Am I Challenging Or Difficult?

This morning I had an appointment with a sports nutritionist and it went much better than my previous appointment with a general nutritionist.  Toward the end of the appointment, she said something to the effect of my being a challenging client, mostly because I'm already educated and eating well.  On top of that, I'm in good health and am at a good weight.  So there's not much for her to work with here.  I didn't mean to make things difficult!  :)  So here's what happened in the appointment:  I didn't eat or exercise beforehand, as she did a measure of my resting metabolic rate.  To measure the RMR, I lay on the couch for about 10 minutes while wearing a nose plug and breathing through a tube (picture a snorkle connected to a machine).  We then reviewed the results and talked about my lifestyle.  Here's a breakdown of the information she gathered and the recommendations she made, along with my take on things:

From the Tanita scale:

• Body Type:  Athletic
• Height:  5'5"
• Weight:  144.4
• BMI:  24.0
• And we already know what I think about the BMI taken out of context....
• Fat %:  25.3%
• Wonder how accurate a measure this is.  Historically, my experience has been that the scale-based measurements tend to overestimate body fat.  Now, I recognize that my scales have been consumer-grade, but they have consistently reported my body fat as being 10% higher than the caliper measurements done at the gym.  I'm interested in having the "Bod Pod" measurement of body fat, since that's supposed to be the most accurate short of immersion in a water tank.
• Fat Mass:  36.61
• This ties into the same question about the accuracy of the percentage. 
• Basal Metabolic Rate:  5964kJ / 1426 kcal
• This is the same as Predicted Resting Energy Expenditure below.  Based on my other measurements, this is the predicted number of calories that my body needs just to keep it running while at rest (not while sleeping).

From the Resting Metabolic Rate Assessment:

• Predicted Resting Energy Expenditure (REE):  1421 (Same as Basal Metabolic Rate above)
• Measured Resting Energy Expenditure (REE):  1771
• This is higher than the predicted level, which is attributed to my having more lean muscle mass
• Lifestyle and Activity:  531
• The calories burned during the course of the day, above what it takes to keep my body working.  The form says that this number was estimated from the measurement, but I'm not sure how this was done.
• Exercise:  184
• Recognizing this is an underestimation of the calories that I personally burn while exercising.  This number also was estimated from the measurement, and I don't know what it drew on to come to this calculation.
• Calories/Day:  2486
• Sum of REE, Lifestyle, and Exercise calories.  I can't help but think that if I were to eat this number of calories that I would easily gain weight, though I guess it depends on the nature of those calories.  More on that later.
• Maintenance Zone:  1771 - 2302
• Weight Loss Zone:  1417 - 1771
• Medically Supervised Zone:  0 - 1417
• Comparable Metabolism (compared to a typical person of similar sex, age, height, and weight):  Fast (+25%)
• This indicates that my body burns more calories than average.

I don't have a copy of her calculations, but she did a breakdown of my daily nutritional intake based on the food logs that I shared with her.  I shared my "Kidney" plan and my current plan.  I thought it was interesting that she estimated my current plan at being around 1800 calories, as my trainer's wife had it calculated at being around 1200.  As we talked about it, I think the difference was that my trainer's wife didn't count vegetable calories in the total calculation.  So, with that in mind, the nutritionist recommended that I aim for 1800 calories/day with the following breakdown:

• 5 cups of fruits and vegetables
• Yup, I'm getting that.
• 6 oz-equivalent servings of grains
•  I'm getting about half of that, with each 1/2 cup of rice being an oz-equivalent and the cream of rice being another.
• 8 oz-equivalent servings of meat and beans
• I think I'm getting 9 servings here between my egg whites (3 servings) and my chicken (6 servings).  The yogurts don't count in this category.
• 3 cups of dairy
• I've got 2 of these with my yogurts.
• 5tsp of oils
• I'm definitely over this with the 3 tablespoons of coconut oil.

