Catching up - weekly reports for Weeks 5, 6 & 7

Sorry that I haven't been active lately -- lots happening. Reports first, then some analysis:
Week 5 weight:

Week 6 Weight:

Week 7 Weight:

So, weight loss has slowed down--not a surprise given some things I'll explain. But 3 pounds in 3 weeks is fine. Bodyfat, by the way, shows just how much this measurement is affected by hydration and other elements, particularly with this kind of scale. In the three weeks: 35%, 36.5%, and 30.5%. I don't think my actual bodyfat changed that much! That's why it's only a good indicator over a long period of time (and I may wish to get bodyfat measured later by another method).

So, what's going on? The good, bad and the ugly (except I'll go in opposite order):

Ugly! This has been an extraordinarily stressful time. School starting back up, usual hyper busy schedule. Stress, as we know, causes the body to release cortisol, which does all sorts of negative things, and stress also causes the body to react by protecting fat stores. My nasal surgery has not been effective, with the right nostril entirely plugged 80% of the time (and almost always at night). This means I've rarely been able to use the CPAP for a whole night, leaving me most of the time with about 4-5 hours of not-very-restful sleep.

Of course, that's what the surgery was supposed to solve! Saw the doctor again Thursday and he thinks the cutting of the turbinate on the right side has caused another problem. For now, I'm on a short course of steroids (prednisone) and a fairly potent antibiotic. We'll see if the prednisone takes down the swelling/inflammation in the right passage and if the antibiotic gets rid of the infection/inflammation behind the turbinate (where the doc couldn't see even with his scope). I'll check back in two weeks with him to see if, once off drugs, I'm getting a better result. If not, it means another X-ray/CAT scan to see what's going on. I don't want that to be another surgery! The prednisone also drives up your blood sugar--not good for me at all.

Bad! One phrase: creeping carbs. A few more carbs each day can add up. A few meals out (including several at a favorite Mexican restaurant where I have some chips and did eat the beans and rice), more of the sugar free (but not carb free!) puddings and nuts at night. Only once had wheat (sub sandwich while out for lunch with colleagues). And protein shakes for breakfast every morning (too easy).

Good! Despite all of this, I've managed to keep calorie counts pretty low with no real breakdowns, binging, etc. That's why, even given all the negatives, I've been able to have a modest weight loss and not lose control. Additionally, I've walked (at the mall--after all, even in the morning it's close to 90 degrees here!) almost every day (23-25 minutes, depending on how fast I get around the mall interior twice). This has made me feel much better. And I've also done my core exercises at least 3 times per week.

So, overall, still going in the right direction. If I can get past the most stressful part of the year and solve my nasal problems, then I should "resume normal operations".

Monday 8-8-11 - extra carbs

Monday was another fairly low-energy day. Doc's appt. follow-up on the septum surgery at 11 and we went to a local Mexican restaurant afterwards.

No chips (good for me) and a taco salad (quite good). The only problem was they layered refried beans on the bottom and put the ground beef directly atop, so I couldn't avoid eating the beans. Very tasty, but more carbs than planned for! Post-prandial blood sugar at 122.

For "dinner" I had 2 oz. of cheese, tomatoes, guacamole (this is always "house-made" and the equivalent of 1/2 avocado). My sweetie also made some interesting baked cheese things (essentially cheese and spices) which are delicious, but will call for some restraint. She also made (the day before) some "crackers" out of some combination of almond flour, sunflower and I'm not sure what. Again, tasty, but even though they aren't made out of grains, still doesn't mean they're low carb (although much lower than most). Also had one of the no-sugar puddings (again, no sugar, but that doesn't mean no carb: around 14 grams). Blood sugar at 110.

Bigger challenges ahead as my schedule becomes busier (crazy at times, I should say), more temptation eating out, etc.

Finding something that's sustainable, checking blood sugar to see how different foods affect me will all be important.

Sunday, 7 August 2011--looking ahead to exercise

Diet back to more normal low carb today, although two protein shakes and one meal (cheese, veggies, guacamole), one low-carb pudding and two 1 oz. servings of macademia nuts. I'm not including sugar-free jello, which I probably eat once or twice each day as a bit of a (no carb) treat.

Sleep not as good, still woke up after 2 hours, but up longer before getting back to sleep. Sunday night's sleep about the same, or even less. Soon I'll be back to a normal work schedule and have to see how I can settle into a pattern and be more regular. In a future post I'll outline a plan to improve sleep.

