Update in OP - Insulin resistance for early teens.

[Mabelen]

My daughter started out very sad at having to make changes. She grieved and mourned for a bit but she is fully on board now.

 

We have been busy looking at ways to improve our diet. We agreed to reduce portions a bit in general, and carbs and dessert in particular. Upping vegetable and fruit. Substituting high refined carb foods with healthier whole grain varieties. We used to eat sour dough bread, we tried 2 kinds of rye bread and we love them! We have tried some pasta varieties that will also work.

 

My daughter has been adding extra exercise time. She is motivated to get better. I want this to become a habit that will stick for life.

 

I am still trying to wade through all your posts and possibilities in detail. I really appreciate your help. Thank you so so much!

 

OP

 

We just came back from the pediatric endocrinologist. We have been concerned about my 13 yo dd's growth. Her height kept going down the percentiles. All tests have come back within normal range. It looks like she will end up being on the very low end of her expected height.

 

Her weight is a concern, especially because it's all on her belly. The doctor saw possible signs of insulin resistance. This needs to improve. Not only for general health, but also specifically because of the effect it has on bone development and final growth. We want to help her lose weight.

 

Our diet is good. I do a lot of cooking from scratch and follow a Mediterranean diet. However,it's not good enough for this particular child. I need to replace the refined carbs with substitutes that will not make her and us feel deprived. Ideas?

 

Her exercise level should be sufficient, but obviously it is not. She has daily P.E. at school, plus 1 weekly dance class, weekly practice and many extra rehearsals. She starts her day by carrying a heavy bassoon (and backpack and lunch box) up a steep road up to her school. You would think she would be burning a bunch of calories just with that exercise alone! She needs more exercise. Any time and cost efficient suggestions?

 

Thank you so much!

Edited October 8, 2017 by Mabelen

[displace]

Weight gain is usually caused by excess calories. With insulin resistance at such a young age, I'd start restricting excess carbs. Half the plate of veg, 1/4 protein, 1/4 fruit. No sodas/juices.

 

Short people also need fewer calories than taller people. My calorie requirements are probably 200 - 400 less than the "average" woman based on height per day. So, if I have dessert on top of a regular sized dinner, I'm overeating, unless my meal was reduced already.

 

I'd consider changing the whole family's diet. No one really "needs" bread, pasta, etc with every meal. Have another side of veg instead.

 

ETA - obviously idk your diet, and what you mean by Mediterranean. But if you have a side or two of carbs with each meal, that's the fastest and easiest thing to change. You could also keep a good diary and visit a pediatric dietitian or diy and start calorie counting for her. Just to see where to start. At 13, I don't think calorie counting is necessarily what you want her to do, but if you do it on her behalf for a few days, just to see about where she's at, it may help you have a better idea of what changes need to happen. Like, is she consuming an extra 1,000 calories per day? Or just 200?

Edited October 5, 2017 by displace

[chiguirre]

Did they consider PCOS? That popped in my mind when I read your description but I don't know much about the specifics.

[Mabelen]

By Mediterranean, I mean I come from Spain and I follow more or less how I used it eat there, what is typically known as a Mediterranean diet: Eating primarily plant-based foods, such as fruits and vegetables, legumes and nuts. Replacing butter with healthy fats such as olive oil. Using herbs and spices instead of salt to flavor foods. ... Eating fish and poultry at least twice a week.

 

The area where I can improve is more whole grains, and reduce starch amounts. We don't drink sugary drinks, only water, non sugar green or herbal teas. The whole family would follow the diet, although I don't want to lose weight. I am 5 3" and weigh 112-114 lb. I am also menopausal so at risk from osteoporosis.

[Mabelen]

Can you have PCOS if you haven't started menstruation?

[wonderchica]

I think your off to a good start with your plan for everyone to follow the same diet. I have a similar body type, and it is NOT an easy road. I'd avoid any sort of talk, comment, unintended insinuation, etc. about her weight. She knows. You're on the right track to reduce carbs. I'd take a close look at the fruit- berries are lower glycemic index than say bananas or apples. Berries are best! Some weight training would be good, maybe starting a long family walk after dinner?

