FINAL RESULTS - 2016 WEIGHT LOSS AND BLOOD GLUCOSE CHALLENGE

Christmas Eve 2015

Today I am posting the final results for my 91-day challenge. I waited several days to post the results so that I would have a chance to do an HbA1c test, put together final photos and think about what I wanted to say about my findings, my feelings, and where I want to go from here in my quest to maintain my new weight and lowered fasting blood glucose.

THE WAY I WILL EAT

One thing is for certain, and that is that I will continue to eat a ketogenic diet - high fat, moderate protein and very low carb. This really seems like the only way to keep on track.  In the past, every time I have tried to increase carbs, I have gained weight.  I really don't want to do that this time.  More about exactly how I will proceed from here at the end of this post...

MY HbA1c TEST RESULTS 

I have taken an HbA1c test to see what my average blood glucose has been for the past three months.  The last time I took one was around a year ago, and I got a reading of 5.4%, which means that my average blood glucose for the prior three months had been 108 mg/dl.  And that is not an average of just the morning reading (FBG), but all the levels at all times of the day.  The ideal HbA1c is around 4.5% which is equal to 83 mg/dl.  You can see a chart of how that works here.

 
My test gave me a result of 5.2%, which is equivalent to an average blood glucose of 103 mg/dl.  This is an improvement over my last test, but I would be lying if I did not say how extremely disappointed I am.  What this means is that although my fasting blood glucose has come down into very good levels, my non-fasting blood glucose levels are still elevated.  As much as I hate the idea, I am going to have to start testing my postprandial (after meals) blood glucose to see what is causing this problem.  If my average is 103, that means that my post-meal readings must still be in diabetic ranges, possibly in the 120s and higher.


But, wait a minute!  It is very hard for me to believe that my average BG is this high when I have been doing all this fasting.  I went to the interwebs and found many articles that show the inaccuracy of the HgA1c test.  This article by Chris Kresser is a good example and is very easy to understand.  In short, Dr. Kresser believes that home monitoring before and after meals is a much better indicator of average blood glucose than the HbA1c test.  He found that his patients who had stellar BG readings before and after meals at home would test artificially high on a standard A1c test.  In the article, he mentions that people with anemia and/or iron-deficiency have incorrect results with the test.  I have been anemic and/or iron deficient since childhood, so a standard home test for BG will be accurate when an HbA1c test may not.  We'll get to the bottom of this!

Over this next week, I am going to check my BG at home nine times per day and find out what my true average is.  I will check fasting when I get up in the morning, one hour after starting to eat breakfast, two hours after starting to eat breakfast, then right before starting to eat lunch, then one and two hours after that, and the same for dinner.  The average of these nine readings should be very close to a true average.  I'm very sure that my result will not show that I have an average BG of 103 mg/dl.  I started doing this this morning, and so far my average over the three readings was 87 mg/dl.  When this week is over, I will post my results. 

The chart below is the final chart that shows my fasting blood glucose test results.  The grey lines are my long term goals. The blue lines are my actual results.  The orange lines are my 7-day averages.  As you can see, I did make progress toward normalizing my FBG.

MY OFFICIAL BEFORE AND AFTER PHOTOS

Although I have posted a few casual photos in this past three months, I wanted to wait until the challenge to post my official before and after photos, so here they are:

As I always do when I take these type of photos, I took special care to stand normally, neither pushing out my stomach in the before photos nor sucking it in in the after photos.  I also crop the photos so that they are the same size and can be compared side by side.  Also, if you click on the photo above, you will be able to see that I have been left with loose skin.  I hope you will not judge me too harshly for this, remembering that I am over 60 years old, and that is part of the reason why.  I remember my father telling me that it would be better to be somewhat overweight in order to have tighter skin and therefor a younger appearance, but I would much rather look a little bit older and have a proper body size for my height!

www.diabetes.org > Living With Diabetes > Treatment and Care > Blood Glucose Testing

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Hypoglycemia (Low Blood Glucose)

Hypoglycemia is a condition characterized by abnormally low blood glucose (blood sugar) levels, usually less than 70 mg/dl. However, it is important to talk to your health care provider about your individual blood glucose targets, and what level is too low for you.
Hypoglycemia may also be referred to as an insulin reaction, or insulin shock.
Hypoglycemic symptoms are important clues that you have low blood glucose. Each person's reaction to hypoglycemia is different, so it's important that you learn your own signs and symptoms when your blood glucose is low.
The only sure way to know whether you are experiencing hypoglycemia is to check your blood glucose, if possible. If you are experiencing symptoms and you are unable to check your blood glucose for any reason, treat the hypoglycemia. Severe hypoglycemia has the potential to cause accidents, injuries, coma, and death.

