Realistically, is there anything else I can try before Metformin?
December 7, 2014 2:45 PM Subscribe
I've read all the other questions about Metformin, and most about PCOS, but I think this is a slightly new twist, so I hope you can help me. I know YANMD. I have already tried everything I can think of to manage without meds, and I'm wondering if any of you have other suggestions, or if I should just give in and start Metformin.
I am early 40s, 5'2", 155 pounds. Type 2 diabetes runs in my family. I have always been pretty active (exercising 3-4 times a week) and paying attention to what I eat. My blood sugar has hovered between say 105 and 110 fasting for about the last five years, even while I was eating fairly low carb. In the last year I gained about 10 pounds without a specific reason other than "another year older, sucks to be you."
In August I started working with a registered dietician, weighing and logging food and wearing a heart rate monitor when I exercise that I calibrated via whichever of those TDEE sites has instructions for it. I discovered the following:
- If I eat about 1400 calories per day (mostly primal/paleo, but with a few servings of grains a week) and exercise (combination of cardio and bodyweight) about 90 minutes a day for about 500-600 calories at least 4 days/week, I lose 1/2 pound/week.
- At 1200 calories/day and exercise 5-6 days/week 90 minutes, I lose about 1 pound/week. That's a supremely depressing net 700 calories/day.
- At 1600, I gain 1/2 pound/week. (I know both calories in vs calories out and Taubes, and arguing about whether I'm really eating/exercising this much isn't super helpful)
- If I keep my ratios such that my carbs are less than 150/day, my fasting blood sugar is...about 105-110. If I don't track so carefully, it might go up about 5 points. My A1C is flirting with prediabetic according to the new lower guidelines.
- To go lower than 1200/day (to lose more than 1 pound/week), I have to keep my carbs < 70 g/day, and then I go into ketosis and my FBG is about 85-95. And then I have three days of euphoria and then after that, I slip into anxiety attacks and start counting blueberries and feeling like I'm on a short slope to an eating disorder.
- I'm planning to do a Whole 30 in January, but I've done them multiple times before and they haven't made a big impact on my blood sugar or weight.
- I feel like I'm being so "healthy" that it isn't actually healthy any more, and I'd kill for an occasional grilled cheese sandwich to go with my endless salads and berries and Greek yogurt.
I talked to my registered dietitian after a couple of months, and she suggested hormone issues. So I talked to my doctor, who is awesome and talked to me for at least an hour about various options. After blood tests, she sent me home with a prescription for Cytomel for borderline hypothyroid, told me to up my vitamin D, and gave me a Metformin prescription to fill if I didn't see improved results after a month on the Cytomel. And the Cytomel hasn't made much of a difference at all. (I lost two pounds, then gained three, then lost two again in the last two months on it.) My doctor suggested that the Metformin may be what I need to be able to lose weight with the pretty darn healthy regime I'm already doing. She gave me a 5 month prescription and an optional referral to an endocrinologist to talk about other meds if I wanted to. I'm not thrilled to manage via meds vs. diet and exercise, and I'm also concerned about Metformin side effects.
tl;dr I've done about everything I can think of as far as "healthy living" is concerned to lose weight and manage my borderline blood sugar. Nothing is working. Give up and try Metformin, or do you have a better idea? If the answer is "start Metformin," what can I do to mitigate side effects?
I am early 40s, 5'2", 155 pounds. Type 2 diabetes runs in my family. I have always been pretty active (exercising 3-4 times a week) and paying attention to what I eat. My blood sugar has hovered between say 105 and 110 fasting for about the last five years, even while I was eating fairly low carb. In the last year I gained about 10 pounds without a specific reason other than "another year older, sucks to be you."
In August I started working with a registered dietician, weighing and logging food and wearing a heart rate monitor when I exercise that I calibrated via whichever of those TDEE sites has instructions for it. I discovered the following:
- If I eat about 1400 calories per day (mostly primal/paleo, but with a few servings of grains a week) and exercise (combination of cardio and bodyweight) about 90 minutes a day for about 500-600 calories at least 4 days/week, I lose 1/2 pound/week.
