Orny's Cycling Journal

For reasons I’ll explain in a second, improving my diet became a critical consideration following my stroke. But I had lots of questions about the areas where healthy eating directly conflicts with sports nutrition’s best practices for endurance athletes. I decided to get answers from a professional, and this blogpost summarizes what I got out of consulting a nutritionist for the first time in my life.

This is one of those posts where it’s not clear whether it belongs on my general blog or here on my cycling-specific blog. Since I came at this from a cyclist’s perspective, I decided to post it to the latter, so that other cyclists would more readily find it. But most of this is equally relevant to my non-cycling readers.

Where I Started

The statistics say that 25 percent of stroke survivors will have a second stroke. And, according to the hospitalist who was in charge of me during my hospitalization, the greatest determinant of whether you have another stroke is diet. Survivors who didn’t change to a heart-healthy diet had the most readmissions, in contrast to those who took dietary advice to heart.

What did she specifically advocate? This:

• Reduce inflammation and chances of developing diabetes by cutting intake of simple sugars
• Reduce cardiac risks by limiting dietary fat intake, especially saturated and trans fats
• Avoid hypertension by reducing intake of table salt and highly processed foods
• Maintain healthy blood volume by staying fully hydrated

That was the first advice I got following my stroke, and – as a Type A personality and someone with an intense fear of stroke – I took her opinions extremely seriously. Even though I’m significantly younger, healthier, and more active than most stroke survivors, improving my diet seemed, at that time, to be a matter of life and death.

However, as an endurance cyclist, two of those strictures are problematic for me. Simple carbs are the preferred and primary fuel for athletes; would I be risking my health by continuing to emphasize them in my diet? And it’s pretty hard to avoid chronic dehydration if you’re riding hard in the Texas sun for a multiple hours every day.

Although I’ve stayed on top of changing dietary recommendations for decades, these contradictory needs convinced me that it would make sense to consult a nutritionist for the first time in my life.

Another factor is that I was very concerned about weight loss. From 2011 through 2022, my body weight stayed in a narrow range, mostly between 76 and 79 kg, averaging out at 77.3. But in the last five months of 2022 I suddenly and inexplicably dropped 6½ kilos (15 lbs). I gained about half of that back, but then lost another 3½ kg in the weeks following my stroke, bringing me down to an adult-era low weight of 71.2 kg (157 lbs). A nutritionist could help me figure out how to stem my ongoing weight loss while simultaneously cutting both carbohydrates and fat out of my diet.

More Medical Advice I Got

I’ve already outlined the alarmist attitude that my hospitalist instilled in me right after my stroke, and where that advice led me.

But I immediately started getting contradictory advice from every other healthcare provider I talked to.

A week after my stroke, I had a followup with my family physician, who told me that nutrition was a long-term concern and not to overdo any drastic changes to my diet. But as a PCP he’s a generalist, so I remained skeptical, while making sure I got a referral to a nutritionist out of him.

A week after that, I had a followup with my neurologist, whose attitude was that nutrition is just about general health and preventing blood clots, which is more of a cardiologist’s domain.

It took another month before a long-awaited meeting with my cardiologist. His attitude was another surprising counterpoint to the hospitalist. He also claimed that diet is purely a long-term concern, saying both “Go eat a pizza if you want,” and “Eating heart-healthy is not the most pleasant thing.”

After all that, I really didn’t know what to think. The obvious consensus was that diet wasn’t the smoking gun that the hospitalist had portrayed. But it was still hard for me to cast aside her staunchly-held opinion, since it was the only obvious thing that I could control.

But maybe my nutritionist would provide a decisive opinion…

My Nutritionist Experience

I’ve never really thought of nutritionists as a highly skilled profession. As I see it, there are two main aspects to the job.

One part is staying up-to-date on the ever-changing “science” – separating genuine dietary knowledge from the deluge of biased pseudo-science – and distilling that down into a form that’s digestible for their uninformed clients.

This would be of some benefit to me. Having paid attention to sports nutrition for 25 years, I’m pretty well-informed. But I’m less up-to-date on heart- and health-related topics, and never had to deal with problematic weight loss. And it’d be nice to get the current scoop on perpetual debates like “Are eggs good or bad?” and “Which is healthier: butter or margarine?”

The other – and possibly larger – aspect to the job is similar to that of a therapist: talking with clients and trying to manage them into growing the self-discipline required to make lasting dietary changes.

As I mentioned above, I’m a Type A; I don’t need external support once I’ve decided to change my behavior. So the coaching aspect of the nutritionist’s job is really of no value to me.

