School me, please, for I am ignorant.
March 7, 2012 4:54 PM   Subscribe

I am a nutritional newbie - I never took any classes on the subject, I'm a lifelong selective eater, and what little I know has been memorized, mostly in the last two months. I'm in need of some specific schooling on my current peculiar weight-loss situation.

The question: what is making me lose weight? And how can I keep this happening? And why does it seem like I'm breaking all the rules here?

The background: In September/October, I was prescribed Geodon, which spiked my blood sugar from 88 to 163 in a matter of a bit less than two weeks. This freaked everyone the heck out, and rightly so. Amongst many other changes, I was enrolled in the YMCA's Diabetes Prevention Program, and starting on December 20th, I started tracking my food intake daily.

I have OCPD and OCD, and am totally confident that if anything, I am underestimating my caloric intake (due to ignorance of things like "how much fat do you add if you fry a tortilla.") I believe these underestimation problems are decreasing over time - that is, what once was in the diary as 100 calories with 8 grams of fat is now 150 calories with 12 grams of fat. Over the last two and a half months, however, my daily caloric intake, daily carb intake, daily soda intake, and daily fat intake have all dropped - by very modest amounts. The December 20-31 average was 2700 calories a day, the March 1-6 average is 2370. It's been a very slow, gradual decrease as I make various adjustments, though I suspect the actual difference (again, I'm improving my calculations over time) is more like 500-600 calories a day, and that really this last week I was around 2400 a day.

I exercised, at the very most, a half hour on any one of those days, primarily in the form of jogging down three or four flights of stairs. Due to depression, upper respiratory illness, and other issues, there were whole entire days where I literally woke up, went down the stairs once, sat in a chair for eight hours, went up the stairs, and went to bed. If I had to guess, I'd say I was doing 5 to 9 minutes (averaged out) of low-intensity exercise a day, or 35 to 63 minutes per week. This didn't really change over time. In fact, this last week was the upper respiratory illness, and I doubt I was even hitting my normal "sedentary" activity levels on three of the seven days in question.

I weigh 243.6 pounds (as of an hour ago) - on December 20th, I weighed 262.0 pounds. I am 5'4" and female.

I don't understand how this is possible.

I know (within reasonable limits) that this is "real" weight loss - my pants are loose enough now that I need to buy a belt, a skirt I haven't been able to fully zip up in months is now fully zip-up-able and I can stick the first part of my arm in it besides. I don't feel skinnier (in a subjective "my body feels smaller, my double chin is gone" sort of sense,) and in fact I walked in to today's weigh-in very, very sure I'd regained some of the weight I've lost - instead I dropped from 246.8 to 243.6. It's been a steady 1.8-2.6 pounds per week for the last four weeks (since the program started.) If anything, I've been losing weight faster as the number of calories I eat goes down, which would sort of make sense, except that MyFitnessPal keeps giving me giant red "YOU ARE EATING TOO MUCH" warnings.

All I've really done is some very basic "be less than insane" dietary changes. I think this week's "calories from soda" percentage may finally be in the single digits, I try to only cook my beans in one tablespoon of Crisco instead of two. I'm still very clearly eating too much, by every single standard I can find online - I'm reading that in order to obtain these results I should be eating 1500 calories, or 1800 plus exercising for an hour and a half.

Again, my question is:
1. Since this is true, does this mean I'm magical or something? Or are those averages online for the 50th percentile, and there's a ton of people for whom they don't really apply?
2. Is the rule really "decrease your average intake over time" instead of "get to this fixed number of calories," or is my fixed number of calories simply wrong? Is the key to weight loss, for me, eating 2300 calories a day and sitting around motionless? Or is it "continue to decrease until the only way forward is pain?"
3. Given that these are the results I'm seeing, how should I be formulating my goals? I'm nearing the point where I have to start actively doing things that make me unhappy (whole meals of nothing but vegetables, only allowing myself spaghetti once a week) and I'd really like some sense of what I have to do, here.

