Lose 20 Pounds on a Keto Diet – But You’re Probably Not Going to Like This Post

On April 2, 2018, I was 269.8 and my blood glucose, which had more or less behaved by staying in the 120s, had begin rising into the 140s in the morning and staying there all day.

Not good.

My cocky, thin doc, who I am sure thought me just another fat slob, had told me years ago that, considering my family history, there was no way I *wasn’t* getting diabetes. “It’s going to happen sooner or later.” He said, seeming to enjoy saying it.

I swore I would bury this doctor at that moment.

Since I’ve been more or less on a low carb diet since the Atkins Craze of 2003, and although during this time there were long stretches where I didn’t follow the diet at all, overall, the past 15 years I have probably kept my carbs lower than the average person. Nearly Every. Single. Day. of these past 15 years has seen me in front of my computer, typing out the goals for my fresh start at my diet. I’d have good streaks – and bad streaks. Sometimes I didn’t get through lunch.

I’ve had this blog for a loooong time. But writing about failing all the time was getting kinda old. So I more or less stopped and wrote only when I thought I had something interesting to say or to report.

I’d been losing and gaining back the same 10 pounds for years – how dull is that? I decided that, unless I could lose 20 lbs., it was not worth my time nor your to blog about weight loss.

So today I can report that I just weighed myself and I was 248.6 lbs. Over 20 pounds lost from the start.

My blood glucose levels have also fallen by 40 points.

You’re probably not going to like how I did it – but stick with me here: there’s something weird and different this time than every other time. I am going to try and explain it the best I can, but first let me explain a little bit more about why I got to the point where I decided I needed to make a change.

So I’ve told this story before and I won’t go into detail, but I was 207 lbs. and actively following a low carb diet when I got appendicitis and had my appendix removed. Within 9 months of that surgery my weight ballooned to 287 for reasons no one can explain, then came down a bit and settled in the 260-270 range.

I had kept off maybe 50-60 lbs. of an initial weight loss of 80 lbs. When I went on Atkins in 2003 for most of a decade at that point – which is statistically impossible. The disheartening truth is – even for the folks who lose weight – most gain it all back in 5 years.

At least that *was* the thinking. Things might be changing. I certainly did.

Gaining all that weight after surgery was a real bummer. Much of that time I was doing low carb and it just didn’t seem to work. It probably has something to do with the appendix removal – but we really don’t understand the appendix that well yet, so any statement would be conjecture – we just don’t know.

My asshole doctor said: “It’s because of lack of exercise after surgery.” Idiot – I didn’t exercise BEFORE surgery!

There’s an old joke: why do people say ‘I found my wallet in the last place I looked!’? Who keeps looking for their wallet after they found it?

My 80-lb. loss on Atkins convinced me there was no other way than a low carb diet for me – but it didn’t seem to work anymore – and I had read and learned too much to just move on to some other diet.

So for a while, I gave up.

I also changed my route to work. Instead of highways with grassy edges, I took a slower but shorter route along what used to be a country road that is now dotted with at least 20 fast food places along my route.

My commute is long and my family doesn’t have regular evening meals for the most part – everyone seems to be somewhere else than the dinner table at the proper time – sadly, this is more normal than it should be these days.

So pizza might be lunch for me, and McDonald’s, usually, would be dinner if I didn’t go home and cook or eat leftovers. I also had a brief but intense love affair with bologna on Kaiser rolls as a breakfast for a while. This was pure comfort food as a kid, conjuring up my Mom and Dad and our breakfast together on Sundays after church. (OK – we didn’t have bologna sandwiches – we had eggs and bacon with the rolls  – but the Kaiser Rolls would bring me back to that table in the 1970s.)

And I didn’t think about it too much because my weight hovered in that 10-lb. range and another attempt at low carb or keto would bring me back to the low end of 260.

Then I’d fuck things up, eat more crap, and go to the top of the range again. Wash. Rinse. Repeat.

But this time it was the blood glucose that made me take action. I’m not a hypochondriac – imagining diseases – but I am a bit obsessive on tracking stuff – and the words of that doctor whose funeral I plan to attend still burned hot in my memory. This 20-point rise was fast – I was eating the same crap but now my pancreas apparently said: “Fuck this!” and decided to give up.

