Speaker A [00:00:02]:
Welcome to the Paralysis Nutrition Podcast, where changing your eating habits is the key to losing weight, improving bowel health, and feeling your best. I’m your host, Fatima Fakouri. I’m a registered dietitian who’s married to a quadriplegic and specializes in nutrition for paralysis. Get ready to be inspired, educated and motivated so you can take control of your health using the power of food. Let’s get started. This is the Paralysis Nutrition Podcast. Hi, everyone. Today on the podcast, I have my very good friend and colleague Devika Sharma, who is a registered dietitian.
Speaker A [00:00:36]:
Devika, welcome to the Paralysis Nutrition Podcast.
Speaker B [00:00:40]:
Thank you for having me. I’m excited.
Speaker A [00:00:43]:
So now I’m going. I’m just going to tell everybody today that Dev has the most amazing cookbook and I want you to first tell us about it and then we’re going to get into the episode. Tell us about the cookbook. I absolutely love it. I have it in my kitchen.
Speaker B [00:00:58]:
Yeah. So the cookbook, it’s called Macro Cookbook for Beginners. It’s geared towards anyone who doesn’t really know what macronutrients are, who’s looking to change up the way that their approach to nutrition is, in particular, if they’re trying to hit a goal. I talk about the importance of macronutrients, how it’s different from calorie counting. It goes through all of it. It’s got a two week meal plan, it’s got 100 recipes to help make this easy.
Speaker A [00:01:25]:
Amazing.
Speaker C [00:01:25]:
Thank you.
Speaker A [00:01:26]:
I appreciate it so much. So that is exactly what we’re going to talk about today. I want you to talk to me about macros because most people don’t really know what they are. So in my program, we do macros. We also do calories, right. Because calories matter. So can you, Dev, tell the listeners why do you like macro counting? Why do you not just promote calorie counting on your page?
Speaker B [00:01:56]:
Absolutely. Okay, well, I think first let’s just talk a little bit about what macro tracking is and the way that I view it. It’s just a way of eating that focuses more on the three macronutrients. So carbs, protein and fat, and each one is really important to the body. It really does shift the idea of certain foods that need to be restricted to more of an inclusive approach where all foods fit.
Speaker C [00:02:21]:
Okay.
Speaker B [00:02:22]:
The key with macro tracking is, you know, you really do want to choose quality foods versus just quantity.
Speaker C [00:02:29]:
Right.
Speaker B [00:02:29]:
So it’s really important to get that part in. So macro tracking is different than calorie counting in the Sense that, well, calories do come from macros. So if you’re tracking macros, you’ll be tracking your calories. Right. It goes hand in hand. But the difference is when you’re calorie counting, you’re not focusing so much on a specific target range. So for each macronutrient, so you can actually put yourself in an imbalance of each one. Like you could run on a 60, 70, 80% carbohydrate diet, which makes it harder to actually lose weight if that’s your goal or if you’re trying to put on muscle.
Speaker B [00:03:00]:
So with macro, the goal is to actually hit a specific amount of each protein, carbohydrate and fat within a specific calorie range. So this is better than calorie counting in the sense that, you know you’re going to hit certain nutrients that your body is going to need to reach a certain goal, whether that be lose weight or put on muscle or whatever it may be.
Speaker A [00:03:21]:
Okay. I love that you really laid it out for us because. Yeah, because most people now, you know, all of my clients and people who follow my page are living with paralysis, right. So they know that they burn less energy as wheelchair users. And so the focus for so many people is to eat as little as possible. And what happens in a lot of cases is that they’re under eating. Right. And so when you under eat, it is impossible to lose weight.
Speaker A [00:03:53]:
It’s just not going to happen. And I think that a really good point that you made is that if you’re eating 70 or 80% of your calories from carbs, you’re not going to be able to lose weight. You’re going to actually lose muscle and it’s going to be so hard to be full. Right. So how are you going to lose weight if you’re not eating enough protein, if you’re not eating enough healthy fat, and if you’re eating too many carbs. So, so I love that because you laid it out really, really simply. So what in terms of percentages, because in my group coaching, I do work with people to figure out their percentages. I know in your cookbook you have this whole very, very informative section in the beginning about percentages.
Speaker A [00:04:45]:
So in general, right, because we’re speaking in general here, what do you think is a good weight loss macro percentage? Like, what does that look like for proteins, carbs and fats?
Speaker C [00:04:57]:
Right.
Speaker B [00:04:58]:
So basically, the way. I just want to say one thing with tracking macros, I always look at it as trial and error. So what’s going to Work for me, may not work for somebody else. So as a general starting point, I usually go with a 45% carbohydrate, 30% protein, and 25% fat. So I find that one to be a very good starting point. And then you can sort of change things the way, you know, you’re going about and doing things. So if you need, you know, a little bit more protein, you can go up to about 35%. So each macronutrient does have what we call the macronutrient distribution range.
Speaker B [00:05:33]:
So for carbs, it’s anywhere between 45 and 65. For protein, it’s 10 to 35, and fat is 20 to 35. So you can kind of adjust your range as you feel it’s needed. But that is the starting point for almost all of my clients. Clients as well, Yes.
Speaker A [00:05:48]:
I love that. Now, with. I think with paralysis, there is reason to go a bit lower on the cow, on the carbs, because you’re not burning as much energy. And I have noticed, too, that people with paralysis really do go for convenience foods, like we all do.
Speaker C [00:06:13]:
Right.
