past two months I've finally broken through my plateau and gained 5 pounds.  I told her that if I had to choose between losing the weight and running that I would choose the running, but sheesh if I could even lose half a pound a month I'd be happy with that.

She asked about long runs.  I told her that I usually eat a bit more before and take a salt stick tab before and take a gel every hour or so.  She recommended bumping the gels up to every 45 minutes.  We talked about hydration and I told her that I'd noticed faster recovery/less GI issues after getting a hydration vest.  I also told her that summer running was a pretty heinous experience and that I was very sensitive to heat and humidity.  She recommended using Gu Rocktane gels and Skratch, and said that we would do some sweat tests.

We talked about food preferences, and I told her about my go-to's (ex: black bean and egg breakfast burritos), let her know that I have a low tolerance for chicken and that quinoa hurts my stomach to the point that I will never eat it again in my life.  I told her that I almost always salt my food to the point of being a bad example to my stepkids, and she said "keep it up".  We also went over medical history (my labs are always fine) and my medications/supplements.  I take a multi-vitamin, an iron supplement (she asked if I'd ever had low iron and I said no, I just take it because I know that women often have low iron and I don't eat a ton of meat), and omega-3 for dry eye syndrome.  She wasn't familiar with the brand that I take, but she looked it up on the spot and said that the dosage was what she likes to see and that she's a huge fan of omega-3 for runners.

She gave me her feedback: it's good that I eat before I run, but I am most likely not eating enough afterward and it's likely that my appetite is suppressed.  By lunchtime I have an energy deficit and that's causing the inferno appetite.  This is a very common running issue and can be fixed.  Once I get my nutrition in place, I should see the extra pounds drop off.  She said that she will send me a food plan in the next few days and a link to a food log.  We will work together to see what works and what doesn't over the next month.

The Food Plan

She gave me options for pre-run food, and examples of six breakfasts, six lunches, six snacks, and six dinners.  The six options weren't "the only six things you will ever eat for the rest of your life", they were just suggestions as a starting point.  She said that it's totally OK to eat the same thing every day and totally OK to eat breakfast for dinner, etc.

For my breakfast options, she gave me:

• Eggs and toast.  Two whole eggs and two egg whites, two slices of toast.
• Breakfast burrito.  My version of a breakfast burrito is a small tortilla with one egg, 1/4 cup of black beans, a sprinkle of cheese, and salsa.  Her version was a BIG tortilla with ~50 grams of carbs, TWO eggs, 1/4 cup black beans, and a bit more cheese. I couldn't find a tortilla with 50 grams of carbs so I settled for a burrito sized tortilla (35g carbs).
• Things that I am never, ever going to eat: a couple of oatmeal options and a smoothie.
  
• The emergency on the go breakfast: a Clif builder's bar.

The lunch and dinner options can be summarized as protein plus starch plus something fun (aka a fat source such as avocado or nuts).  The recommendations were whole grain pastas and rice, and lean proteins: fish, ground turkey, soy products.

The snack list gave me pause because everything was so small...a greek yogurt, 1/4 cup dried fruit & nuts, a muffin, a banana with peanut butter, a Picky bar, or an Rx bar.  She said to start with a snack in the morning and in the afternoon to see how my appetite was.

She gave me benchmark numbers for calories and macros but also said not to obsess over them.  The goal was to find out what works, not hit a metric.  I tracked my intake in MyFitnessPal during the process because I was curious, but that was not part of the plan.

Things that Worked

Big Breakfasts!

The big point here is that when I was eating smaller breakfasts, I felt satisfied afterwards.  I'd talked with another dietitian a few years ago about eating "more" in the morning but it wasn't clear what "more" was.  Following the specific suggestion of doubling the size of my breakfast burrito and the two whole egg/two egg white combo is a keeper.  Yes it's so simple but the point is that I would never have thought of this on my own.

I also want to give a shout out to Clif's Builders Bars for an emergency meal.  I've had them for rushed breakfasts and rushed lunches and felt satisfied without crashing later in the day.

Snacks!

The bizarrely small snacks worked also.  After experimenting, my go-to's became plain Greek yogurt with a little bit of honey or an Rx bar.  As time went on, I found that I didn't need the morning snack, but I always needed an afternoon snack.  

But seriously, the combo of a bigger breakfast plus a stupid little Greek yogurt shut down my three year problem of "I'm starving and the only answer is to eat everything in sight that's not moving".

Protein without eating gobs of chicken or protein powder

One of the reasons that I wanted to turn it over to a professional is that I wasn't sure what my protein goals should be.  When I track my food in MyFitnessPal my protein is usually pretty low - is that good or is that bad?

The dietitian set my protein goal as 100-120 grams a day, and I was able to hit that mostly through the eggs and the Greek yogurt.

The Food Log

I'm no stranger to logging food.  Anytime that I've needed to lose weight, my go-to has been writing it all down and counting calories.  Although I have mixed feelings about it, I also know my way around MyFitnessPal.

