Saturday, March 21, 2015

Absolutely Actively Atkins

Today I saw a number on the scale I last saw a number on the scale I last saw in the year 2000! And the weekly average is also down!  I am overcoming the bounce!  Not blasting through, but maybe an image of chipping a slightly bigger dent with each bounce.

This is taking a whole lot of effort. I'm not sure how long I'll maintain the effort, but I'm really working on finding sustainable things to eat and short cuts and habits to make doing this easier.  I would like to achieve a certain goal - which is less than 10 pounds away - but may be satisfied 5 pounds short of that - if it becomes my new set point.

So this time I am totally, completely, "doing Atkins".  In the past, I have read the books and done it, but decided in many cases that I know it, and so I made choices without thinking them completely through.  I also have been influenced by cultural stigmas around Atkins, which resulted in me being ambivalent about the process, and only committed to it for a short-term weight-loss goal, not for the rest of my life.  I wrote about it this in the past. I've gone back and read those posts, which are newly tagged "Atkins". Now, I'm all in. For life, but that doesn't mean just like what I'm doing now.  I'm out of the closet, and dangerously close to wanting to proselytize.

The science is finally catching up with Atkins, which was developed by Dr. Robert Atkins based on his clinical experience, not conventional wisdom. Current dietary recommendations - and even the way Weight Watchers scores points - is relatively Atkins friendly.  You want to lose weight, control your blood sugar, or improve your cholesterol numbers?  Cut carbs, up protein, and don't worry about "healthy fats".  This is now the conventional wisdom. In fact, the newest recommendations by the "Dietary Guidelines Advisory Committee", (which are draft recommendations and yet to be finalized) basically say this, walking away from the old food pyramid with starches on the big bottom.  The part of this that seemed to grab the most headlines was the point that dietary cholesterol has essentially nothing to do with the cholesterol and so you can feel fine about eating eggs.  The original recommendation was based on a reasonable hypothesis - but no clinical evidence - that there was a relationship.  The science testing this hypothesis has been repeated several times in the last twenty years, always with the same result - the cholesterol in your blood is manufactured by your body, not from eating cholesterol.  But due to prejudice, and scientific and bureaucratic inertia, the draft guidelines finally (and grudgingly) acknowledge this.

There is a counter culture underground that has followed Atkins for years. There are also many other named variations of eating like this - Paleo is the current most popular label. I am sticking with the detailed Atkins guidelines right now, not mixing and matching from other diets. But there are of course sub-variants even within Atkins. I've found several discussion groups on-line where folks are adamant about following "the Atkins diet as Dr. Atkins himself specified it". That is captured in a book published in 1980; there was an update in 1993 and maybe some revised editions until Dr. Atkins died (from injuries sustained in a fall) in 2003.  They seem to think he was a prophet, where I think he was an insightful clinician.  But science has moved on. So there are books written from 2010 on that modify The Doctor's prescriptions slightly. That is what I am following.  I'm going back and reading and re-reading a couple of different books that stick to the same rules but describe and talk about them differently.

Certainly anyone reading this far knows the broad outlines of the Atkins Diet.  Eat meat. Eat fat.  Eat bacon and eggs for every meal. Eat bacon-wrapped bacon.  Eat steaks with bearnaise sauce with a daily glass of red wine. Eat Atkins-labelled shakes and energy bars.

Well, actually not so much.  The main new point is to focus on getting enough vegetables.  This is an element for life.  Limited portions of meat, limited amounts of dairy, limited amounts of avocados and nuts.  No fake sweeteners (though there are raging debates about what is fake - for example, is stevia fake?  Are sugar alcohols?).  Read every label and eliminate any with sugar (in any of its synonyms) listed within the first five ingredients, or that has more than five carbohydrate grams per serving.  Generally, don't even bother looking at anything labelled "low fat" because chances are it has starch and sugar - this is very true in the dairy world, including greek yogurt. Track your food, and start with an average of 20 net carbohydrate grams per day, +/- 2 grams.  "Net carbohydrates" means you can subtract fiber grams from the total, so high fiber vegetables like cauliflower and avocados can add volume.  As you track your food, also track your calories because they do matter if you want to lose weight. I read a lot, and there are tidbits, pointers, and new ideas coming up all the time.