Potentially relevant factors:
  • My cholesterol is now and has always been excellent
  • I'm taking Metformin, Trileptal, Lexapro, Seasonique, Vyvanse, fish oil, Vitamin D, Vitamin C, a multivitamin, and Propranolol (as needed for anxiety.)
  • I've weighed over 240 for at least six years, and over 185 since 1995. In 1997 I weighed 185 despite doing about 200 minutes a week of extremely intense aerobic exercise. In 2003 I weighed 225 despite working in a job that required me to run up and down concrete steps with heavy boxes most of the day, four days a week. I gained 15 pounds at about a pound a week, starting about a month after that job ended.
  • My meals lately have been 65% carb and 22% fat. I only track these, I don't try to eat things to mess with the numbers except in a very general "ugh, too much fat" kind of way.
  • I'm trying to drink more water, but I'm still in the 50-100oz/day range.
  • The Diabetes Prevention Program official goal is for me to hit 233.4 on or around the 16th week of the program. At the rate I'm going, I'll be there on week 8 or 9. If that happens, it'll be the least I've weighed since 2005.
  • I eat ridiculous amounts of pasta and refried beans. Absolutely insane. I'd guess, offhand, that I go through a pound of pasta and 3 15oz cans of beans per week.
  • The Metformin is the only thing I've started, in any real quantity, since the weight loss began. BUT I don't feel less hungry at all, and I'm on the lowest effective dose (it does seem to be helping my blood sugar.) I certainly haven't experienced anything like looking at the plate and deciding I'm not hungry anymore, and the way I cook, I'd know.
Any advice, analysis, suggestions, resources, etc., are more than appreciated.

I also wouldn't mind finding out how much fat/calories/etc. I need to add to my corn tortillas after frying them in corn oil, by the way.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! to Health & Fitness (12 answers total) 3 users marked this as a favorite
If your blood sugar is messed up and responsive to Metformin, you probably have underlying insulin resistance that the Metformin is treating, and that is why you're losing weight. It's not "magical", it's your metabolic systems responding to the medicine. The weight loss will taper off long before you are in any danger of becoming underweight.

If you want to keep your weight at its current level or regain weight, you will have to eat more. If this rate of weight loss is satisfactory to you, eventually you will plateau and will have to adjust your food intake or your exercise regime in order to maintain the same rate of weight loss.
posted by Sidhedevil at 5:51 PM on March 7, 2012 [6 favorites]

Also, let me recommend as a way of answering your questions about specific nutrition information for specific foods.

Has your doctor not suggested that you meet with a dietitian? Your food choices sound high on the glycemic index to me, as you describe them, and switching that up is generally considered helpful for many people with blood sugar issues. A dietitian can help walk you through all of this stuff and give you specific resources, factsheets, etc.
posted by Sidhedevil at 5:54 PM on March 7, 2012

Your basal metabolic rate has probably ramped up, and your body is consuming its stored energy supplies to compensate. It sounds like you are on the outlier side of metabolic efficiency, and it helps to remember that online calculators, whether caloric expenditure or food intake, are estimates, and not necessarily representative of your personal experience.

If you are interested in slowing or stopping your weight loss, you will have to consume more calories, or expend less.
I am not familiar with with the prescriptions you are taking.
posted by the man of twists and turns at 6:03 PM on March 7, 2012

also, yes, FitDay, and yes, dietician.
posted by the man of twists and turns at 6:03 PM on March 7, 2012

regarding the tortillas/oil. are you frying the tortillas to make chips or tostadas, or just browning and warming them? if the latter, try doing it with a measured amount--maybe one tablespoon. soften the tortilla on both sides before leaving it to get a little brown and crispy. after turning it to cook the other side, it is likely that all the oil will have been soaked up, or enough that you feel comfortable saying "I can put one tablespoon into my calculations and be pretty damn close". If that's not enough, or too much, try adding or subtracting some the next time by, say, teaspoon. If you are 'deep' frying. measure out the amount of oil you want to use, fry your tortillas, and when the oil has cooled, measure what remains. subtract that from the original and you have an estimate of the amt of oil the tortillas have soaked up. I don't know if this is true or something I'm making up, but recently I have been using coconut oil for things I want to have turn out especially crispy (fried polenta, reheated mashed potatoes) and it seems like I get a crispier outcome with less fat. I have had good luck with using less oil/butter than I think I need and finding it's enough to satisfy, and trying to stick to monounsaturated and polyunsaturated fats.

I like pasta too, and what I try to do is reverse the proportions of pasta to sauce. I used to have lots of pasta, medium amount of sauce. now I measure out about 1.5 ounces of pasta (before cooking) and let it swim in a lot of marinara sauce rich in vegetables and protein. If you don't eat meat, TVP adds a lot of protein and a similar texture to ground beef. (another way I add protein to my diet is to mix it with my muesli in the morning).

As for the total number of calories you are consuming, whatever that number may be, if it is less than you used to eat, you will lose weight.

