Update on phentermine trial

I've been on the 30mg QAM phentermine for about 2 weeks now and I thought I'd do an update. For one, it's not making me super anxious, which is something I was concerned about. In fact, the first few days I took it I felt extremely exhausted and sleepy. My weight was 357 on the morning that I started the phentermine and this morning I weighed in at 349.8, so it does seem to have kick-started my weight loss again and ended my last plateau. There's often one day per week that I don't take it due to my changing sleep schedule for work.

I do still feel hungry, especially when I first wake up in the morning. And sometimes I wake up at night and I'm so starving I go downstairs and have a protein shake or something quick. I don't know if that's because the phentermine has warn off by bedtime, or perhaps related to my ever-shifting day-night sleep schedule due to work. I don't remember being as aware of the intense hunger in the night during my days off before. I am eating, and thinking about, food less often. I did notice my usual upswing in my cravings for fatty foods in the week before my period, despite the drug.

One thing that I've noticed is that I sweat A LOT since starting the medication, even with mild exertion. For example, for work sometimes I have to wear a plastic gown to go into certain patients' rooms, and this has always been a sweaty, uncomfortable situation for me, but during the last two weeks if I find myself in that situation, I sweat through my scrub top to the point that there are dark circles under my arms, down my back and front. And just walking at my normal pace causes beads of sweat to roll down my forehead.

So, I've only lost 13 pounds in the 6 months my doctor has been intentionally working on weight loss with me, which is discouraging, but the rate over the last two weeks with the phentermine is brightening my outlook some. I have no certainty about keeping it off when I stop taking the pill, or how long it will work for. Another friends said it lost its effectiveness for her after about 6 months. Cautiously optimistic & glad to see the numbers decreasing again.

Attended surgical weight loss seminar

Last night I went to a surgical weight loss seminar put on by a local bariatric surgeon and his team. The doctor said he doesn't perform lap band surgery anymore because it's not proven effective in the long term. Just a few years ago my mom was trying to talk me into having that surgery with her. She got it, herself. Got down to a healthy weight but then gained it all back again. Whenever I pictured getting that done I thought I'd feel like Ping the Duck, in a childhood story I read, with a ring around his neck that prevented him from swallowing his fishing catch.

One thing the doctor pointed out in the seminar that I didn't know is that if you need to take medications regularly, and have them absorb well, a gastric bypass is not the best option -- you not only have limitations on absorbing nutrients, but on medications as well. The gastric sleeve, which is what my friend had, doesn't do this. But sometimes people get really bad acid reflux after the sleeve and end up having to convert to the bypass (which corrects the reflux).

I gave them my information at the seminar with the thought of starting their process in case my current gung-ho efforts at weight loss through increased protein and decreased carbs doesn't turn my health around enough. If I'm going to move forward in their process (which would take at least 6 months before insurance would approve it, including nutritionist and psychiatrist appointments leading up to the surgery) the next step is to get a referral from my primary care doctor and have him send over my labs etc. My next follow up with my primary care doctor is in 2 weeks, so I'll talk with him about it then.

Giving protein another try

Some time has gone by, obviously. I haven't made major headway in the weight department, but I have begun my new career in nursing and it is going well, despite my size. Whew.

At the end of last summer my primary care doctor retired and referred me to another physician in the same practice that specializes in obesity medicine. We met in January for a specially set aside appointment to discuss weight management: he wanted to have a larger block of time and really focus on that. It appeared to be a busy day at the office and we only really met for between 5 and 10 minutes, but I'm refocused on specific goals again. He wants me to aim for greater than 100g protein per day as well as less than 100g carbohydrate.

For a couple of years (and the last time I was updating this blog regularly) I was tracking everything I put in my mouth using the LoseIt app on my ipod. Although I think it was helping, it just began to feel to cumbersome and time consuming for diminishing returns. But I've used it recently to check in on those macronutrient amounts.