I know a lot of the science behind this – I was becoming increasingly insulin resistant to the point where my pancreas simply couldn’t keep up.

The poor thing needed a rest. So on April 2, I decided to start my diet again – but I needed to do something different – the old script wasn’t working. I was also older and what worked for me 15 years ago might not work now.

I had no doubt that a low carb / keto approach was the only way – but within those labels are a world full of different ways to approach this way of eating.

I’ve written way too much already so I’ll continue what I did differently in a part 2 of this post.

Update: here’s part 2 for those of you who care.

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The Physical

“I don’t have time for this. I have other patients to see.” Said my doctor, clearly indicating that I had used up all my allocated time for my yearly physical – or had finally pushed enough of his buttons. One or the other. It was awfully late and I thought I was his last patient. Perhaps it was true that he had other patients to see, or maybe it would have been more truthful for him to say: “I’ve had enough of arguing with you. I’m hungry and tired and want to go home and see my wife and kids.”

Either way I wasn’t offended. I am an exasperating patient. I am exasperating human in general, always questioning the obvious, asking questions that generate cow-stares or mild shock from those within earshot, or saying what I believe to be the unvarnished truth when it might be more prudent to just shut the fuck up.

In this particular instance of exasperating another human being, it was because my doctor, assessing my spectacular weight gain of 40 pounds since my last visit and a crappy total cholesterol count in the 260s, wanted to put me on statins – cholesterol-lowering drugs.

He showed me a worksheet from the American Heart Association that, when my crappy blood work numbers were plugged in, said I had a 14% chance of a heart attack in the next 5 years. He had done his homework probably because he knew I was a hard sell. We had the ‘statin talk’ last year when I was about 207 pounds and my total cholesterol was only a little elevated. I told him ‘no’ then.

And 40 pounds heavier and with really shitty blood work – the worst ever, I told him ‘no’ again.

I told him: “I have to be honest with you: I’m not a big fan of statins. They have not been shown to reduce all-cause mortality in patients like me and they also have a curious side effect, little discussed, of increasing the risk of violent death and suicide.”

My doc is a chill guy. I like him, though we don’t agree on a lot of things. I’ve mentioned this to people and they say: “Why don’t you change doctors?”

“Why? I’m not looking for somebody to always agree with me.” He’s smart and has a good 15 years of experience as a clinician. I also think he cares. He took the time to prep for me coming in by running that American Heart Association risk assessment. I think that counts as ‘going the extra mile’. He genuinely thought that he had the evidence to convince me – a seemingly rational and  medically knowledgeable layperson – to comply with his recommendation.

And I exasperated him by still saying ‘no’.

So I suppose I like him because, with nearly every relationship I have, there is a certain aspect to it where the other person has to put up with me.

People in their professional roles sometime turn into caricatures – and I suppose doctors are probably more guilty of this than most professions. In a line of business where on any given day your job might be to tell a seemingly young and healthy parent who came in with what they thought to be some minor ill that they need to ‘get their affairs in order’ because they are going to die soon, I can’t judge them harshly for perhaps putting up a wall of sorts between their patients and themselves.

But I am fascinated with these walls we put up as part of our daily interactions – and I love to break through them. Being exasperating frequently causes people’s walls to unexpectedly crumble – and what’s behind them is usually interesting.

So when I mentioned the statin research showing no benefit in all-cause mortality for patients without active cardiac vascular disease – and the crack about the increased risk of suicide and violent death, my doc’s usual chill turned less chill. He seemed slightly taken aback by the all-cause mortality, violent death and suicide bit and said with reserved force: “I challenge you to produce the evidence on these.”

I could easily find these mentioned in respected journals like the Oxford University Press, Pubmed, and the Lancet sitting in my car on my smart phone before leaving the parking lot of his office. I’ll be printing out whatever isn’t paywalled before my next visit.