In practice, this pretty much means cook from scratch from primary ingredients.  Almost all prepared salad dressings or sauces have sugar in them. Almost all prepared meats have too many carbs. No yummy beef stews or curried chicken from the food bar at Whole Foods - because I don't know what's in them, but they are almost all thickened with some form of starch.  (I can grab a roast chicken, though, hooray!)

The general idea is to strictly limit carbs and calories initially. One's body takes a couple of weeks to learn how to process fat as the main source of fuel. Once the transition is made, food choices can be slightly expanded, along with the carb count which can ratchet up by about 5 grams a week. Generally, to lose weight, carbs need to be stopped under 50 grams.  Because meat is limited, and carbs are limited, but generally you should eat at least 1100 calories a day, a lot of the food is fat. Atkins does not really emphasize "good fats" versus bad ones, though a consequence of limiting meat is limiting fat from meat.  As I am losing weight, some of my fuel by definition is coming from my own body fat, and I'm limiting total calories.  Once I decide to stop losing weight, I won't be burning my own fat, and so will need to up my calorie count to provide adequate fuel. NOT FROM CARBS, and not from protein, so my fat intake should go up.

So I'm staying under 30 grams of net carbs now, and only gradually widening my food choices. Blueberries are my favorite berries, which is the first fruit allowed. Melon is also allowed early on, but that's hard to do in small portions for just me. I've got all tree nuts, (but not cashews or peanuts) and most green vegetables, and would eat small amounts of winter squash, sweet potatoes, and carrots, but I haven't gone out of my way to get them.

I travelled for work this week, and managed my way through even without a concrete plan. We went as a group of six to a famous barbecue place. It was St Patrick's Day, and everyone had beer.  I looked at it longingly, but found a "dirty martini" on the menu. Alcohol has no carbs, it has a tiny amount of vermouth, and brine from the olive jar. Salty and tasty.  Dinner was way too much meat (no red sauce) and a tasty vegetable kabob.  I boxed up the meat, left it on the hotel room windowsill overnight, and had some plain meat for breakfast, got a green salad from the cafeteria to go with the last of the meat for lunch.  My a handful of almonds I had brought got me home.

Folks on the discussion group are full of discussions about how to make sweets. They use stevia and xylitol. Not for me. They also make "fat bombs" with these fake sweets, to up calorie count without carbs.  But I did make my version where I melted in the microwave roughly a quarter-cup each of almond butter, coconut oil, cream cheese, and 80% dark chocolate. Poured into mini-muffin tins and frozen (because not stable at room temp) a single treat has 120 calories and only 2 carbs - and nothing fake!  One a day max, if my calorie count is low.

I intend to make shrimp alfredo with basil pesto zoodles for dinner.  (Zoodles are strings cut from zucchini, using a vegetti which happily my girl gave me for Christmas. )  Yum!

Tomorrow, I'll eat a treat, and allow myself to go up in carbs - but ideally would like to be under 50. I won't take the whole day off, because I'm on a good trend, and I don't want to upset it.

Excelsior!  Nothing motivates to stay the course like seeing progress!

Saturday, March 7, 2015

*BOUNCE*

Just as I thought - my rubber floor has caused my weight loss to stall.  Why?

I've reallygot to get moving at this moment, so I can't analyze this fully now. The weight point circled in red is my actual scale weight from one day this week - 4 1/2 pounds heavier than today!  This is why I weigh myself every single day, so a single anomaly cannot drive me crazy. Without Tuesday (no idea why it's so different - it has to be water, but I don't see it in my food logs), my average weight for the week would be flat.

I know I've neglected exercise - I got a cold two weeks ago, it's mostly gone now, but it's snowed or rained every day and so even the dog walking has suffered.