- At 1200 calories/day and exercise 5-6 days/week 90 minutes, I lose about 1 pound/week. That's a supremely depressing net 700 calories/day.
- At 1600, I gain 1/2 pound/week. (I know both calories in vs calories out and Taubes, and arguing about whether I'm really eating/exercising this much isn't super helpful)
- If I keep my ratios such that my carbs are less than 150/day, my fasting blood sugar is...about 105-110. If I don't track so carefully, it might go up about 5 points. My A1C is flirting with prediabetic according to the new lower guidelines.
- To go lower than 1200/day (to lose more than 1 pound/week), I have to keep my carbs < 70 g/day, and then I go into ketosis and my FBG is about 85-95. And then I have three days of euphoria and then after that, I slip into anxiety attacks and start counting blueberries and feeling like I'm on a short slope to an eating disorder.
- I'm planning to do a Whole 30 in January, but I've done them multiple times before and they haven't made a big impact on my blood sugar or weight.
- I feel like I'm being so "healthy" that it isn't actually healthy any more, and I'd kill for an occasional grilled cheese sandwich to go with my endless salads and berries and Greek yogurt.
I talked to my registered dietitian after a couple of months, and she suggested hormone issues. So I talked to my doctor, who is awesome and talked to me for at least an hour about various options. After blood tests, she sent me home with a prescription for Cytomel for borderline hypothyroid, told me to up my vitamin D, and gave me a Metformin prescription to fill if I didn't see improved results after a month on the Cytomel. And the Cytomel hasn't made much of a difference at all. (I lost two pounds, then gained three, then lost two again in the last two months on it.) My doctor suggested that the Metformin may be what I need to be able to lose weight with the pretty darn healthy regime I'm already doing. She gave me a 5 month prescription and an optional referral to an endocrinologist to talk about other meds if I wanted to. I'm not thrilled to manage via meds vs. diet and exercise, and I'm also concerned about Metformin side effects.
tl;dr I've done about everything I can think of as far as "healthy living" is concerned to lose weight and manage my borderline blood sugar. Nothing is working. Give up and try Metformin, or do you have a better idea? If the answer is "start Metformin," what can I do to mitigate side effects?
You're doing fine! You have found something that is working - 1400 calories/day with a reasonable amount of exercise. I know it sounds infuriatingly slow, but losing 1/2 pound a week is a perfectly reasonable and healthy pace.
Before trying the Metformin, I'd try tweaking your carbs more. 150g/day is... not particularly low (to me, at least). Can you try tweaking your ratios such that you are still eating around 1400 cal/day but you up your protein and fat and lower your carbs? 150g of carbs per day at 1400 calories is a hair under 43% of your calories from carbs, and I personally tend to do better around 20-25%. What are you currently eating in terms of fats and proteins? Are you trying to do both low-ish carb and low fat? That's really difficult to sustain in the long term. If you lower carbs, try upping fats a bit (avocado! eggs! nuts! all delicious) and make sure the carbs you do continue to eat have fiber. Fiber, fat, and protein are going to keep you feeling full longer.
I agree with telegraph to give it some time doing the 1/2 lb per week plan. It took me almost 18 months to lose 80 lbs, mostly through diet changes, and you have less than that to lose. Frustratingly, the pace at which you can coax weight off slows as you get closer to goal weight. For what it's worth, my blood lipids improved pretty dramatically within a few months, but my fasting blood sugar and A1C took longer to get where my doctor and I wanted them to be. Getting healthier is not just about the effort - it takes a lot of patience.
posted by bedhead at 3:21 PM on December 7, 2014 [2 favorites]
Before trying the Metformin, I'd try tweaking your carbs more. 150g/day is... not particularly low (to me, at least). Can you try tweaking your ratios such that you are still eating around 1400 cal/day but you up your protein and fat and lower your carbs? 150g of carbs per day at 1400 calories is a hair under 43% of your calories from carbs, and I personally tend to do better around 20-25%. What are you currently eating in terms of fats and proteins? Are you trying to do both low-ish carb and low fat? That's really difficult to sustain in the long term. If you lower carbs, try upping fats a bit (avocado! eggs! nuts! all delicious) and make sure the carbs you do continue to eat have fiber. Fiber, fat, and protein are going to keep you feeling full longer.
