Maintaining fitness and sanity on a low-calorie diet
October 30, 2013 5:53 PM   Subscribe

I'm an overweight (technically obese) triathlete who was recently put on a calorie-restricted (1200-1400/day), moderately carb-restricted (100-130 g/day) diet by my doctor(s). They also have me front-loading my calories into breakfast and lunch at the expense of dinner. It's been hard on me in various ways, physically and psychologically -- my training is suffering, and I really miss being able to share a normal dinner with my partner. I'm also on seriously non-optional medication that makes it hard for me to lose weight and, relatedly, has probably made me insulin-resistant. Help me cope. (Psychological beanplating as well as gory metabolic details for nutrition nerds within.)

I'm 5'7", 210-215 lb, female-bodied. My ultimate goal weight is 150-160, but at this point I would honestly be satisfied just getting out of the "obese" category (<195 lb, for my height). Various online calculators estimate my BMR in the 1700-1800 calorie range and my TDEE around 2000 calories (before exercise).

Before the doctor-recommended further decrease in calories, I was already restricting net calories to 1400-1600/day, logging my food in MyFitnessPal religiously, training for triathlon about 7 hours/week at moderate aerobic effort (about 75% of my lactate threshold heart rate) plus strength training, and eating back about half my reported exercise calories (to account for the horrific overestimates in online calculators, even with heart rate data). My total calories for the day were usually around 1700, so hitting close to my BMR, for those who subscribe to the "don't eat less than your BMR" theory of food. On that program, I lost a whopping 2 pounds in 3 months.

Now, as of a few weeks ago, my doctor and sports dietitian have had me drop down to 1200-1400 cal/day, restrict my carbs, and eat back an even smaller percentage of my exercise calories. I feel awful. I've noticed that I hit a mental wall in my training a lot earlier in my workouts now, my energy level is lower, and I'm ravenous afterward. Because my calories are mostly used up early in the day and I'm allotted fewer of them, I often have only a small amount left over at dinnertime, which makes it hard to sit down and have a normal meal with my partner after work, which used to be our catch-up time before putting in more work in the evening. Also, a lot of our go-to quick meals were based around pasta, which I've been told to avoid, so our alternate schedule of catching up while cooking together is also thrown off. And dammit, I miss being able to have a pastry with my coffee in the afternoon without tanking my calorie and carb budget for the day.

I feel like I'm doing all the "right" things -- I've been eating as many raw non-starchy vegetables as I can stand (fortunately, this is a lot). I add in small quantities of "good fats" like almonds and avocado. I think I'm getting enough protein (60-100 g/day). It doesn't seem to be helping -- I still feel enervated and mentally drained. I haven't been on the new plan long enough to tell if the weight is coming off any faster.

How do I deal with this, physically and psychologically? Do I just need to Harden The Fuck Up? How do I buckle down and continue training? How do I cope with being envious of my partner's relative food freedom? How/what do I eat on 1200-1400 cal/day without making myself neurotic/disordered? How long do I give it before I put my foot down and say it's not working? If I have to do that, what in hell do I do to shift this weight, given that the previous plan wasn't really working either?

Assumption-challenging is welcome, with two caveats: 1) I really can't go off the medication that's causing the insulin resistance without losing my ability to function, and 2) although I am totally a fan of health at any size, at least some of this weight needs to come off, for unrelated medical reasons.
posted by dorque to Health & Fitness (29 answers total) 19 users marked this as a favorite
What worked for me in a similar situation was to up my protein and particularly fat consumption significantly - and (for a while) within the calorie restriction I had been given. After a few weeks, I continued to lose weight even while eating more calories. Within my carb limit, I went for sweet potatoes, butternut squash and a bit of fruit rather than grains and heavier starches. I used olive oil on everything and switched from pastries for a treat to a square of dark chocolate. Basically, the paleo diet really works, especially when you're insulin resistant. The first week hurt but after that I didn't really miss wheat or sugar and I felt amazing. And ended up losing something like 70 pounds, incidentally. YMMV. Good luck :)
posted by yogalemon at 6:09 PM on October 30, 2013 [6 favorites]

Best answer: First, be honest with yourself about what you're eating. I will simply say that I don't really believe that you are training the way you think you are and only eating 1400 calories a day. Either you are not training the way you think you are (for instance, by training at a lower heart rate zone and not burning as many calories as you think) or you are not eating only 1400 calories a day. The math just doesn't work out. This is not an attempt to shame you.