Speaker A [00:06:13]:
Like, people are reaching for the easiest thing. Now, that’s in the beginning. That’s in the beginning, when I start working with them is that they’ll track what they typically eat, and it’s like peanut butter and toast for breakfast, and then it’s like a sandwich, and then it’s like pasta for dinner. And I think that even the people who eat healthy, they’re eating way too many carbs. And that’s not just people with paralysis. That’s everybody, you know?
Speaker B [00:06:40]:
I agree.
Speaker A [00:06:41]:
And when you don’t know what foods have carbs or you’re confused about how many people think that peanut butter is a protein or that hummus is a protein.
Speaker C [00:06:51]:
Right.
Speaker A [00:06:51]:
It’s not. Those foods have protein, but they’re not, like, great sources of protein. So when it comes to, I guess, getting your numbers right, what do you think is, like, your top few tips? Because I’ll tell you right now, most of the people in my program, they are coming in a bit high on the carbs or really high on the carbs, and they even can be a bit low on the fat, I find. And I think that can sometimes be a tracking error.
Speaker C [00:07:22]:
Right?
Speaker A [00:07:23]:
You know, people forget to put in the olive oil or people aren’t quite cognizant of measurements and portions and things. So for somebody who has been counting calories, for example, what would be like, your top few tips to get into macro counting?
Speaker B [00:07:40]:
So this is one of the basic Things I feel like it’s often overlooked. But when you’re starting out and you have no clue as to how much of what needs to be on your plate, I do usually recommend starting with the plate method. And that’s basically when you have your plate, you’re going half veggies, quarter, you know, your carb, and then quarter protein. Because that’s going to start to give you a little bit more of an idea of what is on your plate.
Speaker C [00:08:06]:
Right.
Speaker B [00:08:06]:
If you know you’re getting a protein source on there, then you know you’re not going to have as much carbs. Right. So the first thing that I usually say when people don’t know what they’re doing and they’re just tracking carbs is look at your, look at your plate and is it balanced? Okay. The two approaches is I break down carbs into different categories for my clients, so it’s a bit easier. But you know, the way I look at it is do you have your carb veggie, do you have your carb whole grain? Do you have your protein and do you have your healthy fat? So those are kind of the four components that I look at each meal.
Speaker A [00:08:34]:
So you have a carb veggie and, and a carb whole grain. See, so that makes sense because some vegetables are really, really low in carbs, but some vegetables are a bit higher in carbs. And so I think that can, that, you know, when people track like in an app, that’s very. It can be surprising.
Speaker B [00:08:57]:
Yeah. And so for breakfast though, I do say carb fruit. So because not everybody has vegetables at breakfast, but that’s carb where they’re starting.
Speaker A [00:09:05]:
Yeah.
Speaker B [00:09:05]:
So where they’re starting. That’s one thing I always say is look at it, figure it out. And then when you entering it, start to see, oh, I’m actually short on this or I’m a little bit high on that. And then you can start to adjust it. Now everybody’s plate is also going to be different. Right, Right. But if you are someone, let’s say who is smaller framed or you have, you know, you don’t need a whole ton, your plate size will make a difference. Okay.
Speaker B [00:09:27]:
So that’s one thing I do notice as well. Or if you usually use a bigger plate, I get them to start with using a, like a medium, like, you know, an 8 diameter kind of like a smaller size. And it’s interesting because then they’ll start to see A, the portions are going down and B, how much is actually on their plat. And then the Other thing I do teach them is the hand method, which I find, again, it’s a very simple tool, but it’s getting people into the habit of just trying to visualize the portion that’s actually on their plate. So once you have a handle of A, is my meal balance, B, you get into the habit of looking at different sources of foods. I find that it becomes easier to track because now you’re just fine tuning it. Okay. And if you find that when you’re eating a meal, it’s not keeping you full that long, that’s when I start to say, okay, you need to increase your protein, you need to increase your fiber, foods, right? Because then it becomes more of a manipulation without actually having to track it.
Speaker B [00:10:20]:
Because, you know, I have people who do track, quote unquote, but aren’t actually logging.
Speaker C [00:10:24]:
Right?
Speaker B [00:10:25]:
So at that point, what they’re actually doing is paying more attention to the portions until they feel comfortable. And then when it comes down to losing that last, you know, 5 to 10 pounds, they’re putting it into the app and we’re getting the results that they want.
Speaker A [00:10:37]:
Oh, okay, interesting. So I sort of do it the other way around because. And this is so interesting, right? Speaking to other dietitians and how we run our programs. So I tell people, you got to start tracking in the beginning because I find that most people just don’t know. They simply do not know. And I think that it is, you know, it is a teaching tool. And I will also say when they first join the program, right? It is like a three month program. They are very ready to learn and they are fresh and they are brand new to it and they are excited.
Speaker A [00:11:09]:
So the work of logging into an app, you know, putting your meals into an app is not so bad. In the beginning, I will say I do not expect or even ask anyone to track for three months. I think it’s awesome to track for like six weeks. And then after that, the amount of information that you have, you know, learned is huge. And you know, what certain meal combinations look like. Like you said, everyone’s plate looks different. Cultural differences, right? Regional differences, taste preferences. These are all the reasons why our plates all look different.
Speaker A [00:11:45]:
And so I noticed that people, I don’t want to say lose steam, but it’s almost like they learn and they don’t need to track as much. So then we transition more into a plate method where it’s like, all right, half my plate is veggies, a quarter is protein, a quarter is a starch or a carb. You know, hopefully A complex carb. But it’s interesting because you do it the other way. It’s like, all right, let’s start simpler. Let’s do the plate method. And then those last five to ten pounds, which, of course are the hardest. Yeah, start tracking.