My doctor recommended a specific protein supplement (which comes in a whey powder to make smoothies out of, or a pre-packaged "shake" drink). He told me to drink 2-3 of those per day and then have a dinner of real foods, with about half protein (lean meats) and half non-starchy vegetables.

I am mostly vegetarian, but eat fish now and then. After the appointment I went to the grocery store and bought a couple weeks supply of the pre-packed drink and a tub of the powder, as well as some individually freeze-wrapped fish portions.

I'm about a month in now, and I'm doing really well with the protein drinks (and meeting the >100g protein requirement) but I can't bring myself to eat animal flesh, of any kind, daily. One or two tuna salad sandwiches a month, yes. If they have lots of celery and sprouts and lettuce and honey mustard to sort of distract me from the fact that I'm eating flesh.

I went veggie at age 9, and I think when you haven't eaten substantial meat for that long you just lose a taste for it. In my mid twenties I started eating fish again every now and then. Can't bring myself to eat more at this point though.

Anyways, so with the protein supplements, 2 of them per day definitely left me HUNGRY, but 3 per day plus a meal is doable. I make my own blended ones when I'm at home and use the pre-packs to bring to work for my 12 hour shifts (easiest lunch I've ever packed). I also eat almonds through the day. I do end up craving and splurging on carbs and sweets though. I'm working on that and making some headway.

With what I've done so far, I've lost about 5 1/2 pounds over the last 5 weeks. And that's with not complying with the carbohydrate limit yet (I'm working on it!). So I'm feeling optimistic. A pound a week adds up to 50 pounds a year if I can keep it up.

Another thing I've been thinking about though: a coworker of mine got a sleeve gastrectomy at about the same time I started this diet regime. She's lost about 30 pounds so far and has 30 more to go. Her whole process went smoothly and she feels great. I know weight loss surgery is a major, major intervention to contemplate, but I've been thinking about it more seriously after seeing her success.

I'm 35 now. Although I've been making major changes in my professional life over the last 5 years I feel like my personal life (love, family, babies eg) has been set permanently on the back burner due to my size. And I'm increasingly feeling like time is running out. I'm thinking about taking a more drastic approach that would get quicker more permanent results. I've lost 30 to 40 pounds before, repeatedly, the "traditional way" and gained most of it back when I went through a period of depression or had a medication change.

I think part of what really peaked my interest about the surgery my coworker had was that they remove part of the stomach that produces ghrelin, which is the hormone that makes us feel hungry. It is irreversible. I suppose if you were non-compliant with the post op diet you could potentially re-stretch your stomach beyond the banana size one they give you in surgery. I like that there are no foreign objects in there like there are with the lap band, and you don't have to get fills and adjustments.

So my plan for now is to keep going with the nutritional changes, and keep aiming for >10,000 steps per day (easy on work days, harder on my days off), but at the same time start researching weight loss surgery more in depth. My coworker had hers done in Mexico for $4,000 even, and while it sounds sketchy, she said it was the best medical experience she's ever had in terms of cleanliness, safety, comfort. There's also a surgeon in my county who does them and has information seminars about once a month, so I'll go to one of those soon and check it out.

That's where I'm at right now. I've updated my weight chart down at the bottom of the blog -- I'm at 358.4 lbs right now and I've been averaging about 6-7,000 steps per day for the last 3 months.  Next update sooner.

False alarm, I think... (2011 Week 28 Update)

Here are my stats for last week:

1251 calories under budget
down 0.6 pounds
2,234 calories of exercise logged.
13% protein consumed (50% carbs, 37% fat)

My back/hip area isn't hurting today. And my foot, though still tender, is still alright. I need to be more disciplined about doing my physical therapy exercises and stretches, and wearing my splint at night.

My new job has a fair amount of walking and stair climbing built in. And I *do* take the stairs, rather than the elevator, as most of the residents where I work really _need_ the elevator and it is a good reminder that I don't actually require it yet.