I agree with telegraph to give it some time doing the 1/2 lb per week plan. It took me almost 18 months to lose 80 lbs, mostly through diet changes, and you have less than that to lose. Frustratingly, the pace at which you can coax weight off slows as you get closer to goal weight. For what it's worth, my blood lipids improved pretty dramatically within a few months, but my fasting blood sugar and A1C took longer to get where my doctor and I wanted them to be. Getting healthier is not just about the effort - it takes a lot of patience.
posted by bedhead at 3:21 PM on December 7, 2014 [2 favorites]
Metformin's weight loss side effects are generally quite exaggerated. It could be worth a try, not everyone gets the digestive side effects, and it's a pretty safe drug. It's not magic in my experience, though.
You might want to give a ketogenic diet another try. I find that it's much easier to lose without feeling deprived/hungry and it has great effects on my blood glucose and cholesterol ratios. I stay below 20g carbs/day, and lose pretty easily while feeling energetic and full. I'm also a woman in my early 40's and it's the one thing that's really worked for me. The fact that I can have buttery steaks, heavy cream in my coffee and other indulgences while staying on program helps me feel like the change is far more sustainable than salads and berries. There are trade offs, but I'm very happy with my results, so it's not bad at all. My blood work is the best it's been in 10 years, I've lost 65 lbs since Feb, I feel great, and don't get sick nearly as often.
posted by quince at 3:29 PM on December 7, 2014 [1 favorite]
You might want to give a ketogenic diet another try. I find that it's much easier to lose without feeling deprived/hungry and it has great effects on my blood glucose and cholesterol ratios. I stay below 20g carbs/day, and lose pretty easily while feeling energetic and full. I'm also a woman in my early 40's and it's the one thing that's really worked for me. The fact that I can have buttery steaks, heavy cream in my coffee and other indulgences while staying on program helps me feel like the change is far more sustainable than salads and berries. There are trade offs, but I'm very happy with my results, so it's not bad at all. My blood work is the best it's been in 10 years, I've lost 65 lbs since Feb, I feel great, and don't get sick nearly as often.
posted by quince at 3:29 PM on December 7, 2014 [1 favorite]
Good for you. I have a shitty metabolism and I gave up. I'm a happy fat person. I try to eat low carb (and fail miserably on some days), work out and basically just try to eat intuitively.
I have been hypoglycemic my entire life and now that I'm post menopausal and on HRT, along with my anti-anxiety meds...there's no way. Not going to happen.
How about you eat in a way you can live with and enjoy. Exercise for health and let the fat fall where it may?
It's not the end of the world to have a little fat. If you're eating well and exercising, then you're healthy.
posted by Ruthless Bunny at 4:11 PM on December 7, 2014 [6 favorites]
I have been hypoglycemic my entire life and now that I'm post menopausal and on HRT, along with my anti-anxiety meds...there's no way. Not going to happen.
How about you eat in a way you can live with and enjoy. Exercise for health and let the fat fall where it may?
It's not the end of the world to have a little fat. If you're eating well and exercising, then you're healthy.
posted by Ruthless Bunny at 4:11 PM on December 7, 2014 [6 favorites]
One thing to consider might be weightlifting. You won't become some kind of Lady Rambo -- instead, your metabolism is likely to increase as you change your body composition toward muscle and away from fat. In my late 30s, after 2 kids, it's the only way I've been able to lose weight, get smaller and not least have a sense of accomplishment!*
* I get a sense of accomplishment in many ways but typically not while losing weight and dress sizes -- 10 to 6!
posted by chesty_a_arthur at 5:04 PM on December 7, 2014
* I get a sense of accomplishment in many ways but typically not while losing weight and dress sizes -- 10 to 6!
posted by chesty_a_arthur at 5:04 PM on December 7, 2014
Sorry if I missed this, but what is your gender?
It sounds like you know your stuff, but what sort of exercise are we talking about here? If you're a paleo/primal proponent then I'm guessing you're doing some sort of resistance training?
I think there are worse drugs out there than metformin.
Also, I know some people complain of muscle wasting on cytomel. Not sure if that is a legitimate concern.
