March 18, 2007

Dieting on Januvia

UPDATE (April 2, 2013): Before you take Byetta, Victoza, Onglyza, or Januvia please read about the new research that shows that they, and probably all incretin drugs, cause severely abnormal cell growth in the pancreas and precancerous tumors. You'll find that information HERE.

Original Post:

I have maintained my 30 lb weight loss for 4 years by following one simple rule. When my weight goes 3 lbs over target, I diet back to goal. It only takes a couple of weeks to lose 3 lbs. Losing more than that swiftly becomes almost overwhelming.

The only way I can lose weight now is by restricting calories. At my age, 58, and at my size, small, the body only needs 1600 calories to maintain, so to lose weight I have to eat almost nothing. So I kicked off the diet 2 weeks ago with two days at 1000 calories. I was very hungry during those days, which is to be expected at the beginning of any diet, but by day 3, I'd stopped being hungry and I've done extremely well since then.

I log everything I eat in LifeForm software and use a food scale to check portion sizes. This is anal to the nth degree, but it works. Through this 2 week period, my daily input has averaged 1145 calories, broken out into 95 grams of carbs and 11 grams of fiber, for a net carb intake of 84 grams. Protein grams average 57, and fat grams 61.

The 1145 calories is significantly less than what I had intended to eat, which brings me to my point. Januvia , because it has an impact on stomach emptying, does seem to make it a bit easier to lose weight--if you are willing to restrict food. Unlike metformin, it does not cause weight loss without trying when you first start it. In fact, as I've documented, I gained a few pounds after taking it for 2 months. But because delayed stomach emptying makes me feel full when I've eaten relatively small amounts of food, it seems to make it much easier to eat at a low calorie level I have found impossible in the past.

In the past, when I've dieted, I've always cut my carbs way down. But what I found during the first few days on this diet, when I was restricting carbs more stringently, was this: if I don't eat enough carbs to go over the threshold that stimulates GLP-1-mediated first phase insulin response, my blood sugars throughout the day will be higher than if I do eat those carbs. So I do a lot better as far as blood sugars go, while taking Januvia, when eating 30 grams per meal than I do eating 10.

I also find that, as I've learned in the past, my fasting bgs are a bit better if I eat a slightly carby snack before bed--say a pretzel log. But since I've also learned that I diet best if I only eat at meals, I haven't been eating in the evening, so my fasting bg is in the 90s again, rather than the 80s. However, during the day, my blood sugar two hours after eating and until I eat again remains in the low 80s, sometimes even the 70s.

As a result, my total meter average has declined to 94 over the past 2 weeks, from 96 for the month, but my fasting bg for the week is up to 90 from 88 while after meals average is down 1 to 99 from 100. Since my meter average at the end of the period when I was taking insulin was 103, I'm very happy with all these figures (I didn't have a meter that distinguished before and after meals back then.)

After 2 weeks, I am back o my target weight, which suggests that some of the weight gain was water weight, but I'm doing so well with the diet, I'm going to put in another week and see how much lower I can get since it's not all that difficult. However, before I do that, I'm going to eat normally today and possibly tomorrow.

That's because eating at such a low calorie level is likely to slow my metabolism, a common problem with diets, and I don't want to start gaining weight when I go back to eating the 1600 calorie a day diet on which I've maintained so nicely through the last 4 years.

My final comment is that going from 12 grams of carbs (on a LC regimen) to a 30 gram carb intake makes the difference between a diet that feels very stringent and one where I literally, as they say in the crappy infomercials, "lose weight eating all my favorite foods." I've been eating toast for breakfast and 100 g of diet ice cream for dessert, with other occasional "treats" including 4 ounces of a bakery eclair. All weighed and counted--and with no blood sugar over 105 at 1 hour except once, when I saw 119 mg/dl.

That 119 mg/dl occurred several hours after eating, when I got very dizzy from too low a blood pressure and ended up with a counterregulatory response that pushed up both blood pressure, pulse, and blood sugar. Not after eating carbs! It looks like my weird surge of high blood pressure is fading some and starting to see the medication pushing me too low which is what has happened in the past.

Meanwhile, the seedlings are growing by the window sill, the 15 inches of snow on my back yard are enjoying one last wintry blast before next week's temperatures rise into he 40s and 50s, and pretty soon I'll be out in my garden, using up a lot more physical energy and reveling in the wonder that is the New England spring!