Why would someone seek out my professional services to design a low carb or ketogenic meal plan for them, when there are any number of online services that will make ‘personalized’ or ‘customized’ meal plans for free- or only for the cost of a monthly membership?
There is a big difference between an Individual Meal Plan designed for someone by a professional and which is specific to their health background and risk factors, and personalizing or customizing an existing meal plan to a person’s goals, likes and dislikes, using a computerized algorithm.
There are a number of websites that encourage people to use their tools to reach their weight loss goals faster.
One email I received said recently read;
“Tell us what your health goals are and what you like to eat. In minutes, you’ll have a custom-made keto or low-carb meal plan. It’s the perfect meal plan for you.”
This site and other similar types of websites calculate the protein, carbs, fat and total calories for a person to reach their weight goals based on their own computer algorithm, and then provide recipes based on the person’s likes and dislikes that fit those “macros”. The question is will it be the perfect meal plan for you?
It may, or it may not.
Those Without Pre-Existing Conditions
If you have not been diagnosed with type 2 diabetes or pre-diabetes, have normal blood pressure and cholesterol, and have not been diagnosed with any other health conditions and just want to lose weight, then one of these online diets that can be personalized or customized with your likes and dislikes may be a good way to get started. Speak with your doctor before beginning any diet, including one I may design for you.
Some sites and algorithms may be better than others, so look around. In general, I would consider whether a website provides scholarly references in their blogs as possibly being a better place to start, over websites that don’t list their source of information (more about that in this article).
It has been my experience that ~1/3 of clients end up coming to me after doing one of these online low carb or keto diets. Some reach out when they find themselves stuck in a long-term weight-stall, after initially losing some weight. Others, especially peri- and post-menopausal women come to me after they don’t lose weight or in some cases, gain weight. The “macros” may fit the particular website’s algorithm, but not them.
There are also some people who lose weight just fine using an online diet, but end up contacting me after their follow-up lab tests indicate that their cholesterol has gone up a lot, and their doctor wants to put them on medication. Then what?
…and of course, there are those who lose weight successfully with no negative outcomes whatsoever and that is great stuff!
The question is, are online meal plans a good approach for you?
Those With Pre-Existing Conditions
If you have been diagnosed with type 2 diabetes or pre-diabetes, have high blood pressure or cholesterol, then working with a professional is important — especially if you are taking medication. As outlined in a previous article, people should not begin a low carb or very low carb (keto) diet if they are taking certain types of medication, especially:
(1) insulin
(2) medication to lower blood glucose such as sodium glucose co-transporter 2 (SGLT2) medication including Invokana, Forxiga, Xigduo, Jardiance, etc. and other types of glucose lowering medication such as Victoza, etc.
(3) medication for blood pressure such as Ramipril, Lasix (furosemide), Lisinopril / ACE inhibitors, Atenolol / βâ‚ receptor antagonists
(4) mental health medication such as antidepressants, medication for anxiety disorder, and mood stabilizers for bipolar disorder and schizophrenia.
When people approach me for services and are taking insulin or insulin analogues, I refer them to someone with CDE certification who can help them to adjust their dosage, as carbohydrates are gradually reduced. I am not a CDE and do not see people taking insulin or insulin analogues. That said, I have worked with people’s doctors who have gradually deprescribed insulin, as their patients begin to follow a low carbohydrate Meal Plan that I have designed for them.
For those who are taking some of the other medications listed above and with people’s written permission, I coordinate care with their doctors who oversee their patient’s care and adjust medication dosages, as the quantity of carbohydrate is gradually reduced.
This is definitely not something people should do on their own!
As outlined in the article referred to just above, depending on the medication there can be serious side effects.
But what if you don’t have any health conditions and don’t take any medications? Does that mean you are “fine”? Maybe, maybe not.
Very Few People Are Metabolically Healthy
A study published in November 2018 in the journal Metabolic Syndrome and Related Disorders found that 88% of people are already metabolically unhealthy[1].