I am way behind on the whole year-long goal I had set out, but moving in the right direction. I can tell it may be a challenge to keep up a solid exercise routine now that I have two jobs, but I'm feeling determined.

Over and out.

Time to take the reins again (2011 Week 12)

I have gotten really off track in the last few weeks. My calories have been ever-increasing, my mood has been down, I haven't been getting any real exercise. And the scale has been showing it. I'm up to 338.8 today, not the direction I intended to be moving in.

But I am determined to get back on track now. I managed to stay under my calorie budget today for the first time in at least a week. I'm back using the whey protein supplement again. And I'm drinking lots of water. I'm going to start hitting the gym more regularly again, and aim for variety, not just doing treadmill all the time, maybe even try a few classes.

I geeked it up a little bit yesterday, trying to figure out what was going on with my body; I figure, I have amassed a decent amount of data now, why not take a look. I only looked at the 10 most recent weeks from my loseit data, partly because it was taking a long time to get the data in the right format, and partly because I wanted the graph below to reflect about the same weight (+/- 10 lbs). Here's what I found:

There is no obvious pattern between avg net (after exercise) calories for a given week and my change in weight for that week:

I also looked at number of calories burned exercising, grams of sugar consumed that week, grams of carbs consumed that week, and grams of protein consumed that week. The only variable that had any hint of a relationship with my weekly change in weight was protein consumed:

So I'm going to try to refocus my efforts on protein. And it looks like 800 grams of protein per week is a good goal to aim toward. I realize that I'm only looking at 10 data points, there are lot of other factors I'm not looking at, my data may be inaccurate, etc, etc. But this is all I have to go on right now, so I'm going with it.

Bronchitis is kicking my a** (2011 Week 8 Update)

So, this week I am down another 2 pounds, going from 337.4 last week to 335.4 this week. Given the way things were going earlier on in the week (I was up to 338 again at one point) I didn't expect that kind of progress, but I think I can mostly credit it to being sick, especially yesterday. I ended up in the ER due to bronchitis/asthma combination and only ate around 1200 calories yesterday.

Today I'm planning on staying home all day, drinking lots of fluids, and hanging out with my kitties. No planned exercise for now! I'm worried because I read online that bronchitis symptoms can last 3-4 weeks. Hopefully I can nip it in the bud earlier than that. My doc prescribed antibiotics but also told me that most cases of bronchitis are viral, so they might not help. Also supposed to take some tylenol to reduce my fever and get lots of rest.

I've been keeping my sugar intake in mind all week and I managed to get my daily average of sugar intake down to around 112g, still higher than what my loseit friends are reporting (40-60g), but much improved over my past values (as high as 250). I am going to keep working at it.

I also did pretty well on protein this week, about 90g on average per day. I tried to have a protein shake with breakfast most days.

I did get myself back to the gym on Friday, for the first time in almost 2 months. Ugh. That's really bad. And because I wasn't feeling well I only walked for about 1/2 hour. But at least it was a step in the right direction.

I am still about a pound behind my gradual yearly goal (which wants me at 334.6 today) but that's fair enough. Life happens, and maybe it's not realistic to lose 2 pounds each and every week. But I will keep striving toward that goal.

A book I've been wanting to read came in at the library, Moose: a memoir of fat camp. It's a very candid look at some of the things that overweight children go through and I'm enjoying reading it.

I wish you all warmth and wellness!

Sugar problem?

Over the last couple days I've become both curious about and horrified by my sugar intake.

Today so far: 70g
2/20: 150g
2/19: 201g
2/18: 132g
2/17: 229g
2/16: 231g

Eeek! So that sounds like a lot to me, but grams aren't really that meaningful... so I converted to Cups.

Last week on average I ate 182g of sugar per day, (conversion factor 1 C = 196g), which is equal to 9/10 of a cup of sugar. Yuck!

