Wednesday 24 June 2015

Doctors and Dieticians !

Doctors and Dieticians

For the last few years, I’ve often been invited to give motivational talks to runners. 

At the end of such talks, I’m often asked two questions.  These questions are invariably about running injuries and about a runner’s diet.

These are hard questions to answer and I’m not competent enough to answer them. Both these issues lie in the realm of medical professionals. 

So the real question which very often actually needs asking is not how to deal with a particular injury or whether to adopt a particular diet, I think the most important question for a runner is: How does one find the right doctor and the right dietician? 

A runner is never an island.  All of us rely on our family, friends, doctors, physiotherapists, masseurs, dieticians and so many other people to help get us to the finish line. 
Selecting our team is an art.  For me, it’s been an acquired art.   In fact, it’s been a long time in the acquiring and is still a work in progress.

But I want to share my experience with this critical question.  I understand that people may not agree with my opinion and they have a right to do so.  That is the essence of democracy.    What is true for me may not be true for you.  I'm simply explaining my point of view.       
When it came to choosing a doctor for medical issues, some excellent advice was given by Dr Tim Noakes, MD. in his classic book, The Lore of Running.  

In the Chapter titled “Staying Injury Free”, Dr Noakes gives his 10 laws.

Law #8 states: “Never Accept as Final the Advice of a Nonrunner (MD or Other). 
Dr Noakes suggests 4 simple criteria in choosing a medical consultant:

1) Your advisor must be a runner.   Dr Noakes felt that only a runner will have insight into your running issues.  This does not mean that his advice will always be right but there is a greater probability that it will be correct.

2) Your practitioner must be able to discuss in detail the genetic, environmental and training factors likely to have caused your injury. This will be more likely when he is a runner.

3) The practitioner must be able to understand your passion for running.  This is also more likely if he is a runner.  It is patently ridiculous, says Dr Noakes, to accept advice from someone who is antagonistic to your running in the first place.

4) Your adviser shouldn’t be expensive, as most running injuries can be cured without recourse to expensive treatments.  In support of this concept, Dr Noakes, quotes Tom Osler who said, “God heals and the doctor sends the bills.”

I have generally come to accept these rules when it comes to choosing my Doctor for medical injuries.  

I have only modified them slightly.  I am willing to take the advice from a Doctor who isn’t a runner as long as I know that the doctor is passionately involved in some sport.  I want him to have played some sport during his life with the same passion that I run.  

I modified Dr. Noakes criteria because I think it would be hard, for example, for a swimmer to find a doctor who swims or a badminton player to find a doctor who plays badminton.  But I think to share a passion for sport’s is good enough.

My biggest struggle however, has been with dieticians. 

Over the last 10 years, I’ve been to a dozen dieticians. It’s been an eventful journey. 

To begin with, I felt the need for a dietician.  I concede that someone may not feel the need.  There may be some runners who may simply have instinctive knowledge of what their body needs and so are able to naturally eat the right quality and quantity of food.  There may be some who feel that they can do their own research and sort out their diets themselves.   

I am not one of them.  I didn’t mind seeking professional advice. 

The first dietician I went to meet, 10 years ago, was an elderly gentleman who was very famous.

In the first meeting, he gave me a list of blood work I needed to do.  He weighed me and announced that I could easily lose 25 kgs of weight.  That surprised me a bit.  10 kgs might have seemed reasonable. 25kgs seemed a bit over the top.  But the idea pleased me.

It was a very short meeting because he said that we would discuss things only after I get the blood work.  That was end of the consultation.  

I had however noticed that his assistant, who actually shared the desk with him, was slightly overweight.   But I was focused on myself.

In my next meeting even before anyone spoke a word, he put in front of me 3 large photo albums and with a shake of his head, asked me to look at them. The albums were full of those 'before-after' pictures which we see in weight loss advertisements.

After I glanced through them and conveyed my admiration for his expertise, with a similar shake of my head, he looked through my blood work results.

His slightly overweight assistant then input some data from the reports into the computer.

There was a large dot-matrix printer on the next table and out came one sheet of paper.  

She then explained to me that this was list of all the stuff I could eat.  It was generic list: rice, wheat, lentils, vegetables, cooking oil etc given in terms of weight and volume.  She said cook whatever you want with this quantity and eat it.

For the first time, I felt the real need to speak.  I then explained to them that I was planning to run a marathon and I was hoping for some diet advice with that in mind. 

The old gentleman said, “Eggs!! Eggs!! Eat lots of Eggs!!”

After saying that, the old gentleman and the slightly overweight assistant just sat back and didn’t volunteer any more information.   They simply sat and started at me. 

After an uncomfortable silence I asked, “What happens when I eat out?” 

With lightning reflexes, the old gentleman, whipped out a book which he had apparently authored.  He said, “This is a book which explains how to order in a restaurant. It’s for Rs 500/-”. 

After saying that, the old gentleman and the slightly overweight assistant just sat back and didn’t volunteer any more information.  They simply sat and stared at me. 

I left their office.  I’m ashamed to say that I bought the book.  I felt angry that I had given a vial of my blood to no end.  I felt angry that the man had not asked me a single question about my lifestyle and my goals. 

I was traumatised by that experience.  The emotional scars from those two meetings with the old gentleman and his slightly overweight assistant might never heal. 

It was few years before I gathered the courage to go meet another very well established dietician.  

This one went to the other extreme.  After the routine blood work, this one asked me so many questions that I felt I was being interrogated for entry into India’s counterespionage agency.  