It sounds like you really like to pay attention to detail, and you might find tracking your food at a site like sparkpeople to be especially helpful.
posted by QuakerMel at 7:00 PM on March 7, 2012 [1 favorite]

Giving up soda could cause that kind of weight loss imho.
posted by fshgrl at 7:10 PM on March 7, 2012 [1 favorite]

I found your question a little bit confusing, but if I understand you correctly, you're around 250lbs, female, eating around 2500 calories a day, and losing weight. It also sounds like you used to eat a lot more than that.

Reducing what you eat often leads to weight loss, even if your calories are still high. Maybe it takes you 3500 calories a day to maintain a weight of 260 pounds; that sounds reasonable to me - now you're eating a lot less, so you're losing weight.

I don't count calories anymore, but it used to take me about 2400 calories per day to maintain a weight of around 130 pounds at 5'5" (granted, I was more active than you are). So, I know that if I was your weight, and eating what you are eating, I would lose weight pretty rapidly.
posted by insectosaurus at 8:57 PM on March 7, 2012 [1 favorite]

Best answer: Metformin on its own can cause weight loss, even when given to people who are not diabetic. I have a friend who has dieted for years and never successfully lost weight, 6 months ago she was put on Metformin due to polycystic ovaries and she has lost approx 35 lbs without altering her diet consciously.

Metformin works by suppressing the glucose production of the liver. Glucose levels in turn cause an insulin response, and insulin is a key hormone that regulates how the body stores (or uses) fat.

Altering your diet will also lead to changes in your insulin levels (which is the goal for a diabetic diet after all) and hence will also affect your body's propensity to store (or use) fat.

So yeah, if you add Metformin and a diabetic diet into the mix it isn't surprising that your weight is changing. My "everyone's a nutritionist" 2c worth - try to replace carbs with green vegetables whenever you can. You'll see improvements in both weight loss and diabetic control from that move alone.[*]

* - Warning: Anecdotal evidence ahead - I'm diabetic and a former carb addict. I take no diabetes drugs (I'm purely diet and exercise controlled) and my blood glucose has been well under limits since dumping 80% of my carbs for leafy vegs. YMMV.
posted by samworm at 2:29 AM on March 8, 2012 [1 favorite]

I also take metformin, and have recently lost 22 lbs in 2 months with exercise and a change in diet to cut out carbs and wheat as much as possible. I never drank soda, don't like it, nor do I put sugar in anything. I am still on the metformin but go back to the doctor in three months to see if the dose can be lowered or eliminated altogether.

At your weight and height you still have a ways to go with weight loss. Not being hungry is not magic, it is a reaction to cutting down on carbs. Yes, eat more fruits and vegetables, oatmeal with fruit, eggs are ok, protein in general. I joined a gym and got a personal trainer to get motivated to exercise. My trainer gave me a general diet, but I would also recommend talking to a nutritionist about blood sugar levels and glycemic index on foods. Read labels, you would be amazed as I was how many things contain sugar, corn syrup etc that you do not realize. For keeping some pasta in your diet (my weakness too) try Dreamfields Low Carb pasta, and also cut down on portions and frequency.

Rather than running up stairs and knocking yourself out, try a gym where they will give you an exercise program suited to your limitations that can gradually increase in intensity. If you stick to it you will feel better. I was way overweight, did not do much exercise for years, and am in my 60s so it is never too late or too hard if you are motivated. I feel and look much better in every way, and believe me I never thought I could do this.
posted by mermayd at 3:18 AM on March 8, 2012 [2 favorites]

1) You are almost certainly not magical. Metformin is often associated with weight loss.
2) There are multiple rules and methods of weight loss. Ketogenic diets and calorie restricted diets combined with physical activity are the most common and the most effective.
3) "Given that these are the results I'm seeing, how should I be formulating my goals?"

I'm going to assume that you want to lessen your chances of becoming diabetic as well as attain a body fat percentage and weight in the "normal" range of the spectrum and go forward from that point.

You are eating too much food, and too many of the wrong foods. I'm not trying to sound mean about it, but it's the truth. No one taught you what to eat and how much. No one taught me either and it really sucked being terrible at being fit.

I don't really know where to start, so forgive me if I'm not really focused here.

Let's start with your macronutrient split. Going by your numbers, you're eating ~78g protein, 58g fat, and 390g of carbohydrates a day. This is extremely not optimal for a person who is obese, in either the macronutrient split or the total caloric intake. If you want to lose body fat quickly and easily, your macronutrient split should be 150g of protein, 105g of fat, and under 30 grams of carbohydrates. That's 1620 calories a day. This is not "starvation mode" and you will not starve. You will have to radically change what you think you know about healthy eating.