Recommendations:

• Eat more than 1800 calories/day, upwards of 2500.
• I think I'm in that range, once the calories from the vegetables are taken into account.
• Keep the protein where it's at right now (92g/day) but don't go any higher.
• She said that this is a lot of protein and she'd probably recommend a little less.  But it's working for me and she doesn't see there being a point to rocking the boat in this regard.
• Increase dairy intake to 3 servings a day and reduce calcium supplements accordingly.
• This is in line with the philosophy of "Be the kind of person who takes supplements — then skip the supplements." (Michael Pollan's Rule #40 in Food Rules).
• One suggestion would be to have an 8oz glass of milk after exercising.
• Switch from coconut oil to olive oil or other sources of healthier oils.
• The concern here is the level of saturated fats in the coconut oil.
• Add another serving of grains.
• One strategy would be to add a little bit more grain to the servings I already have rather than a whole additional serving.

Here's my take on things:

• I don't think it's really necessary to increase my caloric intake.  It looks like I'm in that target range, once accounting for the vegetable-related calories.  The main reason for increasing my calories was to keep my metabolism from slowing.  When you don't ingest sufficient calories, your body goes into starvation mode - holding onto calories and slowing/stopping weight loss, breaking down muscle to compensate for missing calories/nutrients.  Seeing as my metabolism is already in the "high" range, I don't think there's an immediate risk in this area.  On top of that, I don't feel hungry with what all I'm eating right now.  If anything, I sometimes have a hard time eating everything and have to "make" myself take in all the calories.  But I'll certainly keep an eye on my caloric intake, energy level, and trend for weight loss, making adjustments as necessary.
• I'm cool with keeping the protein where it's at right now.  I'll keep up with my monitoring (every 6 months) to see where my creatinine levels are at.  I still need to follow-up with the doctors at Johns Hopkins, but assuming that there's nothing different from the previous lab tests, it should all be good.
• I'm ambivalent about increasing the dairy by adding another serving.  I agree with the idea of getting nutrients from real foods as opposed to supplements.  Adding in an 8oz serving of non- or low-fat milk isn't going to add that many calories to the day and I'm all about the chocolate milk which is great for recovery after exercising.  I don't feel a pressing urge to add this to my diet, but I may see about adding it every once in a while.
• If I understand correctly, the big concern about the coconut oil has to do with it's possible impact on cholesterol, given that it's high in saturated fat and may raise the level of cholesterol in your blood.  I don't have any concerns regarding my cholesterol at this time, so I'm not rushing to cut the coconut oil from my diet.  I do want to see about possibly shifting back to the "healthier" sources of fats like almonds and peanut butter.
• The extra serving of grains was a secondary recommendation, and one that my trainer's wife said would probably be made.  I'm not scared of carbohydrates but don't feel as though I have to incorporate them into my diet either.  If I had to add something into my diet, I'd be willing to go with some more carbs (the cream of rice is yummy!) but I'd also be happy with a glass of chocolate milk.

So what am I going to do with this information?  For now, I think I'm going to keep things as is.  I'll monitor how I'm doing and make changes as I need to.  I already talked with my trainer's wife about possibly adding things into my diet or making changes, depending on how things go over the upcoming weeks.  Nothing's off limits, but I want to make sure I'm able to keep things in balance.  I'm happy that I met with this nutritionist and it was a MUCH more positive experience for me.  It was good to talk with someone and actually be able to have a dialog about things.  I appreciate the opportunity to learn more, both about myself and on a more general level.  Most importantly, I think it reaffirmed that I know my body best, that I know a lot about health and nutrition, and that I am my own best advocate.

Food Log:

• Meal 1: 
• 3 egg whites
• 30g dry cream of rice (cooked in water)
• 1 tbsp coconut oil
• Meal 2: 
• 2% flavored Chobani Greek Yogurt
• Meal 3: 
• 3 oz chicken
• Green beans
• 1/2c cooked rice
• Meal 4: 
• 3 oz chicken
• Green beans
• 1/2c cooked rice
• 1 tbsp coconut oil
• Meal 5: 
• 0% flavored Chobani Greek Yogurt
• 1 tbsp coconut oil

Exercise:

• Time:  80 minutes (60 minutes on stairmill; 20 minutes on elliptical)
• Level:  N/A
• Calories:  850+
• Average HR:  145
• Max HR:  157
• Distance:  5.1 miles (stairmill); 2+ miles (elliptical)

Weigh-In:  146.8 / 144.4 (according to nutritionist's scale and probably an underestimation given that I think she accounted for the clothes I was wearing as being heavier than they are)