The 3-month check-up

Posted on November 4, 2011 by Viv

This week I had an appointment with my endocrinologist to check up on my progress.

My doctor said that even though I have already lost a lot of weight, she does not want me to go off the Metformin yet. As you know from one of my previous posts, this was a worry of mine – I wasn’t sure what I’d rather do. She said she wants me to get to under 80 kg first and wanted the Metformin to give me an extra push during the Christmas season. Let’s be honest, it’s a time of the year many people gain weight, and even though I have no intention of doing that, it is nice to know that I will not be on my own, off the Metformin and facing all the temptations of the Christmas season as well as the challenge of losing weight without the Metformin.

She was very happy with the amount of weight I have lost already, even asking me whether I have been sticking to my dose of 1000mg a day. I suppose many people struggle more with the weight loss than I do, even though they’re on Metformin, but for me, Metformin is precisely why I am not doing this half-assed. Plus I had lost weight before, and even though I was never able to keep it off, I knew how it worked already, I knew about exercise and healthy eating. It was just about being strong enough to make it a habit again.

She also asked about my PCOS, whether my cycle is normal again but as I have been back on birth control since May, I have no way of knowing and I won’t know as long as I am on birth control – a little frustrating. I may ask her whether it makes sense to go off birth control again in a few months to see if I am doing any better. Though I am really not looking forward to my body going completely haywire again if it hasn’t. What a mess!

So I am going to be taking Metformin for another three months, and then go off the Metformin and keep up my healthy diet and keep off the weight I lost. She wants me to make another appointment for six months after I stop taking the Metformin to repeat the glucose tolerance test and do a full screening of my thyroid again, including ultrasound. That means I will not actually know whether I have kicked the insulin resistance until then, but I am okay with that, being that if I do lose the weight and do keep it off, it is very likely that I have.

They also did some blood tests again. Apparently thyroid levels and weight are very closely linked, and as I have lost a lot of weight in a short amount of time, there was a possibility that my thyroid was not able to adjust as quickly. They are checked my kidney function as the Metformin can negatively impact it. Today, my endocrinologist emailed me and told me that everything looks great.

All in all, it went really well. For the next three months, not much is going to change. I will keep taking the Metformin and doing what I’m doing. I want to make the most of the next three months and then continue to lose weight until I reach my goal weight.

A confession

Posted on October 31, 2011 by Viv

On Wednesday, I have my next appointment with the endocrinologist. As wrote in my post a week ago, I have the slight hope that my insulin levels may be back to normal already. I have no idea if they are, but I have lost about 10kg since the last tests were done* and I am no longer obese so there is a chance that made a big enough difference.

But to be perfectly honest, I am not sure what I want the endocrinologist to tell me. That my insulin levels are back to normal and that I should stop taking the Metformin, or that I should continue to take it another three months. Why?

Because aside from lowering my insulin levels**, Metformin is supposed to have a positive effect on weight loss. I have not been losing at a much faster rate than I used to a few years ago, but I don’t know how much of my weight loss can be attributed to the Metformin and how much of it is healthy diet and exercise. I certainly seem to lose at a faster rate than most of my friends on MyFitnessPal.

Part of me wants to go off the Metformin because I want my insulin levels to be normal and I hate taking a drug like Metformin, and part of me wants to stay on it, because losing weight has been going so well for me, and I am worried it won’t go as well when I stop taking the Metformin.

And of course then I berate myself for essentially thinking of Metformin as a weight loss drug and for wanting to stay on it so I can keep losing weight ‘easily’, because, well, how mentally unhealthy is that?

The truth is, I don’t know how much of my weight loss is due to the Metformin. I prefer to think that it is all due to my discipline, healthy eating and regular exercise, because I am really pleased with the past three months, but I don’t know for sure that it is.

I really dislike when people say, ‘oh yeah you’ve lost a lot of weight, but then you are taking Metformin,’ because it takes away from my accomplishment. Yes, I take Metformin, but that doesn’t mean I haven’t still completely turned around my life. Metformin doesn’t make me go running every other day, even when it’s 4C outside. Metformin doesn’t make me say no to chocolate when a co-worker offers me some. That’s me. But they may be a little right insofar that I may not have lost as much weight as I have, had I not been on Metformin for the past three months.

So as much as I anticipate the appointment on Wednesday because I know how great I have been doing, and I want some good news for once, I am also dreading it a little, because I don’t know if I really want to go off the Metformin just yet.

* I had my endocrinologist’s appointment in July, when I was about 94 kg – I gained another 3 kg before I started losing weight, so I have ‘only’ lost 10 kg since then, not the 13 kg I have lost since my highest weight in August.

** Lower insulin levels also have a positive effect on weight loss, but that is only what the body should be doing anyway. Higher insulin levels inhibit weight loss, even make you gain weight, and the Metformin reverses that. But on top of that Metformin decreases absorption of glucose, so it has an ‘unnatural’ positive effect on weight loss as well.

On seeing a nutritionist [Part II]

Posted on September 30, 2011 by Viv

Please make sure you read part I of this post, if you haven’t already done so.

I am going to divide this post into paragraphs again to keep it structured.