Speaker A [00:12:20]:
That’s interesting.
Speaker B [00:12:21]:
Okay, so I should probably back it up a little bit and say, that’s not for everyone, because my clientele is a bit different.
Speaker C [00:12:27]:
Right.
Speaker B [00:12:27]:
So I have a lot of people who are coming to me with a fear of eating, fear of having carbs. So as soon as they see a number tag associated to anything and tracking, they get really freaked out or too concerned with a number. So for them, it’s a reverse approach to getting them to just eat balanced meals and actually understand that, hey, like, there’s value in each one of, like, these macronutrients. And then for them, if they’re comfortable, then we will track it. Right. And then I do have some who are just like, I know exactly what I want. This is my goal. I want to put on muscle.
Speaker B [00:13:01]:
Help me break it down. And then for those people, obviously, who are calm, comfortable, then we just go right into the tracking. But they already have some kind of framework when they come.
Speaker A [00:13:08]:
Right. So do you get a lot of athletes?
Speaker B [00:13:11]:
Not a lot of athletes, but I do have some clients who are active and they’re just trying to put on muscle or have a hard time putting on weight or putting on muscle.
Speaker A [00:13:21]:
Yeah, we have, like, opposite.
Speaker B [00:13:23]:
Yeah, Maybe that’s why it sounds a little different.
Speaker A [00:13:26]:
I know, and I love that because obviously the topic today is really, like, macros and how to eat, you know, the right ratio and things like that. And it works for literally everyone. So it works for your population, where you said. And I get people like this sometimes, too. Right. It’s usually people who have done a lot of dieting.
Speaker B [00:13:46]:
Dieting.
Speaker A [00:13:46]:
They’re scared to eat fruits. They say in the beginning, like, almost like, as if to get on my good side, they’re like, you know, I don’t eat a lot of bread. And I’m like, you can eat bread.
Speaker B [00:13:58]:
Yeah. I don’t eat a lot of carrots. I’m like, I’ve never heard anyone who’s put on weight just by eating carrots.
Speaker A [00:14:03]:
You can eat carrots.
Speaker B [00:14:04]:
Like, there’s nothing wrong with it.
Speaker A [00:14:06]:
But I hear that’s certainly like, the minority for me is that people who are afraid to eat carbs because they have done so many diets that have confused them. Right. I would say maybe, like, 20% of my clients have a Fear or a hesitancy towards eating carbs. And what’s so great is that once I get them eating fruit and whole grains, usually they feel so much happier because they haven’t eaten those foods, you know, freely in quite some time. And also, it’s really good for your gut.
Speaker C [00:14:42]:
Right.
Speaker A [00:14:43]:
You’re not going to get adequate fiber. You know, you were talking about protein and fiber earlier, about keeping you full. Absolutely. But in my population, you know, the spinal cord injury, the paralysis clients that I have, constipation is a huge issue. So, like, getting enough protein, getting enough fiber, this helps you go to the bathroom.
Speaker B [00:15:01]:
Right? So absolutely.
Speaker A [00:15:02]:
So I do have some clients that are hesitant on the carbs. But I’ll be honest, the majority of my clients are eating too many carbs. Right. And they’re not eating fast food every day. They’re not like eating what I would say, like a poor quality diet. It’s just the ratio right on their plate. Like, most people are not eating enough fiber. Nobody’s eating enough fiber.
Speaker A [00:15:29]:
Yeah.
Speaker B [00:15:30]:
Maybe you and I at that point, maybe. Maybe even some days I think I fall short.
Speaker A [00:15:35]:
But yes. And I know that I do because I recently started tracking because I started a new group recently and the app that I recommend changed. So I was like, you know what? People are asking me questions. I need to just get into this app and tell them, this is where you find this and this is where you find that. So I started tracking, and it’s real interesting. The days that my carbs are on the lower side, there’s no way I got enough fiber.
Speaker C [00:16:01]:
Right.
Speaker A [00:16:02]:
Because fiber comes from carbs.
Speaker B [00:16:05]:
Right. So, you know, the ratio, I would say, out of my clients who fear carbs, I would say is about 70%.
Speaker A [00:16:12]:
Right. Okay. Right.
Speaker B [00:16:14]:
Mine’s quite high. So that’s why for them, they are just. They are just so hesitant to actually add in any fruit, any grains, vegetables they’re okay with. Right. But then the starch, those are safe.
Speaker A [00:16:26]:
Yeah.
Speaker B [00:16:27]:
So. So, yeah, it’s a little. Yeah. It’s interesting to see how different the two populations are.
Speaker A [00:16:31]:
Right.
Speaker B [00:16:32]:
When they’re coming to hit their goals.
Speaker A [00:16:33]:
But yeah, absolutely. But everyone can use macro counting because everyone needs to get enough. Right. I always say adequacy first. So in the beginning, I always tell people, like, let’s work on your protein and fiber. Like, let’s get those up, because the vast majority of people are not eating enough of those. And I say, don’t worry about the carbs. Don’t worry about the fat.
Speaker A [00:16:56]:
Let’s just get your Protein and your veggies up because naturally, like the carbs will go down when your protein and veggies, you know, non starchy veggies go up.
Speaker C [00:17:06]:
Right.
Speaker A [00:17:07]:
So it’s a little game.