The most valuable and immediate advice she game me was when she confirmed what my other healthcare providers had said: that I didn’t need to approach dietary changes with a crisis response and rigidity, and that no one individual choice is gonna kill you. I didn’t need to eliminate all fats and simple carbs from my diet, after all. I was already living a pretty healthy lifestyle, and the emphasis should be on fitting increasingly beneficial habits into a healthy diet whose results compound over time.

But beyond that high-level advice, after four meetings in five months, I’m still not convinced that a nutritionist brings a ton of expertise and value to the table. My nutritionist mostly just repeated standard advice that variety is most important and that even “bad” foods are okay when taken in moderation.

At the same time, I don’t want to sell her short. I did get some novel, useful information from her that manifested in some dietary changes I wouldn’t have considered otherwise. So let’s take a look at those…

Specific Dietary Recommendations

It’s pointless talking about the changes I’ve made without first reviewing my diet prior to my stroke. After all, I made a number of significant improvements over the years, and those remain a noteworthy part of the overall equation. Here are some positive features of my baseline diet that I’ve observed for some time:

• Daily multivitamin and psyllium husk fiber supplements
• Replace full- and low-fat milk with fat-free/skim
• Virtually eliminate beef intake
• Never, ever add salt to anything (except corn on the cob)
• Cook at home; eating out is a rarity
• Emphasize broccoli as my primary leafy vegetable
• Replace ice cream with sorbet/sherbet or fruit pops
• Replace high-fat sauces like alfredo with low-fat tomato sauces like marinara
• Keep an eye on the ever-changing recommendations regarding eggs, butter vs. oil-based spreads, etc.
• Reduce or eliminate soft drink intake, replace with fruit juices like OJ, apple cider, lime- and lemonade, and fruit punch
• No significant intake of caffeine outside of major events and medicinally
• No alcohol in any form, ever, period

Even after accepting that the hospitalist’s alarmist warning was misguided, I still wanted to make incremental improvements to my diet. Specifically, I wanted to reduce fats, sodium, and simple carbs (beyond my athletic needs). Between my own research and input from my nutritionist and cardiologist, I’ve landed on the following new guidelines:

• Daily statin prescription to keep cholesterol down, even tho my numbers were never high
• Daily Omega-3 fatty acid supplements (algae-based rather than fish oil)
• Whey protein isolate powder supplement
• Eliminate or curtail high-fat foods, particularly commercially-prepared baked goods, cocoa, frozen pizza, etc.
• Read labels to select lower-fat chocolate candies, and healthier salty snacks that are baked or use healthier oils like avocado
• Reduce overall cheese intake, and use 2% milkfat cheese over full-fat
• Sauté and stir-fry in avocado oil rather than corn or peanut oils (it has a higher smoke point than olive oil)
• Substitute ground turkey and pork for ground beef
• Supplement wheat-based pastas with lentil-based
• Favor lower-sodium soups like corn chowder; at some point start making my own soups
• Expand meal repertoire by reintroducing or increasing things like:
  • Boiled chicken
  • Oatmeal (with raisins, sunflower seeds, and dried fruits)
  • Baked beans
  • Mashed potato
  • Sweet potato
  • Nuts, especially hazelnuts
  • Apples

Conclusion

Despite having a longstanding interest in sports nutrition, I never bothered consulting a nutritionist until now. I always doubted whether a nutritionist could add any useful information beyond what any self-educated layman could glean from readily-available public sources.

After a 5-month engagement, I mostly stand by that opinion, although it does need to be refined. My nutritionist helped refute the bad advice I got, and provided some suggestions that were truly useful. But those were largely tactical adjustments, rather than significant course changes. So she definitely did add value… just perhaps not as much as I had hoped for from a licensed medical professional.

I’d be temped to conclude that it wasn’t worth the money, but my health insurance covered the entire tab! All it cost me was time, so in that respect I got way more valuable insights than I paid for.

But I’m still skeptical about whether consulting a nutritionist is worth it for most cyclists or your average non-cyclist. If you have a very particular situation, like I did, then perhaps it would be. But if you’re interested enough to have questions about nutrition, you’re probably also motivated enough to find the answers for yourself, rather than pay someone else to do it for you. A nutritionist really isn’t privy to any information that can’t be found elsewhere.

It absolutely does make all kinds of sense for a cyclist to learn the basics of sports nutrition, and there’s no shortage of available material. For myself, my bookshelf includes the fairly lightweight “Bicycling Magazine’s Nutrition for Peak Performance” by Ed Pavelka, and the more comprehensive “Sports Nutrition for Endurance Athletes” by Monique Ryan. But these days there’s ample other sources, too.

That’s it! Now let’s go eat to ride, and ride to eat!