Here’s one link: http://www.thennt.com/nnt/statins-for-heart-disease-prevention-without-prior-heart-disease/

It says – and backs it up with a boatload of legitimate citations – that after 5 years of statin use in patients without known cardiac vascular disease:

  • None were helped (life saved)
  • 1 in 104 were helped (preventing heart attack)
  • 1 in 154 were helped (preventing stroke)
  • 1 in 50 were harmed (develop diabetes)
  • 1 in 10 were harmed (muscle damage)

Here’s another: http://qjmed.oxfordjournals.org/content/97/4/229 – you might have heard of Oxford, it is the world’s second oldest university, having been around since 1167. 16 Nobel prizes in medicine were awarded to alumni. It’s not a citation from some jackass with a blog and an axe to grind.

The study was small and warrants further investigation, surely, but a few people put on statins got really grumpy afterward. The link notes:

Manifestations of severe irritability included homicidal impulses, threats to others, road rage, generation of fear in family members, and damage to property.

Now – don’t get me wrong – statins have their place. In people with CVD it is a lifesaver (http://www.thennt.com/nnt/statins-for-heart-disease-prevention-with-known-heart-disease/). However, I come from a family with no predisposition toward heart disease even though my father’s side of my family ate and drank with abandon and all had potbellies and ruddy faces from all the beer they drank. A good part of my heredity ate whatever the hell they wanted and lived well past 80 – with 80 being the point where the dodginess from the family predisposition toward Alzheimer’s began to take full effect.

I don’t have known heart disease, nor do I have diabetes though my brother, sister, father, and mother all had it – with my siblings getting it way before the age I currently am. I don’t have a family history of CVD. I see nothing in my medical history nor my heredity that makes me a good candidate for statins and have to put up with the potential to develop diabetes, the potential for muscle damage, or the potential for negative psychological effects.

Before the ‘statin talk’ I had already parried with him on diet. As I sat in my underwear, an unpleasant sight except perhaps to a clinician who has trained themselves to be detached and doesn’t really give a shit as a protection mechanism from going insane, he mentioned in what in retrospect was carefully chosen language that “I was a much larger patient” than when he last saw me – and he hoped I had a plan.

“Yeah. My plan is to go on a low carb diet.” I said.

“Do you mean below 100 grams of carbs or below 50 grams?” He asked.

“Oh, I want to do a ketogenic diet. I’ve been on one on and off for a decade and I find it works quite well for me. It even seems to make me calmer.”

“What is recommended is a calorie-restricted diets with legumes, whole grains, and lean meat, along with vigorous exercise most days of the week.”

“Well, a ketogenic diet has worked for me in the past.”

His tone changed. He was going into his ‘learned clinician schtick’. It became more patronizing. “Well you know, a ketogenic diet puts your body into a mode similar to starving. You body can’t live without glucose. What is most important is that a diet be sustainable – and a low carb diet isn’t sustainable.”

OK – a decade of sustained weight loss shows it isn’t ‘sustainable’ – he’s right – I gained weight after a decade. Got it.

I did counter on the glucose thing, though: “Um…but your body can create the glucose it needs from a moderate protein diet and converts the protein into glucose through gluconeogenesis – right?”

He didn’t say anything for a bit – frankly, I don’t recall a direct response at all. Perhaps he had busied himself with the next part of the examination – the part that included the snap of a latex glove and ‘bend over’.

Given the asymmetry of the situation – he fully clothed and I in my skivvies – I wasn’t about to tell him that my lack of exercise is almost a badge of honor for me. I follow the advice of a quote I once read: ‘Whenever I get the urge to exercise, I lie down until the feeling passes.’ I have a sneaking suspicion that the relentless advocation of ‘exercise for everyone’ is not so much for the health of individuals but rather the health of the economy: every gym membership, every Thighmaster, every pair of running shoes raises the GDP – and so do the attendant sports injuries: muscle pulls and torn ligaments provide physical therapists gainful employment; injections of steroids provide income to doctors as well as relief to the patients who have exercised their way to worn out joints, and finally the people who thrive on a steady stream of former exercise enthusiasts who, instead of choosing the next pair of running shoes to buy, now have a choice between a hip replacement or a walker and constant pain.

I also feel that above a given weight, it is smart to start losing weight without the exercise (it can be done – I did it) – and with an increasingly lighter body comes more energy and the freedom of movement that can make you *want* to exercise.

