The Path to the Low-Carb Way

In the previous post I outlined my struggle and cycle of weight gain and loss. For the last 3 to 4 years, I maintained a fairly steady weight bordering on a 30% BMI. I was no longer able to outrun my bad diet. I thought I would go back to the teachings of my nutrition education. This is what I had been telling patients for years. Reduce caloric intake; increase exercise. This is the so-called "eat less, move more." The problem was that it hadn't worked. I thought I hadn't been active enough or diligent enough in monitoring my intake. I decided to strictly monitor calories in and calories out with tracking of fitness and exercise and daily caloric burn. I started with the MyFitnesspal application. Based on my BMI, I calculated that I could lose 1 to 2 pounds by restricting my calories to approximately 2000 kcal per day. For a few months, this worked. I actually lost 10 to 15 pounds. When I did exercise, I thought, "I burned some calories so I can eat a little bit more but I'm still under my caloric debt for the day." After a time, my weight reached a steady-state. I'd go up a pound or two here and there and for several YEARS there was no traction despite me adhering to the 1900 cal/day that was calculated based on the lower BMI. I was stubborn and based upon my prior teachings I thought that as long as I kept at it I should be losing weight. It took a couple of minor alarm bells to get me to consider other approaches.

In the beginning of last year, I went to my primary care physician for a persistent cough. At that visit and a follow-up visit, my blood pressure was borderline elevated for the first time. It had been a few years since my labs had been done and my lipids were always slightly borderline. I knew that I needed to increase my exercise, lose weight and improve diet. I wanted to postpone going on any medications for as long as possible.

My first exposure to low-carb, was courtesy of the Adam Corolla show podcast. For many years, a longtime guest is fitness expert Vinnie Tortorich , founder of NSNG (No Sugar No Grains) . My initial reaction to his low carbohydrate, high-fat approach was that this was quackery, and I was quite skeptical. After all, I had nutrition in medical school! So for years I had discounted his information.
About this time, a long time friend who would work with my wife for many years visited. She looked good and had attributed much of her success to the ketogenic diet. It was quite similar to NSNG from her description so I decided to check it out. At her suggestion, I began to read The Obesity Code written by Jason Fung, MD. The book was logical, factual, and laid out the history behind the growing obesity problem in our country. The science was sound and well referenced for those of us in the medical profession, and the examples were relatable to the lay reader. I can go into more detail in a later post, but I would strongly urge any readers who haven't read this book to check it out.

So, since what I had been doing hadn't worked, I decided to give NSNG and the low-carb approach a try. I joined the NSNG Facebook group and downloaded Vinnie Tortorich's PDF. A link to download this PDF is on his website and I have linked it on ourlowcarb.com/. In the coming post, I will let you know how this experiment fared.

A Physician's Journey to Weight Gain

As a physician now for over 25 years I have been blessed with a lifelong of learning. Part of having a base medical knowledge is to also know what you don't know. Probably most important is knowing where you can get the right answers and the knowledge that you need for the particular medical problem. I thought that I had a good base in nutrition. My medical school, the University of Nevada was a newer school and fairly progressive with a concentration in primary care. As I subsequently found out, medical school education in nutrition is scarce or lacking except in clinical rotations. We would learn about rare nutritional deficiencies in pathology which in our modern society with abundance of easily obtained food sources are fairly rare. This compared to the days when our ancestors had to deal with famine or shortages on a regular basis. At one point I thought I was fortunate because our medical school actually had 1/2 semester course in nutrition. This is more than many other medical schools. I carried this knowledge out in my practice and personal life for many years. As an Emergency physician, you deal with the acute and urgent problem. Because of the busy nature of the emergency medical field, there's not a lot of time for things such as nutritional counseling. We are dealing with the end results of many chronic conditions such as hypertension, diabetes mellitus, chronic kidney disease, and cardiovascular disease.

Because healthcare professionals make the worst patients, you tend to self treat based on your own knowledge. I have had a love-hate relationship with food and weight beginning in late adolescence. I was always physically active playing sports such as JV wrestling, cross-country, and varsity baseball. I began getting into some weight training to build lean muscle mass however my passion was running. After high school when I began working two and sometimes three part-time jobs in addition to going to college, I quickly noted weight gain. Suddenly, as I was testing for positions in law enforcement, I realized that I was overweight and out of shape. In those days, I ate as much as I wanted, whenever I wanted. It was easy to go out and start running a few miles regularly and get in better shape and cut some weight. Ultimately, I did get hired in law enforcement and continued to struggle with weight off and on for my 14 year career particularly when working night shifts. In those days, when my uniform pants and belt started to get tight it was easy to try to outrun my dietary stupidity. After 10 years in law enforcement, I decided to try to attempt a career in medicine. I was back in school full time while working full time and taking care of a family full-time. My exercising fell by the wayside and the weight jumped. During my first year of medical school I was working full-time in addition to attending classes full-time. This is when things first got really bad. By the beginning of my second year of medical school I had gained 30 pounds. I was gassed during our sophomore versus freshman class football game. During third and fourth year clinical rotations which mirrored resident schedules, sometimes doing 36 hours on call, you grab whatever junk food you can get, and deal with sleep deprivation and stress. As I have subsequently found out these are major drivers in weight gain. By the time I graduated from medical school, I was at my heaviest up 65 to 70 pounds from my weight at the Sheriff's Department.

During internship, the long hours, stress, sleep deprivation and bad eating continued. I knew it was time to get a handle on things. Despite having very little time, I joined a gym that I could bicycle to from my house; I bicycled to the hospital, and I began my running again. Within a year, I had gone from 260 pounds down to 182. Towards the end of my third year of residency, I crashed my bike and injured my heel on a curb. I could no longer run without pain. After graduation, I entered the world of private practice emergency medicine. Due to financial pressures and debts run up during medical school and residency, I began working almost the equivalent of two full-time emergency medicine jobs picking up every extra shift I could find. What fell by the wayside? Yes, exercise and back into bad diet. In addition, I was in the United States Air Force Reserve medical core and struggled to maintain weight and ultimately was passed over twice for promotion because of my excessive weight and inability to complete training. Although I did receive an honorable discharge for my three years of service, again I knew it was time to do something as I had ballooned to over 255 pounds. I would moderate my diet, and again, trying to outrun my dietary stupidity. 10 years into my emergency medicine career, I had lost 60 pounds again. I tried to maintain this despite dealing with stress, travel, shift work and poor sleep habits. I always thought that if I could moderate my calories I could eat whatever I wanted. I was a carbohydrate addict. I loved pasta, pizza, Mexican and Chinese food. I would grab fast food while I was traveling. I was frequently overtired after a long overnight shift and facing a long drive I would caffeinate and stop several times on my drive for food. I did try to maintain my gym routine and actually worked with a personal trainer. I became frustrated because despite all of this, I was still gaining weight all over again. At this point, I gave up in frustration and very quickly was back up close to 260 pounds again. This was much like the treadmill that I frequently ran on, a vicious cycle that got me nowhere.

So this was just nine years ago. Where does the story go from here? I will continue the journey in the next post.

My Purpose

Welcome to this site which will be an informational resource regarding the low-carb lifestyle and wellness. We'll address things like risk assessment and prevention of common health conditions like metabolic syndrome and cardiovascular disease. While I am a physician, I am also an individual who has struggled with weight gain and loss most of my adult life. I'm going to use these personal stories to give insights into why this works.