Speaker C [00:17:08]:
Right.
Speaker B [00:17:08]:
I feel like it’s like trial and error.
Speaker A [00:17:11]:
Manipulating the number.
Speaker B [00:17:13]:
Yeah.
Speaker A [00:17:13]:
Manipulating the plate, you know.
Speaker C [00:17:15]:
Yeah.
Speaker A [00:17:16]:
And so do you find. Now, I don’t think that there’s an average for how much weight people want to lose, but in my program it’s at least 20, maybe upwards to £50 and beyond. Right. For weight loss. And so it takes a long time.
Speaker B [00:17:35]:
It does take a while.
Speaker A [00:17:36]:
It does take a long time. Can we talk a lot? Can we talk a little about that? So how do you, I guess, how do you see this in terms of timing? Right. Like, I know a lot of dietitians on social media say, like, oh, you should lose a half pound or one pound, up to two pounds per week. And I never really say that because for the paralysis community, they can’t really weigh themselves regularly. Some people can, but most people don’t have a roll on scale or anything like that at home. So I don’t really stress that too much. It’s just like, let’s change our habits and let’s get there. But I would love to hear your perspective on people’s thoughts on how long it should take to lose 10, 20, 30 pounds.
Speaker B [00:18:24]:
So depending on what program they’ve signed up for, I mean, I hear things like, I want to lose £12 in four weeks. And so, you know, a big part of that is I have to go back in there and explain to them, okay, well, this is the signs behind weight loss.
Speaker C [00:18:38]:
Right.
Speaker B [00:18:39]:
And these are the things that can impact your weight loss. So I don’t necessarily promote a certain amount either, unless they ask me specifically. So. Okay, well, how much do you think that I can lose? And so once I’ve explained it to them, you know, I think half a pound to a pound is realistic for my. The people that I deal with. Right, right. A big part of that also is that a lot of them are coming in with so much dieting history that in itself can slow down weight loss. It is like earlier.
Speaker B [00:19:08]:
Yeah.
Speaker A [00:19:09]:
And you’re eating this diet, right?
Speaker C [00:19:13]:
Absolutely.
Speaker B [00:19:13]:
Yeah, absolutely.
Speaker A [00:19:14]:
I actually recorded an episode with our colleague and friend Casey from Hormone Weight Loss, and she was talking about re. Was it re dieting or no undieting. Reverse dieting.
Speaker B [00:19:29]:
Reverse dieting.
Speaker A [00:19:30]:
Reverse dieting. And she gets so many people, her population, she works with women and they have hormone imbalances. And she was like, yeah, it takes months if you’re under eating. So let’s talk about that, about the under eating, because I get quite a bit of, I don’t know, hesitation, maybe pushback from people who are like, listen, I’m quadriplegic. I eat 900 calories a day. I don’t want to eat 1200 because I tell them that no one in my program is allowed to eat less than 1200. And so I try to explain to them that that’s under eating and that it’s tanking your metabolism. How do you approach that dev, when people are like, I’m not going to eat more calories, like, it makes no sense.
Speaker B [00:20:20]:
Okay, that is a fantastic question and one that I deal with all the time. So the first thing that I find that I need to explain to them, or at least go through them is when we do undere, we do lose weight. Absolutely. But that weight is not all fat. That weight is water, that weight is lean muscle mass, and that weight is fat. So the minute we even stop doing what we are doing, or we eat a little bit more or whatever it may be, what ends up happening is we will put on that weight, but it is not necessarily lean body mass. What you are actually putting back on is fat and water. And we all have to remember that muscle will burn more calories at rest than fat.
Speaker B [00:21:00]:
But muscle cannot just be made by eating protein. There is more to it. Like you need to get the resistance training in, so on and so forth. Right? So that’s a big piece. What ends up happening is when we continue with these cycles of under eating and then all of a sudden maybe we eat a little bit more, we continue to undereat, we’re eating away important muscle mass. And that in turn is going to, it’s going to break down, obviously, right? And calorie or your, the amount of calories you burn in rest is going to go down. So this is actually working against us. The second piece that I always talk to them about is we pay a lot of attention to macronutrients, but we forget about micronutrients, okay? We, as an adult, we have certain ranges that we’re supposed to meet for each micronutrient.
Speaker B [00:21:42]:
And there is a reason for that. Certain nutrients, like our B vitamins, for example, they are important for metabolism. So if you’re not eating enough food to get all of the micronutrients you’re getting, then how are you going to sort of fuel that weight loss piece? Right. I mean, we can take pills, I’m not one to say have supplements, but you also have to consider, well, there are a lot of things that are going to impact the absorption of the supplement. So how much of that supplement are you actually absorbing?
Speaker A [00:22:09]:
Exactly.
Speaker B [00:22:10]:
Right. So those are the kind of two biggest approaches I take to that. And they’re like, yeah, okay, you’re right, you’re right. Like, you know, if I feel tired, I’m undereating, I’m not going to want to do X, Y and Z. There’s also a deficiency happening there.
Speaker C [00:22:23]:
Right.
Speaker B [00:22:23]:
And so our body does a very good job at communicating to us, but it’s whether or not we choose to listen to it.
Speaker A [00:22:29]:
So true. So true. And I think that most people just don’t know this.
Speaker B [00:22:35]:
And so.
Speaker A [00:22:36]:
And we also are in a. I don’t know, I feel like everyone just thinks less is more. And so if you’re going to eat less, you’re going to lose weight.
Speaker C [00:22:46]:
Right.