Continue getting better from the surgery, less congestion, although still enough to interfere with CPAP breathing and sleep.

Saturday was incredibly energized. Went to a mall where we walked ca. 2 miles. Then in the evening walked again at our "home" mall, very energetic. Sunday, however, felt tired, logy--walked at the mall but at a slower pace. Decided not to go to an opera at school--a bit too tired and the congestion gets much worse at night. Thought I would go Sunday, but was very tired and more congested (from doing more the previous day?).

Local mall is open for mall-walking from 7-9 every morning but Sunday, so I need to do before work as I work into a regular schedule.

Every day, I should walk, twice if I don't have an evening commitment. Not long, perhaps 20 minutes of continuous walking. Enough to get some aerobic effect. Eventually, I should do either stairs or running in an interval fashion, perhaps once or twice per week.

Then, 3-4 times/week my core exercises: bird-dog, plank, side planks.

3-4 times/week, simple body-weight strength exercises: pushups, pull-ups, leg raises and squats. For this, I'll use a progression from very simple (e.g. wall pushups to knee pushups, etc.) to more difficult (full pushups to one-arm pushups).

Essentially, I'll alternate core exercises with the body-weight ones. All this should build muscle and the core should help my back, long-term.

The progression in the body-weight exercises will come from a book with a somewhat terrible title, Convict Conditioning, but quite a good idea of how to progress from very easy exercises to very difficult. These move through 10 progressively more difficult versions of each exercise, plus recommendations for reps and sets . . . and when you're ready to move to the next, more difficult version. Ultimately there are two other foundation exercises (bridge and handstand pushups), but you can't begin those until you've gotten to at least level 6 out of 10 in the four listed above.

There are probably other things I must do too--some stretching, exercises for my rotator cuff, grip exercises--but those can be fit in to other times and places--at the office, while watching TV, etc.

I'll work my way into these slowly, not all at once. I need to adapt, both muscles and overall ability to do exercise and my normal schedule as I recover from the combination of surgeries and lack of activity this summer.

Week 4 Report

Here are the results for 4 weeks:

So, a pound and a half this week, 14 pounds in the first 4 weeks--truly good, especially considering the surgery this week and terrible sleep, plus lack of exercise.

Friday, protein shake in the AM (still makes me feel bloated--air in the blender shake or problem with the dairy in the whey protein?); hot dog w/o bun at 5 Guys; cheese, tomatoes, 1/2 avocado. Then a small amount of home-made ice cream (mostly cream/half & half, egg yolks, very little sugar), blood sugar afterwards 107.

Getting good sleep has been a long-term problem for me and sleep is one of the elements mentioned prominently by writers and researchers in the area of weight loss. Adequate sleep takes down stress levels, where inadequate sleep raises cortisol and insulin levels, both negative for healthy weight loss.

Robb Wolf makes it a very important part of his program. One of the things I eventually want to do is some intermittent fasting (Swede Martin Berkhan has one of the more interesting sites on this and has a particular protocol of working out and intermittent fasting to get very lean and muscular) and Wolf as much as says that until both your diet (paleo, of course) and sleep are in order, you shouldn't even attempt intermittent fasting.

My own sleep is made worse by being inconsistent--my natural tendency is to stay up late and I can very quickly be back to a late (read, 1-3 AM) bedtime. Any book on sleep disorders or increasing good sleep will mention consistency of bed-time/wake-time.

I also have interruptions to my sleep almost every night (i.e. I rarely sleep more than 4-5 hours at any one time) and once awake am often up for 1 1/2 to two hours. Part of the interruptions are normal for middle-aged guys: waking up to pee. But it is often because, since I use a CPAP for my sleep apnea, if my nose gets plugged up enough, you wake up (because the mask means you only breathe through your nose). That's the reason for: 1) doing the sleep studies and getting a new, better CPAP device and 2) doing this surgery and improving the air flow through my nose.

Temporarily, of course, sleep is much worse, since my nasal passages have been extremely swollen/inflamed due to the surgery, and I was having to sleep in a recliner to keep head higher to make drainage better. This meant three nights of even worse than even my usual crappy sleep: the night before the surgery with about 3 hours (on a late-night pattern, had to get up very early, stressed about the surgery), then not more than 2 hours at any one time for the next couple nights, waking up totally dried out (from breathing through my mouth) and uncomfortable. As my surgeon said, you'll have several days of cat-naps only.

