My diet
I'm a GP doc about 120 days into my own diet. I'll try to keep this to my own observations, but the method is controversial, so let me lay it out up front: I eat one meal a day. I skip breakfast and substitute lunch with a 1-hour run or swim. On Sundays I work out for about 3 hours, usually a 20 mile bike ride, a 1 mile ocean swim, and 20 miles home.
==The tipping point==
I started this because my work-out partner trounces me on the run in triathlons. I can out-swim and out-bike him, but he gains all that time and more on the run. My BMI at the start of this was 29.1. Normal range for my height starts around 190, the average runner of my height is probably closer to 165-170. I'm picking 180 as a goal, it's a nice round number. It's pretty clear dragging around an extra 43.5 lbs makes running harder.==Reaching the tipping point==A pile of observations, from medicine and elsewhere, have helped along the way1) Excess carbs are stored as fat. Lots of the foods we eat are cheap carbs (pasta, rice, bread, potatoes, beer, breakfast cereal, crackers, cookies, candy),2) Fructose does not make you feel full,3) You don't really burn fat until you burn down glycogen,4) Men and women both tend to eat more around women,5) Obesity spreads over social networks,6) The movies King Corn, Food Inc, Forks over Knives, the BBC's The Century of the Self and since I started, HBO's The Weight of the Nation has also come out,
7) It's easier to make simple changes than complex ones,
8) Willpower can be exhausted,9) I am always and will always be on the see-food diet,10) In a prior job, I had a hand in the weight-control program at the US Naval Academy. The nutritionists kept the midshipmen on a 2 lb/wk glide slope. They felt any faster was between unsafe and impossible (we're talking people who needed to loose 20-30% of their body weight),11) Leptin levels remain low for years after dieting. If you decide to diet, you will be accepting a new baseline level of hunger for a very long time, or certainly rebound,12) starving cancer patients on hospital wards seem remarkably peaceful,13) people who weigh themselves daily are more successful in keeping weight off,14) Sometimes I would bike to work (21 miles each way), and I usually wouldn't eat lunch or breakfast on those days. I was always a couple of pounds lighter the next day. This proved to be a bit of a distractor, but it was a kernel of my thinking,15) One of our chief residents when I was an intern, very lean herself, once quipped, to the department head, regarding the bariatric patients tending to have normalized blood sugar just before surgery "Anorexia is garunteed to work!" (they have to fast for 24 hours before surgery).16) I asked my mom what diseases people in the family had: a lot of diabetes and heart disease.
17) My brother came to visit. He used to be noticably overweight. This time, he obviously qualified as "thin". I asked. He weighed 180 lb. He's an inch taller than me. And became a vegetarian several years ago.
==A solid base==
You get in shape, and more importantly stay in shape, by accumulating significant, but livable, improvements to your lifestyle over time, and building on that. Not by going through some horrible ordeal requiring Olympian willpower. (http://liamrosen.com/fitness.html)
For me, A pile of small modifications added up over time
Special events are special. I'm not going to skip the big easter egg hunt and dinner with friends on Sunday. On Saturdays, if I'm home, I still eat bacon and eggs with the family. I eat like a champ at parties, everyone loves cooking for me because I always love what they made, and I usually wish I hadn't when I step on the scale for the next few days. If I had stuck with this every single meal, I probably could have lost more but the cumulative strain might have broken me. I can't imagine eating less but still eating three meals a day. I am definitely a see-food eater. But I've dropped from 223.5 lb down to 192.5 yesterday before dinner.
I have gotten in the habit of weighing myself 3 times a day: before bed, in the morning, and when I come home, just before dinner. From 5 pm to 10 pm, I'll eat and drink 5 lb. That struck me. Another lesson learned: always measure against the end-of-fast weight. The others are more variable. Even if you diet with 3 meals a day, you'll still be most consistent at the end of your longest fast, eg, just before breakfast.==Side benefits==
I don't have to pee as much. I used to have to get up in the middle of the night. Basicly, blood sugar osmotically retains water. As you burn it off at night, you undergo volume contraction, and have to pee. The same thing happens during the day. You eat a lot, ergo you drink a lot, ergo you pee a lot.
Incidentally, I also sleep better, and don't spend as much money during the day (none really) on diet coke or snacks.Congestion is way down. Mucus is basically mucopolysaccharides: long sugar chains attached to a thin protein core. One way to burn off excess sugars: build something with them. Your body is, at the end of the day, an equilibrium machine. More in equals more out. No extra sugar, no extra mucopolysaccharides. Less snoring probably helps too, but the decrease in mucus was swift, impressive, and durable. Has to be linked to blood sugar.My run times are down. My usual loop is 4.5 - 5 miles. I used to do it in 45-48 minutes. Now on the longest version, I can do it in 38. Interestingly, my swim times are also down. I'm finally able to tolerate 100 m intervals below 2 minutes (in high school it was closer to 1:15-1:20, so still a ways to go)==Side effects==I started taking a daily multivitamin after I got some labs (I'm doc, I gotta know!). LDL was 98, HDL is 53, normal CBC, normal chemistry, but calcium was 8.8, low end of normal, so DMV for me. Follow up labs showed stable lipids, calcium returned to normal, and my blood glucose was 86.I'm always cold. One thing your body does with excess sugar is burn it in a waste heat cycle in mitochondria. That's what makes brown fat brown: mitochondria. the less energy your body has, the less they can burn. There's some thinking that this can actually be leveraged to induce weight-loss, but I don't recommend trying to loose weight by cranking up the A/C! Global warming is a big enough problem, thanks.Having left 30 1lb cans of crisco behind me, I have to work out more to burn as many calories. I literally have to run further to get the same work out.==Risks==The risks of malnutrition are non-trivial, but I'll leave them as an exercise to the reader. Suffice to say, I haven't seen as nearly as much malnutrition in skinny ritalin kids as I have in the hundreds of obese young adults I see in clinic.Anorexia is one horrible disease I'll entertain briefly. Technically, I'm anorexic for about 18-19 hours a day. I don't know what it would take to become truly anorexic. I think I'd fall off the bandwagon too quickly. It probably helps to have met a few though. However, it is weird, because to loose weight, you have to tell yourself "You are carrying too much fat." As you approach your goal, you can actually become proud of yourself for doing it. And it doesn't really seem ... harder, on a day-to-day basis. It might take longer to drop a pound, but once you've reorganized your life to eat less, you can maintain that mental state indefinitely. So I think it is very important to plan out an end game.
==My end game==
I still have 15 lbs to go. But I think it's doable. We'll see. There were some dark days around that first plateau. and again around 193.5, my old college weight. I just passed that after bouncing off it for a month.I am trying to get to know this ... not hunger ... but not always satiated feeling. I've been loosing about 2 lb a week, which makes 7000 Calories, or a 1000 Calorie/day deficit. Based on Carson Chow's more sophisticated calculator at NIH, my actual caloric deficit is probably only 500 calories a day now, and falling. Interestingly, that calculator suggests I'm consuming 3986 calories a day! That seems like a lot to me, but maybe. My work outs are burning around 750-800 calories, so if I didn't work out, I might actually gain weight at this point. So, I think I can probably add lunch back in, but it's going to have to be a pretty skinny lunch. I think I'd rather add breakfast and keep the lunch workouts.According to Chow's NIH calculator, I have another 90 days to go. 210 days total. It's mid-May. The entire summer. Still.
==Epilogue==
If you are seriously considering changing your eating habits, do it! Don't wait for a doctor's visit, that's just another excuse. But do bring up your plans and methods with your physician.