I've done a look at what I'm eating. I log every bite through My Fitness Pal, and I learned a couple of weeks ago how to do an export of the data using an add-on.  It's kind of annoying to use so I brought things up to date manually just now.  The light area at the bottom are net carbs, which is what I'm trying to manage, while keeping an eye on the total I'm eating as well.

Based on Atkins procedures, at this point I should be widening my food choices and slowly increasing my net carbs. Until I see a true drop on the scale, I'm going to hold at about where I am right now - 25 grams of net carbs per day, with berries and nuts but no beans or grains or very starchy veggies.  Bacon and egg breakfast salad, steak and asparagus dinners, I'm lookin' at you!

Sunday, February 22, 2015

The Crucial Tipping Point

I've been very good at sticking to eating well, or at least controlled. I started this determined round of weight loss on January 20, four and a half weeks ago.  I've been focusing on the details of Atkins, not just the general principles. I've been concentrating on eating vegetables at every meal, even breakfast. And it has had results. I've lost about six pounds, and I feel great.

But now I'm once again at the crucial point.  I've hit my "rubber floor", the weight at which I lose momentum, turn arounc and gain weight again. This has happened to me four times before, in the time I've been doing this blog. Here's my post on this from 2013, when I hit this point.

Here is what is going on that makes it difficult to keep going:

  • The weight loss has slowed. The instant and heady success of the first few days and weeks are gone. This week I lost weight but less than before. (This is using my simple average of the week's daily readings.)
  • The work of cooking is starting to seem to hard to sustain. I have other ways I'd rather spend my time.
  • The food is starting to get a bit boring. When I make a big batch of something, I get bored before its done. 
  • I want to eat with my girl more often, but she often she doesn't like what I like in the limited selection I have available.
  • I crave certain treats which aren't allowed.
So here's what I'm doing to counter these problems, which are always the same:
  • I'm upping the exercise. I'm working towards the first 5K of the season in March. I've kept up with two weight training sessions a week besides. 
  • I'm really focused on getting sufficient vegetables at every meal. This is often harder than finding the protein.
  • I'm really focused on portion control. Previous runs at Atkins used the food lists of "allowed" foods, without paying attention to how much of each is reasonable. Nuts, for example, no more than a quarter cup a day. Dairy, only a couple of ounces.
  • I am ratcheting up the carbs a bit. Atkins recommends adding in a wider range of foods, and upping the carb level slightly, when you are close to goal, which I am. But I'm striving to keep it down. The other point they make is the wider range of foods cannot be at the expense of the main foundation vegetables that you have to eat every single day.
  • I've got a set of "go to" quick and easy foods. A roast chicken from Whole Foods, for example, with easy vegetable sides. I found some Atkins and other low carb frozen meals when I stopped by a fancy new supermarket in a different neighborhood.
  • I'm reading recipes and finding new things to cook. This also helps in trying to find things for my girl - adding sides she will like.
  • I've got a couple of treats I allow myself, that are naturally low carb. (I tried a "low carb" Atkins brand chocolate-coated bar and couldn't stand the taste of malitol.) The two so far are blueberries (fresh or frozen) with creme fraiche or mascarpone, or crunchy almond butter with celery.  I think anything with actual chocolate in it is too dangerous right now.
  • I've been giving myself some non-food rewards. I've bought some clothes, about which I may post later.
  • I'm making very short term goals. Right now I want to sustain this through the next weekend. It's likely to be a social weekend, and I want to have fun!  But I'm setting parameters on what that can include.
So I've played with my data all morning while writing this post. Time to get out there and move!

Sunday, February 15, 2015

How Different my Priorities Are

The coldest day of the year by far, queuing up outside the gym waiting for them to open!

Thursday, February 12, 2015

Mixed Bag

Haven't been able to keep the energy level up, and now I'm running out of the food I made for myself. Plus, I will be cooking and eating in company a lot more often, which means compromises. But compromises are what life is made of.