And I haven’t even begun with my feelings about what constitutes ‘healthy eating’. If my differences with the standard accepted notions on exercise were a flaming match head, my differences on nutrition from most people were a nuclear bomb.

As I left I mentioned he should check out the book ‘The Big Fat Suprise‘ – a masterfully written work that clearly explains just how we ended up vilifying fat as a nutrient because of bad science, big egos, and politics. He just snorted. It was only a:

  • A New York Times bestseller
  • Named one of The Economist’s Books of the Year 2014
  • Named one of The Wall Street Journal’s Top Ten Best Nonfiction Books of 2014
  • Kirkus Reviews Best Nonfiction Books of 2014
  • Forbes’s Most Memorable Healthcare Book of 2014
  • Named a Best Food Book of 2014 by Mother Jones
  • Named one of Library Journal’s Best Books of 2014

Kinda what I expected. 

For those of you unfamiliar with my backstory, in 2003 I lost 80 pounds on a low carb diet. Unlike most people who would have reveled in their success, bought new clothes and left it at that, I needed to know why. How could I eat like I did and lose weight? I had only read the Atkins book, and learned about ketosis: a chemical transformation to your body that allows you to run your body on ketones – the product of burning fat – instead of glucose – which comes from sugars and starches and is what the vast majority of human beings run on these days. In fact, running your body on ketones is so rare that one way of measuring your ketones to track your progress – urine strips – are actually manufactured for people with severe diabetes to manage a severe side effect called ‘ketoacidosis’.

Being slightly obsessive – or maybe a tad more than ‘slight’ – I spent the next 10 years reading books, research, blogs, and articles and all aspects of diet nutrition, the history of diets and dieting, how diet has changed over the centuries, the psychology and sociology of food and eating, as well as a myriad of odd little detours into admittedly wacky material produced by people with dubious credibility as well as my own hare-brained ideas.

All that obsession spilled out into a blog on low carb which I started on a whim and then wrote and published over 500 articles over 7 years. I sort of abandoned writing on low carb and shuttered the blog at the end of 2014 for reasons not entirely clear to me. Perhaps I had grown tired of it all. Perhaps I had said all that I had to say on the subject.

Perhaps I was just paying lip-service to my low carb lifestyle and writing about it – as I gained weight – seemed disingenuous.

Perhaps I needed to regain enough weight to give a shit again.

Who Is This Guy?

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After a newfound commitment to begin again, and off to a great start in week one, things slowly drifted back to the habits that helped get me fat again and the passionate indifference returned.

I’m now back to pretty much where I started.

Iv’e spent some time reading some of my old posts – which I typically forget moments after writing and have to ask: who IS this guy? He seems more eloquent than I. He seems more curious, more committed, and more energetic.

He *is* younger than me – and thinner. I don’t think that time spent on the right-hand side of the big five-zero has been kind to him. He can’t claim any bad luck – actually the Universe has been quite generous to him in comparison to many of his age. Yes – there have been the sort of things one starts to expect as the car passes the 50,000 mile mark. Parts start to wear.

My eyesight isn’t what it once was and while wearing readers for almost a decade, it seems I need them now more than ever. I also have Uveitis in one eye – a condition that makes the vision quite blurry in that eye – and is treated with an injection – INTO THE EYEBALL.

Did that make you cringe? It really isn’t as awful procedure as you’d imagine, but it does make your eye blood red for a while.

And the 12-year-old in me get a kick by seeing the faces of the people who ask why my eye looks like that and I tell them it’s because I got an injection in it.

An appendix got removed. It’s wasn’t a big deal except that it was a milestone of sorts: my first surgery. Yet more proof that the Universe has been kind: how many people get cut open for a myriad of reasons well before the half-century mark?

Still – despite my good fortune in many aspects of my life, something seems changed. I’m different than the guy who wrote all these posts.

First, I’ve become somewhat tired of the science aspect of a lot of nutrition. Perhaps it’s that I know enough – or at least I think I do.