I also wanted to compare this with what other people are generally eating... google gave me lots of estimates of what americans are eating vs what they should be eating in terms of added sugar, but not total dietary sugar (the numbers above are a combination of fruits, dairy, and also processed foods).

So I put the question to my loseit buddies, and lo and behold, even these other folks who have self-selected as having a weight problem they need to fix are only eating 40-60ish g of sugar per day. Shame on me!

Obviously sugary foods are a part of the problem, for sure. I have always had a sweet tooth. As I type this I'm eating a piece of my dad's leftover homemade birthday cake, 19g of sugar plus an unknown amount in the frosting/glaze I made out of, you guessed it, powdered sugar.

But another culprit, and one that I wasn't as aware of until now, cow milk. I grew up in a household where I was encouraged to drink nonfat milk all day, every day, even in the place of water, as a cheap source of animal protein. Most foods taste much better to me with milk as a chaser. Currently, nonfat milk is at the top of my "favorite foods" list on loseit, with 35 times that I've logged it in the last 4 weeks. And that doesn't even mean 35 cups, because usually I drink 1 1/2 to 2 cups at one sitting.

One cup of milk has 9 grams of protein and 12 grams of sugar. The sugar is lactase, and some people will tell you that because you are ingesting it along with some protein, it isn't as bad as eating just plain sugar.

There are *a lot* of websites about milk out there to try and dig through for accurate information. The dairy council pushes hard that cow milk is good for you and even aids in weight loss. Other sites make this out to be almost a conspiracy situation, pointing out that the purpose of milk is to make baby cows *grow* quickly, and no other animal on the planet drinks milk past early childhood.

I started researching other options. When I've tried soy milk in the past, it has tasted *too* sweet to me, which is saying something given my addiction to sweets. It does have less sugar than cow milk it looks like, about 5-8 g per cup. It seems strange to me that soy milk would taste so much sweeter to me but have less sugar than cow milk. Hmmm.

Unsweetened almond milk has ZERO sugar, but it also only has about 2 g of protein per cup, depending on the brand. Maybe a good approach, since I'm doing the whey protein mixes lately, would be to mix the whey powder with almond milk instead of cow milk.

And do my damndest to wean myself off the stuff as a drink. I have been trying to aim for herbal teas lately, which is doable in the chilly winter. And plain water, or water with a wedge of lemon.

Also, I need to be very careful when I'm shopping to check nutrition labels on salad dressings, jams, yogurts, pasta sauces, etc. Keep the sugar confined to just desserts. I really can't stand artificial sweeteners, and have a hunch that they give me headaches (and a suspicion that they are really bad for the body). So I'm going to try to reduce my sugar by actually cutting down on the amount of sweet, instead of substituting a chemical sweet.

It might be worth it to do a little exploring around stevia as well. Wikipedia says its extracts have 300x the sweetness of sugar but negligible effects on blood glucose. Sounds good to me.

I think this might be a good key toward my weight recovery, if I can get it under control.

Looking Up (2011 Week 7 Update)

It has been slow-going this week, weight-loss wise. The first day of the week I was up a pound, but I've been steadily and slowly going downwards from there and I'm now 2.6 pounds lighter than my last week's weigh-in, coming in at 337.4.

I hit this same weight, 337.4 about 3 weeks ago but my weight bounced right back up again. This time I think I'm going to keep trending downward. Just have to hang in there and hang tough. Once I hit below 330, I can start using my wii balance board, yay! I am still about 1 pound behind my gradual year long goal, but I am hopeful that I can catch up.

Yesterday my eating got a little out of control. On the way home from the post office I stopped at a donut shop. I've *never* in my life stopped at that donut shop. I bought 3 donuts and a thai iced tea, and by the time I was home and finished eating the loot, about 1000 calories later, I felt physically horrible. I didn't feel like eating the rest of the day.