They seemed to want to know all my most intimate secrets.  I think, they have with them now, stored somewhere in their hard drives, more information about my personal habits than Neepa, my wife, will ever know.   

This team asked me my goals, my long term and short term plans.  I felt I was in good hands.  

This dietician’s office was inside an establishment which also housed her husband’s shop.  

He owned a shop which sold diet and protein supplements and although I saw a complete conflict of interest, I happily bought more than 10,000/- worth of vitamins and minerals from him which she prescribed.  Actually she stood right next to the counter and asked the salesman to get the stuff ready.  I also bought different types of protein powders and amino acid supplements.  I didn’t mind buying stuff which I felt might be lacking in the basic diet.

I had given them an exact idea of my goal.  I had explained to them that I didn’t come to them for weight loss but to become stronger. I told them I that I wanted to increase my immunity levels.  I told them that when the energy drop comes during my run, I did not want it to come due to lack of nutrients in my diet.  I wanted to eat healthy.  I wanted to run strong.    

They made me report back on every small molecule of food which went into my mouth. I was made to generate data for them at an atrocious rate.   Recording data actually become time consuming.  I had to email data every day and carry hard copies with me. 

After two weeks, they started removing all carbs and fat from my diet.  They were high on proteins which I felt was good but they didn’t add anything else which I could use as fuel during my runs. 

By the end of one month I was finished. I had no energy left in my body and my runs became unbearably tiring.   I had bought thousands worth of supplements from her but they wanted me, an 80kg man, to live on a frugal carb and fat deprived diet.   

I guess they had never consulted with a marathon runner before.  I think that they simply had a large clientele of people who went to them for weight loss.  So although they had asked me my goals, they had no idea on how to help me get there.  They had put me on a weight loss diet.

I vowed to stay away from dieticians. 

But, of course, I couldn’t.  I knew I needed some help to sort out what to eat.  In my opinion, reading about diets is never enough because there is no one perfect diet for all.  A diet has to be tweaked to each individual’s requirement.  That is why one needs a living breathing person advising.

So let me tell you how I finally solved my problem.  It took me close to 10 years to sort it out.  Let me tell you how I came to see the light. 

It happened at a seminar organized for runners.  I was one of the speakers and so was one dietician.  I was sitting in the audience awaiting my turn while the dietician was speaking.  

Someone from the audience asked a question. “Ma’am, you advice that we eat two hours before the run, but you know in Mumbai sometimes we have to start our long runs very early because it later gets very hot.  How do we eat the breakfast which you suggest at 3:00am in the morning if I have to leave my house at 5:00am?”

The dietician didn’t miss a beat, she cupped her cheek in the palm of her hand to suggest that she was lying in bed with her face in the pillow and answered in a sing song tone. “Eat as you sleep, Eat as you sleep”.  The audience laughed and the next question was asked.  I wanted to punch myself in the face.

I am forever grateful for that moment because at that moment I saw the light!  I had realised what was wrong with every single dietician I had met so far.  

None of them were runners.  None of them were interested or played any sport. 

They were professional dieticians yes, but none of them had run even a 5K in their entire life.  

This lady couldn’t answer that man's question because she had no instinctive idea about the issues a runner faces.  

She had no firsthand knowledge of what a runner needs and experiences.   She simply didn't understand running the way even a novice runner does. 

What Dr. Tim Noakes has written about doctors is true even for dieticians.   His concepts for choosing your medical practitioner can be applied for choosing your dietician. 

So finally after a 10 year search, just 3 months before Comrades 2015, I found such a dietician.  Someone who was not just a runner but someone who was a Boston qualifier and someone who ran like I would want to run. 

She did not sell me a single supplement. She simply introduced a massive amount of natural foodstuff in my diet.  She added all sorts of seeds and nuts.  She added far more protein than I was eating. She added more vegetables than I was eating. She allowed certain fats.  She allowed certain carbs.  

My weight stayed stable and my energy levels increased.   She understood that losing weight wasn’t my goal, running strong was. 

She gave me different diets based on my weekly volume.  She gave me different diets based on my daily volume.   My pre-run meals differed based on intensity and volume of that days run. 

She gave me a different diet during my peak training weeks and she gave me a different diet for my taper weeks.  
She helped me to hydrate with healthy homemade drinks during the hot months of March, April and May when we did our peak training in the hot and humid Mumbai weather.  

She gave advice which was specific to a runner.  She knew all this because she was a runner.  I will always remain grateful to Roopali Mehta for what she did for me.

I have now learnt to never take advice from a dietician who is not a runner or someone who is not passionately involved with sports. 

But all good things come at a cost.  Finding this dietician also had a couple of major drawbacks. This new food regime drove Neepa nuts for all the new cooking and shopping which had to be done.  But Neepa going nuts, was acceptable. It wasn’t the major cost.   We actually ended up buying an additional refrigerator because of the amount of different things we ended up eating.   But then, who said that running was inexpensive.   

For those 3 months before Comrades, we stayed with her diet.  But now after Comrades, I’ve backed off for a while.  For now, I have been eating everything in moderation. 

And I believe that in the long run, perhaps that is the ideal diet. 

Eat everything in moderation!  

It's been 24 days since Comrades and I have been eating everything and more.   I have even been eating lots and lots of desserts and drinking alcohol.(these perhaps not as moderately as one should) 

I am simply enjoying the feeling of having finished another Comrades Marathon.  

But soon Neepa and I need to restart our training.  

Moderation, unfortunately, will again have to wait for later. 


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