Didn't hear you mention taurine. It's not a wonder cure but might help you out slightly. The only other supplements that seem to have any notable effects in published studies are: Gynostemma pentaphyllum and Tauroursodeoxycholic Acid. Finally, Zinc might have a small effect if you're deficient.
I pulled all of this info from Examine which is about as good as you can get from the internet.
posted by Telf at 5:12 PM on December 7, 2014
It sounds like you know your stuff, but what sort of exercise are we talking about here? If you're a paleo/primal proponent then I'm guessing you're doing some sort of resistance training?
I think there are worse drugs out there than metformin.
Also, I know some people complain of muscle wasting on cytomel. Not sure if that is a legitimate concern.
Didn't hear you mention taurine. It's not a wonder cure but might help you out slightly. The only other supplements that seem to have any notable effects in published studies are: Gynostemma pentaphyllum and Tauroursodeoxycholic Acid. Finally, Zinc might have a small effect if you're deficient.
I pulled all of this info from Examine which is about as good as you can get from the internet.
posted by Telf at 5:12 PM on December 7, 2014
I started Metformin at the full prescribed dose and experienced pretty severe diarrhea. This was a major bummer because I was still getting around on a walker after hip surgery. I waited several months until I was more mobile and tried again, ramping the dose up very slowly. Half a tab once a day for four days, then half a tab twice a day for four days, etc. It took me nearly two weeks to work up to the full dose of one tab twice a day, and I haven't had any problems since then. I've been on the full dose for about a year now, and my doctor is pleased with my hemoglobin A1C numbers.
posted by Bruce H. at 5:19 PM on December 7, 2014
posted by Bruce H. at 5:19 PM on December 7, 2014
I'm surprised your doc is prescribing metformin if your A1C is "flirting with pre diabetic" and your fasting blood sugar is 110. I mean, you're not diabetic, you're not even pre-diabetic. You are barely "overweight" per national guidelines (less than 10 years ago, you would only just have barely been in the overweight category per the NIH). You exercise regularly. What is the actual problem?
I don't mean to downplay your concerns, but my perspective is that you sound healthy and perhaps you're on to something when you say, "I feel like I'm being so "healthy" that it isn't actually healthy any more"
posted by latkes at 5:32 PM on December 7, 2014 [1 favorite]
I don't mean to downplay your concerns, but my perspective is that you sound healthy and perhaps you're on to something when you say, "I feel like I'm being so "healthy" that it isn't actually healthy any more"
posted by latkes at 5:32 PM on December 7, 2014 [1 favorite]
Why not check in with the endocrinologist and see what they say? They might be able to give you a better strategy to dealing with your blood sugar and weight. I also feel like they'd might be most experienced in managing the dosage if you decide to start metformin.
some personal anecdotes for you
My mother was able to manager her blood sugar w/o out metformin and stay just out of the diabetes ranger for maybe 10 years. It did mean that she exercised a lot - like a couple of hours of walking a day + aerobic exercise 5+ days a week and ate really very little. By that I mean maybe a very small breakfast, a half sandwich for lunch and a salad for dinner. There was also a person in my diabetes awareness class who was managing with only diet and exercise.
I was initally given metformin for PCOS and was then diagnosed as a diabetic. At the time my a1c was 7 or a bit higher. The dose I was given for PCOS was 2x higher than what I was eventually prescribed for the diabetes. The metformin did make me sick at first but now I can take it no problem. (A coworker who was on it had no side effects so YMMV) .We ramped up the dose 1x a week for 3 weeks. Once the side effects passed I felt better immediately and lost 25 lbs over a couple of months with not a lot of effort. I've probably gained 5 of that back but overall all am lighter than I was and my blood sugar remains under control.
posted by oneear at 8:04 PM on December 7, 2014
some personal anecdotes for you
My mother was able to manager her blood sugar w/o out metformin and stay just out of the diabetes ranger for maybe 10 years. It did mean that she exercised a lot - like a couple of hours of walking a day + aerobic exercise 5+ days a week and ate really very little. By that I mean maybe a very small breakfast, a half sandwich for lunch and a salad for dinner. There was also a person in my diabetes awareness class who was managing with only diet and exercise.