Speaker A [00:22:46]:
But what happens with a lot of people in my community, in the paralysis community, is that I think they under eat for, you know, Monday through Thursday, essentially starving yourself.
Speaker C [00:23:02]:
Right.
Speaker A [00:23:02]:
So like eight, one meal a day, 800 calories, drinking coffee instead of eating lunch, you know?
Speaker B [00:23:08]:
Right.
Speaker A [00:23:09]:
And then on the weekends, it’s a free for all and you’re starving. And so it’s like, oh, I worked hard this whole week, so I’m going to just eat whatever I want. And what people. This is why I love tracking in the beginning, is to show people what their habits have been like before the program. So I say, you know, I want you to track for a week before you make really any changes.
Speaker B [00:23:33]:
Right.
Speaker A [00:23:34]:
And let’s get some data. Because that eating pattern is what got you to where you are now, right?
Speaker B [00:23:40]:
Yes.
Speaker A [00:23:41]:
So it’s kind of like the writing is on the wall. Like if you are a wheelchair user and you would like to lose, I don’t know, 40 pounds, you didn’t put that 40 pounds on in three months.
Speaker C [00:23:54]:
Right.
Speaker A [00:23:55]:
You probably put it on slowly over the years. And what I noticed is that so many people are working so hard to eat as little as possible during the week, and then come the weekend they can’t do it anymore.
Speaker C [00:24:09]:
Right.
Speaker A [00:24:09]:
It’s too hard. And so four days of undereating followed by three days of eating too many calories.
Speaker B [00:24:17]:
Overeating. Yeah.
Speaker A [00:24:19]:
Meaning more calories than their body burns. What happens to the average for the week?
Speaker C [00:24:24]:
Right.
Speaker A [00:24:24]:
What happens to your calorie average for the week is that it is actually higher than it should be. And so that is what is really heartbreaking.
Speaker B [00:24:34]:
Right.
Speaker A [00:24:34]:
Is that people are working so hard during the week to deprive themselves, and then they undo their calorie deficit, which is actually good. I don’t want them to do that. I don’t want them to starve themselves seven days a week. But after the seven days, four days of undereating, three days of overeating, you are stuck, you are stalled. And so I think it is an interesting exercise for anyone to just track a typical week and do it honestly. Like, if you skip breakfast, you know, skip breakfast on the app and see what that looks like. And I’ll tell you, I think that it’s such a good teaching tool to learn, not just logging your meals, but also macro percentages. Because you mentioned about the muscle mass, right? So like, when we under eat, we’re losing muscle mass.
Speaker A [00:25:28]:
That is so bad for people with paralysis, right? Because they’re not able to build muscle. They have no control over their muscles after, you know, a certain level, you know, depending on the level of their injury. So it’s like maintaining your muscle mass and hopefully gaining some muscle mass wherever possible. You know, that’s like a huge goal for some people, but it’s this mentality of as little as possible. Right. And it really causes so much harm.
Speaker B [00:25:59]:
It does. It really does. And this is where tracking macros can actually work in someone’s favor.
Speaker C [00:26:04]:
Right?
Speaker B [00:26:05]:
Because once you become more accepting to the fact that, hey, you can eat X, Y and Z during the week and on the weekends, you’re actually creating a balance for yourself. And that balance is what you need to help reduce muscle wasting. Because that’s what is happening when you are undereating, you are losing muscle mass. And the minute you start overeating, like I said, it’s not going to be stored as muscle mass that’s coming in as fat. Because your body can’t differentiate between, hey, we’re trying to lose muscle. Hey, we’re trying to lose, you know, fat or whatever it may be.
Speaker A [00:26:36]:
It didn’t get the message.
Speaker B [00:26:38]:
No, it didn’t get the message. But yes, that’s why it is important to create that balance and remove that mindset about, oh, it’s just all about calories. It’s not all just about calories. It really isn’t.
Speaker A [00:26:54]:
It’s not.
Speaker C [00:26:54]:
Right.
Speaker A [00:26:55]:
I mean, probably calories are the simpler way, I want to say, of doing it, but I actually think it’s harder because when you’re only focused on the total number and say, for example, you logged breakfast, you logged lunch, and now it’s dinner, Time. If you’re like, okay, I have 500 calories left, you might just say, all right, I’m going to eat pasta. But you didn’t eat any protein, so.
Speaker B [00:27:19]:
Exactly, exactly.
Speaker A [00:27:21]:
It’s so helpful to track macros instead and be like, okay, I need about 18 more grams of protein. I have this many grams of carbs left. I have, you know, so it’s like you can make up for it and actually feels. I don’t know, I mean, I told you, I started tracking like two weeks ago. I don’t track seven days a week. But it does feel very, almost, in a way, liberating because it’s like my choice. It’s my choice how I’m going to fill these percentages up. Right, exactly.
Speaker A [00:27:55]:
Do I want to have toast with my omelet or do I want to have, you know, an apple cider donut later, you know, when we go out to pumpkin picking or whatever?
Speaker B [00:28:06]:
Right, right, right.
Speaker A [00:28:08]:
You can choose these things. And it doesn’t have to be like, ugh, a donut has so many calories. I just, like, can’t eat that. It’s like, no, you can. You just have to plan, you know, you have to plan around.
