My meeting with Susan; the registered dietician/nutritionist

Susan Dopart

I walk in to a fancy office building, head to the second floor, find her suite number and open the door to a very zen and cleaning looking office space... which was empty. Two seconds later this woman with curly hair comes up behind me, before I close the front door and there is Susan Dopart; the woman I'm hoping will answer my questions, give me solutions in exchange for a big chunk of money. She seemed warm. I felt safe.

We walked in to her office and she asked me about what I'm worrying about and what I want from this meeting. I told her that I have PCOS. I have been dealing with excess weight most of my life. That I lost 40-50 lbs but I've been stuck for years. That one of my biggest problems is my skin and it's my biggest worry apart from (maybe more importantly than) losing weight. I told her I don't want to live with pills if I could help it and I needed help.

We went back and forth about what I ate, my family history, my exercise routines, how I feel when I don't eat vs. eat too much, cravings, being in touch with my body, the vitamins and supplements I take (I brought the bottles to the office), my PCOS symptoms and background, taking Metformin, and my blood test results.

She kept looking at me after I explained something to her and she kept saying things like "You're very aware of your body aren't you?" "You've done everything you could to figure this out." "That's a good question. You're a smart woman." Ego boost aside I was happy to hear that my efforts haven't been silly and that someone appreciated all the trouble I've gone through so far to get healthier.

------Now to the real stuff---------

Early in the meeting, after I talked about my symptoms with skin and food, we figured out my problem. Insulin resistance and carbohydrate intolerance.

Seems obvious? Maybe but she broke it down for me.

A regular person:
Eat a starchy carb like bread --->body turns it in to sugar/glucose---> pancreas makes insulin---> insulin takes glucose to cells---> body is happy

Insulin resistant person:
Eat starch carb like bread--->body turns it in to glucose---> pancreas makes insulin---> cells don't respond well to insulin---> glucose doesn't get processed---> pancreas makes more insulin---> extra insulin stores itself as fat--->extra glucose is sucked up by liver---> liver makes more cholesterol--->obesity, high cholesterol, and unhappy body

Most of this I already knew but then she brought it back to my body. My test results came back normal except for cholesterol. I have unstable blood sugar spikes like super cravings soon after breakfast and super energy lows in the middle of the day. My body is refusing to let go of the excess fat. It makes sense that this is happening to my body.

The solution?
NO Starchy Carbs. 
S:"Starch carbs are your nemesis." 

She explained to me that my recent lactose intolerance, my skin irritations and some sensitivity to some fruits was due to carbohydrate intolerance. "Your body can't process carbs due to insulin resistance. You keep putting carbs in and your body turns chaotic. It takes it out on your skin and later it starts not being able to tolerate different foods, like lactose." Well, shit.

---------Now the scary stuff-------------
She asked me to take off my boots, complimented my colorful socks, weighed me, checked my height and asked me to lay down on a futon and take off my left sock. She then brought out a very fancy looking contraption to check my body fat percentage.

She put pads on my left foot and pads on my left hand. She then used the machine to run an electric current around my body to see how much body fat and muscle and water I had. I told her about the hand-held devices they use at the gym and she said those were useless and cost $50 while hers was much more accurate and cost close to $3,000.

Her response to my results,
S:"Huh, you must have a lot of internal fat because you don't look that fat." 
me: *paled face* "Uh, thank you..."
S continues: "You have plenty of muscle. About 120 lbs of it."***
me: "That's good."
S: "Yes, but you have around 43% body fat." *slightly bewildered face
me:  *inwardly appalled and trying not to show it* "Wow. That's crazy."
*** She later explained that because of the excess androgen (male hormones) I have I can easily gain muscle.

-----------Now the good stuff---------------
We sit back down and start talking about the kinds of foods I should be eating.

-5-6 oz of protein per meal
-vegetables and salad as desired
-good fats like avocado, olive oil and coconut oil
She then gave me different examples of meals and snacks I can have. Avocado and nuts kept popping up.

We talked about Omega 3's and Omega 6's. I need a lot more Omega 3's and stay away from 6's. She gave me a list of supplements I need to get:

-1 tbsp of ground flax seed/day (I asked why ground vs. whole seed and she said the whole seed passes right through you and you don't absorb the nutrients. Whole seeds only give you fiber and not omega's.)
-Liquid fish oil (Liquid gets absorbed quicker)
-Grass feed meat (She explained that if they eat grass their bodies turn it in to omega 3 but if they eat corn/soy they turn it in to omega 6 and in turn we absorb it when we eat it)
-Vitamin D3 (Helps regulate insulin levels)

Throughout the whole session we talked about things I should avoid:

-Starchy and/or 'human made' carbs like potatoes or bread (I need to eat things like yams, squash and quinoa)
-sugars (artificial sweeteners like what they use in Starbucks drinks is an example)
-Omega 6's (corn, soy, soy bean oil, corn oil, vegetable oil, canela oil)
-not eating longer than 4 hrs between meals (I need to make sure I don't wait too long between meals)
-ripe bananas, or too many grapes (too much sugar)
-intense exercise (too much cortisol. My body can't take it. Daily, moderate exercise is key)

-------------A note on exercise------------------

I asked Susan about what I should do about exercise. I explained how I read that 20 minute intense interval sessions were best with women with PCOS, but that I also read that just as long as you move and stay active you'll be fine.

She told me that I really have to worry about diet first but being active is still very important. She said moderate, daily exercise is best for me. To mix moderate cardio with light strength training.

She was very adamant about me not over exerting myself saying my cortisol and other hormone levels get agitated very easily when I have PCOS and that I shouldn't make it worse.

She suggested I do yoga as a supplement exercise.

----------Now the bottom line stuff-------

I can't eat (starchy) carbs. We all know that vegetables have carbs, carbs are needed etc etc. My body just can't process all the glucose I'm making when I eat starch and sugar. It disrupts my hormones, stores fat, makes me lactose intolerant, gives me rashes and skin infections, and I can't have that when my body is dealing with PCOS. I don't want to depend on an insulin regulating pill like Metformin so changing my eating habits and my lifestyle are required for me to get better.

S: "It's not going to be easy. You're going to have days when you curse you ever came to see me."

I'm going to make this experience a good one. Instead of complaining I can't eat toast anymore I'm going to get excited in learning how to cook new things. Instead of wondering if I can eat that piece of candy or pizza I'm going to focus on what new workout classes I can take at the gym. I'm going to treat it as an experiment. A good challenge like, when I go out how can I make this menu work for me? or see how eating differently affects my skin, my mood, my routine.

In the end she gave me a folder with her notes and sheets of food suggestions. She thanked me for coming to her and that she was very happy to see someone so in tune with her body and really cared about getting better. She then asked me if I liked to read. I said yes. Next thing I know she brought out a copy of her book, personalized it and gave it to me saying "I don't usually do this but you splurged today."

She asked me to call her in a week and check in, hugged me and I was on my way. I felt like I had been listened to. I felt like I got answers and a rough guideline to where I should go next. I also left wondering if I had the discipline to do it. The 43% body fat was such a blow of information. I woke up this morning still thinking about it. 

I went back to work and at night I was asked to join a group of new colleagues for a drink. I didn't discuss beer with Susan but I know that it's probably not on the list of good carbs. I decided I was going to say goodbye to carbs, sleasy style. I ordered a Guiness, french fries and a turkey burger with mushroom. I ate it all and sweet potato fries. I finished my beer and I went home, knowing it was going to be a looooong time until I did that again.

-Elina