I was initally given metformin for PCOS and was then diagnosed as a diabetic. At the time my a1c was 7 or a bit higher. The dose I was given for PCOS was 2x higher than what I was eventually prescribed for the diabetes. The metformin did make me sick at first but now I can take it no problem. (A coworker who was on it had no side effects so YMMV) .We ramped up the dose 1x a week for 3 weeks. Once the side effects passed I felt better immediately and lost 25 lbs over a couple of months with not a lot of effort. I've probably gained 5 of that back but overall all am lighter than I was and my blood sugar remains under control.
posted by oneear at 8:04 PM on December 7, 2014
Best answer: Note: the poster at least implies in the the header that she has been diagnosed with polycystic ovarian syndrome (PCOS). Metformin is a treatment for PCOS, not just for diabetes. I've taken metformin for PCOS and my fasting blood sugar and hemoglobin A1c are stone cold normal, nowhere near pre diabetes.
OP, if this is all about weight loss, and you think that where you're ending up with calories and maintaining weight is a place where you could sustainably be for many years, then I would agree with the above posters and suggest that you go at 1/2 pound per week level until you lose the weight you want to lose. That seems like a very healthy and normal rate of weight loss, especially for a woman in her 40s. However, several remarks from your question imply that this really isn't a very sustainable way of living for you, and that you're not happy while doing it. For that reason, I think you should consider the metformin. You can't always fight genetics with lifestyle, and you shouldn't feel like a bad person if lifestyle changes don't achieve all that you want them to, because what you're doing right now takes monumental willpower and dedication, and that's something that most folks out there could not do.
I have gone off and on metformin 3 times now, because I have used it to treat my PCOS when I've been trying to get pregnant. The first two times I got the metformin from a reproductive endocrinologist, and both times I had to very slowly increase the dose from a half pill once daily to the full pill twice per day dose, and I felt awful, I'm not going to lie, until I had been on the higher dose for about 2-3 months and my body somewhat got used to it.
The third time I took metformin I got it from a regular primary care doctor. I told them about my concerns and he was like "oh, did you try the extended release formulation?" and I said no, I didn't think so. I made the switch that day and suddenly…. zero side effects. I have been kicking myself ever since for spending a year and a half of my life on a medication I hated when I could have been using the ER form the entire time. And I'm a doctor! Yet didn't even think of doing that myself. So that's my biggest pro tip - and that the GI side effects are way worse (or were for me) if you eat a big carb meal like a big plate of pasta, so especially for the first few weeks, just try to stick very well to your paleo diet - sounds like that won't be as hard for you since that's how you're eating anyway. Anyway, I think I had more trouble than most people with it, because it seems like everyone in the world is on metformin these days.
It's not like you have to stay on it if you start it - you can try it and then decide to stop. Don't think of it as giving up and not trying to live healthy anymore… that's a battle you've got to stay motivated to continue to fight.
posted by treehorn+bunny at 8:18 PM on December 7, 2014 [2 favorites]
OP, if this is all about weight loss, and you think that where you're ending up with calories and maintaining weight is a place where you could sustainably be for many years, then I would agree with the above posters and suggest that you go at 1/2 pound per week level until you lose the weight you want to lose. That seems like a very healthy and normal rate of weight loss, especially for a woman in her 40s. However, several remarks from your question imply that this really isn't a very sustainable way of living for you, and that you're not happy while doing it. For that reason, I think you should consider the metformin. You can't always fight genetics with lifestyle, and you shouldn't feel like a bad person if lifestyle changes don't achieve all that you want them to, because what you're doing right now takes monumental willpower and dedication, and that's something that most folks out there could not do.
I have gone off and on metformin 3 times now, because I have used it to treat my PCOS when I've been trying to get pregnant. The first two times I got the metformin from a reproductive endocrinologist, and both times I had to very slowly increase the dose from a half pill once daily to the full pill twice per day dose, and I felt awful, I'm not going to lie, until I had been on the higher dose for about 2-3 months and my body somewhat got used to it.