I moved about a month ago, and I've been slowly unpacking all of my stuff, including clothes that I haven't seen in about 6 months. I was happy to find that this morning when I tried on a pair of pants I bought over a year ago that never fit me (I bought them online and was reluctant to return them at the time), now fit! I bet that's true of a few other things in my closet now that I'm about 45 pounds lighter.

I have only gotten rid of a few things that were too big so far. Not sure if I should save that one pair of "fat pants" for the photo op at the end of my weight loss, you know the one where I stand in them and hold out the waist line to show how far I've come, or fit both legs in one pants leg.

I did better on my protein goals this week:
Feb 14 119.8g
Feb 15 122.4g
Feb 16 90.8 g
Feb 17 59.2 g
Feb 18 121.3g
Feb 19 114.5g
Feb 20 tbd

There were those 2 days, again days where I was on campus all day, when I didn't make the mark, but overall much better.

I have an appointment with a podiatrist to try a cortisone injection for my plantar fascitis. It's in a couple weeks.

Frustrated, hormonal and sad (2010 Week 6 Update)

My weekly weigh-in this morning was 340 lbs. That's only up 0.2 pounds from last Sunday at this time, so basically I held constant. and I'm now 1.5 pounds *behind* my gradual 2011 year goal, which is frustrating the heck out of me. But, I have to remind myself that it is that time of the month and I bet this week the numbers will start behaving again. Also, I did really well by going on that hike last week (even if I was in agony afterward due to my foot). And I did well with staying under my calorie budget generally... by the end of the week loseit said a had a 1370 calorie deficit.

I really felt like crap most of yesterday. Slept in late, did some painting (home repair type, not artistic type), a little gardening, watched some t.v. At night I drove over to the pet store to buy a deshedding tool for my cats (I'm hoping it will help prevent mats). Then went over to my parents' house because I was feeling lonely and blah but I didn't have the attention span for the movie my dad was watching. I went to the drugstore then and made retail therapy impulse buys of new makeup and some hair products, and wandered around for a bit more considering buying random crap I didn't need... among them, a counter top herb garden. I really don't need that if I have an outdoor garden, dammit. I didn't succumb, thankfully.

Oh, by the way, I didn't meet my 100g protein daily goal this week either:

Feb 7: 116.8 g
Feb 8: 89.5 g
Feb 9: 90.5 g
Feb 10: 74.5 g
Feb 11: 105.8 g
Feb 12: 76.8 g
Feb 13: t.b.d.

So looking at that, the two days I got over 100g were days that I had a very flexible schedule and was mostly at home. I can have a protein smoothie for breakfast (I generally didn't though...) but it's hard to bring one to campus for lunch.

I'm still kind of dragging, mood-wise. Hopefully this week it will turn around again.

100g per day protein challenge

I saw that one of my friends on loseit tried eating at least 100g per day of protein last week and had good results, so I'm going to try the same this week.

In order to help me reach this goal, I found a big tub of whey protein powder mix that my mom bought, probably a couple years ago, and never used. Each scoop has 22 g of protein. So I'll have 1 or 2 scoops of that per day mixed with low fat milk to make up any protein deficiency at the end of the day, while still staying under my calorie goal.

Let's see how my body responds to this change.

Greek style yogurt = YUM

Some truly healthy foods you might expect to taste blah or cardboard or tasteless, but there are others that really are surprisingly good. I went grocery shopping tonight on my way home and happened to pick up some non-fat greek-style yogurt that a friend mentioned that she liked over a year ago, and wow!

Check out this nutrition label:
Calories: 130
Total Fat: 0
Cholesterol: 5mg
Sodium: 45mg
Carb: 20mg
Sugars: 17g
Protein: 12g

I've been looking for ways to increase my protein intake, and I think this might help that goal right along. It's thick & creamy and nothing like the typical watery nonfat yogurt I'm used to. I only got one serving of it, and ate it tonight for dinner with some honey wheat pretzel sticks for dipping and some almond butter for variety. Yum.