[TheBugs]

My 11 year old son has always gained weight quickly and it had starting to be too much and at a point where his future health could be affected. I've had a lot of success by simply measuring the amount of rice or pasta. So 3/4 of a cup. I measure olive oil. And I will weigh higher calorie foods like cheese. This can easily fit in with Mediterranean style eating. I taught him to do this too and he is managing his eating very well, as far as snacking. Maybe he will have an ounce of cheese and an apple.

[displace]

Your diet sounds very healthy. Is she eating school food? It can be very unhealthy and she may be getting snacks or high calorie foods there. Or maybe hanging out with friends. It sounds almost like a disconnect, like what is the missing puzzle piece to cause this?

[Pen]

How much sugars does she get including from fruits every day?

 

Protein beyond the twice per week fish/ poultry?

 

Fats other than olive oil?  (Fats can help stop cravings for carbs and sugars and give feeling of satisfaction.)

 

Does she eat other food than what you have mentioned, such as at school or elsewhere?

 

For replacing refined carbs: how about things like homemade whole grain bread if no one has gluten issues --with butter.  Sweet potatoes, perhaps.  

 

Maybe try the book Fat Chance by Robert Lustig, M.D.?

 

I agree that it sounds like a disconnect between what is reported here and the result--but if there are a lot of processed refined carbs and more sugar from fruit than her body can handle, maybe that is part of the explanation. Plus if she has gotten into a metabolic state where she can't process foods efficiently...

[ScoutTN]

I would drop sugar, lower carbs and add healthy fats. Avocado, butter from grass fed cows, cheese. Eggs. Full fat dairy from grass fed cows. Fat satisfies the appetite and takes longer to process.

 

Does she get exercise consistently?

Edited October 6, 2017 by ScoutTN

[kewb]

My daughter has pcos and it sounds like your daughter might, too.

I had been having my daughter's thyroid checked since she was 9 and constantly told her pediatrician I thought something was wrong. I knew what she was eating. I saw how much exercise she had to do just to maintain her overweight status. The pediatric endocrinologist told me he wasn't in the business of giving out pills to make people skinny. I am still so angry about that. No one took me seriously util she didn't get her period for a year. I believe if she had been given metformin at 13 instead of 17 that she wouldn't be obese now even though she has been a competitive swimmer since she was 9 years old.

The curse of pcos is that losing weight helps symptoms but the hormone inbalance makes it incredibly difficult to lose weight.

If she is already showing signs of insulin resistance make a fuss until someone takes you seriously.

[MBM]

A few more things to consider:

 

When she eats and how often. A person who eats the exact same diet will gain more weight if they eat in a longer window of time. Eating later, especially, leads to more weight gain. This has to do with the times we make certain hormones.

 

Note what she's eating and what you can switch out. Zucchini noodles for pasta, quinoa for rice, nut flours for grain flours for treats. Decrease sugar in recipes. Eat treats with meals, maybe lunch because that would be earlier. Healthy fats. She should feel satisfied after eating and not feel hungry too soon after eating.

 

I wonder about PCOS, too, but I don't know at what age symptoms can appear.

 

Here are some resources/studies about timing of meals from researcher Rhonda Patrick. You can also find her interview with Dr. Satchin Panda, circadian rhythm researcher, on YouTube.

 

Scroll down to "The principle behind time-restricting feeding"

http://podcastnotes.org/2016/07/11/time-restricted-feeding-and-its-effects-on-obesity-muscle-mass-heart-health/

 

More studies:

https://www.foundmyfitness.com/news/t/circadian%20rhythm

Edited October 6, 2017 by MBM

[Tanaqui]

If it turns out NOT to be a medical issue like PCOS - and yes, please just get that checked out! - then, you know, it's not to early for her to start strength training. Girls and women should do that at least two or three sessions a week, because it helps build healthy bones and also (in this case) because muscle at rest burns more calories than fat.

 

(I wouldn't consider "daily PE" to count as exercise, btw. I mean, it might be very energetic, or it might be a lot of kids standing around chatting and hoping the teacher doesn't notice they aren't playing the sport-of-the-month that they're not very good at and they don't want to get sweaty doing.)

