Eventually, I plateaued at around 210 lbs. The exact number will vary up and down by 10 lbs depending on how careful I am about my diet/exercise. My general health has similarly deteriorated over time. The first problem was snoring and sleep apnea, now controlled via CPAP therapy for the past 20 years or so. Before I went on the machine, I would literally fall asleep at the wheel while waiting at a red light on my commute home!
The second was cholestrol and high blood pressure that began a little over 10 years ago. I am now on a statin and 2 BP medications. Thankfully that has been under control for the past 5 years or so and my numbers have not changed too much. Cholestrol has been good since I went on the statin. BP is on the high side of normal, though that may not be case any more with the most recent changes in guidance from AHA.
However, a third problem has reared its ugly head in the past 2 years: diabetes. I am now on 2000mg of metformin. In a way, it is probably a miracle that I have not had issue with this sooner given my weight and the fact that I was diagnosed as having impaired glucose tolerance as a teenager. Given the progressive nature of this disease, I am concerned that relying on medication is only addressing the symptom of the problem, i.e., merely delaying the execution date of my death sentence.
Somehow, I need to figure out how to lose at least 20, and ideally up to 40 lb; something I have never managed to do, and stay there.
Thanks to Miles Kimball's blog, I've recently become acquainted with the work of Jason Fung and the role of fasting in losing weight. Read Jason's book for the details, but he makes, supported by both academic research and his clinical practice, several key insights about diabetes and obesity.
1. The calories in and calories out model of weight control is, while not technically incorrect, extremely misleading. The reason is that our metabolism (calories out) is not exogenous. The body behaves like a thermostat set to a particular temperature. For example, if you cut your daily intake of calories but change nothing else, you will lose a little weight at first, but the body will begin to compensate by reducing your metabolism. Over time, the weight loss will stop and reverse itself. Eventually, you will end up more or less where you started. The exact same logic applies when you increase the amount of exercise.
2. The question is then how do you move the set point i.e., how do I reduce calorie intake in a way that will not cause my metabolism to slow down to compensate? (I first came across the notion of a set point, via the late Seth Robert's Shangri-La diet. His formula was to ingest a light flavorless oil or sugar water. It actually helped me a bit a few years ago to lose about 10 lbs. My weight fell to around 200 but I was not able to lose any more and after awhile lost the discipline to stick with it.)
3. When the body burns energy, it first uses the glucose in your blood stream, followed by glycogen, which is fat stored in your liver, and finally triglycerides, which is the fat stores in the rest of your body.
4. When you eat, the body converts the carbohydrates into glucose in your blood stream, as glucose rises, the body uses insulin to convert some of that excess glucose into stored fat. If you have diabetes, your natural secretion of insulin is unable to cope with the excess glucose, manifesting itself as extremely elevated levels of sugar in your blood. In other words, insulin resistance. The key here is to recognize that the elevated levels of sugar is a symptom of diabetes and not the disease itself. The cause of the disease is insulin resistance.
5. Therein lies the rub in traditional drug treatments for diabetes. As a rule, without changes in your diet, the disease progresses to the point where you need to inject insulin to keep blood glucose levels in a safe range. Unfortunately, this means that you are now treating the symptom rather than the disease and your insulin resistance will begin to accelerate.
What this basically boils down to is that the traditional remedies: dieting, exercise, and medication will at best merely slow down the progression of diabetes, leaving you, in the long run, no better off and likely more miserable. So what does work?
Jason Fung argues that there two key techniques that will make a difference:
1. Low carb diet
2. Intermittent fasting
For the past month and a half, I have been experimenting with 2. and to a limited degree, 1. In my next post I will share some of my results. Jury is still out, obviously, but suffice it to say, for the first time in a long, long, while, I think I may finally have control over my problem.
A