How do I buckle down and continue training?

I can either train or lose weight, but not both. The sort of nutrition you need for triathlon training (high carb, moderate protein, low fat, low fiber) is not the same sort of nutrition you want to lose weight (high protein, high fiber, moderate fat, low carb). Fundamentally a calorie is a calorie. However, if you eat a "training" diet, you will not feel full all day and will almost definitely start overeating. This is not bad, because athletes undereating feel horrible and perform worse. If you eat a "weight loss" diet, you will not have the energy (carbohydrates) to operate at your level continuously all week long. When the energy starts to go away, you'll start to overeat in order to train harder/better. Net result in both categories: no weight loss.

It is possible to exercise (note, not train) and lose weight. You have to exercise realizing that you aren't going to significantly improve your performance (the best you can hope for is losing weight only partially from your muscles), that you're not going to perform at your peak, that you're not going to feel great after two or three hours at a go (due to glycogen depletion), and that you can't compensate for your exercise with eating. It's not very fun. I can't manage it consistently, so I don't expect anyone else to be able to manage it. Hence, my advice to pick training or losing weight.
posted by saeculorum at 6:16 PM on October 30, 2013 [8 favorites]

I feel you; I've been on 1230 calories a day since August. It's hard. Is there wiggle room to pick your battles? I can handle being hungry in the middle of the day because I'm so busy, but doing without in the evening makes me feel deprived. I tend to do a standard daily breakfast of around 450 calories, fruits and raw vegetables in the midday and afternoon, and that leaves me enough leeway for a normal dinner. For me, alcohol is completely out and so would be pastry in the afternoon -- the calorie trade off is not worth it.
posted by xo at 6:17 PM on October 30, 2013 [1 favorite]

Well, first of all, congratulations on your efficient metabolism! You'll be running laps around the rest of us while we starve during the apocalypse.

But seriously, your situation sounds rough! Can you ask your partner to share a smaller meal with you in the evenings, so you don't feel as deprived? Your partner could eat more at another time. I would also consider moving your exercise time later in the day. That way, it won't be making you as hungry throughout the day, and will give you something else to focus on other than food in the evenings. I would discuss all of these feelings with your doctor and dietician - they know that psychosocial factors play a huge role in successful weight loss, and will be able to guide your personal plan better than us.
posted by fermezporte at 6:26 PM on October 30, 2013

One book that helped me through the nutritional minefield is 'Racing Weight'.

Nancy Clark is also another great resource.

Another thing I bear in mind, as a more medium-sized athlete, is only to 'carb up' for activities over a certain time limit (so for me, my longer runs and bike rides). Anything under 1.5hrs I don't really take in that much more.

It might also help to think in terms of nutrition rather than calories in/out. But full marks to you for getting out there and being the healthiest you can. When I raced seriously, I was in the grip of an eating disorder and now I'd rather be heavier than thinner and doing terrible things to my insides.

Hope you find the balance that works for you.
posted by poissonrouge at 6:41 PM on October 30, 2013 [1 favorite]

Former bike racer and current cycling coach for a triathlon team here:

Is there any really good reason to limit your calories so much? What is more important to you: losing weight or performing well in your training and racing? As said above, you can't really have both. As it's the off-season (here in the U.S. at least), you would do well to curb your training a bit and focus on the calorie restriction.

In the bike racing world, the accepted wisdom is that you don't try to lose weight during the racing season, only in the off-season. I recommend a similar approach.
posted by computech_apolloniajames at 6:45 PM on October 30, 2013 [3 favorites]

Best answer: I am not a doctor, but has you doctor considered prescribing Metformin for the insulin resistance?