[Greta]

By Mediterranean, I mean I come from Spain and I follow more or less how I used it eat there, what is typically known as a Mediterranean diet: Eating primarily plant-based foods, such as fruits and vegetables, legumes and nuts. Replacing butter with healthy fats such as olive oil. Using herbs and spices instead of salt to flavor foods. ... Eating fish and poultry at least twice a week.

 

Your diet sounds very healthy, so I don’t think you need a radical change, just a few tweaks. Switching to whole grains rather than white flours, as you mentioned, is a good idea. You didn’t mention desserts, but that’s something you could cut out or cut back on. I always have fruit for dessert, and I’ve lost weight during a time that I’ve eaten more fruit than ever before (I’m not on my desktop so I can’t do hyperlinks, but I’ll put some links below to studies showing that fruit does not cause weight gain).

 

Meat intake is associated with weight gain and diabetes, and saturated fat intake has been shown to cause insulin resistance. So I think you are doing right by using olive oil instead of butter, and eating meat sparingly. In her particular case, she might need to eat it even more sparingly, and cut back on the oil a bit more. I read somewhere recently, much to my surprise, that chicken is actually the food that is most strongly associated with weight gain, probably because farming methods have changed and now the chickens themselves are obese. It is not the low-fat meat that it used to be. I can’t remember where I read that one, but I will put some links below about meat in general and saturated fat.

 

I know this must be frustrating and you must be worried about her. But you’ve got such good habits in place already, I think you’re going to be able to address this pretty easily.

 

https://www.ncbi.nlm.nih.gov/pubmed/18439712

 

https://www.ncbi.nlm.nih.gov/pubmed/21745628

 

https://www.ncbi.nlm.nih.gov/pubmed/21883530

 

https://www.ncbi.nlm.nih.gov/pubmed/20592131

 

https://www.ncbi.nlm.nih.gov/pubmed/22223576

 

https://www.ncbi.nlm.nih.gov/pubmed/23509418

 

https://www.ncbi.nlm.nih.gov/pubmed/11317662

 

https://www.ncbi.nlm.nih.gov/pubmed/16596361

[jewellsmommy]

Can you have PCOS if you haven't started menstruation?

 

Yes. In fact PCOS will often prevent you from mensturating. PCOS causes the hormone levels to be imbalanced such as having too much testosterone/androgens. Insulin resistance and other metabolic problems are part of the equation as well.

 

 

ETA: The symptoms of PCOS that are usually first noticed occur after menstruation begins, but the metabolic issues may already be in place.

 

 

Edited October 6, 2017 by jewellsmommy

[Mabelen]

I just want to say that I am reading all of your input. I am trying to digest the different possibilities and suggestions.

 

She definitely loves her white carbs. That maybe the main culprit. She also loves her dessert, but we have already cut down on that, portion and frequency wise.

 

She does not eat junk at school from other kids nor does she eat school meals. I get up early in the morning and make her lunch to take to school. Birthday parties I suspect she does not hold back.

 

As far as timing, breakfast is usually between 6.45-7.10. Lunch is at school at 11.50. As far as dinner, we have started eating dinner early for about a month now. She comes home from school and eats dinner around 4.30pm. If she is hungry later, she can have a snack, but it is always a healthy low calorie snack and before 9.00pm. Today she had 1/4 cup of red kidney beans and 1 glass of 1% whipped milk topped with pumpkin spice.

 

We aim for bed by 9.45 but it is usually 10.00. She gets up around 6.45 am.

[Mabelen]

Regarding exercise. She does have 1 hour daily P.E. She has always had demanding teachers that keep them moving. However she is not an athlete. She likes dancing and swimming. We have some weights at home. I just don't know what to do with them! Any work outs that you guys recommend?

[hornblower]

Maybe consider checking thyroid levels?  Hypothyroid pre puberty is not uncommon but it's often missed as few drs screen for it. Mine was caught only because we had really extensive blood work for emigrating. 

[Jann in TX]

With insulin resistance and weight gain is more than 'calories in' vs 'calories out'... it is a metabolic disease.

