interesting week

Not the best of weeks so far.

My wife is gone this week and I went off the very deep end on Monday. Dinner at my favorite Mexican restaurant, didn't limit chips/salsa and had a whole carne asada (ate the whole thing) including beans and rice. Post-prandial blood sugar 186.

Later that night got the munchies and had what was left of a bag of fritos and then a late night bowl of grapenuts. Next morning fasting glucose was 181!! (which tells me that my reaction to too much carb/sugar is still abnormal/diabetic.

Tues. AM, after a walk and breakfast (back to the protein shake) it was 130, still too high.

One hour post-prandial it was 112, much better.

After another larger meal later that night, 152, too high.

Had a slice of pizza before choir rehearsal and a chicken taco afterward. This morning (Thursday), fasting BG 96, back where it should be.

Clearly, I have to control the amounts of carbs to keep tighter control of BG.

I'm moving out of the strict liquid, VLCal/Carb diet. But need to make sure that I don't go off the deep end any more!

Hopefully, next week will be much closer to "normal!"

Update 10-15-2011

When I talked with my doctor, the lab has to store the blood in a particular way/container to test for A1c, which they did not, so I'm out of luck until my next lab.

Blood sugars have been good, fasting in the morning always under 100 (usually 96-98) and low post-prandial. Even yesterday with a lunch at one of our favorite Mexican restaurants, where my wife and I shared a carne asada: probably around 15 chips w/ salsa beforehand, steak, rice & beans, 1/2 avocado, and 3 nachos (chips with melted cheese), my one hour post-prandial BG was 126. It will be interesting to see when I go back to a more "normal" diet, what happens to my BG and if this brief low calorie/low carb diet has made a difference in how I process sugars, per the study in England.

Weight and Bodyfat:

Weight loss of 1 pound. Total now 24.5 pounds.

A bit of a slow down this week. Hard to know if I've adapted in some ways to this diet and down-regulated, or if it's just the way it is.

I've certainly seen exercise continuing to get better (reps increasing), although I've found the more intense schedule difficult and my back is sore today, perhaps from planks, leg lifts, and squats being one day right after another. If my back's still sore next week, I'll modify.

I've also been seeing pants becoming less tight and belts at yet one more notch tighter, so I'm losing inches. It could be that the muscle increase (since muscle is heavier than fat by volume) is making up for some of the fat loss. Again, we'll have to see.

I have only one week left on this restricted, mostly liquid diet, then will relax back, but hopefully still to an amount that will mean continued weight loss of a pound or so a week.

Oh yes, tried a fast this week (Monday dinner to Tuesday dinner). Neither difficult nor easy. Definitely felt hunger pangs. Broke fast with a taco salad, instead of shake. Not sure if I'll do one this week or not. My wife's gone this week, so I'm on my own Monday through Friday.

Weekly Update + labs - 10-8-2011

The weekly update is minus photos of the scale because my rechargeable batteries died. However, my weight was 222 and bodyfat 29.5% (lowest it's registered thus far, but again, this method is extraordinarily susceptible to fluctuations in fluid retention--but overall, it shows a continued drop). That's 3 pounds again this week, my second week in a row of a 3 lb loss on the low calorie/low carb plan. I don't know if that can keep up for successive weeks, but we'll see.

For the 13 weeks, 25.5 lbs. lost, 1.96 pounds a week, almost 2 pounds, a very good rate.

I've been quite strict on the low calorie/low carb, mostly liquid diet with a few salads (sometimes in place of the protein drink, occasionally in addition. I've had a few taco salads at restaurants, but since I do without sour cream and many add ons, still fairly low calorie and the break from drinking a meal is helpful, if not necessary. Tomorrow (Sunday), I'll relax a bit for lunch on carbs, but breakfast and dinner will be the usual protein drink.

At this point I've modified my plan so that I'll stick with this for 4 weeks, then take one or two weeks off (not going crazy, but allowing the kind of eating with more carbs I was doing prior to this). This serves several purposes. It allows me to re-load glycogen stores, bring metabolism back up (if it's dropped) and give enough of a break that I can go back to the VLC/C diet successfully. It also coincides with a visit by my parents so I can eat with them at restaurants more easily. I expect I'll gain a little weight back (mostly water after induction levels of carbs), but should get back on track quickly.