Secondly, I am generally a fan of changing one thing at a time in situations like this - otherwise how do you know what part worked? I would comply on the calories, but eat them at whichever time of day makes you happiest. Several studies have demonstrated that time of day doesn't affect weight loss/gain. If after a few weeks that doesn't change anything, then try front loading your day as suggested by the doctors.
posted by cecic at 6:46 PM on October 30, 2013 [2 favorites]

So that we have all the info, can you share what medication(s) are you taking that cause insulin resistance? Olanzapine or something in that class of drugs?
posted by killdevil at 6:47 PM on October 30, 2013

Best answer: First, be honest with yourself about what you're eating. I will simply say that I don't really believe that you are training the way you think you are and only eating 1400 calories a day. Either you are not training the way you think you are (for instance, by training at a lower heart rate zone and not burning as many calories as you think) or you are not eating only 1400 calories a day. The math just doesn't work out.

You have no way of knowing this. There are lots of people who eat restricted calorie diets and are still heavy. I'm saying this as someone who used to have what amounted to a compulsive overeating disorder (eating around 4000-5000 calories almost every day, little or no exercise) and who has always been thin. I would have been gaining 10 pounds a week if it was just about calories expended versus calories consumed. Nutrition and metabolism are extremely complicated and individual and not entirely understood. It is not just about the "math". It's entirely possible that they are doing and eating exactly what they say they are. Especially when you add in medication that causes insulin resistance.

As far as coping goes:

(1) Have you tried or asked your doctor(s) about the possibility of trying medications that improve insulin sensitivity?

(2) Agreeing with the other suggestion that skipping food in the middle of the day and eating a little bit more at night might be less difficult. Occasionally when I'm super busy and don't want to take a real lunch break and also didn't bring food to work, I end up eating significantly less than I do on normal days without really feeling that much effect, because I eat enough for dinner.
posted by treese at 6:51 PM on October 30, 2013 [16 favorites]

Have you tried varying your exercise routine? It's much easier for me, when hungry, to get through 20 minutes of high intensity and/or heavy weights than 90 minutes of long slow distance. Shorter higher intensity workouts might be more feasible, though perhaps not as ideal for triathlon training.
posted by lab.beetle at 7:10 PM on October 30, 2013

Best answer: I think you need a second, third, fourth opinion, until you find a doctor who is willing to work with you to achieve your health and fitness goals in a way that allows you to stay mentally and physically well. Because it sounds as though this diet, even if it's leading to weight loss, isn't actually helping your overall health much if it's leading to fatigue, anxiety, constant hunger, and inability to enjoy your exercise program. I'd also insist on a second opinion after any doctor told me to eat substantially below BMR indefinitely. What you're doing now is not good for you, and it's not sustainable, which means that in the long-term, you're not likely to be able to maintain any weight loss you achieve on this diet. I'd start looking for new doctors. And discuss every possibility: new medication, diet changes, adding treatments that might counterbalance the side-effects of your medication, etc. Everything should be on the table, because you need to find a way to live your life, permanently, that allows you to be as happy and healthy as is possible for you. And it sounds as though this diet isn't it.
posted by decathecting at 7:18 PM on October 30, 2013 [15 favorites]

I'm currently aiming for 1370 net calories per day, and I've been cycling 80-120 miles per week since April. I've found that Strava and a Garmin Edge 800 do a decent job of estimating exercise calories, far better than online calculators. You might try logging workouts on Strava and "eating back" its reported number of calories (scare quotes because I prefer to think of it as "replenishing" energy expended). I've lost 42 lbs. since January, while improving my average speed and endurance on long rides (50-110 miles).

I did find the first few weeks the hardest (I started on Jan. 6). By February, I had gotten used to a substantial calorie deficit, and things improved: I was no longer as ravenous, and I seem to have gotten better at drawing on my fat stores during endurance exercise. I did bonk once this year, but in general I find I can ride a lot longer than I used to without eating. You may find that after a month or six weeks, the restriction is easier to endure.

