There were a couple reasons for the weight gain:
- Last winter I went off my usual very low dose estrogen supplementation regimen for a few months. Blood sugar control got harder and weight started packing on. When I went back on the very low dose regimen (1/6 of what most women take) the weight I'd put on remained.
- Last summer I developed a burning pain in my upper stomach region which seemed to be linked to metformin, so I stopped taking metformin. That cleared up the stomach problem. It came back when I went back on met, so I stopped it a second time this November. The weight gain I experienced the first time I stopped metformin was modest, but when I stopped metformin the second time and also had to switch to using Lantus and Novolog instead of the R insulin I'd been taking for years thanks to what look like antibody problems with R, my weight gain increased dramatically. I gained about five pounds in two months.
- One last factor that may have played into weight gain is this: In the summer of 2006, for some reason that my doctor never adequately diagnosed despite a lot of tests, I started having a problem with mild nausea that kept me from being able to eat. I dropped five pounds without dieting. This was, I have to tell you, terrifying, given that I'm a cancer survivor and that I had never before in my entire life lost a pound that wasn't the product of a lot of hard dieting work. But tests showed no obvious cancer return and after a couple months, the problem, whatever it was, went away and I went back to eating normally. However, once I could eat again, I gained back those five pounds I'd lost very quickly and it seems like after that regain I've been much more prone to gain weight. So I wonder whether getting down to the the lowest weight I had ever been in fifteen years may have further lowered my metabolic rate and made it easier to gain weight in the future. There is a lot of research suggesting that the more you lose the more your metabolism slows.
Whatever the explanation, when I found myself up ten pounds at the end of the year compared to the previous January, I knew I needed to take steps.
I decided to do a very low carb diet because the analog insulins seemed to be causing me to gain weight and because my last attempt at weight loss, after the estrogen fiasco, a carefully weighted and measured low calorie diet with with more carbs, where my blood sugar was very well controlled by meds had not worked.
Because I wanted to eliminate all insulin if possible I decided to eat the classic Atkins induction diet: meat, cheese, eggs, whey protein powder, a large salad daily, and low carb veggies like spinach and green beans. Nothing else.
At first this diet was giving me too-high fasting blood sugars and hence too high post-meal blood sugars. Since the fasting blood sugar I wake up with each morning tends to stay my fasting blood sugar all day, that was a problem. But I accidentally discovered that drinking 1/2 a glass of white wine in the evening knocked my fasting blood sugar down significantly. With that tweak, I was able to stay in the 90s all day instead of the 110-115 range. Though to do this I could not even eat at the 6-12-12 carb level Dr. Bernstein recommends. I've been eating about 3-5-5.
This is no surprise. The reason I started using insulin in the first place is that I was going up to 140 mg/dl eating 12 grams of carbs.
The good news is that I've lost three pounds of water weight and one pound of real fat after twelve days. The bad is that this isn't a way that I can keep eating for a long time as it is too extreme. I'm going to stick with it for another week or two and then take stock.
Meanwhile here are a couple other things I remembered about dieting that might be of interest if you're dieting:
- Weight fluctuates up and down all the time, but if I average up my daily values each week and pay the most attention at the weekly average weight, I'll see a much clearer picture of my progress.
- Successful weight loss is slow. I went back and had a look at the records from the year I spent losing the 30 lbs and found that after the first month I never lost more than three pounds a month. Some months I lost only two. That means I better accept that weight is not going to drop off at anywhere near the rate I'd like (which is, of course, instantly!)
- No snacks. If you are young and have a real metabolism, you may be able to ignore this, but at my age snacks stall weight loss.
The older we are, the less food our bodies need and that means no nuts, no slices of cheese here and there, and modest portions at meal time. I believe that even on a low carb diet calories matter. Especially for people who in the past were long term low carbers like me whose bodies are no longer shocked and surprised by the switch to a ketogenic diet.
Cutting the carbs eliminates hunger and makes it easy to cut calories way down, but it's very easy to rack up a couple hundred calories by adding even the lowest carb treats. My food scale tells me that I can add three hundred calories of nuts and cheese and not even feel like I have eaten anything. So I don't even try.
- Water weight loss is motivating, but not real.
I also found that if I'm not taking metformin I lose a lot more water weight when I cut back on carbs than I do if I am taking it. In fact, the last couple times when I went to a ketogenic diet while taking metformin I didn't lose any water weight at all. This time without met in the mix I lost three pounds the first couple days.
This gives an interesting insight into what metformin might be doing for me--suppressing liver glycogen synthesis? Or it might just mean that Lantus was packing water on me since I also stopped the Lantus when I started the diet.
It's hard to say. Whatever it is, I have to remember that as soon as I go over the ketogenic boundary, I'm likely to put those three pounds of water weight back on, so I shouldn't consider those three pounds as lost weight. Still I feel sleek and thin right now and my clothes fit again, and that does make it easier to not eat.