From the Editor’s Desk: Check-In (Premium)

I had been waiting for this.

On the last day of July, we returned home from Mexico City, and then I experienced a very different kind of doctor’s appointment the next day: thanks to about six weeks on what I’ll call a “healthy low-carb” diet, I had lost 25 pounds and normalized my blood pressure, and based on the data from a continuous glucose monitor, had also significantly lowered my blood glucose levels, dropping from pre-diabetic to normal levels.

Everyone was very happy about these changes—me, my wife, my doctor, and a nurse I’ve seen a lot lately—but I was also urgently curious about the next milestone: my next quarterly blood work, which would include a hemoglobin A1C test showing my blood glucose levels from the previous three months. Plus, other data from other tests, all of which are linked, in some way, to the glucose. We scheduled the blood workup for the very end of August (last week).

I went into that previous doctor’s appointment knowing that everything would go well: I could tell I had lost weight and had successfully transitioned to this new diet while eating twice a day (no breakfast, with an intermittent fast between each dinner and lunch). But in the month since then, things have predictably slowed down. I didn’t feel like I was losing much if any weight, which is normal but not desirable, and I started seeing weird results from the glucose monitor in the second half of August, which reported my blood glucose levels rising over a few weeks before coming back down to normal this past week.

But I figured the three-month average provided by the A1C would still be a big improvement over my previous scores. And so I walked into the testing lab last Tuesday morning in a great mood. I went the gym afterwards, and the day proceeded accordingly. I figured I’d hear about the results in the next few days. And then promptly forgot about it.

Then my phone buzzed while we were watching TV the next evening. I looked down, saw that my test results were available, and immediately opened my healthcare network’s mobile app to see the good news. What I saw was … not quite as good as I had hoped.

There were two sets of results.

The first, for hemoglobin A1C, showed an A1C value of 5.6 percent, which is just inside the normal (non-pre-diabetic) range (under 5.7 percent) but a far cry from the 5.0-ish I was expecting (perhaps nonsensically). That said, it had been 6.0 in June, so this is still a nice step in the right direction. However, my estimated average glucose was 114 mg/DL, which is much higher than what I’d been seeing over the course of five continuous glucose monitors and about 9 weeks: after falling into the very high 80s, I’ve been somewhere in the 90s ever since, excepting that weird two-week anomaly, and that’s within the normal (non-pre-diabetic) range; 114 is … high.

I figured the second test, a lipid panel—a complete cholesterol test—would have good news, however, given my diet. But here, I saw what I took to be even worse news: my cholesterol, non-HDL cholesterol, and LDL cholesterol were all still slightly elevated (meaning over the “standard range”) and, worse, they were all a bit higher than they were back in June too. But my triglyceride measurement, 103 mg/Dl, was well within the normal range (less than 150 mg/DL), and it was also lower than it was in June.

So my initial reaction was a crushing sense of despair. I stopped watching and listening to whatever show we had on and stared off into space wondering how this was possible. But as one does, I started to think about these scores a bit more.

The A1C was good, not as good as I had hoped, I guess, but then my expectations were based on literally nothing anyway, and it is obviously trending in the right direction. But as my wife pointed out, it’s an estimate over three months, and I had only been doing low-carb for two of those months: in June, I was either eating normally or purposefully experimenting with carb-heavy foods to see how they impacted my glucose. (I still can’t explain the high estimated average.)

Having read a lot of Gary Taubes, I know that he busted the enduring misconceptions about cholesterol years ago, a point he’s repeated and expanded on in his books, and so I wasn’t too worried about that per se. But I also had this vague notion that one of those scores was more meaningful than the others in terms of it impacting heart health and the possibilities of future complications. And so after fretting about these tests into the night and the next morning, I finally looked it up.

And it goes like this: based on the science, and despite the accepted medical dogma that says otherwise, cholesterol is not the artery-blocking cause of heart disease, triglycerides are. (I know. Got 5 minutes? Watch this for a quick peek at the cholesterol data.) And one’s triglycerides are impacted by eating refined carbohydrates and processed foods, which I’m not doing. And on that note, my triglyceride level is both fantastic and better than it was three months ago. This is nothing but a good thing.