As for eating back a lower percentage of exercise calories: have your doctor and dietician explained why they want you to do this? At your height and weight, it doesn't seem to make a lot of sense to random strangers on the Internet, but presumably they have good reasons to do so.

Air-popped popcorn and pickles are great ways to fill up without extra calories. Unless you need to limit sodium, I recommend the pickles. But then, I love pickles, so I'm not exactly unbiased. If dinner with your partner is suffering, how about a dinner salad? Greens, celery, peppers, and a little bit of nuts, cheese, or sausage makes for a satisfying meal without many calories. Soups are also good: use low fat, low sodium stock or broth as a base, add vegetables and legumes, and perhaps a little meat if you want the flavor.

A final point to keep in mind: feedback is crucial. You can estimate calories eaten, BMR, TDEE, exercise calories, etc., but when push comes to shove, the key factor is how much you're losing. If you lose a pound a week, you're effectively running a daily deficit of 500 calories, regardless of what the other numbers are. If you're maintaining weight, then you're not running a deficit, regardless of the numbers. Use estimates as a tool, but if your numbers say that your daily deficit is 750 calories, and you're losing a pound a week, then your numbers are wrong. Look at results and adjust your assumptions accordingly.
posted by brianogilvie at 7:24 PM on October 30, 2013 [3 favorites]

Response by poster: killdevil: yes, it's an atypical antipsychotic (aripiprazole).
posted by dorque at 7:33 PM on October 30, 2013

oof, yeah, those drugs are notorious for both weight gain and insulin resistance, sorry about that. Seconding asking your doctor about metformin. There appears to be an established literature about using it together with antipsychotics to reverse or ameliorate the side effects (e.g.) and it appears to have relatively few side effects of its own. Good luck!
posted by en forme de poire at 7:39 PM on October 30, 2013 [1 favorite]

I know this is doctor's orders, but is the front loading of calories to breakfast and lunch due to the thinking that it will cause faster weight loss? I personally have never been able to lose weight without saving well over half of my calories for a late dinner. It's both a psychological and physical thing (can't go to bed hungry)
posted by whistle pig at 7:43 PM on October 30, 2013 [2 favorites]

Is the 5:2 diet a possibility? 5 days of eating ~1700 calories, 2 days of eating ~500 calories (and not training on those days of extreme calorie restriction). Dr. Mosley's stance is that there isn't a huge difference when you eat those calories, just time your meals so it's easiest on you psychologically/hunger-wise. Some people really need breakfast, some people really need dinner. I haven't tried the 5:2 split yet myself, but at least from an emotional reaction, it feels much more doable for the long haul than a constant ~1350 calories a day, even though it works out to the same weekly caloric intake.
posted by spamandkimchi at 9:04 PM on October 30, 2013 [1 favorite]

I wonder if your calories are too restricted to be reasonable. For instance, right now I'm doing weight watchers, which has one of the best records of success. I punched your info into a calculator and found that, on WW, you would get 34 points/day, which is approximately 1700 calories, plus you would get extra points for working out (which you can choose to use or not).

I'm saying this not to suggest that you should do WW (though it is great!) but that 1200 is a really low calorie amount and I think most people would have trouble staying on such a regimen. The thing is, a weight loss program is only going to be successful if you can stick with it. And if you're constantly feeling tired and hungry, and can't do the things that make you feel good (training, spending time with your partner), you're not going to be able to stick with it.

I think it's worth going back to your dietitian and doctor and telling them the ways this is not working for you. Tell them you need to find something that DOES work for you.
posted by lunasol at 10:42 PM on October 30, 2013 [1 favorite]

Best answer: You have lost weight. While on Abilify. You have lost weight while on Abilify. Dear lord, have some reasonable expectations of yourself! You're trending downwards on a drug that a lot of people cannot even vaguely maintain weight while they're on it. You are doing great. Have some reasonable expectations, here--you'd be doing pretty well even to be maintaining. Some people seem to magically miss that side effect, but I know a lot of people who've gained 40+ pounds while taking this sort of thing. Like, a pound a week sort of thing. If your exercise regimen and stuff keeps you at a stable weight, you are effectively working hard enough to lose a pound a week, otherwise. If you are losing weight on top of that, you're doing even better.

