On Going Keto, Losing 100+ Pounds, Reversing Type 2 Diabetes, and Feeling (Mostly) 19 Again

As we enter the holidays and the Season of New Resolutions, I've been getting a lot of questions from people looking to start a ketogenic diet. But why are they coming to me, you might be wondering? First, I'll provide a little backstory for people who don't know me all that well, and then I'll get to answering some basic questions. If you know my story, feel free to skip ahead to the next section.

How I Got Here

In mid-December of 2016, I went to the doctor complaining of extreme fatigue, thirst, and a litany of other symptoms I was almost certain were those of Type 2 diabetes. Not only do I have a very strong family history of this disease, but I was carrying a whole lot of risk factors of my own. 410 pounds worth of them, to be exact.

Now look, I'm no stranger to being fat. Starting at puberty and beyond, I've weighed in excess of 200, then 300, then eventually 400 pounds.  I've spoken at length about the need for more body positivity, for respecting that good health is possible at a multitude of sizes (I will tie back into this in a bit). But despite these beliefs, I knew at some point along the way, I'd crossed a threshold where I could no longer make the claim to good health. I had bad acid reflux and other digestive problems. My knees, ankles, and hips were growing too painful and weak to support me. The same could be said for many chairs. In fact, the one I'm sitting in now is meant to support up to 500lbs. I'd been thinking ahead, see. Furthermore, the largest sizes in most plus size stores were becoming too small, and I was being relegated to online stores that carried sizes larger than 4X. Even such small, practical things like tying my shoes and washing my body were becoming harder to manage. Worse, I was also becoming clumsier. Because there was so much weight hanging from my skeleton, I could no longer prevent falls the way I used to. Anytime I tripped, my ass went down hard. In fact, it was best to just roll into the fall to prevent a worse injury that would result from stopping that much momentum. That lack of basic control is really scary, and I feared that if I did really hurt myself, my size would present a barricade to proper and prompt treatment. Getting a 400+ pound person onto a stretcher and out of a house for instance, or onto an operating table is a burden I was terrified to place on medical personnel as well as myself, never mind the increased risks associated with things like general anesthesia for people my size. Again, this wasn't just about being generally fat. Most people can carry around an extra 30 to even 100 pounds without pressing their luck too hard in this area, but I was beyond that. I was the size of two large people at this point. 

And let's be honest here. I didn't get there by being judicious with my food choices. Yes, there are plenty of studies pointing to how obese people don't necessarily eat more than thinner people, but that their genetic makeup can control how their body stores calories. And yes, I do believe there is a lot of validity to this, which is why what I was doing was even worse, because I wasn't paying any real attention to what I put in my mouth. I ate everything I wanted in whatever quantities I wanted, even while knowing I would pay digestive hell for it later. Inside my mind, I was going for broke for as long as I could until the slack ran out of the rope. And it finally ran out just before Christmas last year when my fasting blood sugar was tested at 186 and my Hemoglobin A1C test came back at 7.6 (anything above 7 is classified as diabetic). 

Granted, as far as diabetes diagnoses go, it could have been much worse. I know people who receive diagnosis with blood sugar over 400 and A1Cs in double digits. I'm lucky I got in there when I did, because it sure as hell wasn't going to get any better at the rate I was going. My doctor started me on Metformin and didn't give me much diet and nutrition advice after that. I've come to find out that this is pretty much the standard protocol with diabetes management anymore, which is disappointing to say the least. Luckily I've always been a precocious self-starter type, and I already knew carbs/sugar would have to be addressed immediately. It comes down to this: Type 2 diabetes results from your body no longer being able to properly use the insulin it produces, which means you wind up with a whole lot of extra glucose floating around in your body. If you have too much sugar in your body, the best thing you can probably do is stop putting so much of it in your damn mouth. 

So off I went learning about keto and how to get going. The following section will hopefully get you going on some basics.

December 2016, just after my Type 2 diagnosis
Getting Going On Keto

Now hopefully, you've been doing your homework on this already, so I'm not going to cover every single base here. The first site I tend to send people to is Diet Doctor, which provides a good introduction to how this way of eating works, as well as some tasty recipes. There is a membership you can join, but there is plenty of info you can glean there for free.