I think that it was the Buddha that tried to teach his students that his teachings didn’t need to be worshipped, made sacred, or endlessly studied but were only a tool meant to be used to accomplish a goal and discarded. He described it as a boat to cross a deep river. Even though it was valuable to make the crossing, once the river was crossed there was no need to carry the damn boat all over creation – it could be left on the shore while the journey continued unburdened by it.

In Zen Buddhism there is a state where an adherent is said to ‘stink of Zen’. It means they are going overboard. The tool has become more important than its purpose. The study has become more important than its application.

Zen has little tolerance for righteousness or for excessive knowledge. It’s about the practice.

Perhaps I know enough and it’s time to get my nose out of the books and practice more.

Second, which might be the bigger problem, is that I’ve become bored with low carb eating – and this extends from the fact that I’ve become tired of low carb cooking. As my enjoyment of cooking has waned, low carb eating by necessity becomes less varied, and perhaps this is what is derailing me.

Third, perhaps the gain in weight, combined with age, and combined with the fact I no longer drink 3 pots of coffee a day, contribute to a lack of energy. I used to happily get up at 4am, drink a pot of coffee, write blog posts, maintain a little notebook of goals and to-dos, then leave for work, put in my time while putting away another 2 pots of coffee, and come home and cook and do other chores. Now I get up between 5 and 6, have a cup of coffee while staring into space, then go to work where I have maybe 3 or 4 cups.

The decline in coffee drinking was not intentional – not something I wanted to necessarily do – it just happened. Perhaps being a caffeinated speed-freak was good for me, but it’s not me anymore.

Fourth, perhaps my long-documented love of sloth – and the ability to lose weight without it – has to come to an end. I don’t know where I read it, but the case was made that, while this nonsense of burning calories talked about as if it is a financial transaction: “If I run for 30 minutes I will burn 200 calories” is a simplistic explanation, wrong, and yet enshrined as a myth so strong that every treadmill purports to tell the user down to the calorie just how much they’ve ‘burned’, it was said that there is *something* more subtle going on with exercise and weight. It isn’t well understood – but there’s a connection.

I can buy that.

After years of reading all sorts of research on these topics, I’m more comfortable with the people who know that ‘I dunno’ is not an admission of stupidity but one of honesty.

A good friend is moving and giving away their treadmill. I’m going to try to get it. Maybe it will jumpstart some better habits.

Maybe my repeated failures shows I’m not ready for a full-blown low carb diet just yet. I’ve done a hard-core program before with great result – and I can do it now, too – for about a week. Then I crumple like a cheap suit.

Maybe I’m not ready for a diet just yet, but instead in need of a ‘pre-diet rehabilitation’. Maybe I should start small, make small wins where I can, and proceed slowly in the direction of the headwinds of the right direction than to think I’m going to do it in a dash.

After thinking this, I bought a salad – just vegetables – and bought that home. My wife asked if this was the start of a new beginning. I told her: “I’m not being that ambitious. I’m just thinking that ‘maybe a salad now and than wouldn’t kill me'”.

Her birthday is soon and I’m thinking of giving her a gift: I abstain from alcohol until I’m under 200 pounds.

The dynamics are different here: promising yourself is one thing – but promising the spouse you love? That’s another.

The occasional salad and the abstention from alcohol are not going to result in an almost 60 pound weight loss – but they might not hurt.

I have a quote on the recent change in dietary guidelines that has announced that all the dietary cholesterol we were supposed to be worried about? Nah – they were wrong. “It isn’t a nutrient of concern.” Apologies to all those egg lovers frightened into avoiding a food they loved by science that has now been dismissed.

One section really struck me of the article on the topic in the Washington Post (emphasis mine):

“These reversals in the field do make us wonder and scratch our heads,” said David Allison, a public health professor at the University of Alabama at Birmingham. “But in science, change is normal and expected.”

When our view of the cosmos shifted from Ptolemy to Copernicus to Newton and Einstein, Allison said, “the reaction was not to say, ‘Oh my gosh, something is wrong with physics!’ We say, ‘Oh my gosh, isn’t this cool?’ ”

Allison said the problem in nutrition stems from the arrogance that sometimes accompanies dietary advice. A little humility could go a long way.

