The Nutrition Debate #213: How I lost 125 pounds (Part 1)

I started eating Very Low Carb (VLC) on Atkins Induction, at my doctor’s suggestion, to lose weight. I am a long-time (28yr) type 2 diabetic so after 4 years I switched to Dr. Bernstein’s program. I have been very successful at both,getting “normal” fasting blood sugars ( 80s and 90s mg/dl) on only 500mg ofMetformin once a day and losing ,at one point, 170 pounds.

When I began VLC 12 years ago, I was “maxed out” on two classes of oral meds and starting a third. Within a day of starting Atkins Induction, I was getting hypos (BG readings in the 50s and even 40s). I ate some sugar and called my doctor. He told me to cut my oral diabetes meds several times over the next few days. As I lost weight, my blood pressure gradually dropped from 130/90 to110/70 at the same level of meds. Over a period of time my HDL doubled and my triglycerides dropped by two-thirds. My Hb A1cs are now consistently in the mid to high 5s, and both my HDL/TG ratio and my hs C-Reactive Protein are almost always under 1.0. I am never hungry. I have lots of energy, and I feel great. By all these measures I am much healthier today than I was 12 years ago. How did this come about? In gradual steps, except the medication reductions came immediately.

When I first started eating VLC, for a few years I wrote down everything I atebut only counted estimated carbs. I didn’t measure anything. I just listed everything I ate and guessed at the carb content. I did this in an Excel table I created that totaled the daily estimated grams of carbohydrates. The math was simple and the method not very accurate, but I was learning about low carb eating. Since I was doing blood glucose measurements before and two hours after each meal (6 pricks/day), I was learning what foods raised my blood sugar and what foods didn’t. Ala Bernstein, I was “eating-to-the-meter.” This is a learning process every diabetic or prediabetic eating low carb for blood sugar control must do.

Then I became interested in how much protein I should eat. I didn’t care for Bernstein’s method of protein measurement. But I did subscribe to his “prescription” to eat a similarly sized, small-to-medium portion of protein with each meal, and to space the meals at regular intervals. He also counseled that, to lose weight you should reduce the portion size of protein for one meal and if that wasn’t enough, a second meal each day. This advice would later guide me to the low side on protein.

Another factor I considered is that about half of every gram or ounce of protein you eat is going to become glucose in your blood. This occurs after the protein is digested into amino acids and, if not taken up by your muscles, etc., is stored in the liver. There, through a process called gluconeogenesis, it is converted to glucose when the body calls for glucose. That is the main mechanism of the drugMetformin: to suppress the up-regulated synthesis of glucose by the liver in the disregulated sugar-based metabolism that many people have developed on the carbohydrate-based Western diet most of us eat today.

How much protein you should eat is dependent on several factors: among them age, gender, and especially level of activity. If you are very active, i.e. you exercise regularly, you will need more protein to repair and maintain the muscle tissue you have developed and use. I don’t exercise at all (except in my daily activities such as kayaking or gardening). I don’t like to sweat and besides, aren’t we advised to exercise to “work up an appetite”? If you’re trying to lose weight, as I am, who wants to do that! So, I began a search to find out how much proteinthe “experts” said I should eat.

The Nutrition Facts panel required on processed food packaging by the U. S. Government (HHS/FDA) calls for a Minimum Daily Allowance of 50 grams of protein a day. That’s 200 calories of a 2,000 calorie diet or 10%. But which is operative: 50g or 10%? If you eat less than 2,000kcal/day, say just 1,000, that would then be 20% of 1,000, wouldn’t it? More on this later.

An abstract of an authoritative paper I read said that American men eat about 16% protein by calorie and American women 15%. But the measure used by virtually everyone today is expressed in terms of grams of protein per kg of “leanbody weight” (or grams per pound in U.S. measure). This was confounding to me for two reasons: 1) The range of recommendations was so wide, and 2) the definition of “lean body weight” was imprecise, indeterminate and frequently subject to misinterpretation. This latter point is particularly true for the overweight, obese and morbidly obese, like me.  

The “experts” recommend a very wide range of protein amounts. You need to pick one and go with it. I did from the get go. For me (old, male, diabetic, morbidly obese, relatively inactive and without excessive musculature to maintain), I chose 0.6g of protein/lb of ‘lean body weight’ (about 1.3g/kg). The amount is independent of fat weight, since protein builds and maintains muscle and does other things not fat related. The BMI table says that at 5’-11” my “Normal” weight should be 150 pounds. At 0.6g of protein per pound of lean body weight, that’s 90 grams of protein a day. So, that’s where I started.