Carbohydrates

As you may know, carbohydrates are saccharides. In layman’s terms, they are converted into sugar in the body. How quickly this happens depends on whether they are monosaccharides, disaccharides or polysaccharides. Mono- and disaccharides are converted into sugar very quickly – they enter the blood stream right away and cause the blood glucose levels to rise. They can be found in household sugar and candy, but also in refined grains, dairy and fruit. These are the carbs I have to watch out for because for me it is important to avoid spikes in my blood glucose levels. Polysaccharides, or complex carbohydrates, can be found in vegetables and whole grains, and they are the good carbs. I also need to limit the amount of complex carbs I eat, but not as strictly as the refined carbs. I can have, e.g., 60g of oats in the morning, one slice of whole grain bread for lunch, and one portion of 60–80g of whole grain pasta for dinner. She emphasized how important it is for me to always have vegetables or salad, and protein, such as meat, fish, eggs, or legumes, with my meals. I should have a maximum of 200g of carbohydrates a day, and it has been hard for me to stay under that.

Fruit

Fruit have always been my go-to snack when losing weight. I have a sweet tooth and fruit have been a great alternative to candy or chocolate. Sweet but good for me at the same time, right? Unfortunately, as you may have been able to guess, as fruit has a lot of sugar, I have to limit the amount of fruit I eat very strictly. And yes, that includes my beloved fruit smoothies. I can pretty much say goodbye to them. (Well, let’s be honest, I’ll still be having one occasionally but not as frequently as I used to.) My nutritionist told me to limit the amount of fruit I eat to two handfuls a day. As I always have a banana in my oatmeal in the morning, that leaves one handful for the rest of the day. One handful is, e.g., one apple, one kiwifruit, or 100g of grapes. As you can imagine, this is hard for me. I mean, one piece of fruit for the entire rest of the day? And how am I going to choose between all the delicious fruit ?

Vegetables

I’m supposed to eat them. Lots of them. I am actually not sure if there is a limit to the amount I am supposed to eat, but I should have vegetables with both lunch and dinner. And I reckon cherry tomatoes are a good substitute for fruit for snacking.

Protein

Protein is very important for me. As I don’t really like to eat fish, and only like to eat meat in moderation, my nutritionist suggested adding more legumes to my diet. I have started eating beans more frequently – especially as a salad, nom! – and in the past few days, it has been much easier for me to hit my goal of 60-70g a day. As I already mentioned in my other post, I should also have a protein component in my breakfast which I am doing by having a yogurt in the morning. Speaking of…

Yogurt

Until now, I had been eating non-fat yogurt. I had already made the switch from flavored to plain, but I thought eating non-fat was good for me. Turns out, it’s not. My nutritionist is not a fan of the non-fat yogurt at all, it should contain at least 1.5% fat or even 3.5% fat, because it contains amino acids that are vital for me. Since then, I have switched to the regular yogurt which is 3.5% fat and I am doing fine. I was worried about my calorie intake, but let’s face it, the additional 30-50 calories aren’t going to make me gain my weight back. I thought this was so interesting, because most dieters think that non-fat dairy products are so much better for you, and turns out that they’re not.

Fat

I got a goal of 60g of fat a day, and to be honest, unless I make an effort and eat some walnuts, I am usually under my fat goal. My nutritionist suggested I consume 1–2 tablespoons of oil a day, so I make a point to cook with olive oil or add it to my salad. Switching to 3.5% yogurt has also increased my fat intake a little. Eating more fat is something that has always been hard for me. I like for my food to be low-fat because fat seems like empty calories. Do I really want to fry that chicken in a whole tablespoon of oil which will add 120 calories to my dinner? 120 calories is a lot for just a measly tablespoon of anything. But what is important to keep in mind is that the body needs fat just like it needs vitamins and protein.

Fiber

As I have switched to whole grains and have increased my intake of vegetables, I eat plenty of fiber. My goal is 30g a day and I usually make it or don’t stay far below it.

Nutritionist vs. MyFitnessPal

As you know, I use MyFitnessPal for tracking my calories, and interestingly, the goals I got there are not completely off from the ones my nutritionist gave me. That made me pretty confident about using MyFitnessPal, which has been great for me, especially in terms of receiving support from and giving support to others.

Aside from all the advice, the nutritionist also gave me a few recipes for meals, which I thought was great. I definitely want to try them some time. The hour flew by so quickly, and I wanted to ask her so many more questions. On the one hand, as you can see, we covered a lot of ground, but there is still so much more to know about nutrition. There wasn’t much time to delve into the details of a lot of her advice. Luckily, she offered me to send her my food diary for three days, and she would analyze it for me and discuss the results with me. She also suggested that with my PCOS, it would be a good idea to see her regularly and – this is the best part – she said that in situations such as mine, my health insurance will probably cover extra sessions, as nutrition is so important for keeping my condition in check.

I am planning on seeing her again in the first week of November and I cannot wait to discuss my nutrition some more as well as get feedback on my food diary. I had been a bit wary of seeing a nutritionist, because I had heard of others having bad experiences with them (receiving bad advice or the nutritionist knowing less than they did), but it was really an all-around positive experience.