From the Editor’s Desk: Halfway (Premium)

Last Monday, we flew home from Mexico City. And last Tuesday, I went back to my doctor’s office for a very different kind of appointment than I am used to.

(I promise this column isn’t going to turn into Paul’s health weekly. But this was kind of a big milestone.)

A quick recap: in early June, I visited my doctor with an agenda: I had been overdue getting complete blood work done, and with those results in hand, I went in determined to advocate for myself and do the right thing for my health. Key among my concerns was my blood glucose levels, which had been borderline high my entire adult life, and I wanted to get a continuous glucose monitor so I could see which foods triggered the worst glucose spikes and avoid them. I was also planning to continue my intermittent fasting (I skip breakfast most days) and transition to what I think of as a “healthy low carb” lifestyle, and see how different foods things impacted my glucose, and, more generally, my overall health.

I wasn’t able to get the monitor because our broken healthcare system requires us to have a disease, in this case diabetes, before qualifying for such a thing. So I eventually just paid out of pocket by joining a service called Veri for three months that would prescribe me the monitors. And then I set out to lower my blood glucose, which is measured continuously by these monitors (each lasts two weeks) and then (normally) once every year via an A1C test at the doctor’s. Using the actionable data provided through the hardware and an online service, I at first experimented by just eating normally. And then I started on my so-called “healthy low-carb” transition, which is basically keto (high-fat, low-carb) with healthy greens/vegetables.

(I also read Gary Taubes’ excellent The Case for Keto: Rethinking Weight Control and the Science and Practice of Low-Carb/High-Fat Eating during this time and recommend it to anyone who has trouble losing weight.)

And then we went to Mexico. This is an interesting place if you’re trying to avoid carbs, given the population’s fixation on Coke, sugary processed foods, and tortillas. But I don’t eat those kinds of things that much anyway, and my adjustments were minimal. I got a few raised eyebrows and one outright laugh, but my requests for food “sin pan” (without bread), “sin papas” (without potatoes), “sin tortillas” (you get the idea), and so one were all granted. Hamburgers without bread. Tacos without tortillas, just on a plate. Skirt steak with the mole sauce but not the tortillas. Guacamole with a fork. Whatever.

Something interesting happened. My daily average blood glucose levels went down from just over 100 mg/Dl to the 90s. And then even into the 80s, though I’m now kind of back in the low 90s. My wife commented that I looked thinner, and then said something she had also said back in 2017, when I lost 35 pounds on keto: “I can feel your ribs.” My belt tightened by one loop. And then two. My shorts kept starting to fall down as we walked no matter how much I tightened them. I was clearly losing weight.

But how much weight? We don’t have a scale in Mexico City and I’m pretty sure I would have otherwise been compulsively checking it, just as I did do with my glucose levels. But it was better not to obsess over it. I felt good, and that was enough for the short term.

And then it was time to come home. I had mixed feelings about this as I often do—my wife and I would like to spend more time in Mexico City than we can, currently—but I had very certain feelings about something else. For the first time, perhaps ever, I wanted to go to the doctor. I could tell I wasn’t going to get bad news.

And so we went, my wife and I, in part because I wanted my doctor to hear a different voice from mine about what we had done, one that might be more critical or honest. (Despite being nothing but honest with my doctor, I have this long-running theory that doctors don’t trust patients because people lie about their health so much.) After checking in and sitting down in the waiting room, a nurse I’d interacted with a lot came in to call on someone else, but our eyes met, and her face lit up, and she smiled at me. And when she came back and called my name, she blurted out, “I could see it the second I saw you: you’ve lost weight haven’t you?”

It’s hard to explain how much this meant to me. I said, “Yes, I think so,” and as we walked into the examination room, she directed me to get on the scale immediately. Then she whistled.

I had lost 25 pounds. In just under two months, though most of the work had happened in the previous 6 weeks or so. She also checked my blood pressure: a healthy and normal 120 over 73 mmHg. The nurse was almost more excited than I was, and it suddenly occurred to me that these poor people must spend entire days hearing and then delivering mostly bad news. This win, temporary and ephemeral if I don’t keep it up, was a big deal to me. But it was clearly a big deal to her too.

And then for my doctor as well. I don’t get a lot of smiles in the doctor’s office, but I did that day, and she told me that the weight loss was fantastic and to keep up whatever it was that I was doing. She excitedly offered to give me a new A1C test right there, but I told her I preferred waiting for early September, since that test covers the past three months and early September marks the three-month mark from my last A1C and complete bloodwork test. She agreed and scheduled a test and a follow-up to go over it, practically beaming at me.

Sitting there alone with my wife for a moment when the doctor left to go grab some printouts, I finally blurted out, “Just to be clear, this is not how these things usually go. Hell, I don’t recall it ever being like this.”

And to be clear with you, I know the caveats here well. That the first month or so is easy and that subsequent months will show less weight loss, and then much less, and then probably none at all. I know that I will plateau, and that there will be struggles. I’ve done this before, I get it.

But the difference between this time and my keto experience of 2017 is multi-fold. For starters, I’m doing this with the oversight of a physician I trust. I will be regularly retested (I’m thinking once every three months for now) to see how my bloodwork and glucose levels change over time, and to make sure I’m not missing some crucial nutrients or experiencing a deficiency (though I am now taking a multi-vitamin too). I’m also seeing regular metrics for comparison purposes, including the continuous glucose monitor for now (though I’ll be done with that, for now, in about a month), monthly or quarterly weight check-ins, the exercise and health data from my Fitbit, and so on; in 2017, I was basically just winging it.

And we will see. But I do expect progress. Maybe not regular, linear progress. But progress over time.

And it is interesting to me that my wife, who is thin and healthy in ways I am not, has observed my progress, watched what I ate—and did not eat—every day, and saw the reactions in the doctor’s office last week. And she is adopting the same high-fat/low-carb eating style to see what impact this might have on her own health. She had asked me in Mexico whether it would bother me if she ate tortillas or whatever—no, not at all—or whether I missed any particular foods. And the only thing I miss, really, is bread, but even that isn’t hard to avoid, and you miss it less when you don’t eat it. That’s how carb addiction works. Anyway, I knew she’d be supportive, but I didn’t expect her to even want to join me in this.

Whew.

25 pounds is halfway to my internal—and now explicitly stated—goal for weight loss. The other half will not come in six weeks, or in two months. It may never come at all, I guess. But I feel like it will, and I will continue doing what I can to get there. And maybe beyond.