As I slowly came around partially on the test results, I was more curious than ever what my doctor thought. And by the time we headed to the doctor’s office on Thursday—my wife once again joined me for that confirmational voice about my eating behaviors—I was feeling OK. Not great, but OK.

Fortunately, the news and feedback were mostly positive.

I was down another 5 pounds, for a total of 30 pounds lost over two months, and my blood pressure had gone down again, to 113 over 72 mmHg. The nurse, who had been so happy for me on the last visit, once again congratulated me. When the doctor came in, I was ready to confront the data and find out what she thought. But she started talking about Adderall instead.

It took me a minute to mentally switch gears.

Concurrent with my physical health initiatives this year, I was also finally diagnosed with ADHD and have taken the unwelcome step of accepting medication (Adderall) to help overcome this problem. This is tricky on a few levels, but I’m particularly unhappy that we will need to monitor and keep adjusting the dosage over time; I wish this was more of a “set it and forget it” thing. Long story short, I was taking one pill a day in Mexico, switched to two pills per day in August—one in the morning and one a noon—and now we’re switching to two pills per day, both in the morning.

I had a hard time sticking to this topic (which is ironic, because that was probably my ADHD talking). All I wanted to discuss was the glucose.

And then the doctor finally switched gears.

She was happy with the results overall, though she was more concerned about the cholesterol than I think is warranted, which was disappointing (though not unexpected, given that the prevailing medical wisdom on this hasn’t caught up with the data). But she agreed that no changes were needed, and she told me to simply keep doing what I was doing from a diet and exercise perspective.

Weight loss is difficult.

Everyone plateaus—meaning, they stop losing weight—over time, no matter the diet, and one of the trickier things about long-term progress is figuring out how to counteract that. And so this is something I will be working on for this current quarter, and ahead of my next set of blood work in early December. But based on my recent reading—Gary Taubes’ The Case for Keto: Rethinking Weight Control and the Science and Practice of Low-Carb/High-Fat Eating and Jason Fung’s Life in the Fasting Lane: How to Make Intermittent Fasting a Lifestyle—and Reap the Benefits of Weight Loss and Better Health—I have a few ideas.

The first thing I’ll try is related to intermittent fasting. I’ve been skipping breakfast most days for quite a while now—I ate something in the morning only once in August, for example—but before my recent dietary shift, I would snack on occasion, more on weekends, and almost always at night. But for the past two months, I’ve not done that, and I’ve noticed my body adapting to the new schedule, which is that I literally only eat twice a day, at lunch and dinner. And … I am never hungry. I never desire or need snacks, and it’s quite sustainable.

This is incredibly freeing. But I think it’s set me up for the next step, and Dr. Fung and other intermittent fasting enthusiasts recommend turning it up a notch once you’ve settled in. And while there are a variety of ways in which to do this, it basically boils down to extending the fast. And that means skipping another meal. In my case, lunch, meaning I will go from dinner one day until dinner the next day without eating.

Or, I will try. I don’t get hungry now, as noted. Will I get hungry when I try this longer fast? How often do I need to do this in a given week? Once? Twice?

I don’t have those answers yet. But the benefit here is similar to that of a Keto diet (which I’m not really doing, though my carb intake is very, very low) in that our bodies adapt to consuming our own fat as a fuel source, which is of course the desired outcome. Because we lose weight, and not just weight but the right kind of weight, as it comes from fat and not lean muscle mass or water.

And so I will experiment with this in September, continue with my diet (which is basically “low-carb, high-fat” but with lots of whole vegetables), and push through it regardless. Depending on how resistant your body is to carbs, and mine is not at all resistant, weight loss is a lot like blogging or creating a YouTube channel: anyone can start a diet and lose some weight, that’s easy. The trick is to keep going. And that’s especially true when you are no longer seeing the results you want.

Early December. Hm.

UPDATE: I unexpectedly have an update to this article just a day later. You can read on in Quick Check-In Follow-Up (Premium).

I go into each of these articles with a sense of dread and need to stress that none of this constitutes advice as I am unqualified to deliver that. (And I know that bit about cholesterol will be especially controversial in some circles despite the evidence.) But as always, this is just a record of what I’ve done and am doing, and the only recommendation I can and will make to others is to do the research and work proactively with your own doctor. Health isn’t a moment in time, it’s a lifetime. And many of us have to work on it, especially as we get older. Only you can do that work.