But the dietitian's food log was different and in a good way...a simple spreadsheet where I logged: 

• Pre-run food
• What my workout was that day and any nutrition that I had during
• Breakfast
• Morning snack
• Lunch
• Afternoon snack
• Dinner
• How I was feeling
• Any questions that I had

The "feelings" row was very useful.  I got insights like "I had a handful of potato chips and now I am so tired" and "I was so hungry that I wanted to scream so I had an Rx bar and nearly died of boredom but I felt fine afterwards". 

Things That Didn't Work

Going from eating very few whole grains to eating a ton of whole grains 

Right out of the gate I had a huge fail.  While I've had recent-ish (aka documented somewhere on this blog) bad experiences with wild rice and quinoa, I didn't realize that brown rice also caused the same problem.  The most brown rice I ever eat is the standard Chipotle size, and I don't eat at Chipotle very often.  I can eat one meal with a bunch of whole grains and I'm fine, but repeated exposure causes misery: stomach pains, bloating, and GI yukkies.

In the first week, following the dietitian's plan to get my carbs up, I ate a lot of brown rice.  The first day it was fine and I felt great.  The second day I felt exactly the same way I would as if I'd had quinoa, the third day was worse, and there was no fourth day.  I had a similar problem in the third week with Banza pasta.  So for about half the time that we worked together, I was pretty sick.

The dietitian's take: if whole grains bother me, then don't eat them.  Just get the carbs.

The sweat test was a "so what?"

The sweat test was very simple.  Right before I go for a run, get buck naked and weigh myself.  Put my clothes back on and go run and record how many ounces of water I drink.  Come home, get buck naked and get my ending weight.

We did three different sweat tests in three different weather conditions.  The data showed that - wait for it - I am a heavy sweater.

The problem is that there's no answer.  The dietitian's advice was "more salt".  Like I said, I already salt my food quite heavily, there's no "more". 

For a hot minute it looked like Skratch was the answer.  I'd gotten a free bag from a Strava challenge, and the first day that I used it I chopped through a yucky humid run like a beast.  But as the summer wore on I started racking up a number of terrible runs with Skratch.  I don't have an answer besides that I'm someone who drinks a ton of water and eats a ton of salt but the answer is to drink more water and to eat more salt...I just can't seem to get there and not for lack of trying.

Eating the same amount of food every day regardless of activity level

The recommendation was to eat the same amount of food every day - a lotta food on rest days and no pizza and ice cream binges on long run day.  But in practice I couldn't make that work and eating a large breakfast on my rest days felt horrible.  Every once in a while I'm extraordinarily hungry on a rest day, but for the most part my appetite fluctuates with my activity level.

I was never able to hit my carb goals and I burned myself out trying

I'm not carb adverse...I'm just someone who eats what I wanna eat.  I like pasta, I like bread, I like rice...I don't like a ton of them in one sitting. 

If you put a pizza and a couple of beers in front of me, I have no problem packing away a ton of food.  If you put two cups of rice or pasta in front of me, it's just a ton of food.  (1) it's not fun and (2) I didn't see any improvement in performance.

Hold up, let me say that differently: I might very well see an improvement in performance if I could get my carbs up to the recommended level...the point is that to date I haven't been able to hit that level without getting sick or eating a ton of food in general, which just takes me back to where I started.

Stopping the out of control snacking dropped my calories which was very counterproductive for running

Once I had broken the Snack Monster, I lost the desire to eat a ton of food.  That led to a lot of low energy running.  That was exactly the opposite of the goal.

I am so confused about how many calories I am "supposed to be" eating.  When I was on my out of control afternoon rampages, I was seeing 2,500-2,700 averages over time.  On the high end I would usually (easily) get over 3,000+ calories on long run day and on the low side see a few sub 2,000 calorie days here and there.  The dietitian's range was 2,000 to 2,400, which was easy to hit and had me feeling great - until I started running and had no energy.  And to anyone who says that calories aren't a good metric - I think I've proved your point but I don't know how else to look at it.

What Now?

I'm at an impasse.  I can't figure out how to eat to support my running, and tinkering around with things put hella damper on the joy of food and the joy of running.  I've gotten to the point where I'm just banging my head against a brick wall and it's time to stop.  No I'm not giving up on running, but for a variety of reasons I'm backing off.  After my half marathon this weekend running will go from "20 to 30 miles a week" to "however much I wanna run" to match my "imma eat what I wanna eat" diet plan.

I stopped working with the dietitian after a month because I wasn't going to get any answers besides "eat more carbs" and "eat more salt".

My starting point of the out of control snacking was not sustainable and needed to be shut down, so that was a win.  I'd say that if you have a specific food problem like I did that a dietitian can help, so yes I would recommend it.  But in my case the story ends with "to be continued" instead of "happily ever after".

Your turn: have you gotten nutritional counseling, either from an R.D. or someone else?  How did it turn out?