You wrote "I'm nearing the point where I have to start actively doing things that make me unhappy (whole meals of nothing but vegetables, only allowing myself spaghetti once a week) and I'd really like some sense of what I have to do, here."

This is unavoidable. We would all like to eat whatever we want whenever we want and suffer no consequences; however, It Doesn't Work That Way. When I start to wish I could Eat Whatever Whenever, I remind myself that I had decades of that behavior and now it's time to eat and act like a responsible, grown mortal adult who does not want to keel over of a heart attack at age 40.

But! You will not have to eat whole meals of nothing but vegetables. Keto/low-carb/whatever you want to call it requires meat and eggs and, yes, vegetables. You can't eat pasta, and you can't eat refried beans. You can't have corn tortillas. You can't even have fruit. But you can have beef, poultry, fish, pork, eggs, cheese, and more or less as many green leafy vegetables as you want.

Throw out the Crisco and corn oil. Crisco is lab-created garbage and it should be illegal. If you want to fry something up, fry it in coconut oil or lard or grass-fed butter.

Sorry to get wordy and off-track. I'm not very good at this. But please trust this random internet person who is telling you that trying to avoid diabetes by eating tortillas fried in Crisco is doomed to fail. Doomed. I sent you a message because I have to get out of the office but I don't want you to just zoom on past this because you think I'm bullshitting you. Thanks.

Oh PS you should lift weights instead of killing yourself on a dumb treadmill for hours but that's for another discussion
posted by a_girl_irl at 3:05 PM on March 8, 2012

Response by poster: Thanks, everyone! Feel free to send more sciency (and/or easily understandable) answers my way. :)

As a head's up, I'm very, very, very not going to make drastic changes. Slow and steady is the only thing possible - I get scowly looks from my therapy team when I go to bed an hour later or get up an hour earlier or make any other kind of change; hypomania has been induced by me cleaning an extra room on a weekend afternoon.

Oh, and I'm now in the mid-230s, if my bathroom scale (deliberately analog so I can't obsessively track my weight every two hours) is to be believed.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 2:43 PM on March 11, 2012

seconding the advice of a_girl_irl on nutrition. you are eating too much and the metformin is why you are still losing weight. please try to eat less carbs, LOTS green vegetables, and plenty of protein. fat is fine too, you can probably have more than you are now, but make it HEALTHY fat from vegetables or whole sources -- not processed corn oil and crisco!

the #1 thing i want to tell you is to please stop cooking with and eating processed food. it's poisonous. real, whole foods taste better, have way more nutrition, and are more satisfying.

i promise once you start enjoying them all the time, you will look back and wonder why you ate that other stuff. for example: coconut oil is definitely better than crisco. so is organic butter and real lard and good quality olive oil. lemonade made with actual lemon juice and cane sugar, or iced tea made with herbal tea and a bit of real sugar or stevia -- that's way better than a can of soda made with corn syrup. try having a bowl of oatmeal with toasted nuts and dried fruit on it; much better than a giant bowl of dry cereal with milk, even skim milk.

you don't have to make drastic changes about what you eat other than fewer carbs. just eat real food, not stuff that had to be created in a processing plant or factory. if you want to enjoy something carby here and there that's ok if it's a whole food; and you can add protein to help prevent that dramatic rise and crash in blood sugar. so, want to make pancakes or muffins? sure, no problem, but this time use a whole wheat mix and add a scoop of protein powder or some chopped nuts so that the recipe is higher in protein. little adjustments like that help.

also: YES LIFT WEIGHTS instead of doing dumb low intensity cardio. lift heavy, and no, you won't bulk up. i lift really heavy 2-3x a week, and all that happens: i got much stronger and a few inches smaller. my metabolism/blood sugar control has improved, too. this happened way more than if i had just been running, or biking, or walking, or doing some other medium to low intensity cardio. i did cardio for years, sometimes even more than an hour a day, and i saw little to no results in terms of weight and shape, even when i was pretty disciplined about it. (but i did get a little endorphin rush from running, which is why i could be disciplined about it for any length of time.) i wouldn't really lose weight or get "toned" in the way i wanted just from cardio.

true resistance training is much better for your strength, metabolism and bone density than cardio. you do not need a lot of time to have a very effective weight lifting workout: i can do one that hits all the major muscle groups in about 20 minutes. this is worth talking to a professional about, such as a certified kettlebell instructor, who can assess your fitness level and design a program that helps you improve muscle tone and sparks your metabolism.

sorry to write a novel but this is one of my topics i get passionate about. good luck with your plans for the future!
posted by zdravo at 11:56 AM on March 12, 2012 [1 favorite]

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