The ketogenic diet is considered a low carb/high fat (LCHF) diet with moderate protein intake. But there is a misconception at work here that going keto means you go from eating bread and pasta to bacon dipped in butter for every meal, and I'm just gonna have to stop you folks right there. The high fat is really just a relative term. With your carbs restricted and your protein moderate, the fat macro takes up a bigger slice of the pie chart you see below here:

These are my current target macros using the calculator here. Yours will vary. And you will notice that yes, 61% of my daily calories CAN come from fat. BUT, I would rather use the fat on my body. Which brings me to the first rule of the ketogenic diet:

FAT IS NOT A GOAL MACRO. Eat enough fat to keep hunger at bay and your food tasting good. It's okay if you don't eat even half what the calculator says you can eat. But in the beginning, as your body begins to transition from burning carbs for fuel to burning fat, you're probably going to be feeling hungry, sluggish, and a bit out of sorts. I ate a lot more fat during those days than I do now. Fat kicks hunger and cravings to the curb. Fat keeps your mind from wandering over to all the chips and other junk food you're probably jonesing for. My fat intake included a lot of things like fattier meat cuts (ribeye, ground chuck, chicken thighs, pork belly, sausage/bacon) cheese, butter on my steaks, Bulletproof coffee, spoonfuls of coconut oil, and nuts. After a couple months, I eventually pared back on all that, because my body was now using its own fat stores to keep my hunger at bay. I now enjoy leaner meats and (gladly) took the butter back out of my coffee (I never liked it much to begin with). So really, fat is like a training wheel. Enjoy it and all its benefits in the beginning, but eventually, let your body be your fat macro.

This brings me to the next guideline:

PROTEIN IS YOUR GOAL MACRO.  The math states we should be eating anywhere from .06g to 1g of protein per pound of lean muscle mass (that's what's left over after you subtract your body fat percentage), but since most of us don't know our actual body fat percentage, this macro is often more of a ballpark figure. The general rule is that sedentary people can get away with the bare minimum of the .06g figure while active people can get closer to 1g. I try to strike a balance here by meeting a minimum of 80g daily. Some days will be higher, some lower, but in the end, it balances out.

And finally, the thing this brings me to carbs:

CARBS ARE YOUR LIMIT MACRO. And that's NET carbs (the amount left over after subtracting indigestible carbs like fiber and some sugar alcohols). Technically, most people can maintain some ketosis with anything under 50g net carbs. When I was starting out, and for about 6 or 7 months thereafter, I stuck pretty faithfully to 20g net a day. Often, I was much less than that. However, this is a number that you will have to play with on your own in order to find a sweet spot. Most people will find that 20 grams is something they can stick to for a while, but probably not forever. But I definitely recommend when first starting out to stick to the 20g limit in order to induce your body more quickly into ketosis.

Now I will bulletpoint a bunch of other wisdoms I eventually discovered as I got going on keto. 