The third time I took metformin I got it from a regular primary care doctor. I told them about my concerns and he was like "oh, did you try the extended release formulation?" and I said no, I didn't think so. I made the switch that day and suddenly…. zero side effects. I have been kicking myself ever since for spending a year and a half of my life on a medication I hated when I could have been using the ER form the entire time. And I'm a doctor! Yet didn't even think of doing that myself. So that's my biggest pro tip - and that the GI side effects are way worse (or were for me) if you eat a big carb meal like a big plate of pasta, so especially for the first few weeks, just try to stick very well to your paleo diet - sounds like that won't be as hard for you since that's how you're eating anyway. Anyway, I think I had more trouble than most people with it, because it seems like everyone in the world is on metformin these days.
It's not like you have to stay on it if you start it - you can try it and then decide to stop. Don't think of it as giving up and not trying to live healthy anymore… that's a battle you've got to stay motivated to continue to fight.
posted by treehorn+bunny at 8:18 PM on December 7, 2014 [2 favorites]
Response by poster: Sorry if I missed this, but what is your gender?
Female. Sorry, I should have spelled out PCOS = Polycystic Ovarian Syndrome, which would have made that clearer.
Didn't hear you mention taurine. It's not a wonder cure but might help you out slightly. The only other supplements that seem to have any notable effects in published studies are: Gynostemma pentaphyllum and Tauroursodeoxycholic Acid. Finally, Zinc might have a small effect if you're deficient.
Thanks, I haven't tried taurine. I have tried: zinc/magnesium/calcium, D, chromium piconilate, cinnamon, inositol, and occasionally even goat's rue (which I have in liquid form, and it is vile).
You might want to give a ketogenic diet another try.
I've tried it 3 or 4 times this year, both on purpose and accidentally falling into ketosis and then deciding to stay there. In theory, I'm all for it, but in practice I find it triggers my brain chemistry into anxiety in a way that is kind of scary. Also, the general nutritional value of my food tends to go down when I feel like I can't eat berries or carrots or other colorful produce, which feels super counter-productive to me.
One thing to consider might be weightlifting. You won't become some kind of Lady Rambo -- instead, your metabolism is likely to increase as you change your body composition toward muscle and away from fat.
Actually, probably due to the PCOS, I sorta do turn into Lady Rambo. But I'm ok with that! I like that my body builds muscle quickly and efficiently. Right now I am doing body-weight exercise with lots of planks, pushups, lunges, squats, to fatigue and cardio. In the last two months, I've only lost about 1 pound overall, but when my dietitian reminded me to eat at least 100g of protein a day I noticed that I'm definitely getting body recomp and building more muscle than with the same workout and calories but different macros. I've considered switching up my exercises to lift, mostly to help build muscle and avoid injuries, but that would require joining a gym, and I just haven't made that change yet. I may try that in February, when the gyms aren't overrun by NY resolution folks.
My mother was able to manager her blood sugar w/o out metformin and stay just out of the diabetes ranger for maybe 10 years. It did mean that she exercised a lot - like a couple of hours of walking a day + aerobic exercise 5+ days a week and ate really very little. By that I mean maybe a very small breakfast, a half sandwich for lunch and a salad for dinner.
Yeah, this is where I feel like I am right now. Except, oh, man! A sandwich! With, I presume, bread?
You're doing fine! You have found something that is working - 1400 calories/day with a reasonable amount of exercise. I know it sounds infuriatingly slow, but losing 1/2 pound a week is a perfectly reasonable and healthy pace.
Before trying the Metformin, I'd try tweaking your carbs more. 150g/day is... not particularly low (to me, at least). Can you try tweaking your ratios such that you are still eating around 1400 cal/day but you up your protein and fat and lower your carbs?
I aim for carbs between 90 and 120g (about 20 of those fiber, so effectively 70-100g), 100g protein, and the remainder fat. This is relatively doable 2 days out of 3, but surprisingly hard to do every day. Some days I feel like, "hey, this is fine! I'm totally fine having eggs on spinach instead of toast for breakfast! I could do this forever!" But more and more the last 6 weeks or so, I feel like, "Oh. Yay. Another party where I had seltzer and lime. Fun." I actually left a get-together practically in tears that I just couldn't be freaking normal and have fresh baked bread and s'mores like everyone else. I'd eaten veg-and-protein a couple of hours before, and I'd strategized with my dietitian to bring cheese, smoked salmon, blackberries, pears, limes-for-seltzer to the potluck, so it should have been a win. Yes, I know I could have just had a s'more. I did just have a little bread-- this time of year, though, there are so many parties and celebratory dinners that I can't make exceptions for all of them.