Speaker B [00:28:20]:
Yes, absolutely. And I think one thing we should mention here, though, is that tracking doesn’t have to be 100% all the time. Because, you know, at the end of the day, there is no A, perfect ratio. B, our days won’t always be perfect. You can step out of that ratio range. Like, you may be maybe 15 grams over in protein one day, maybe 5 grams under. Right. Like, it is still working within that framework, but giving yourself that breathing room of, hey, if I am a little bit order over because I had the cookie, that’s okay.
Speaker B [00:28:52]:
That’s also a big piece of where you really do need to take that macro piece and put it the way it is, but also embrace an 8020 lifestyle, because otherwise it just becomes a number game again.
Speaker A [00:29:04]:
It does. And it’s so interesting that you said 80 20, because so for anyone who doesn’t know the 8020 principle is that 80% of the time, you know, you’re eating very, very much on point, and 20% of the time, you’re a bit more relaxed and you can enjoy some things that are, you know, we would call them fun.
Speaker C [00:29:24]:
Right?
Speaker A [00:29:24]:
So, like, some fun things. And I got to tell you, Dev, 8020 works for most people, but I tell people in my program it’s more like 90 10.
Speaker B [00:29:33]:
Is it okay?
Speaker A [00:29:34]:
I do you know why? And I hate to even say that it’s because with paralysis, like, say, for. Let’s use my husband as an example.
Speaker C [00:29:43]:
Right?
Speaker A [00:29:43]:
Spinal cord injury, 18 years injured. Quadriplegic. If 20% of the time, he were to, like, overeat. It’s so, like, it doesn’t sound like a lot, but as we age. Right. He’s, like, in his 40s now. And I’m not correcting you, by the way, in any shape or form.
Speaker B [00:30:03]:
No. What are you.
Speaker A [00:30:04]:
No, no.
Speaker B [00:30:05]:
You’re just. You know what? This is what I mean, There is no perfect ratio. There is no perfect number. This is what you have found works for your population.
Speaker A [00:30:13]:
Yeah.
Speaker B [00:30:13]:
And that’s great.
Speaker A [00:30:14]:
And I got to tell you, I’m more of an 80, 20 person for me.
Speaker B [00:30:19]:
Right, Right.
Speaker A [00:30:20]:
But for my husband, I do go for, like, 90, 10. So it’s like two meals out of the week. We eat out, we order takeout, whatever. Like that. No, no problem. Because now being in his 40s. Right. And let’s not forget, I didn’t meet him until 10 years post injury.
Speaker A [00:30:38]:
So for 10 years, he was doing goodness knows what.
Speaker B [00:30:41]:
Right, Right.
Speaker A [00:30:42]:
And, like, his weight is fine. I don’t exactly know what it is because we don’t have, like, a wheelchair scale. But, like, if he were to gain 10 pounds, 20 pounds, he would lose his independence.
Speaker C [00:30:54]:
Right.
Speaker A [00:30:54]:
And so the stakes are so high. And, like, also, we didn’t even talk about things like heart disease, things like diabetes, like these sort of medical issues that pop up with age unfortunately do occur in the paralysis community at higher rates.
Speaker C [00:31:14]:
Right.
Speaker A [00:31:15]:
So, like, your chances, or this should say not chances. The prevalence of type 2 diabetes in the spinal cord injury population is like, two and a half times higher than the general population. So I love 80, 20, and I do it for myself, for every person who’s in my program. For my husband, I say 9010 only because. Not because I think, you know, you have to eat healthy all the time. This and that. It’s just. It’s harder.
Speaker C [00:31:41]:
Right.
Speaker A [00:31:41]:
So, like, I know a lot of your clients, like you mentioned, they’re very active. Right. I get clients sometimes that work out six days a week, and they’re eating 1800-2000 calories. This is, like, super active, Right. So it’s like two to three hours a day of exercise, and they’re gaining weight. They’re gaining weight because there’s not really an exact science to figure out how many calories they’re burning.
Speaker C [00:32:08]:
Right.
Speaker A [00:32:08]:
There is, you know, indirect calorimetry. But, like, who has.
Speaker B [00:32:12]:
Who has that? Who has the money for that. Yeah.
Speaker A [00:32:15]:
You know what’s interesting?
Speaker B [00:32:16]:
I wish I had one of those.
Speaker A [00:32:17]:
Wouldn’t it be cool? I actually worked at a doctor’s office that had one. It was a few thousand dollars for to buy it. I have no idea why he even bought it. I think he just thought it was cool. And for anyone who doesn’t know, indirect calorimetry is this really high tech machine and you breathe into it, it measures your gas exchange and it tells you really accurately how many calories your body burns per day. So it tells you your resting energy expenditure. And then based on the gas exchange and things like that, it also figures out your total energy expenditure.
Speaker C [00:32:52]:
Right.
Speaker A [00:32:52]:
So how many calories you burn per day. Most people do not have access to this. Right, right. So I get these guys, usually guys that are drinking protein shakes, better eating protein bars, that are following advice from their trainers. And it’s too many calories. And so it’s so frustrating because they work out a lot and they’re gaining weight. So I think that’s just probably the number one sign that you’re eating too many calories.
Speaker B [00:33:19]:
Yeah. And you know, you’re 19, 10, 80, 20. Again, it looks so different for everyone. Like someone’s 80 20, how they view that, it would be like having a cookie every day. So their 8020 is. No, all my meals are on point versus other people are just like having a glass of wine once a week. Right. That’s what they consider 80 20.
Speaker B [00:33:39]:
Right. So you make a good point. Like 1990, 10. If that’s what works for your population, then that’s amazing.
Speaker A [00:33:45]:
I wish, I Wish it was 80.