Last night was my first night back in bed (yay!). My nasal passages weren't clear enough to use the CPAP when I went to bed (around 11:15). Slept until 1:30 or so, up for about an hour and a half, used saline to clear nose and got back to sleep around 3, but able to use my CPAP, awoke 7:30--so about 6.5 hours total (and I might yet go back to bed for another round).

Long-term, I need to work on several things:

• consistency of bed-time/wake-time (weekends as well as weekdays)
• figuring out a cut-off time for liquids to make sure the need to pee doesn't wake me up
• consistency of bed-time routine
• shutting off TV and not using computer after a certain hour
• dark as possible room (I usually do this)
• cool sleeping room (impossible now with the high heat here--I've had to keep our thermostat up near 78, even at night)

Hopefully this can lead to more consistent and deeper sleep (I would like to see around 7.5 hours per night), which should have huge physical and mental benefits.

I'll start tracking sleep better as part of this whole transformation.

Another great post by Dr. William Davis on blood sugar

Yet another great post on blood sugar by Dr. Davis. Speaking of carbs with fewer bad effects than wheat, oatmeal, etc. (brown rice, black beans, etc.), he says:

So these non-wheat carbohydrates, or what I call “intermediate carbohydrates” (for lack of a better term; low-glycemic index is falsely reassuring) still trigger all the carbohydrate phenomena of table sugar. Is it possible to obtain the fiber, B-vitamin, flavonoid benefits of these intermediate carbohydrates without triggering the undesirable carbohydrate consequences?

Yes, by using small portions. Small portions are tolerated by most people without triggering all these phenomena. Problem: Individual sensitivity varies widely. One person’s perfectly safe portion size is another person’s deadly dose. For instance, I’ve witnessed many extreme differences, such as 1-hour blood sugar after 6 oz unsweetened yogurt of 250 mg/dl in one person, 105 mg/dl in another. So checking 1-hour blood sugars is a confident means of assessing individual sensitivity to carbs. 

Of course, others such as Robb Wolf (whose book, The Paleo Solution, is great) wouldn't want you eating them because of anti-nutrients (I'll write more about that some other day). And even Paul Jaminet of the Perfect Health Diet (another great book, by the way), who does advocate more carbs, around 100 grams/day (although not for those whose metabolic systems are compromised), only wants "safe carbs" (i.e. those without the problems) such as white rice (no anti-nutrients/safe source of glucose) and tubers such as sweet potatoes and taro.

Davis further says:

Some people don’t like the idea of checking blood sugars, however. Or, there might be times when it’s inconvenient or unavailable. A useful alternative: Count carbohydrate grams. (Count “net” carbohydrate grams, of course, i.e., carbohydrates minus indigestible fiber grams to yield “net” carbs.) Most people can tolerate around 40-50 grams carbohydrates per day and deal with them effectively, provided they are spaced out throughout the day and not all at once. Only the most sensitive, e.g., diabetics, apo E2 people, those with familial hypertriglyceridemia, are intolerant to even this amount and do better with less than 30 grams per day. Then there are the genetically gifted from a carbohydrate perspective, people who can tolerate 50-60 grams, occasionally somewhat more.

People will sometimes say things like “You don’t know what the hell you’re talking about because I eat 200 grams carbohydrate per day and I’m normal weight and have perfect blood sugar and lipids.” As in many things, the crude measures made are falsely reassuring. Glycation, for instance, from postprandial blood sugars of “only” 140 mg/dl–typical after, say, unsweetened oatmeal–still works its unhealthy magic and will lead long-term to cataracts, arthritis, and other conditions.

Humans were not meant to consume an endless supply of readily-digestible carbohydrates. Counting carbohydrates is another way to “tighten up” a carbohydrate restriction.       

Clear for me that I need to stay where I should!

A good example is today. Still recovering from surgery, had a visit to the Doc's to check up on results (very good!), clean out my nose at the sites with stitches, etc. Afterward, my wife and I went to a great breakfast restaurant. I had two fried eggs, two slices of bacon, about a half portion of hash browns, and a serving of strawberries. One hour later, blood sugar was 144. Not something I should do! But I'm willing to bend a bit around this kind of illness and stress. But tonight I'll be back on low carbs--and hopefully blood sugar in the 95-105 range.

Surgery! (Wed. August 3, 2011)

Tuesday was a normal day with pretty normal results.

However, Wednesday I had surgery to correct a deviated septum, remove part of the turbinate, etc. Should make it much easier to breathe through my nose (eventually, not today!).