I'm also curious to see how my blood sugar levels are--if the diet (even in 4 weeks) has taken enough fat out of my pancreas to make a difference in how insulin-resistant I am. Blood sugars, by the way, have continued to improve, now always below 100 in the morning (fasting) and none rising above 110 one hour post-prandial. What will happen when I have more carbs now? Will they soar up to 160 or more? Or will they stay in a more reasonable level? We'll see.

There have been some interesting debates lately on some of the blogs on glycation (the bonding of a lipid with a sugar molecule)--that process that leads to AGE's (advanced glycation endproducts, which are not a good thing (cardiovascular disease, neuropathy, Alzheimers, cancer, etc.)! The debate is whether high (or moderately high) blood sugar leads to AGE's or not. I don't know enough of the science to judge who's correct, but I can only believe that having much more normal blood glucose can only help at this point, especially for a diabetic. Here's a quote from that wikipedia article on glycation and its importance for diabetics:

Red blood cells have a consistent lifespan of 120 days and are easily accessible for measurement of recent increased presence of glycating product. This fact is used in monitoring blood sugar control in diabetes by monitoring the glycated hemoglobin level, also known as HbA1c. As a consequence, long-lived cells (such as nerves, brain cells), long-lasting proteins (such as eye crystalline and collagen), and DNA may accumulate substantial damage over time. Cells such as the retina cells in the eyes, and beta cells (insulin-producing) in the pancreas are also at high risk of damage^{[citation needed]}. Damage by glycation results in stiffening of the collagen in the blood vessel walls, leading to high blood pressure, especially in diabetes.^[9] Glycations also cause weakening of the collagen in the blood vessel walls^{[citation needed]}, which may lead to micro- or macro-aneurisms; this may cause strokes if in the brain.

At the 12-week point I also did my labs for my regular diabetic check-up. Unfortunately the lab didn't measure A1c (which shows blood sugar over a 3 month period)--my doctor was going to get the lab to re-test (apparently they hold your blood for 7 days), but when I called yesterday it wasn't in yet. I would guess it's good--with metformin and a mediocre diet + no exercise it's always been just fine, so I hope with a much lower carb diet that it'll be even better.

Triglycerides were 83--under 150 is considered normal and low risk for cardiovascular disease, so I'm in terrific territory there.

Cholesterol 154, with HDL at 26, which is low. Mine's always been low and I hope I can eventually raise it with exercise, some more dietary modifications, and as I move closer and closer to a healthy metabolic range, weight, musculature, etc. Under 200 total cholesterol is considered fine, but "optimal" LDL is under 100 (mine at 111). My doctor follows the lipid hypothesis, which would say that with my risk factors (diabetes, a not-perfect calcium score) I should be on statins to lower LDL.

However, from the wikipedia article linked above on some evidence that low cholesterol can be a problem:

Given the well-recognized role of cholesterol in cardiovascular disease, some studies have shown, surprisingly, an inverse correlation between cholesterol levels and mortality. A 2009 study of patients with acute coronary syndromes found an association of hypercholesterolemia with better mortality outcomes.^[50] In the Framingham Heart Study, in subjects over 50 years of age, they found an 11% increase overall and 14% increase in CVD mortality per 1 mg/dL per year drop in total cholesterol levels. The researchers attributed this phenomenon to the fact that people with severe chronic diseases or cancer tend to have below-normal cholesterol levels.^[51] This explanation is not supported by the Vorarlberg Health Monitoring and Promotion Programme, in which men of all ages and women over 50 with very low cholesterol were increasingly likely to die of cancer, liver diseases, and mental diseases. This result indicates the low-cholesterol effect occurs even among younger respondents, contradicting the previous assessment among cohorts of older people that this is a proxy or marker for frailty occurring with age.^[52] 

The vast majority of doctors and medical scientists consider that there is a link between cholesterol and atherosclerosis as discussed above;^[53] a small group of scientists, united in The International Network of Cholesterol Skeptics, questions the link.^[54]

This is the crux of the matter and one I'll have to research more and deal with in making decisions.

I'll also see if my doc can run a panel that separates out the different LDL particles, since the small dense ones are considered most dangerous and the large, puffy ones are considered beneficial.

More as I research more. If the lab gets my A1c, I'll list it in the next post.