Signs and Symptoms of Hypoglycemia (happen quickly)

• Shakiness
• Nervousness or anxiety
• Sweating, chills and clamminess
• Irritability or impatience
• Confusion, including delirium
• Rapid/fast heartbeat
• Lightheadedness or dizziness
• Hunger and nausea
• Sleepiness
• Blurred/impaired vision
• Tingling or numbness in the lips or tongue
• Headaches
• Weakness or fatigue
• Anger, stubbornness, or sadness
• Lack of coordination
• Nightmares or crying out during sleep
• Seizures
• Unconsciousness

- See more at: http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html#sthash.99Em6ldy.dpuf

As I always do when I take these kind of photos, I take special care to stand normally, neither pushing my stomach out in the before photo, nor sucking it in in the after photo.  I also crop them in such a way so that they are equal in actual size and a true comparison can be seen.

I had a bad incision during my c-section in 1977, and my stomach muscles were cut in such a way that I will never really be able to use them to hold my stomach in.  Because of that, I will probably always have a little bit of a "pooch" no matter how slim I am, but I can live with that.  Some tummy-control undies go a long way to giving me the impression of a flat stomach.  By the way, I am not wearing anything like that in either of these photos.  I am wearing regular, non-slimming leggings.

MY BODY MEASUREMENTS

Another thing that I have been doing in the background during the challenge is tracking my body measurements.  Here are the results for those:

NECK

12 3/8"  -  11 3/4"

LOST 5/8"

BUST

36 3/4"  -  35"

LOST 1 3/4"

WAIST

33 3/4"  -  29"

LOST 4 3/4"

BELLY

41 1/2"  -  37 1/8"

LOST 4 3/8"

HIPS

41 1/4"  -  38 1/4"

LOST 3"

THIGH

22 7/8"  -  21 1/4"

LOST 1 5/8"

CALF

14 3/8"  -  13 5/8"

LOST 3/4"

TOTAL INCHES LOST - 19 1/4"

When I do the math for the total inches lost, I count each measurement as one unit with the exception of my thighs and calves, which I count as two units each.  Because I have two of each of those.  That might not be the right way to do it, but it is the way I do it.

SCALE WEIGHT AND BODY COMPOSITION

 Before I talk about my weight loss, I want to explain how I determine my body fat and lean body mass percentages.

In the past few years, I have had DEXA scans and Bod Pod testing done to determine my body composition.  These are very accurate, but are expensive, usually costing around $100, depending where you get it done.

Several years ago, I found an online calculator that is used by the US Navy and is based on neck, waist and hip measurements.  I tried it out and found that the results, at least for me, were so similar to the expensive tests that I decided to start using the free online calculator to get an estimate of my body composition.  In my experience, I have found the free results to be within a few tenths of a percentage point of the other tests.  For my purposes, this is close enough.

My goal for the past several years has been to reach my goal of 136 pounds with 30% body fat. When trying to lose weight, the goal should be to lose body fat and not lean mass.  So knowing what your body composition is starting and ending is very useful.  Here are the results for those:

January 1, 2016

60.1 pounds of body fat - 39%

93.9 pounds of lean body mass - 61%

154 pounds of total scale weight

April 1, 2016

41.7 pounds of body fat - 30.3%

95.9 pounds of lean body mass - 69.7%

137.6 pounds of total scale weight

LOST 18.4 POUNDS OF BODY FAT

GAINED 2 POUNDS OF LEAN BODY MASS

The way I see it, I have come close enough to my weight loss goals to declare this part of the challenge a victory.  Technically, I still need to lose 0.9 pounds of body fat and I am actually over my goal for lean body mass by 0.7 pounds.

Because my lean body mass is over my goal, I need to make a shift in my goals.  Now, the new goal is to achieve 30% body fat regardless of my scale weight.  To reach this goal, all I need to do is lose another 1/4" from my waist.

By the way, according to my measurements, I am the smallest I have been since starting low carb in 2009, and also the smallest I have been in around twenty years.  Before now, the lowest body fat percentage I achieved was around 32% and that was three years ago, but I gained the weight back.  This time, I am bound and determined not to do that, no matter what it takes.

One thing that I want to be sure to mention is that I purposely did not do any kind of exercise during the challenge.  I did not want there to be any confounding factors pertaining to my results.

The chart below is the final chart that shows my scale weight results.  The grey lines are my long term goals. The blue lines are my actual results.  The orange lines are my 7-day averages.  As you can see, I came very close to reaching my goal.

FEASTING AND FASTING

 When I started this challenge, I really had no idea that I would end up fasting as often as I did!  I even said that I was going to fast at least once a week, even if I was meeting my goals for weight loss and FBG.  Little did I know that I would end up fasting three, four and even five times per week to reach my goals!  Here is my little heat map to show how often I needed to fast to achieve my goals:

I have said it before, but it bears repeating, that if I had known this going in, I wouldn't have started.  I probably would have just started micromanaging my food intake again, lost some weight, gotten sick of it, quit tracking and then gained all the weight back again.

I have fasted in the past, and I knew I could do it, but it is still hard to start doing it again once you haven't done it in a while.  I went in with a lot of commitment and drive and made it to the end, even when it was difficult.  But how often was it difficult?  Surprisingly seldom, to tell the truth.  For me, once I started and my body adjusted to it, I rarely got truly hungry, and I could even be around other people (most notably, my husband) when they were eating and I would not feel anything.  

