Tuesday, September 17, 2019

Retrospective #213: How I lost 188 pounds (Part 1)

At my doctor’s suggestion, I started eating Very Low Carb (VLC) in 2002 to lose weight. At the time I had been a long-term (16yr) Type 2 diabetic. I have been very successful, at one point losing 188 pounds. I also had to give up most of my diabetes drugs while getting “normal” fasting blood sugars (80s mg/dl) on only 1 low-dose Metformin once a day.
When I began VLC 17 years ago, I was “maxed out” on two classes of oral diabetes meds and starting a third. Within a day of starting to eat just 20g of carbs a day, I got my first hypo (BG reading in the 50s). I ate a candy bar and called my doctor. Over the next few days he told me to cut my diabetes meds three times, twice by half . As I lost weight, my BP gradually dropped from 130/90 to 110/70 at the same meds. Over time my HDL doubled and triglycerides dropped by two-thirds. My Hb A1cs are now consistently in the mid-5 range, and both my HDL/TG ratio and my hsCRP, an inflammation marker, are both usually under 1.0. I am never hungry. I have lots of energy, and I feel great. By all these measures I am today (age 78) much healthier than I was 17 years ago. How did this happen? I’m going to tell you.
When I first started eating VLC, for a few years I wrote everything down that I ate but 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 estimated carbohydrate grams daily. The math was simple and the method not very accurate, but I was learning about low carb eating, and I was being totally accountable and brutally honest. I was learning what foods raised my blood sugar. This is a learning process everyone eating Very Low Carb for blood sugar control must do.
Four years later I became interested in how much protein I should eat. I decided to eat a similarly sized, small-to-medium portion of protein with each meal, and to space the meals at regular intervals, ala Richard K Bernstein, MD. Bernstein also counseled that, to lose weight you reduce the portion size of protein for one meal, and if that wasn’t enough, a second meal each day, due to its “insulin effect.” This would later guide me to the low side on protein.
The “insulin effect” is about how 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 needs glucose. That is one of the main mechanisms of Metformin: “to suppress the up-regulated synthesis of glucose by the liver in the disregulated sugar-based metabolism that many people have developed on a carbohydrate-based diet.” This glucose requires insulin for transport and uptake. Elevated insulin in the blood stops weight loss: the “Insulin effect.”
How much protein you should eat is dependent on several factors: among them age, gender, and 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: gardening in New York and kayaking in Florida). I don’t like to sweat, and besides, doesn’t exercise “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 protein the “experts” say I should eat.
The “experts” recommend a very wide range of protein amounts, all based on “weight.” You need to pick one and go with it. The one critical measure, though, is the “weight” that you use. It should be your hypothetical “lean body weight.” The definition of “lean body weight” is difficult to ascertain and frequently misinterpreted and misguided. But lean body weight is what you should use because protein is not required to maintain your fat mass, or helpful in reducing it.
This latter point is particularly true for the overweight, obese and morbidly obese, like me. For me (old, male, diabetic, morbidly obese, relatively inactive and without excessive musculature to maintain), I chose to define “lean body weight” as the middle weight of “normal” in the WHO’s BMI chart for my height, now shrunken with age to 5’-10.”  
The BMI table says that, at 5’-10”, my middle-of-normal weight should be 150 pounds. In the beginning, though, I thought a “lean body weight” of 150 pounds for me was ridiculous, so I substituted a “goal” or “ideal” weight of 180 pounds. At 0.5g/lb. (1.1g/kg), that worked out to 90g of protein a day. Then, after I had lost over 100 pounds, a “lean body weight” of 150 began to sound realistic, so I reduced it to 0.4g/lb. (0.9g/kg), or 60 grams of protein a day.

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