But I did get out to the gym this morning, and then for a cold weather run with the dog. It was up to 40 according to the kitchen thermometer when we left. I was head-to-toe in specialty clothing, which helps to motivate me.

We're in training for the 5K season which will start in March.


Sunday, February 8, 2015

Eating and Moving Through Stress

It was a very bad week this week, maybe the second worst of my life. But on this, my diet and exercise blog, that's not the story. The story here is I took care of myself.

As stress built over the past couple of weeks, I had started a new diet and was making progress. I also started a training plan for the 5K I intend to run in March. As things got tense, I hunkered down and cooked and cooked and walked / ran with my dog outside.

When all hell broke loose, there was no time. But there was a fridge full of good food to reheat quickly. A couple of days, I hardly passed through my own house to grab and eat the food, and besides had essentially no appetite. But every other day, I ate well and adequately without having to waste energy on it.

There were two days this week that are tied for the fewest number of steps I took during a day, since I've been tracking my steps with the current devices.  When I got a break Friday morning, I contemplated going out for a terrific breakfast. Instead, I suited up in my cool new running clothes, wired myself with all the tech, and the dog and I took my training run only a day late. This is what I wanted to do with my time. This was the best way to dissipate my stress. It was like meditating, it was so refreshing.

What an enormous change in my mindset - and for that matter, to my body itself.

Emergency! Emergency? (2014 Edition)

After only one trip to the emergency room in the last twenty years, 2014 was my year of emergencies for myself. I've had many trips during that time and recently to ERs with family and friends, but it's very different when it's you.


The killer tree and the telephone pole it brought with it.
First, in August, was the Attack of the Killer Tree, the 100-foot tall, 100-year-old oak that decided to come down on me. I ran, it missed me, but when I looked over my shoulder to see if I was clear, the dog kept going and over I went, backwards. (Good to know I can outrun a tree, too bad I was so clumsy.) I cracked the back of my head open on the curb and ended up in an ambulance. It turns out ambulances have protocols of where to take people, but some discretion on how they do it. Head injuries were supposed to go all the way across the county; I talked them into the hospital in my neighborhood, just a half mile away.

Good to arrive in an ER via ambulance. They look at you right away, no waiting for triage. On the other hand, once they figured out I wasn't going to die from it, I spent a total of FIVE hours there. Luckily, a helpful neighbor had taken my dog home for me, and scooped up my purse and got it to me before the ambulance left. My kindle lives in the purse. As it turns out, that was at least as useful as having my insurance card.  I read a complete VI Warshawsky novel. If you aren't familiar with VI, she is the original hardboiled female detective, by Sara Paretsky. It is not uncommon for VI, after having been beaten up or even shot, to get up and walk out of a hospital with doctors telling her not to. At once point, I considered doing likewise, but talked myself out of it.

Another helpful neighbor called my brother-in-law to tell him I was being taken off in an ambulance. I had texted him, something like "I'm off to get my head bandaged because I fell." But after the call, he came creeping into the ER, scared to death. This ER is fraught with pain for us. My sister died a few feet from where I was lying. He was reassured to talk to me, though the back of my head looked like I failed to outrun the zombies and they had some of my brains.  He assigned my nephew to await my call to come get me when I was released.

Four metal staples, a week's worth of bad headaches, two weeks of no running or jumping, an inability to sleep on my back for several weeks, and eight weeks before I could get my hair colored, was the only aftermath.

I had to go back to the ER to get the staples out, because it takes a special tool. (Of course, the family kindly offered to go to Office Depot and take care of it, but I decided to stick with the professionals.) I estimated 7 am was the deal - after 6 am shift change, but before most walk-ins would get there. BINGO!  One hour in -and-out, exactly.