 

My 25 yr old daughter is cursed with this.  In her teen years she was extremely active and was very careful about what she ate... still she was 'over weight'... her older sister ate JUNK, never exercised and remained skinny as a rail... not fair! 

 

DD also has PCOS.  Her cycles were normal and predictable from age 10-12....after that they stopped for a while and the PCOS raged-- lots of painful x-large cyst ruptures... not to mention the 'woman beard' and hormonal roller coaster.

 

Also have your dd evaluated for thyroid issues-- very common alongside of other hormonal issues like PCOS-- and PCOS goes hand in hand with insulin resistance.. all of that is related!

--

Be extremely careful about reducing caloric intake in a growing child.  Thin is not always healthy!  Proper, balanced nutrition is needed for body growth. 

 

 

Edited October 6, 2017 by Jann in TX

[Mabelen]

Thyroid levels are normal. She had extensive blood work recently due to our concerns regarding her growth.

[Jann in TX]

Thyroid levels are normal. She had extensive blood work recently due to our concerns regarding her growth.

 

Did they do a full thyroid panel or just the general screening test?

 

Also note that there is not a perfect test for thyroid function... a person can have 'normal' reports and be in extremely poor health due to under-active and even over-active thyroid.

[Pen]

blurb stuff from Amazon...

 

"About the Author

 

--------------

 

Robert H. Lustig, M.D., MSL, is professor of pediatrics in the Division of Endocrinology and a member of the Institute for Health Policy Studies at University of California, San Francisco. He has authored 120 peer-reviewed articles and 70 reviews, as well as The Fat Chance Cookbook and the upcoming The Hacking of the American Mind. He has mentored 30 pediatric endocrine fellows and trained numerous other allied health professionals. He is the former chairman of the Obesity Task Force of the Pediatric Endocrine Society, a member of the Obesity Task Force of the Endocrine Society, and a member of the Pediatric Obesity Devices Committee of the U.S. Food and Drug Administration. He is also the president of the nonprofit Institute for Responsible Nutrition, dedicated to reversing childhood obesity and Type 2 Diabetes. He consults for several childhood obesity advocacy groups and government agencies."

 

 

 

-----------------

 

“Our eating habits are killing us. In this timely and important book, Dr. Robert Lustig presents the scientific evidence for the toxicity of sugar and the disastrous effects of modern industrial food on the hormones that control hunger, satiety, and weight. He gives recommendations for a personal solution to the problem we face and also suggests a public policy solution. Fat Chance is the best book I've read on the relationship between diet and health and the clearest explanation of epidemic obesity in our society.†--Andrew Weil, M.D., author of Spontaneous Happiness and You Can’t Afford to Get Sick

 

 

--------------------

 

 

 

 https://www.amazon.com/Fat-Chance-Beating-Against-Processed/dp/0142180432

 

eta:

There is also a cookbook to go with this that I am thinking of getting as a way to work with this method of eating without feeling deprived.  I was developing a belly area fat problem (prob due to thyroid issue) after having been slim to medium most all my life.  I started some mild T-Tapp (Teresa Tapp) exercise (has to be mild due to chronic health problems, and also I am having trouble learning the routines).  I lost 1 pant waist size in three weeks, not even close to perfectly doing either the diet or the exercises.  I am hoping to get the rehab DVD version of the exercises soon because while not severely obese, I have too much chronic health issues, fatigue and joint issues to do the regular version.

Edited October 6, 2017 by Pen

[wonderchica]

Weight training- There are lots of DVDs to get you started with hand weights. Jillian Michaels has some that are good. I would do them together as a bonding activity. You might also check out a gym or Crossfit. They have kids/teens crossfit classes.

[shinyhappypeople]

We just came back from the pediatric endocrinologist. We have been concerned about my 13 yo dd's growth. Her height kept going down the percentiles. All tests have come back within normal range. It looks like she will end up being on the very low end of her expected height.

 

Her weight is a concern, especially because it's all on her belly. The doctor saw possible signs of insulin resistance. This needs to improve. Not only for general health, but also specifically because of the effect it has on bone development and final growth. We want to help her lose weight.