By the way, exercise continues to go well. I began doing a 2nd set of my core exercises today since I had several days holding the plank for 60 seconds. I continue to add reps to all exercises on a regular basis and walk 30 minutes or so each day. The next thing should be adding some running/sprinting/going up steps for intervals, which would kick my butt (and I would have to very gradually adapt to that), but which would be excellent. More from Clarence Bass's website on intervals here, here, and here.

Quote from the last one:

Another study from Norway, reported in Circulation (July 7, 2008), compared moderate and high intensity exercise for increasing aerobic capacity (VO2max) and treating metabolic syndrome: a cluster of disorders representing a major risk of coronary heart disease (http://www.cbass.com/SyndromeX.htm). 

According to the researchers, individuals with metabolic syndrome (high blood pressure, high cholesterol, elevated blood sugar, and abdominal obesity) are three times more likely to die of heart disease than healthy people. 

As in the previous study, aerobic interval training (90% of heart-rate maximum) proved more effective than the same volume of moderate continuous exercise (70% of max). Intervals increased VO2max by 35%, compared to 16% for continuous training. This is significant, because individuals with metabolic syndrome usually have reduced fitness. Intervals also did a better job of removing or reducing the risk factors—probably due at least in part to the greater increase in VO2max. 

Interestingly, the researchers gave a clear rationale for interval training: “Most evidence suggests that it is the pumping capacity of the heart that limits VO2max and [intervals] enable patients to complete short work periods at higher intensities, which thereby challenge the pumping ability of the heart more than would be possible [with] lower intensities.” 

The study included 32 adults (average age 52) with three or more of the metabolic syndrome traits. As in the previous study, they exercised three times a week,  doing either four 4-minute high-intensity intervals (with three minutes of active rest) or 47 minutes of continuous moderate walking on an “uphill” treadmill. The difference was that the experimental period was longer, 16 weeks compared to 13 weeks. Again, exercise time was calculated to burn the same number of calories. 

To cut through the technical nature of the report, the following summary of results is drawn in part from a press release from the American Heart Association (publisher of Circulation). 

While both groups experienced a reduction in blood pressure and lost about the same amount of weight, the interval group showed more improvement in how their bodies handle blood sugar and respond to insulin. In addition, the interval group increased HDL “good” cholesterol by about 25%, while the continuous training group showed no improvement. 

Definitely important for me!

12 week Update - 10-1-11

So, here I am, 12 weeks later.

Weight/Bodyfat:

Sorry for the blurry photo. Lost 22.5 pounds, 1.875 lb/week. Bodyfat listed as 39% at beginning, but hard to compare (with this kind of measurement, due to differences in water), but the general direction is good. With new diet, down 3 pounds this week. Question is, can I sustain that loss, or close to it, with the current, much more restricted diet?

I went in for labs on Thursday and will see my doctor Monday and let you know the results.

At the end of August I started exercising (was walking before that, but started my core exercises and the "Convict Conditioning" ones--bodyweight exercises) at that time.  For core, I do side planks (from the knees), bird-dog, and plank (on elbows), plus some stretches. All have gotten better, the plank held around 30 seconds at the beginning, now one minute (one month later).

The other exercises are easy push up/pull up/leg lift/squat variations--remember, there are 10 versions of each exercise, each getting progressively harder. Up to one-arm pushups and pull ups, for example--the middle ones (around 5) are getting towards "normal" exercises, like a regular pushup. The version of pushups I'm doing now (wall pushups) have gone from 1 set of 10 to 2 sets of 25. I will need to get to 3 sets of 50 before moving on to step 2 in the sequence of 10, so an very slowly graduated pace of improvement--good for me at age 61!

Pictorial evidence (beginning/now):

And from the side:

As you can see, I've improved, but am hardly a hardbody!

Much more to be done. You can't see easily in the photos, but I've lost more in my legs than in my belly (although that's reduced, too). That's one of the most important things to do now--and the reason behind the current plan--to get rid of as much visceral (belly) fat as possible, since that has a very negative metabolic effect, hormonally. If the new plan can lower abdominal fat (and take it out of my pancreas and liver, making my responses to blood sugar much better (lower insulin resistance), it will be a very positive thing!

I figure it will take a minimum of 48 weeks--3 more 12 week periods--and likely more, to get to where I need to be. And that doesn't mean where I can be ultimately, but to close to where I can/should be for excellent health.

So, not bad for the first 12 weeks. Here's to seeing what I can do for the next 12!