Wednesday, October 27, 2010

The I Can't Take It Anymore Diet

Several years ago I was diagnosed with severe sleep apnea with a minimum blood oxygen saturation of around 70% which is to say, "you're dying because your brain is starving." I was placed on a CPAP machine and was immediately relieved of almost all symptoms. Problem solved, right? Well, no.

Life on a CPAP machine isn't fun. You have a bulky thing that you have to carry around anywhere you intend to sleep and anyone who intends to sleep with you has to deal with your having medical equipment strapped to your face and making airflow noises all night long. Mind you, it's much quieter than most apnea sufferers themselves, and far less distressing to hear than a pause in breathing followed by a loud snoring, choking intake of breath, but it's not exactly sexy.

Those were just cosmetic/lifestyle issues though, and I could have lived with that. The real problem was that I found the thing painful to wear and while it gave me a better night's sleep, it also caused me to get less of it, due to the difficulty of falling asleep and plenty of events where I would wake up with it pulled partially off.

So, I decided to give it up. That's not a small decision. I essentially decided to risk injury to my brain and/or death, so I needed a plan. Most apnea sufferers, myself included, have their breathing problems as a result of their weight. Over a certain, individual-specific weight threshold, your airway just doesn't work the way it was designed to. In my case, I was 265 lbs. and the threshold was about 230 lbs.

This made a diet a fairly obvious solution. (click the title for the rest of the story)

The First Diet: Low Carb

To those who advocate low-carb diets, let me be clear about one thing: going generically low (not zero, or even close, really) carb worked well... at first. For over a year I dieted and lost weight by eating 3 meals a day with moderately low carb counts. I ditched pasta, rice, bread, most sugar, potatoes and all of the other obvious sources of nearly pure carbohydrate intake. I still had a moderate amount of alcohol (I've never been much of a drinker) and I made a point of cheating on small things: a fry from a friend's plate; a plate of battered fish (sans chips); etc. These small bits of carbohydrate intake made me feel better about what I was doing, but still allowed me to lose weight.

Spurred on by my driving desire to lose the CPAP machine (which I continued to use until I confirmed I was losing weight), I lost around a pound or less a week over the course of a year and a half. There were some periods of weight gain, but I never counted them as failure: just noise in the data stream. Not giving up was important.

In the end, I went from 265 to 215 and felt so much better in every measurable way that it can't adequately be described. Just describing it in this blog nearly brings me to tears. When you're really fat, not just paunchy, but actually carrying around 50 lbs. or more of gut, hanging off your body, you don't realize how it makes you feel. I'm a high-energy guy, but when getting up off the couch is like lifting a crate of milk-cartons, you don't do it without a reason.

Yet, wonderful as this feeling was, it was my downfall. Without the sense that I literally needed to diet to live, I didn't want to continue to restrict what I ate. I experimented with various, lesser forms of my ad hoc diet, even trying one book-based diet called the Carbohydrates Addict's Diet with mixed success. The problem was that I wanted to enjoy food of any sort, and eating with my friends was one of the joys that I wanted back in my life. I maintained my weight for a year or two, but after that I started climbing back up. At 220, I though, "well, I still feel good." At 230 I started to feel the old symptoms, but it wasn't too bad. Finally, this year I crossed 240 and was feeling terrible in the mornings again.

Waking up from sleep apnea is always an adventure. You never know how it's going to hit you. Sometimes you're just sore all over. Sometimes you feel like you haven't slept. Sometimes your eye burns more and more as you slowly wake up to realize that you've been in pain all night. My favorite, and I never really got back to this point, thankfully, was waking up with an arm so numb that at first, I was convinced it was a pillow that was wedged in my side oddly.

Once I started feeling like that again, I decided to re-start the low-carb diet. The problem is that it's very hard, without a sense of impending danger, to make myself avoid carb-rich foods for more than a week or two, and the sense of loss in terms of not being able to come home to whatever looks good is demoralizing at best.

Epiphany: Eat Less

So, I re-evaluated. A recent episode of a TV show called Food Detectives had an interesting hypothesis: give people smaller plates and they eat less. I'd certainly fallen into the trap of buying larger and larger plates and bowls over the years, so I figured I'd test that out. Indeed, when I had a smaller bowl, I was more comfortable with a portion size more in line with recommended serving sizes. The problem was, I was still going out to dinner and still snacking enough to make up for whatever reduction in meals I was making.

So, my next step was to put a hard cap on a recommended serving (I'm eye-balling this, not measuring, but essentially 1 cup of food plus drink of choice) of a reasonably healthy breakfast and lunch. That is, I'm eating a high-fiber, low-sugar mix of breakfast cereals (Fiber One 50%, Fiber One Honey Clusters 10%, Honey Nut Cheerios 10%, Chocolate Cheerios 10%, Kellogg's Special K Protein 20%) with enough milk to just barely make them "swim"... probably 1/2 cup. That's most days, but I switch up with 2 eggs fried in about half a pat of butter (nothing else) every now and then, just to avoid giving my gall bladder ideas about playing dead as so many friends have had happen when they lowered their fat intake precipitously. Then for lunch I eat either the same cereal mix or about a half-portion of whatever a local eatery provides (without side items like chips). That's pretty harsh and when I then put the clamp-down on snacking, it makes me feel like I've been hit in the gut, but it's a clear and easy thing to do: eat less, vary the lunch a bit, don't snack.

Now, to dinner. So far, I've been successfully dropping about 2 lbs. per week without changing my dinner habits at all. I do keep one element of the Carbohydrate Addict's Diet, probably more out of habit than anything else: I restrict my eating to a 1 hour window. This means that if I eat a piece of bread, wait for 20 minutes for food and then nibble at it for the rest of the hour, dessert is off-limits, because that would technically be a snack. It's a compromise that's trivial to live with everywhere put parties and receptions, where I just have to suck it up and stop eating (remember, eating for more than 30 minutes straight is called "grazing"). And yet, for all my yummy dinner, food it's working and working faster than I'd planned. My belt is feeling looser and my apnea symptoms have yet to subside, but they're not as bad.

This is good news, though I probably want to put the breaks on when I hit 230 and start increasing the lunch portion just enough to not lose weight so fast that I injure myself. But the great part is that I'm going out to dinner with friends (and cooking at home with more gusto than before as well), enjoying myself and generally not feeling like I'm dieting outside of those "snack times" where I really want to kill something and eat its bloody carcase whole. OK, I'll admit, that part's rough, but it's so much easier to manage than trying to restrict myself to doing the right thing when I'm out and about with friends in the evening; picking over an Italian menu to see what I can eat besides a Caesar salad is just no fun.

There's a mental angle as well, and this is probably the most important part: being hungry during the first week to month is normal. You have to get yourself to the point that you want to eat and then stop and think about what you're feeling. You have to think about the fact that what you are feeling is called weight loss. You've trained your body to expect too much food. Now, you're going to feel a little bit of pain while it re-calibrates. That's not a bad thing, and if you can come to terms with that, not eating is so much easier.

Anyway, I'm rambling. I suppose I should close by pointing out that I do walk to work. I'm not a total couch-potato, and if you don't walk to work or go to a gym or do something physical at least 4 days out of the week, then no amount of dieting is going to change the fact that your body is atrophying. That's a bad thing, so go out and do something.