Speaker B [00:33:47]:
I wish it was 80 20.
Speaker A [00:33:49]:
Because you know what the other thing is too? We’re talking about macro counting and weight today. But the bowel health is such a big issue, you know, the constipation and everything. And so when people don’t eat well, you know exactly. What happens when you go to a restaurant? What happens to your fiber for the day?
Speaker B [00:34:07]:
Oh yeah, what fiber? I’m just kidding.
Speaker A [00:34:12]:
I can’t even, I cannot even think of anything that we order and we order, you know, nice takeout. We order from like restaurants, you know.
Speaker C [00:34:21]:
Right.
Speaker A [00:34:21]:
There’s no fiber in anything. Like, I’m not ordering anything crazy. Actually, today is takeout night and it’s the fall here in New York. And so we have these kind of fall salads coming out. I order this delicious brussels sprout salad. It has chicken. It’s so delicious. It still doesn’t have that much fiber.
Speaker A [00:34:41]:
Whenever you go out to Eat. It’s not going to be as good, you know, as healthy as when you cook at home.
Speaker B [00:34:48]:
Right.
Speaker A [00:34:50]:
And so when I say the 90 10, it’s not just for weight loss. It’s because people are spending hours sometimes per week in the bathroom. And so when they’re not on point, then their bathroom stuff is not on point, and then their whole schedule is messed up. You know what I mean? So I think that it’s super interesting and I love talking to other dietitians who have different populations, because, I mean, I don’t know any other dietitians that work with people with paralysis. But for you, you get active people, you get a good, I think a good mix, Right. Of men, of women, of young people, this and that. And I get a good mix, too. But everyone’s a wheelchair user, right? So it’s like talking about the calories and the macros and all of that, the stakes are just, like, higher because it’s not only about weight loss.
Speaker A [00:35:39]:
It’s also about maintaining independence. It’s also about remaining like, as. As active and functional as possible. I told you, if my husband, he’s six one or six two, if he gains 20 pounds, he’s not going to be able to, like, slide into his car and go pick up the kids. He’s not going to be able to, like, do the things.
Speaker B [00:36:02]:
Yeah, right.
Speaker A [00:36:03]:
That feel good to him and all that kind of stuff. So obviously I do a lot of weight loss, but I think it really comes down to. And I’m sure you agree to this. It’s how you feel, right? How are you feeling?
Speaker B [00:36:16]:
Absolutely. It makes such a difference. I think that feeling, that mindset, the way you view things, it absolutely impacts your goals and that motivation factor too.
Speaker C [00:36:29]:
Right.
Speaker B [00:36:29]:
If you don’t feel good, it’s like when you have a cold or flu, like, who wants to get out of bed and start working out and eating like, you know, smoothies all day long? Most of the time you just want to rest. Right. And so I agree. The way you feel, the way you view yourself, the way you view, you know, for my population, it’s more about how do they feel in their clothes.
Speaker C [00:36:47]:
Right.
Speaker B [00:36:48]:
That’s such a big point. And if they don’t feel good about themselves, well, it’s going to be a long ride to getting to where they need to go with their weight loss goals. Right. So a big, big portion of what I do is shifting that mindset.
Speaker A [00:37:00]:
Yeah. So much of this is just emotional, right? So much of it. And it depends on the person. Like you Just said, feeling good in your clothes. For my clients, it’s like feeling good in your chair, right? Because you’re in a seated position. You know what happens when you’re in a seated position, right? Like everything in the middle. Everything’s in the middle. And so I think that, yes, it’s good to look good and feel good, but I also think that really the overarching thing, especially as dietitians, is we want people to be healthy.
Speaker A [00:37:38]:
I just had this conversation with a client of mine who was like, I got all my labs done. I feel so much better. I feel energetic. I have more energy to do my workouts. I am sleeping better. She used to also go to the bathroom once a week, once a week. And now she goes seven days a week. And she said, I feel sad though, because I don’t think I have lost any weight.
Speaker A [00:38:01]:
And I said, well, how do you feel? She was like, well, I feel awesome. Like, I feel great. And I said, well, isn’t that also important?
Speaker B [00:38:10]:
Absolutely.
Speaker A [00:38:11]:
And like, so much of the focus is on weight. And of course, you and I, we are weight loss dietitians, right?
Speaker B [00:38:16]:
Like, this is the work that we do.
Speaker A [00:38:18]:
We think it’s important. And yeah, it’s good to feel good and look good. But the biggest thing is let’s not get sick, right? Let’s not become diabetic, let’s not become heart patients at the age of 45. Because that’s also really related to eating well.
Speaker C [00:38:38]:
Right?
Speaker A [00:38:39]:
And weight and health are not always one and the same.
Speaker C [00:38:42]:
Right.
Speaker A [00:38:43]:
They can correlate. For sure.
Speaker B [00:38:45]:
For sure.
Speaker A [00:38:46]:
But there’s so much bias. I think, like, if you were to look at my labs and you didn’t know how much I weighed, you’d be like, oh, she’s teetering on prediabetes. She has borderline high cholesterol. Oh, you know, you might make some assumptions, assumptions about my weight, but they’re actually. You would be wrong if you thought that I was overweight or that I was obese. Because it’s not always about weight. It’s about genetics. It’s about stress hormones.
Speaker A [00:39:13]:
So leave us with some quick lifestyle tips. You are a beautiful cook. You have that awesome cookbook you guys gotta follow Dev on Instagram. She’s at one more bite. But tell us, Dev, your favorite kind of non nutrition related wellness stuff. What’s your few things that you like to do every day to take good care of your health that don’t have to do with nutrition?