 

Our diet is good. I do a lot of cooking from scratch and follow a Mediterranean diet. However,it's not good enough for this particular child. I need to replace the refined carbs with substitutes that will not make her and us feel deprived. Ideas?

 

Her exercise level should be sufficient, but obviously it is not. She has daily P.E. at school, plus 1 weekly dance class, weekly practice and many extra rehearsals. She starts her day by carrying a heavy bassoon (and backpack and lunch box) up a steep road up to her school. You would think she would be burning a bunch of calories just with that exercise alone! She needs more exercise. Any time and cost efficient suggestions?

 

Thank you so much!

 

I'm not sure how overweight your daughter is, so take everything I say with a grain of salt.  Hopefully there's something helpful in here.

 

My older daughter is obese and was pre-diabetic :(  However, after changing what she eats her glucose levels are very, very good, but she continued to gain weight. 

 

The absolute worst advice I've had to deal with is "don't put your kid on a diet."  OK, maybe if we're talking a few extra pounds, or if your child has chubbed up during a growth spurt, then yes a diet is overkill.  But for kids who have serious weight struggles or are very overweight, changing their eating plan and even limiting portion sizes and requiring exercise is necessary.  I am so angry at myself for listening to the "experts" instead of listening to my gut.  My 14 yo 5'3" daughter is down to 169 lb.  She's lost 25 lb.  Do the math.  Healthy eating alone is NOT enough.  She gained a good 20 lb eating a very healthy diet... just too much of it.  And her food amounts weren't crazy huge, but she has a naturally slow metabolism.

 

After changing how much she ate, she began losing weight - 25 lb in 4 months.  The only successful, healthy way for her to lose weight has been Weight Watchers Points Plus. WW+ is easy to adapt for the whole family, with the understanding that not everyone will be counting points, but everyone can eat healthy foods.  It basically comes down to eating a LOT of fruits and vegetables (because they're 0 points), lean meats, and low to moderate grain/starch carbs.  However, no food is off limits. You can google Points Plus and find a ton of information about how to do it for free. (The current WW program is called "Smart Points"  I don't have any experience with SP, so we're sticking with WW+.)

 

As for as exercise, she uses a stationary bike and youtube cycling workouts (like these).  A few weeks ago she added in Jillian Michaels (I think the ab workout).  She's lost 3" around her middle.  She works  out 5 days a week for about an hour total.

[Pen]

I'm not sure how overweight your daughter is, so take everything I say with a grain of salt.  Hopefully there's something helpful in here.

 

My older daughter is obese and was pre-diabetic :(  However, after changing what she eats her glucose levels are very, very good, but she continued to gain weight. 

 

The absolute worst advice I've had to deal with is "don't put your kid on a diet."  OK, maybe if we're talking a few extra pounds, or if your child has chubbed up during a growth spurt, then yes a diet is overkill.  But for kids who have serious weight struggles or are very overweight, changing their eating plan and even limiting portion sizes and requiring exercise is necessary.  I am so angry at myself for listening to the "experts" instead of listening to my gut.  My 14 yo 5'3" daughter is down to 169 lb.  She's lost 25 lb.  Do the math.  Healthy eating alone is NOT enough.  She gained a good 20 lb eating a very healthy diet... just too much of it.  And her food amounts weren't crazy huge, but she has a naturally slow metabolism.

 

After changing how much she ate, she began losing weight - 25 lb in 4 months.  The only successful, healthy way for her to lose weight has been Weight Watchers Points Plus. WW+ is easy to adapt for the whole family, with the understanding that not everyone will be counting points, but everyone can eat healthy foods.  It basically comes down to eating a LOT of fruits and vegetables (because they're 0 points), lean meats, and low to moderate grain/starch carbs.  However, no food is off limits. You can google Points Plus and find a ton of information about how to do it for free. (The current WW program is called "Smart Points"  I don't have any experience with SP, so we're sticking with WW+.)

 

As for as exercise, she uses a stationary bike and youtube cycling workouts (like these).  A few weeks ago she added in Jillian Michaels (I think the ab workout).  She's lost 3" around her middle.  She works  out 5 days a week for about an hour total.

