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!

New plan - Week 11 report

Still not too disciplined this week, although not bad. I'll check again tomorrow on weight for a more accurate read, since I had a sandwich at lunch (bread!), a large Mexican meal (see a pattern here?) for dinner (didn't split the carne asada with my wife, but we each ordered one), then after a concert, had a friend over and had some "good" dessert snacks and a glass of white wine. Weight this morning after a high (and late)-eating day is:

We'll see what tomorrow's shows.

I'd been considering a very low calorie diet for 8 weeks (and still might). A very interesting study out of England used a VLC diet (600 calories/day, plus non-starchy veg). Report here . . . excerpts:

People who have had obesity-related type 2 diabetes for years have been cured, at least temporarily, by keeping to an extreme, low-calorie, diet for two months, scientists report today. 

The discovery, reported by scientists at Newcastle University, overturns previous assumptions about type 2 diabetes, which was thought to be a lifelong illness. 

Eleven people with diabetes took part in the study, which was funded by Diabetes UK. They had to slash their food intake to just 600 calories a day for two months. But three months later seven of the 11 were free of diabetes. 

"To have people free of diabetes after years with the condition is remarkable – and all because of an eight-week diet," said Roy Taylor, professor at Newcastle University, who led the study. "This is a radical change in understanding type 2 diabetes. It will change how we can explain it to people newly diagnosed with the condition. While it has long been believed that someone with type 2 diabetes will always have the disease, and that it will steadily get worse, we have shown that we can reverse the condition." 

The research, presented today at the American Diabetes Association conference, shows that an extremely low-calorie diet, consisting of diet drinks and non-starchy vegetables, prompts the body to remove the fat clogging the pancreas and preventing it from making insulin. 

The volunteers were closely supervised by a medical team and matched with the same number of volunteers with diabetes who did not get the special diet. After just one week into the study, the pre-breakfast blood sugar levels of the study group had returned to normal. And MRI scans showed that the fat levels in the pancreas had returned to normal. The pancreas regained its ability to make insulin. 

After the eight-week diet the volunteers returned to normal eating but had advice on healthy foods and portion size. Ten of the group were retested and seven had stayed free of diabetes. 

Taylor thought the massive drop in calorie intake after surgery could be responsible and to test this hypothesis set up the study, which included MRI scans of the pancreas to look at any changes in the fatty deposits. 

"We believe this shows that type 2 diabetes is all about energy balance in the body," said Taylor. "If you are eating more than you burn, then the excess is stored in the liver and pancreas as fat, which can lead to type 2 diabetes in some people. What we need to examine further is why some people are more susceptible to developing diabetes than others."

Interesting, huh?

The full study may be found here: http://www.diabetologia-journal.org/Lim.pdf

I started by thinking I'd do the diet as is, but with perhaps a little extra "good fat." Today I calculated a bit of what I'm eating and what it might look like, in terms of calories, protein, carbs, fat, etc.

My protein drinks are now Mark Sisson's protein powder, made with with 5 grams of BCCA's, one egg yolk, about 1/8 c. yoghurt (help keep healthy bacterial population in my bowel), and 2 tbl. virgin coconut oil (Tropical Traditions). I'm also talking fish oil 2 x day, plus a product called SafSlim, which is a specially processed high linoleic safflower oil, which is supposed to reduce belly fat (the bad kind!).

When I add this all together (3 shakes, plus the fish oil and SafSlim, I get the following:
87 gm. protein (ca. 20% of calories)
47 gm. carbs (ca. 10% of calories)
142 gm. fat (ca. 70% of calories)
and around 1800 calories/day.

Much more than 600 (you can probably do the math, too!).

The question is whether the coconut oil, which is a medium-chain triglyceride, fish oil, and SafSlim (there's also coconut oil in Sisson's protein powder, and a little fat in the egg yolk and yoghurt) will cause problems. MCT's are supposed to be burned directly in a different way. But will this much fat, even of a "good" kind, cause me to keep fat in the pancreas?

Presumably the positive effects of the 8 week/600 cal/day diet comes from lowering the fat in the pancreas, allowing the beta cells to return to normal function.

I'll see how I feel after a week and what the results are.

My choice, if I wish to lower fat and calories is, first, to eliminate the extra coconut oil--two tbls are 28 grams of fat, times three shakes is 84 grams, or 756 calories of fat. Hmmm . . .

I could also eliminate the yoghurt (I'm already taking some probiotics to help re-populate my gut after taking a fairly powerful antibiotic post-nasal surgery). Next would be the SafSlim, since there's perhaps not enough evidence that it works as promised.

That would lead to ca. 1000 calories/day, 84 gms. protein (33% of calories), 44 grams of carbs (17% of calories), and 54 grams of fat (ca. 50% of calories).

So, I'll see what happens this week, how my body reacts, and then decide if I should cut down fat. I could do that gradually, eliminating one element at at time.

An experiment of one. We'll see.

Weeks 8 & 9 report

Still incredibly busy, so haven't posted much. Moved too far from lower carbs, so reigned that in this past week starting on Monday. Exercise has continued very well: walking almost every day (finally out my front door instead of the mall with the heat broken), core exercises, and adding my bodyweight exercises (variations on push ups, pull ups, squats, and leg lifts) plus some grip work and a bit more stretching.

I've also started weekly massages (leave for one in about 10 minutes!) to help cope with a 6 days x week schedule that's really intense.

Week 8:

 

Week 9:

So, overall, back on better track. Total weight lost 18.5 pounds. A hair over 2 pounds/week lost.

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".

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.