Speaker B [00:39:39]:
Okay. So every morning and I do story this, I start my Day off with a quote.
Speaker C [00:39:43]:
Okay.
Speaker B [00:39:44]:
And the goal is to shift the mind so it’s anything I have them ready to go, I’ll read it, I’ll story it. And the reason is because I want to start my day off on a positive note.
Speaker A [00:39:53]:
Okay. I love that.
Speaker B [00:39:54]:
So that’s the first thing I have to, I have to bring that positivity in. It doesn’t mean the rest of my day might be positive, but it is just a way that I get things starting off, that is the first thing. The other thing I always do is I do plan for my day. What is my day going to look like? And I know we said not nutrition, but part of what I do on a day to day basis is oh, do I have my groceries, do I have X, Y and Z?
Speaker C [00:40:17]:
Right.
Speaker B [00:40:17]:
And that is a big part for me. I have a few health issues, I guess you could say maybe that I can’t do as much exercise, but I still will make time to find something that brings me some kind of mental peace. So for me it’s Pilates.
Speaker C [00:40:31]:
Right.
Speaker B [00:40:32]:
So I do schedule that in as well. Another key thing is I do try to get my seven to nine hours of sleep. It’s not always something I can do, but it’s something it’s so important, especially for men. Like I find that when you don’t have the energy, you also, not only do you crave certain things, but just the way you view things and the way that you’re more cranky, your energy levels, it just impacts a day.
Speaker C [00:40:54]:
Right.
Speaker B [00:40:55]:
So that is a big one for me. And hydration. I will do what I need to do to make sure I am getting that water and fluid in for the day. Again, nothing to do with so much of like, you know, losing weight or anything like that. But it is more of a body perspective, mental health again. Right. Just being able to make sure that I am doing what I can do to help my body. And so those are, those are the things.
Speaker B [00:41:21]:
And of course my day to day is quite, quite busy like yours.
Speaker A [00:41:24]:
We have a lot of different stressors.
Speaker B [00:41:26]:
Right. But when I, when it comes down to it, those are the big things that I try to focus on in my day to help dictate how it’s going to go.
Speaker A [00:41:34]:
I love that. So you start with a positive quote. You make sure you have what you need for the day in terms of your food. And I know that you work both at home and outside the home. So it’s like packing lunches and things like that. Your hydration, your movement, some Sort of movement and sleep. The one thing I will add to that is because I see your stories and I know that you do. This is sunlight.
Speaker B [00:41:59]:
Yes, yes, that too.
Speaker A [00:42:01]:
Getting some sun. Yeah, for sure. And I will just say I think it looks different for everyone. Right. But setting up some sort of rituals, Right. To help us just feel like we are in control. And if we have this weight loss goal, it’s going to be really hard to lose weight or do anything. Right.
Speaker A [00:42:23]:
In terms of health and nutrition if we’re not in the right mindset. Right. So I love that you have that. I’m going to do that quote thing. I love that.
Speaker C [00:42:33]:
Yeah.
Speaker B [00:42:33]:
You know, and the biggest takeaway is like, this is one quote I think most of us have heard. But if you fail to plan, plan to fail, like, if you can’t have it ready to go well, then it’s not going to go. Right. And that also I find that on the days I’m also not always 100% on.
Speaker C [00:42:50]:
Right.
Speaker B [00:42:50]:
On the days where I find that I’m doing that, I haven’t planned my day well. Things aren’t going the way I want to. Right. So the results. I’m not getting the results that I want.
Speaker A [00:42:59]:
That is such a good quote. Put that on a post it people. Stick it on your. On your fridge or on your. Wherever that you look at all the time. Thank you so much, Deb. This was such a good conversation. And tell the listeners where they can find you on Instagram and tell them where they can buy your macro counting cookbook.
Speaker B [00:43:17]:
Yes. So you can find me on Instagram at Nutrition by DeVita. My book is available actually on Indigo. It’s also available on Amazon, ca.com I think Barnes and Nobles also has it. I think Target also may have it. Now.
Speaker A [00:43:31]:
You’re a great place.
Speaker B [00:43:31]:
So there’s a few different places. Yeah. But you’ll know you’ll get it for sure if you go through Amazon.
Speaker A [00:43:37]:
Amazing. Amazing. And there’s a whole section, you guys in the front, about macros and just so, so much information. I know because Dev sent me a.
Speaker B [00:43:47]:
Copy and I was so grateful that you were able to read it and just give me some feedback. So thank you so much.
Speaker A [00:43:53]:
And I will also say the recipes are not difficult. Right. It’s not. It’s not super time consuming to make those recipes. So, Dev, thank you so much. And thanks for having me.
Speaker B [00:44:05]:
Yes, of course.
Speaker A [00:44:06]:
Loved having you. That’s our episode for today. Thanks for listening. I hope you enjoyed it and that you learned something new. Remember, if you want to lose weight with paralysis, improve your bowel health and feel your best you can. It’s possible, you just have to change your eating habits. If you need inspiration on how to get started, check out The Paralysis Nutrition Cookbook 101 Recipes to Help you lose weight and improve bowel health. The cookbook comes with a bonus 30 day meal plan and is the perfect way to start eating healthier.
Speaker A [00:44:36]:
You can find it online at paralysisnutrition.com cookbook I’ll talk to you again soon.