  • ELECTROLYTES ARE LIFE. Keto is a highly diuretic way of eating. This is because when you're storing excess sugar for energy, your body requires a certain amount of water to hold it in place. The early days of keto will have you likely peeing a lot, because your body is releasing all of that water. This means that you'll also be shedding salt, as well as magnesium and potassium. This can result in sluggishness, nausea, constipation, muscle cramps, crankiness, and brain fog, otherwise referred to as "keto flu." This can be avoided by adding extra salt to your food, drinking a cup of broth, or taking a shot or two of pickle brine. You can also sprinkle a little bit of salt into your water bottle. If you get leg cramps, you very likely need magnesium as well.
  • YOU DON'T REALLY NEED KETOSTIX. People on this diet will tell you to pick up some ketostix at the local pharmacy so you can test your urine for ketone bodies. And that's all fine and good if you want to do it, but a few caveats. These sticks won't paint a very helpful picture for you if you're more than a couple weeks into keto. That's because over time, your body will stop excreting ketone bodies into your urine because it will actually be USING them. Furthermore, you can usually tell when you're in ketosis through physical symptoms (higher energy levels, less hunger, more mental clarity). If you must know your ketone levels, a blood meter is a lot more reliable, but the strips are crazy expensive and not usually covered by insurance. 
  • DON'T OBSESS OVER "CLEAN" FOOD. This is a bit of a controversial view, I realize, but a lot of people who follow this lifestyle will tell you to buy only Kerrygold butter and grass-fed beef and organic vegetables. If you CAN do those things, great. But please don't let an inability to afford those things bar you from getting on the keto train. I've seen people sabotage themselves more than once with this erroneous thinking. You'll do plenty fine on conventional foods. In fact, 99% of the time, that's all I buy. This diet should not be breaking your bank. In fact, over time, it can save you a lot of money, because of how much less you'll be eating overall. 
  • FEEL FREE TO EASE IN. I was diagnosed with diabetes on 12/21/16. I started keto on 1/2/17. In that span of two weeks, I started cutting back on bread, pasta, grains, and sugar and watching portion sizes. We ate through several pantry items. By the time I started actually doing keto, it was much less of a shock to the system, and we also didn't have to throw out a ton of food. 
  • TRACKING IS GOOD. Get yourself a tracking app for your foods, especially in the beginning. Accountability is important so you can see exactly where you're strong or need improvement in your day. It helped me a lot to know exactly what 20g of carbs a day looked like. My Fitness Pal is probably the most common app for this. Admittedly, the food database can be a bit of a mess, but it's also the most comprehensive one out there.
  • EXERCISE IS GREAT, BUT... 90% of the weight battle is about what you eat. Working out will make you feel good, maintain weight, help with blood sugar, tone muscles, and make you stronger both mentally and physically, and as you lose more and more weight, you'll have a ton of energy and will WANT to exercise. But it also has a tendency to encourage more eating if you aren't careful. Focus on getting the diet under control first. Go for light walk if you must. Lift some free weights. Heavy exercise can always come later. 
  • AVOID THE SCALE. Okay, I know most of you will ignore this. I do too. But it doesn't hurt to remind folks that the scale is actually quite evil and it lies a lot, and you should avoid weighing yourself every day, otherwise you'll be in for a lot of unnecessary heartbreak. It won't tell you that the extra three pounds you gained overnight is due to the fact that you haven't pooped in a couple days (keto will likely slow your bowel movements) or you're retaining water because you're dehydrated or in a particular part of your monthly cycle (ladies). It won't tell you that weight fluctuates a LOT for all sorts of reasons having NOTHING AT ALL to do with fat loss or gain. And it sucks because, there is SO MUCH MORE to being kinder to your body than a number, so many more victories to celebrate that have nothing at all to do with actual weight loss. I try very hard to remember all my non-scale achievements, because there are too many to count, and they mean more. Which leads me to:
  • WEIGHT LOSS IS NEVER LINEAR. For me, with the exception of the first few weeks when I was losing a couple pounds seemingly every day, every ten pounds has been a rollercoaster. I'm up two, down one, down three, up two. I'll go sometimes an entire week or more with no net change. This despite carefully watching what I eat, maintaining a caloric deficit, and staying somewhat active. Then all of a sudden I drop six pounds, and I'm onto the next ten-pound bracket for the next one step forward, two steps back, one giant leap forward. I haven't tracked my weigh-ins by graph, but if I had, I guarantee you it would look like a volatile stock market ticker. Nevertheless, if I zoomed out, I would see the line trending downward, and that's the important part. Don't get too hung up on the day to day. Changes creep up on you when you're shrinking, just like they do when you're growing. Somehow, some way in less than a year, I've lost the equivalent weight of a small adult.
  • YES, HEAVY CREAM HAS CARBS. You will likely be directed to start replacing milk with heavy whipping cream for certain recipes, and that's because there is a lot fewer carbs in it than in milk. However, the 0g carbs you read on the nutritional label isn't a true or infinite zero. There is, in reality, about half a carb per serving in heavy cream. Labeling laws permit a food manufacturer to put 0g if there is less than one gram. When you're trying to live on 20g a day, the carb numbers can add up really fast if you're using a lot of it, so if a recipe is calling for a cup of heavy cream, beware.
  • EMBRACE THE SIMPLICITY. Being keto means your shopping is easier. Protein and vegetables, full fat dairy, nuts. If you live with people who aren't doing keto, you might be wondering how you can do your thing while feeding everyone else in the house, but it's really simple. You can all still eat the same proteins and vegetables. Just leave the starches off your plate. Or have spaghetti squash with your sauce and make noodles for everyone else. Have your burger off the bun on a bed of greens and save the buns for everyone else. In the beginning, it might be hard to prepare starchy or sweet foods for your kids, for instance, but eventually it gets easier. Then again, a family tends to benefit as a whole from having less junk in the house. I know my kids are eating far less sugar now than they were a year ago, and that's perfectly fine. 
  • BE CAREFUL WITH ALCOHOL. Yes, you can enjoy some alcoholic beverages while doing keto. You just have to avoid beer and sugary mixers. That said, ketosis makes you a much cheaper date in the booze department. One or two drinks might be all it takes to do you in, so watch out. I learned this lesson the hard way in the beginning.
  • A BAD MEAL WON'T RUIN YOU. Yes, you will sometimes indulge in a real piece of cake or bread or ice cream or whatever, and when you do, you might fall into a panic and think you've ruined everything. Knock it off. The second you start bringing shame into the equation, the sabotage has already begun. Shame is a fucking killer. Forever is a long time, and if you set such unrealistic expectations on yourself that you'll NEVER eat (insert "naughty" food here) again, the only possible result IS failure. Enjoy your treat for what it was and move on. Remember how good you feel without those foods being a daily part of your diet, but how good you still feel having the occasional treat. Go easy on yourself. I've been doing this nearly a year. I fully enjoyed my birthday and Thanksgiving with "treats," and I plan to do so for Christmas. The difference now is I know the difference between eating for a special occasion and eating day to day for sustenance. They are two different things, and I now enjoy those lovely indulgences even more because of it. This is how it should be.
  • YES YOU CAN DO THIS WITHOUT A GALLBLADDER. This is a common question, and of course I always have to tell people to defer to their doctors, but for the record, I've been without a gallbladder for several years. I haven't had a single problem that way with this diet, and there are scores of people who tell the same story. I also have the lab work to back it up.