If you have not been told you have diabetes or pre-diabetes, high blood pressure or high cholesterol, then how do you know if you are among the 12% that are still metabolically healthy?
Here are a few questions that you can ask yourself to help you determine if you may be part of the small metabolically healthy group of people — or part of the 88% that are already metabolically unhealthy:
Are you carrying excess weight around the middle? If you are a guy and your waist circumference > 40 inches or 102 cm or are a woman and your waist circumference >34.5 inches (88 cm) then the answer is you are already part of those who would be considered metabolically unhealthy [1].
An even easier way is to measure your waist-to-height ratio as described in this article, and if the result is more than 0.50 then you are at increased risk of cardiovascular disease[2]. If you have already been told that you have type 2 diabetes or pre-diabetes, high blood pressure or high cholesterol, then your risk is even higher.
Do you have blood pressure higher than 120/70? If either the top number (systolic blood pressure) is larger than 120 and the bottom number (diastolic blood pressure) is larger than 70, then you are part of those who would be considered metabolically unhealthy, based on this study.
Do you have high fasting blood sugar? Is your blood sugar measured first thing in the morning after not eating anything for 10 or 12 hours > 5.5 mmol/L (100 mg/dL)? If yes, you are already part of those who would be considered metabolically unhealthy.
If your fasting blood glucose test comes back normal, does this mean everything’s “fine”? Maybe yes, maybe no. This previous article explains the different stages that exist before people are diagnosed as having pre-diabetes –when their fasting blood sugar is fine, but their ability to regulate blood sugar is already ‘not fine’.
What about your insulin response? A large-scale 2016 study found that 75% of those with normal fasting blood sugar and normal blood sugar after a 2 hour Oral Glucose Tolerance Test had abnormal blood sugar results between 30 minutes and 60 minutes — indicating that they were at increased risk of being diagnosed with type 2 diabetes, even though their 2 hour Oral Glucose Test results were still normal.
Is your three-month estimated average blood sugar (HbA1C) high? If your HbA1C is > 5.7% then you are already showing signs of being metabolically unhealthy.
Do you have “high cholesterol”? Are your triglycerides > 1.7 mmol/l ((150 mg/dl) or your HDL (good cholesterol) < 1.00 mmol/L (<40 mg/dl) if you are a man or >1.30 mmol/L (50 mg/dl) if you are a woman, then based on this study you are already considered metabolically unhealthy.
Getting an Individual Meal Plan?
If you have already been diagnosed with any of the conditions mentioned above — and especially if you are taking medication for them, then speak with your doctor about working with a Registered Dietitian such as myself to design an Individual Meal Plan for you. Some physicians and other healthcare professionals who are familiar with the therapeutic benefits of a low carb or very low carb (keto) diet refer their patients to me, and we work together to coordinate care, as described above.
I design people’s Meal Plan based on their specific macronutrient needs, taking into account their age, gender, stage of life, health history and previous diagnoses, lab work, any medications taken, food likes and dislikes, religious preferences, time constraints, as well as cooking ability. I design each person’s Meal Plan in such a way as to be as close to how they like to eat, with the “fixes” built in.
For those who don’t know if they are metabolically healthy or not, we find out in the course of me assessing them as I look at all of the parameters outlined above. If they are already showing signs of being metabolically unhealthy, then I will design their Meal Plan in such a way as to enable them to make dietary- and lifestyle changes that may delay- or even prevent diagnosis of some of the conditions mentioned above.
Final Thoughts
The “best macros” are the ones designed for each person in light of any health conditions and risk factors.
There is no one-sized-fits-all low carb or keto diet©.
More Info?
If you would like more information about my services, then please have a look under the tab of that name or send me a note through the Contact Me form.
To your good health!
Joy
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References
- Araíºjo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009—2016. Metabolic Syndrome and Related Disorders Vol 20, No. 20, pg 1-7, DOI: 10.1089/met.2018.0105
- Ashwell M, Gunn P, Gibson S (2012) Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev 13: 275—286
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