The next adventure was much less exciting. I sliced a nice clean oval off my thumb the very first time I used a mandoline. (Thanks to my wood-working friend Jeff for the tip on the stainless steel mesh glove, which has enabled me to use the mandoline again, even though I twitch at the thought. Even more thanks to my girl for my new vegetti - like a pencil sharpener for vegetables. Still, I'll wear the glove when using it.) It's really hard to work your way into a first aid kit and sort through packages of bandages while blood is flowing freely from your thumb on your dominant hand.  Pretty much, my bathroom looked like a slasher movie by the time I was done. The next morning, I asked the nurse at work to help re-bandage it. She took one look, and ordered me off to the ER. (I have since decided this was unnecessary - this is actually what "urgent care" is for. I had thought of them as the flu clinic, but they do bandages.)  This time, I went to the downtown hospital at prime time. Still, they had two tracks, one for the easy things like my thumb. They talked to me and took my temperature, checked when last I'd been in West Africa, and had me back being looked at in about twenty minutes.  Two times, they unwrapped it and pulled off the bandage, which started it bleeding and hurt like billy blue blazes. Gave me a chance to practice my cowboy cursing, and to realize you have to ask for painkillers. Two hours later, and I had a high-tech bandage that could stay on for 10 days without pulling the scab off again.  I had to wear a waterproof finger cap over it during my sailing excursion, and I've got a nice scar now, but otherwise uneventful.

This last trip is the reason I actually started to write this.  Two weeks before Christmas, on a Tuesday, I woke up with chest pain. I got up and started doing my morning stuff. The pain got worse. It was like a pressure, and to the extent I could localize it, it seemed to be coming from between my shoulder blades.

I was terrified and skeptical, all at once.  I have a tragic family history of heart problems. My sister dropped dead at 46, waking up one morning with chest pain and declared dead two hours later. My older brother had a bypass operation while in his fifties. My grandfather died of a heart attack at age 52.

 I had felt something like this pain before, intermittently and for brief (< 5 minutes) periods.  I have had intense heart screening because of this family history, with no indication there is anything wrong. But I've read a fair amount about how women's heart trouble presents differently than men's. There was a recent article in the New York Times from a woman who wrote a book about her husband's heart attack and recovery, but who had a hard time believing she was having one herself a couple of years later.

I kept on getting ready for work. I drank some coffee. In the bathroom, I found myself with my eyes closed, leaning against the wall, feeling the pain and trying to push it away.  I remembered how good I felt in the gym last night, as I worked my upper body with very heavy weights. "That's it!" I thought "That's what is causing this!", and then I closed my eyes again from the pain. A deep breath, which hurt to do, I straightened up, and went to the computer. I googled "chest pain in women" and came to a website with short anecdotes from women who dismissed their chest pain.  "SECONDS COUNT!" was the theme between them. "I had a powerful pain between my shoulder blades and it hurt to take a deep breath" read the third narrative I read.  

That did the trick. I would have told anyone else to go to the hospital. I might have been dialing 911 for them. I knew I needed to go get this checked out. Still mostly convinced it was the gym, I thought of my family, and how my fragile girl shouldn't have to go through this again.  I might be embarrassed, but the embarrassment would be worth it.  I got dressed-I'm not sure exactly what I was thinking, but I put on work clothes, though especially comfortable ones, except for the ankle boots.  It was 44 degrees out, pouring rain, and 6:30 in the morning. I put on my foul weather jacket, grabbed my purse (the one with the kindle) and my car keys, rested my head against the door and tried to make the pain stop, and then headed towards the hospital.

Note to readers:  DON'T DO THIS!  Never drive yourself to the emergency room if you suspect you are experiencing something that could incapacitate you along the way. It is as bad as driving drunk. You may be endangering other people which you don't have the right to do. Always always call 911 for yourself or your spouse. The folks on the ambulance will start treating you when they arrive, saving some of those precious seconds that count.  This is true even if you live a quarter mile away from the regional cardiac care center's emergency room, with just two right turns  and one traffic light to get there, and you are already somewhat embarrassed about making a fuss about probably (but only probably) nothing.