You are barely "overweight" per national guidelines (less than 10 years ago, you would only just have barely been in the overweight category per the NIH). You exercise regularly. What is the actual problem?
My first problem is that I gained 10 pounds last year while eating healthily and exercising vigorously 4-5 times/week, after about 10 years of maintaining at "overweight but probably mostly healthy" at that same level of effort. That honestly kind of freaked me out, in a "holy crap, if my body does this in my 40's, what'll it do in my 60's" way. The second problem is that there are specific physical things I want to be able to do, that I find difficult and injury-prone at this weight: backpacking, rock scrambling, yoga arm balances, running. I've lost about 8 pounds since summer, and all of these things have gotten so much easier-- another 10-20 would make a huge difference in doing lots of fun things. The third problem is that I'm smack in that zone of "your blood sugar and cholesterol are on the high side; you should be able to control them via diet and exercise" except they're on the high side while I'm doing just about everything I can via diet and exercise, and diet and exercise aren't getting them to actual healthy levels. It's really, really demoralizing. And it's feeling more and more eating-disorder-triggery-- I start to feel anxious when I can't exercise for two days in a row, I spent a lot of nights in the last four months too hungry to sleep, I've found myself sneaking in a run on sacrosanct rest days, and all this to lose .5-1 pound a week and get my fasting blood glucose under 100... ok, that looks even more orthorexic when I type it all out.
I think AskMe may be like that trick where if you can't decide what to do you flip a coin and if you're disappointed in the results, you know what your decision really is. treehorn+bunny, about a million thanks, because going on and off Metformin was something I was worried would reduce effectiveness if I "really needed it" later, and "You can't always fight genetics with lifestyle, and you shouldn't feel like a bad person if lifestyle changes don't achieve all that you want them to, because what you're doing right now takes monumental willpower and dedication, and that's something that most folks out there could not do" is probably exactly what I needed to hear.
posted by etranger at 5:07 AM on December 8, 2014 [2 favorites]
Female. Sorry, I should have spelled out PCOS = Polycystic Ovarian Syndrome, which would have made that clearer.
Didn't hear you mention taurine. It's not a wonder cure but might help you out slightly. The only other supplements that seem to have any notable effects in published studies are: Gynostemma pentaphyllum and Tauroursodeoxycholic Acid. Finally, Zinc might have a small effect if you're deficient.
Thanks, I haven't tried taurine. I have tried: zinc/magnesium/calcium, D, chromium piconilate, cinnamon, inositol, and occasionally even goat's rue (which I have in liquid form, and it is vile).
You might want to give a ketogenic diet another try.
I've tried it 3 or 4 times this year, both on purpose and accidentally falling into ketosis and then deciding to stay there. In theory, I'm all for it, but in practice I find it triggers my brain chemistry into anxiety in a way that is kind of scary. Also, the general nutritional value of my food tends to go down when I feel like I can't eat berries or carrots or other colorful produce, which feels super counter-productive to me.
One thing to consider might be weightlifting. You won't become some kind of Lady Rambo -- instead, your metabolism is likely to increase as you change your body composition toward muscle and away from fat.
Actually, probably due to the PCOS, I sorta do turn into Lady Rambo. But I'm ok with that! I like that my body builds muscle quickly and efficiently. Right now I am doing body-weight exercise with lots of planks, pushups, lunges, squats, to fatigue and cardio. In the last two months, I've only lost about 1 pound overall, but when my dietitian reminded me to eat at least 100g of protein a day I noticed that I'm definitely getting body recomp and building more muscle than with the same workout and calories but different macros. I've considered switching up my exercises to lift, mostly to help build muscle and avoid injuries, but that would require joining a gym, and I just haven't made that change yet. I may try that in February, when the gyms aren't overrun by NY resolution folks.