 

 

Most of this sounds like another possible good option from someone who has btdt with a dc with similar issues.

 

My father is diabetic though and just to say, he cannot have any fruit juice, and only extremely limited, rare, whole fruit--and not just any fruit, but only types with high fiber / low sugar... grapes, for example are not okay as being almost all sugar, or so I am told.  "A LOT" of fruit is definitely not okay, though I think some fruits are okay in larger amounts, though not necessarily his favorite ones...I vaguely recall that whole apples are fine, even if a lot of them, but bananas can be eaten but not gorged on.  

 

Maybe pre-diabetic "a LOT of fruit" would be okay--or maybe your idea of a lot of fruit and mine are different.. Or maybe not, and you just aren't seeing the ultimate longer term result yet of a lot of fruit.  This is not a weight issue, but a long term diabetes issue as I understand it.

Edited October 6, 2017 by Pen

[SKL]

I would want to up her activity.  Would it be an option for her to swim or hike most days when she doesn't have dance?

 

Is her sleep good?

[Pen]

For excellent replacement ideas, Maria Emmerich is hard to beat for kiddos. Her stuff is delicious and really helps assuage that ‘deprived’ feeling, while allowing someone who is intolerant to carbs to live more healthfully.

 

https://www.amazon.com/Art-Healthy-Eating-Savory-Sweets/dp/0988512483/ref=la_B004OU19MU_1_10?s=books&ie=UTF8&qid=1507318925&sr=1-10M

 

She has a lot more books than this. I haven’t regretted a single purchase.

 

 

I've heard people say that her recipes are tasty, but haven't ever taken that plunge because I have seen comments and descriptions that sounded like they are still relatively high in gluten and on the carb side may still include processed foods and sugar or sugar substitutes.   ???.

 

Does she still use white carbs?  I see things like "clam chowder in bread bowl" and "lasagna" as samples of what is inside and wonder if they are being done without white carbs?  And what about gluten amounts?

 

What about sugar and other sweeteners?  Comments indicate that perhaps substitute sweeteners are used, but my sense is that a lot of those are also considered to be unhealthy.

[Mabelen]

I wrote an update in the original post.

 

Some of you were asking about her sleep. She sleeps well, when left to her own devices she will sleep 9 hours, unless it has been a particularly busy exhausting day, then she will occasionally sleep up to 10, but in general she seems to need 9 hours. On school days she usually gets close to 9 but not the full 9 hours.

 

I hear you, shinyhappypeople. We have been consulting with the pediatrician and the pediatric endocrinologist for over a year, and not once have they even mentioned her weight as something we had to do something about until I brought it up last week. They were asking about her diet and exercise levels and saying her height should eventually catch-up with her weight. Anyway, we finally got the kick in the pants we needed to work on it and have my daughter on board!

[shinyhappypeople]

Most of this sounds like another possible good option from someone who has btdt with a dc with similar issues.

 

My father is diabetic though and just to say, he cannot have any fruit juice, and only extremely limited, rare, whole fruit--and not just any fruit, but only types with high fiber / low sugar... grapes, for example are not okay as being almost all sugar, or so I am told.  "A LOT" of fruit is definitely not okay, though I think some fruits are okay in larger amounts, though not necessarily his favorite ones...I vaguely recall that whole apples are fine, even if a lot of them, but bananas can be eaten but not gorged on.  

 

Maybe pre-diabetic "a LOT of fruit" would be okay--or maybe your idea of a lot of fruit and mine are different.. Or maybe not, and you just aren't seeing the ultimate longer term result yet of a lot of fruit.  This is not a weight issue, but a long term diabetes issue as I understand it.

 

Well, I actually said, a lot of fruits and vegetables.  She doesn't gorge herself on fruit (or any food), but does eat heavily from the produce aisle, more or less what she's craving.  I have no doubt that having full-fledged diabetes requires stricter protocols.  For DD, a whole foods, produce-laden (fruits and veg) diet using modest portion sizes (where the points come in) has been very helpful.