You don't need to buckle down and try harder, you need to have reasonable expectations about what your body can accomplish. You're making progress and you seem to be doing great about getting generally healthier. You are doing the right things. Check into the metformin because it helps some people, but if that doesn't work, don't starve yourself to try to compensate. Take your time. Your doctor's advice probably is what you need to lose weight quickly, but maintaining your overall progress is a lot more important than your waistline.
posted by Sequence at 11:37 PM on October 30, 2013 [11 favorites]

Is it worth shifting your eating period to later in the day? There is a range of evidence that eating first thing may not be beneficial due to cortisol release interfering with insulin, causing hunger shortly after. A decent article on the subject with numerous sources: Why does breakfast make me hungry? I understand there are numerous studies claiming individuals who eat a 'proper' breakfast have better diets, but these studies are typically observed rather than controlled, which potentially suggests other factors may influence the better diets.
posted by bumcivilian at 2:21 AM on October 31, 2013

Now, as of a few weeks ago, my doctor and sports dietitian have had me drop down to 1200-1400 cal/day, restrict my carbs, and eat back an even smaller percentage of my exercise calories.

You're a triathlete, and 210 lbs/5'7"?

That level of restriction seems batshit insane. I would seek a second opinion from another doctor.
posted by A Terrible Llama at 3:12 AM on October 31, 2013 [3 favorites]

There are a few things I've learned from my own vaguely-similar struggles.

1) People, including doctors, overgeneralize personal experience and anecdote to what will work for everyone. What they think will work for you might not.

2) The most important thing is to track whether what you're doing is working. It seems like what you were doing before (~1700 calories, 7 hrs/week of 75% exercise) wasn't working to accomplish your goals. That's not a moral judgement, that's a reality you observed.

3) Now that you can track what works, you are free to experiment to find something that does work. Your doctor and dietician gave you a new system that might or might not work to lose weight, but definitely isn't working to keep you happy and sane. I would call that also a failure. It's possible it'll get easier after a week or three more; that was not my experience though. But you don't need permission from anyone besides yourself to try something new. There are lots of suggestions in the thread (move calories around in the day, redefine success, exercise harder, eat different food, eat only on some days...). You don't have to know what will work before you do it - all you have to do is pick one, really do it for long enough to find out if it works, and then either change or stick (depending on whether it works). If you think of it as brainstorming ideas to try, it can be much easier to come up with plans and then evaluate what you want to try next.

4) As long as you stick pretty well to whatever you're trying, you're doing a good job. It's not a failure of character if it doesn't work, it's a failure of whatever plan you're evaluating. All you have to do is measure what's working, (how happy are you? How constantly-hungry are you? How much weight are you losing?) and adjust accordingly.

Good luck!
posted by contrarian at 5:11 AM on October 31, 2013 [2 favorites]

Dear god, that sounds horrible, and I'm sorry your doctors aren't working with you on this. Read Yoni Freedhoff for a different perspective. The best diet is the one that works for you.

I would agree with seeing a different doctor and asking about Metformin. Also -- have you had all the Usual Suspects tested (thyroid, Vits D and B12, etc.)?
posted by pie ninja at 5:54 AM on October 31, 2013

I don't think you can stay sane on a diet like that. I've read about starvation studies that were more lenient than what your doctor has prescribed.

Have you ever considered going more of a paleo route? Good fats, protein, vegetables in that order, with no grains or legumes and limited white potatoes. You can learn more about it at Robb Wolf's site or here at Mark's Daily Apple.

I'm prejudiced in its favor because I (female, over forty, obese, on prednisone) have lost over 100 lbs on it, while lowering my blood pressure, backing out of pre-diabetes, and improving my cholesterol profile. Losing weight on prednisone is notoriously difficult, and it also increases your diabetes risk, so doing this while taking it is a bit miraculous.

It's also ridiculously easy to follow, and you don't have to worry too much about counting calories.