This meant a couple things. Diet not normal at all today and, because I'm a singer, the anesthesiologist used a little steroid to keep swelling of the vocal cords down (I had full anesthesia). One of the problems for diabetics using steroids is that they cause your blood sugar to rise.

All went well and I felt better than they advertised today, not much pain, only one of the prescribed pain pills, then naproxen after that. Also, not much draining. I'll see the Doc again tomorrow and see how things have progressed. Very little sleep last night (bed late and very early rise, since we had to be at the hospital at 6 AM) or today (just not sleepy) and the whole day in my recliner (and sleeping there tonight, too) since I have to keep my head higher than the rest of my body so any drainage goes the right direction!

I was supposed to eat rather bland, soft food (post-anesthia and with a slightly sore throat from the tube), so I did two protein drinks today, some cheese, about 3 sugar-free jellos and 3 sugar-free puddings (but not carb-free--about 13 grams of carbs). Also later, when it became clear I could handle some nuts, about 3 oz. of almonds over the evening. This means my carbs are NOT at my normal level, probably 100 grams or more instead of 30-35. I suspect my weight on Saturday will reflect that, although I should be able to get back on track by Friday and perhaps tomorrow. I'm also doing NO exercise or movement (lots of TV, though), where lately I have been walking most days for at least 30 minutes.

Blood sugar reflected stress from the surgery, more carbs and the steroid: 146 when I got back from the hospital around 2 (oh yeah, I had 6 oz. of Sprite in the recovery room, but of course hadn't eaten or drank anything since about 10:30 the previous evening), 134, 141, and then finally, at 1 AM, back to 107.

All-in-all, not a bad day, compared to what the Doc warned it could be (headaches, feeling stuffed up like a very bad cold, lots of drainage, etc.). But more symptoms could show up tomorrow!

When to measure blood sugar

Dr. William Davis' Heart Scan Blog is one of the better ones (I need to get a blogroll here soon).

I was wondering if measuring my blood sugar two hours later (as the ADA and the makers of my glucose monitor say) was correct--I hadn't gone back to check Dr. Bernstein's book, but remembered one hour as the significant time (and that's how I've been testing).

And so, along comes a post on Dr. Davis' site: "One hour blood sugar: Key to carbohydrate control and reversing diabetes." Just what I needed!

A bit of what he says:

Diabetics are instructed to monitor blood glucose first thing in the morning and two hours after eating. This helps determine whether blood sugar is controlled with medications like metformin, Januvia, Byetta injections, or insulin.

But that’s not how you use blood sugar to prevent or reverse diabetes. Two-hour blood sugars are also of no help in deciding whether you have halted glycation, or glucose modification of proteins the process that leads to cataracts, brittle cartilage and arthritis, oxidation of small LDL particles, atherosclerosis, kidney disease, etc.

So the key is to check one-hour after-eating (postprandial) blood sugars, a time when blood glucose peaks after consumption of carbohydrates.

Perfect for me right now.

He also mentions building your own peaking curve by testing every 15 minutes. I may try that a few times to see if my peak is different than just one hour.

But this is incredibly helpful.

As does Bernstein, he forcefully questions allowing blood sugar to go high:

I reject the insane notion that after-eating blood sugars of less than 200 mg/dl are acceptable, the value accepted widely as the cutoff for health. Blood sugars this high occurring with any regularity ensure cataracts, arthritis, and all the other consequences of cumulative glycation. I therefore aim to keep one-hour after-eating glucoses 100 mg/dl or less. If you start in a pre-diabetic or diabetic range of, say, 120 mg/dl, then I advise people to not allow blood glucose to go any higher. A pre-meal blood glucose of 120 mg/dl would therefore be followed by an after-eating blood glucose of no higher than 120 mg/dl.

More important advice for me to reinforce that I need to keep truly tight control over blood sugar, not what the ADA calls "tight" control!

Next three days and further experiment

So, I'm continuing to see drops in blood glucose:
Saturday - 97, 82, 105
Sunday - 98, 81
Monday - 86, 86, 85

More significant was an experiment done twice with protein drinks, but now with 2 scoops of Designer Whey, one of BCCA, 1 tbl coconut oil, 2 tbl heavy cream, 1 raw egg. The first day I followed one hour later with BG of 81, the next day of 86.

This is very helpful for me, since I tend to get tired of meat if I eat it too often (strange that I can eat chips, burgers, tacos, and drink cokes day after day with no let up!).

On the other hand, doing this rather than real food may lead to slightly slower weight loss, but it's worth it if I can be more successful at keeping on the diet.