I parked at the hospital visitor parking, and stood under the overhang just out of the rain and outside the door literally turning in circles,  "It's nothing", I thought. "I don't want to be here and I don't want this to be happening", I thought more honestly.  This place is fraught with tension for me.  My sister died right here. What is going to happen when I walk through that door?  One thing I know for certain, a chain of events is going to start that I won't be able to control.
I walked into the ER, and sat down at the intake window. "Why are you here?" asked the lady I recognized from my staple-pulling visit.  "Chest pains", I said, wishing I was anywhere else. She scooched her chair back, called "chest pain" to someone over the cube divider, scooched back, and asked for id and insurance cards.  I had them out, and requested she double check the address because of a mixup in the billing statements.  She asked who my primary care doctor was. "Well, my cardiologist is Dr. B" I said. "Dr. B!" She said with reverence.  She scotched back and said over the partition, "Dr. B's patient!"  A nurse came out and asked me to come back.  He took me into a little room and put those little electrodes all over my chest and did a quick EKG.  He said the doctor would look at it but but it looked fine to him. 

I don't know what I expected to happen but this was really low key. My mental images had been of the noise, confusion, and many many people surrounding my sister, overlaid with several seasons of ER on TV. This was almost bucolic, and certainly anti-climactic since I had worked myself into such a tizzy. I had on a hospital gown on top by now, but I walked behind my nurse to a work station, carrying all my stuff, thinking now I'll just get dressed and head on to work. 

Not so fast. I described my symptoms in more detail, first to the nurse and then to the doctor, how I'd been having intermittent pain for some days and then big pain this morning, continually adding that I'd worked out with heavy weight the night before and it certainly could be muscle pain. "But then why have you felt it before?"  I said I was fine and I wanted to leave to the doctor, and she said fiercely, "There is no place else you should be right now!"  I stayed.  I sent an email to work, "No Nan today" with no other explanation.

The rest is even more of an anticlimax.  I was there for some hours, during which time I was hooked to cardiac and blood pressure monitors, had two lines for blood draws/drug pushes put in my arms, given aspirin, nitroglycerin, a proton-pump inhibitor (for acid reflux, because the odds were growing it was not cardiac related), and an MRI. I resisted other stronger drugs that were recommended, and when the doctor talked about admitting me to stay overnight I really grew alarmed. At that point, my pain was less but not gone.  It's really hard to listen so closely to your own body and distinguish sensation from suggestion after a while. I took my own notes on my iPad about what was happening when, and what my symptoms were. I regretted the ankle boots, which I was still wearing, along with my comfortable work trousers. My own cardiologist, the important Dr. B, (who had done all those tests on me before) practices at that hospital, so the ER doctor talked to him on the phone. "Dr. B will be coming to see you himself" she told me with some awe. When he came, he looked through all the charts again and sort of apologetically told me he really needed to use his own stethoscope with his own ears to listen to my chest. The doctors agreed to let me go if I took the PPI and went for a follow up at his office for a stress test. 

So yeah, I'm fine.  I did an echocardiogram a week later, running on a treadmill at maximum effort then having an ultrasound of my heart while it was going fast from the exercise. The crew had to repeat the test because we didn't move fast enough. It turns out I'm in such good aerobic condition my heart rate dropped too fast for them to catch good video of it pumping hard.  When I reviewed the overall situation with the glorious Dr. B, he said every marker said I was very healthy, and he was impressed at how long and fast I was on the treadmill.  "Well, yeah, I ran some 5Ks this summer", I said, then very grandly, channeling our friend Chris, "it is my intention to go vigorously into old age". Quickly then, hearing the hubris echo in the room, sheepishly, "I'm going to be 60 this year. I have to think about these things."  "I'm right there with you" he said with a grin. He basically told me it appeared I won the genetic lottery, mitosis had favored me, and there was no reason to believe I had any cardiac problems, I should take the medicine for the acid reflux and follow up with my own doctor.

But I think I did the right thing. Here is something to think about during this red month of February -"just a little heart attack".




So that's my ER stories from  last year.  It's all over but the billing and insurance paperwork, which may last for some time to come.