Personally, I feel like the more rules I have around food, the more obsessed with food I am. Dropping grain and sugar has really been my only hard-and-fast rule. And by "hard and fast" I mean, I am not above indulging in a few scoops of ice cream once or twice a month.

If you're really serious and don't mind a lot of rules, you could also check out Whole 30, which is basically a really strict version of paleo that you try for 30 days to see what happens.

Last point, I think it's more important to limit between-meal snacking than it is to pick when you have your meals. If I were you, I'd make dinner with my SO the most important/calorie-rich meal of my day, and save most of my carbs for whatever meal is pre-workout.

Good luck!
posted by kythuen at 6:14 AM on October 31, 2013 [6 favorites]

Nthing more protein and more fat! It's the only thing that worked for me. I felt full and fat melted off with no sense of desperation, or feeling like I was doing something unhealthy to myself (which is how I always felt when I tried to limit food while not getting enough fat and protein.) As someone above said: Paleo works.
posted by thegreatfleecircus at 6:52 AM on October 31, 2013

Mod note: folks please don't start an argument about calories in this thread and direct answers towards the OP
posted by jessamyn (staff) at 7:05 AM on October 31, 2013

Can you ask your doctors if you can up your calorie intake for a month or so and in that month train yourself away from carb addiction? I used to have a monsterous sweet tooth with a tendency towards CARB CARB CARB hugemungous breakfastses and when I decided that needed to change I was floored by how much more protein/ fat things I could eat comfortably (without feeling grossly full) and wanted to eat. I never counted calories, but I went from eating 2 bowl of cereal to eating 2 eggs, with a thick bacon strip and with a fistfull of some veg sauteed in the bacon grease. I got more sustained energy, but it did take about a month for the carb beast to go away, especially since carbs seem to require less effort to prepare for a meal.
posted by WeekendJen at 10:03 AM on October 31, 2013

I think the suggestions about moving around when you consume theses calories are worth pursuing. If you could eat a small breakfast and lunch and then have a bigger dinner with your SO that would be nice, right? I think the science on this one might be mixed so why not try it?

When are you eating in relation to the exercise that you do? Can you make sure you're getting calories before you exercise for fuel? Personally, I have to have a small snack about 2 hours before I go running in order to have enough fuel to go the miles. If I have it too close to exercise time, I get all nauseous. If I don't fuel up, I want to quit the entire time and it's awful. (It took some trial and error to figure that out.) My pre-exercise snack also has to include fats, protein and readily accessible sugars. For me this means Lara bars or an apple with a cheese stick or nuts.

Personally, I don't understand the "eating back" exercise calories concept. Isn't it really hard to gauge how many calories a person actually burns during exercise? Plus then food can get tied to exercise as some sort of reward and for my own sanity, the endorphins from exercise have to be reward enough. That's my baggage though.

Making big dietary changes is HARD. And deeply emotional because food is such a primal need. It's normal to struggle and have feelings, is what I'm saying.

Any changes you make need to be somewhat sustainable long-term. People don't lose weight and keep it off by dieting, they keep it off by changing their lifestyle. Something more to think about as you tackle this challenge.

I'm rooting for you.
posted by purple_bird at 1:22 PM on October 31, 2013

Your weight is not a good measure of health, you could weigh a third as much as you do and have a higher body fat percentage. You should calculate your lean muscle mass (using something other than tape) and work from there.
Your resting metabolism is directly impacted by your lean muscle mass. If restricting your calories sucks the life out of you and you can't imagine restricting even further, why not try the other side of that equation and take up weight lifting?
You're getting enough protein in your diet to put on muscle, and don't let anyone tell you that you can't gain muscle while on a calorie restricted diet. You can and you will. Not to mention that the endorphins that newbie weight lifters get will do a lot to elevate your mood.
posted by domo at 2:51 PM on October 31, 2013

Response by poster: Sequence: to be fair, the losing-weight-while-on-Abilify part did come after the gaining-lots-of-weight-while-on-Abilify part. :)

Thanks all, lots to think about. Restraining myself from going through and ticking best answer on just about everything.
posted by dorque at 8:39 AM on November 1, 2013

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