In the evening, after a full day or two of fasting, I would start thinking about how wonderful it would be to eat in the morning.  Then I would get up in the morning and not be hungry at all.  This is one of the blessings/curses of fasting and being in deep nutritional ketosis.  Running on ketones instead of glucose is a big appetite suppressant!  Very often, I would have to force myself to eat something when I was not hungry.  If there was one downside to having a suppressed appetite, it was the concern that I was not going to be getting the nutrition I need.

Obviously, though, I was able to maintain my muscle mass while losing body fat, even though I was eating only every few days for the last half of the challenge.  I even gained some lean mass!

WHERE I AM GOING FROM HERE

As I mentioned at the beginning of this post, I intend to keep eating a ketogenic diet.  But will I continue to feast and fast, or will I go back to caloric restriction, which is eating a smaller amount each day and tracking my food?  I would like to look at the pros and cons of each.

FEASTING AND FASTING

Pro - On a feast day, I never have to count calories or grams of anything or weigh food.

Con - On a feast day, I sometimes don't want to eat and worry about getting nutrition.

  

Pro - On a fast day, I don't even have to think about food.  Or pay for it!

Con - On a fast day, I don't get to eat if I want to, and I have to watch others eat.

Pro - On either day, my metabolism stays strong and does not slow down.

Pro - This way of eating seems to be sustainable.  I may not feel like I need to give up.

CALORIC RESTRICTION

Pro - I get to eat every day.

Con - I have to measure everything I eat and track it on a spreadsheet.

Con - I have to stop eating when I am not satisfied.

Con - I have to pay for food every day.

Con - This is not a sustainable way for me to live.  I hate it and I always give up.

And the biggest con of all - Caloric restriction has been shown to slow the metabolism, meaning that the longer you restrict calories, the slower the metabolism and the less food you get to eat to try to maintain your weight.

I found this to be true for myself.  In the past, even when eating low carb, I had to continually reduce the amount of food I was allowed to eat in order to keep losing weight.  I'll leave it to others to get into the science of why that is true, but I know it is and I have read many articles about the subject.

So, as nice as it seems to be able to eat every day, I think that the preponderance of the evidence in my case is that I need to continue to feast and fast to maintain a healthy body composition and normal blood glucose.  This is what I have decided to do, and I can only hope that it will be sustainable over time.  I have done it for three months without too much drama, so it is sustainable so far.

From here on out, I will not be using the bathroom scale as the measure of my success.  Starting next week, I am going back to the gym once a week to do my weight training and I will also be starting a walking regimen to help with insulin resistance. 

Because I intend to gain more muscle (and hopefully tighten up my loose skin!), I know that the number on the scale may start increasing.  However, even as I gain muscle, my body size should not increase.  For that reason, I will be using my body fat percentage as a guide of whether or not to eat on a given day.  Using the free online calculator mentioned in this post, I will check my neck, waist and hip measurement each day and use those numbers in my decision for feast or fast.  If the scale is over 136 pounds, but the calculator says that I am still 30% body fat, I'm feasting.  If it is 30.1% or higher, I'm fasting.

The only drawback of this is that I am basically going by my waist measurement, and the day after I feast, I always feel a little bloated, which may be due to water weight and not true body fat gain.  Also, like I mentioned earlier, my stomach muscles don't work very well, and just having food in my stomach, even the right kind of food, makes my tummy stick out.  But, I figure that if I am fasting each time my waist measurement goes up a little, it will be good for me.  Fasting is good for me.  I need to keep telling myself that!  

Throughout this challenge, as I was needing to fast more and more often, I have been concerned that I would need to keep up only eating a few times a week in order to maintain my health.  But I'm thinking that it may not be the case, because I am now no longer needing to lose weight.  When the challenge was in full swing, and I gained weight after a feast day, I would not only have to "fast off" that weight, but also an additional 0.2 pounds to keep up with my weight loss schedule.  Now, if I gain weight (and by that, I mean body fat) on a feast day, all I need to lose the next day is that same weight and no more.  

I fully expect that I will be transitioning into a regular pattern of Alternate Day Fasting.  I hope that it will go well enough that there may be times that I eat two days in a row, but if not, so be it.

Rebecca on April 2, 2016

Well, I guess that's about all there is to my summary.  It's been a great three months!  I learned a lot, and I lost a lot.  I hope there has been enough content here that my challenge has been food for thought for those that feel like they are stuck and don't know what to try next or where to turn.

Thanks so much for reading and for sticking it out with me for the full challenge!

Oh, and just in an effort at full disclosure, I must admit to my faithful readers that I went out to a restaurant and to the mall on April 1st, the first day being off the challenge, and I ate things I should have not eaten.  It's all a blur now, but I have vague memories of a few French fries, some popcorn and a Dark Chocolate Pixie from Fannie May.

I gained weight.  I fasted on April 3rd and 4th.  Today I am eating and checking my blood glucose before and after eating.  Onward and downward!

This is a personal challenge just for me, but if anyone reading would like to join me, please talk to your doctor and make sure that it will not conflict with your current medical condition or medications.  If you are taking the challenge, please be sure to let me know how you are doing!  Thanks for reading!

To find out more about this challenge - the rules and how it started - click here.