12/6/17. A work in progress!
In less than a year, I have lost 115 lbs, four pants sizes and 5 shirt sizes. My fasting and post-meal blood sugar numbers stabilized within the first couple weeks. After 3 months, my first A1C test was 5.5 (down from 7.6). After 9 months, it's now a 5, and that's even after incorporating more carbs than the initial days of the diet. My triglyceride numbers, which were over 270 at diagnosis, are now well under 100. I still take 500mg of Metformin daily, but I could probably stop that if I wanted. However, it does help with the insulin resistance and I'm having no adverse side effects from it. I no longer have any symptoms of GERD or irritable bowel. I no longer get "hangry." My energy levels are through the roof. I have physical stamina, mental clarity, and I also have a lot less anxiety and irritability overall. With the exception of having some of the ailments of a normally aging body (my joints say I'm not really 19 anymore as much as I would like to be), I haven't felt this good in nearly two decades.

With my current state of health, I could just stop here and maintain my current weight and remain as healthy as a horse, and that's still with a good chunk of fat left on my frame (there's that tie back in to Health at Every Size, which I still firmly believe in). I'm in a place now where I can find clothes that fit, where I can sit in a normal sized chair, where I no longer feel like my body is a major injury waiting to happen on the other side of a bad fall. In many ways, I've already attained every goal I set out onto this journey with. But I'm happy to keep going with what I'm doing, because so far, it's been virtually effortless getting here, and if that means my body keeps shrinking, so be it. I can remain the size I am now and still feel comfortable inside my own skin, with healthy blood markers and a lot of get up and go. I also feel like I'm eating mindfully now, rather than mindlessly cramming food into my mouth and being ruled by constant craving for something sweet and something more. I don't think that's something I've ever had, and I'm so grateful for it now.

So yes, this works, without a doubt. This has been normal life for me for nearly a year and I foresee no return to the ways that made me sick, anymore than I see lighting up another cigarette after 7 years of being nicotine-free. And unlike a diet, I don't feel hungry or deprived. I don't have to do anything high maintenance or expensive to stay on this path. I no longer have food-related anxiety or shame. I feel more closely in tune with my body than I ever have.

Maybe it sounds silly to say that diabetes saved my life, but in a way it did, because it brought me to keto, and keto brought me a peace and sense of control I've been waiting my entire life to feel.

Feel free to drop questions in the comments. I know y'all probably have plenty. 

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