“Where nutrition has some trouble,” he said, “is all the confidence and vitriol and moralism that goes along with our recommendations.”

Perhaps professor Allison’s admonition to his colleagues might apply to those of us trying to lose weight as well. More humility, less moralism, less hubris about progress  – those resolutions the emptily echo because you know you and know it ain’t gonna play out like that. Patience and tolerance for ourselves while gradually moving toward a better way of eating – without worrying about the scale as much as how we feel might do a world of good before taking the plunge into a more serious diet.

For me that means trying to score me a treadmill and maybe replacing a few meals a week with a salad.

 

 

 

 

What Does Gaining 50 Pounds Feel Like?

It might be worthwhile at this point to spend some time detailing how it feels to gain 50 pounds. It can be summarized as ‘it sucks!’ but beneath that lies a litany of things that ought to be detailed in case I forget.

My newfound shortness of breath. Wearing a 50-pound bodysuit every day makes me winded easily. My disdain for exercise doesn’t help here, but I’ve certainly noticed that climbing a flight of stairs can leave me winded to a point where I need a minute or two to catch my breath. Just the normal exertions in life – like rummaging through a low cabinet for some cooking gizmo – can do it.

A rekindled relationship with massive amounts of Tums. If you follow the stock market and see the stock of the company that makes Tums go up unexpectedly – that’s me. It seems nearly *any* carb-laden food that ‘normals’ regularly eat quickly turns into a fire-bomb in the pit of my stomach soon after. Only a handful of Tums can extinguish this.

The resurfacing of GERD symptoms. Waking at night choking. Coughing, sometimes for a good part of the day. It’s connected.

The lack of accessibility to body parts. My feet seem further away and putting on socks has become bit of a challenge. This ain’t cool. I don’t like to think of myself as handicapped nor incapacitated, but being close to not being able to get my own damn socks on is one of those things that is really pissing me off. I wrote a review of mobility scooters as snark – it’s beginning to seem my fate if the current trend keeps up.

The snoring. Apparently quite loud according to innocent bystanders. Might involve sleep apnea, which at the worst isn’t good for your health long-term – oxygen being somewhat important to we humans – but it also ensures a crappy sleep, which is going to contribute to…

The total lack of energy. While there are bursts of energy here and there, the default state is ‘tired’. I wasn’t exactly a ball of energy to begin with given my love of sloth, but I could rise to the occasion when needed. Now I am more or less exhausted by the time I *get* to work, revived by coffee, then go home completely spent. I’m pretty much worthless in the evenings – a pile of protoplasm in sweatpants with butt affixed firmly to couch until I drag said butt to bed.

Joint pain. Especially my knees. I’ve known a number of people who’ve had their joints sawed out and replace with spiffy titanium substitutes, but I’m the kind of guy who’d like to make due with the knee joints I was born with. This dovetails nicely with my plan to use this as an excuse to not exercise until I’ve done some serious debulking, but this is a topic for another post.

My diminishing wardrobe. My clothing choices are becoming less and less, and the few items that still fit are comically tight. The button of my khakis is about to come off so I need to get out the sewing kit – and I’ve become more fond of the riveting used in jeans as it can better hold back the boatload of blubber attempting to burst from its constriction within garments to small. I haven’t even gone into how uncomfortable I feel in my clothes.

My crappy blood work. Bad cholesterol high. Triglycerides high. Blood sugar elevated. A doctor warning of a 17% potential for a heart attack within 5 years and pushing statins. My blood work was always pretty good when I kept the carbs to a minimum and swam in fat.

People telling me I’m not fat. I’m not sensitive about my weight. I’ve gotten fat – and I’ll come right out and say it. When I hear people say: “Oh, you’re not fat.” despite the evidence in front of them as well as my forthright admission, I translate this to: “Oh. My. God. You’re. Fat. You’re so fat my prefrontal cortex has shut down and I’m sputtering lies because I don’t know how to deal with how fat you are.”

All of this I attribute to eating like a ‘normal’: don’t get all hung up on this ‘carb’ thing – just eat what you like in moderation and you’ll be fine.

Plenty of people pull this off. I can’t. I have to accept this.