My mother was able to manager her blood sugar w/o out metformin and stay just out of the diabetes ranger for maybe 10 years. It did mean that she exercised a lot - like a couple of hours of walking a day + aerobic exercise 5+ days a week and ate really very little. By that I mean maybe a very small breakfast, a half sandwich for lunch and a salad for dinner.
Yeah, this is where I feel like I am right now. Except, oh, man! A sandwich! With, I presume, bread?
You're doing fine! You have found something that is working - 1400 calories/day with a reasonable amount of exercise. I know it sounds infuriatingly slow, but losing 1/2 pound a week is a perfectly reasonable and healthy pace.
Before trying the Metformin, I'd try tweaking your carbs more. 150g/day is... not particularly low (to me, at least). Can you try tweaking your ratios such that you are still eating around 1400 cal/day but you up your protein and fat and lower your carbs?
I aim for carbs between 90 and 120g (about 20 of those fiber, so effectively 70-100g), 100g protein, and the remainder fat. This is relatively doable 2 days out of 3, but surprisingly hard to do every day. Some days I feel like, "hey, this is fine! I'm totally fine having eggs on spinach instead of toast for breakfast! I could do this forever!" But more and more the last 6 weeks or so, I feel like, "Oh. Yay. Another party where I had seltzer and lime. Fun." I actually left a get-together practically in tears that I just couldn't be freaking normal and have fresh baked bread and s'mores like everyone else. I'd eaten veg-and-protein a couple of hours before, and I'd strategized with my dietitian to bring cheese, smoked salmon, blackberries, pears, limes-for-seltzer to the potluck, so it should have been a win. Yes, I know I could have just had a s'more. I did just have a little bread-- this time of year, though, there are so many parties and celebratory dinners that I can't make exceptions for all of them.
You are barely "overweight" per national guidelines (less than 10 years ago, you would only just have barely been in the overweight category per the NIH). You exercise regularly. What is the actual problem?
My first problem is that I gained 10 pounds last year while eating healthily and exercising vigorously 4-5 times/week, after about 10 years of maintaining at "overweight but probably mostly healthy" at that same level of effort. That honestly kind of freaked me out, in a "holy crap, if my body does this in my 40's, what'll it do in my 60's" way. The second problem is that there are specific physical things I want to be able to do, that I find difficult and injury-prone at this weight: backpacking, rock scrambling, yoga arm balances, running. I've lost about 8 pounds since summer, and all of these things have gotten so much easier-- another 10-20 would make a huge difference in doing lots of fun things. The third problem is that I'm smack in that zone of "your blood sugar and cholesterol are on the high side; you should be able to control them via diet and exercise" except they're on the high side while I'm doing just about everything I can via diet and exercise, and diet and exercise aren't getting them to actual healthy levels. It's really, really demoralizing. And it's feeling more and more eating-disorder-triggery-- I start to feel anxious when I can't exercise for two days in a row, I spent a lot of nights in the last four months too hungry to sleep, I've found myself sneaking in a run on sacrosanct rest days, and all this to lose .5-1 pound a week and get my fasting blood glucose under 100... ok, that looks even more orthorexic when I type it all out.
I think AskMe may be like that trick where if you can't decide what to do you flip a coin and if you're disappointed in the results, you know what your decision really is. treehorn+bunny, about a million thanks, because going on and off Metformin was something I was worried would reduce effectiveness if I "really needed it" later, and "You can't always fight genetics with lifestyle, and you shouldn't feel like a bad person if lifestyle changes don't achieve all that you want them to, because what you're doing right now takes monumental willpower and dedication, and that's something that most folks out there could not do" is probably exactly what I needed to hear.
posted by etranger at 5:07 AM on December 8, 2014 [2 favorites]
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In my opinion, you can't predict what your blood sugar is going to do until you actually get the weight off. I say forget about the Whole 30 (and the potential orthorexia issues it may bring out or exacerbate), and stick to the 1/2 lb per week plan. If your fasting blood sugar is still problematic later in 2015 when you've reached a healthy weight, then consider addressing this with pharmaceuticals.
posted by telegraph at 3:01 PM on December 7, 2014 [2 favorites]