WHAT ABOUT ME?

I don’t have any fear whatsoever about how I will behave when I approach my target and start lifting my foot from the diet pedal.

It’s going to be manageable, because I know my head is now sufficiently together that I’ll be able to control the transition from a very low calorie intake to a moderate and reasonable, well balanced, carb-sensitive intake ( and hopefully without me becoming too obsessive about the thing). What I’ve learned is the simple and undeniable lesson of the scales: whenever that figure shows an increase, however small that be, then it’s up to me to control the input until the issue is resolved. Nothing more complicated than that. Is it?

However, one thought that’s nagging me is this: given that I reach my target, and I maintain that successfully and painlessly for a while, say, for instance, I go on holiday, eat reasonably but perhaps a little more freely than usual, and get back to discover a ten or twelve pound gain. Yes, I’m confident that I could adjust my behaviour and pull that weight down, but I’m worrying about what my body might at that stage be telling me. Ultimately, I’m worrying about what my body might already once have told me, a message I might not have been prepared to receive and understand.

And I’ll say right here that if some of what follows appears to contradict in part what I wrote slagging nutritionists in my last post, well, that’s how it is. When I write these things I’m usually feeling white hot and passionate, an evangelist for my cause (which is ultimately, selfishly, focussed primarily upon my own weight loss and reclaiming my own health: how could it be otherwise, though I’m happy for everyone that reads my rantings to reclaim their own health as enthusiastically as I race toward my goals). The trouble is that, enflamed though I be, much of the time I’m groping my way in the dark, armed only with scraps of (frequently imprecise or conflicting) information to guide me, the experience of having gone through this process once before and knowing the what (if not the how) of the likeliest pitfalls, the determination not to have to endure this again for ANY reason, and an intelligent instinct which I just hope isn’t leading me astray….

So, what’s this caginess all about? Why am I coming among you today less than Bible-thumpingly positive than usual?

Because I’m a bit worried and a trifle scared, and it’s time I owned up to it because it’s a fear that isn’t going to go away, I don’t know if it’s really real, or whether I’ve managed to convince myself there’s a bogieman in the cupboard. But I am worried in case there really is a bogieman in the cupboard. My cupboard.

One of Neil Young’s greatest songs is The Needle And The Damage Done, which is Old Neil’s song about Crazy Horse’s Danny Whitten’s descent into heroin addiction and ultimately death. (The video, by the way, is taken from The Johnny Cash Show in 1971). Well, there’s no way I’m claiming parity with any of that, but there are words which keep going round inside my head, with a rising, interrogative inflection: ‘the diet and the damage done?’ I wonder……

We all know that most weight loss projects crash and burn. Either people don’t get where that wanted to be, or they get there and yo-yo back to and usually beyond where they started from. People like me, in fact. I eventually ended up a sickening 84lbs heavier than before I started shedding weight. There’s plenty of research out there suggests this happens to more than 90% of slimmers, with all the weight and more coming back after a period (typically between two and five years), and with that increase increasing each time we complete the circle. OK, so this time I have to be in the less than 10% that succeed; that’s obvious. Same for you, right?

So how can we make sure that happens for us?

For a start, we need to make certain that, while we’re on our way down, we do not use our diet programme either to lift us out of or immunise ourselves from our regular daily life, using it as an excuse to disengage. Instead we would do better to be upfront about it and consciously integrate our diet into (and thereby fundamentally amend) our established way of life. You know, the same one that got us fat to start with!

For instance, look on any weight loss forum, and you’ll see panicky messages like one I saw yesterday which said, ‘I’m doing the Atkins diet, but my boyfriend wants to take me to an Italian restaurant on Saturday. What can I do?’ We all recently had a bout of heart (and conscience) searching over how we would handle the Christmas / New Year festivities. These seemingly big events are really part of what we do, regularly: there’s nothing big deal or exceptional about them, except they appear to rub up against and threaten the strict dietary precepts we’re struggling to maintain, whereas in reality it’s just a management and information thing, non-threatening and easily dealt with.

OK, so we might have an issue here regarding perspective that needs to be addressed. Because what it suggests is that we haven’t yet successfully completed the shift in our perception, understanding and feelings regarding food in order to have completely changed and rebalanced our relationship with food. I suspect that most of us (me included) never will; not completely. We’ll never be rid of our addictions and instead must prepare ourselves for a lifetime not of abstinence, nor of denial, but rather of vigilance and care.

Otherwise when your foot does come off the control pedal, we’ll just drift back to our old ways and we’ll start to gain again, and we’ll be back with the same old lies, justifications and delusions. Pointless. It’s like the worry I’ve had about VLC diets like LighterLife (much as it’s been wonderful for me), where you get isolated from normal eating for the abstinent period of your weight loss, and it’s then up to your counsellor to help manage you back to a new and dramatically improved eating regime as you gradually (and often gingerly) step away from the powders.

It more and more strikes me that managing that transference, if I dare borrow and mangle a concept from classical Freudian psychiatry, back to sustainable, healthy moderate eating is by far the hardest part of the jigsaw: also the most important. But are we perhaps playing a game where the dice are loaded, and not in our favour?

I’ve written at length before, and doubtless will again, that a major key to successful weight loss is much more to do with what’s going on in your head than what’s going in your mouth. How? Well, what you put in your mouth is a direct function of the decisions and choices you make in your head. You choose what to eat, and it helps if you understand why you make those choices, both the good ones and the really bloody disastrous ones. Of course, the trouble is that some of what goes on in there is really deep-rooted and unconscious. It’s unsettling to realise that there is little more occluded from us than things going on inside our own brains, and that we are being driven to action by forces which are inside ourselves and frequently battling against our own perceived better interests. Having written that last sentence, I look at the word ‘unsettling’ and decide that’s one of my all time great understatements. This stuff is scary.

We can each of us analyse it plus or minus to the best of our own abilities, but really being confident you’ve got this one licked requires a degree of self-knowledge only a few of us can muster, or probably would want; and even then we might be missing a really crucial trick, as we’ll see later. On the top layer, then, I am confident, so far as it is within my control, that I’ll be able to manage, but equally I know it’s very likely to be an ongoing struggle. I’m certain I’ll never be able to let slip the reins, kick back and relax (don’t do it!). Back to the Paresh Principle, mentioned at length in earlier posts: my mate Paresh has maintained his weight all these years by SDCM, self- control, discipline, and motivation, and it’s a pattern I know I have to emulate. It’s the only way I can even hope to keep those demons secure in the corral and prevent myself from laying down more fat stocks all over again.

I have to stress that what we end up eating is one of a large and inter-related number of lifestyle choices, including becoming less sedentary, and we have to become much more conscious of how they’re inter-related and the way consequences of one chunk of behaviour manifest themselves elsewhere.

Successful long-term maintenance of weight loss requires that we understand how to avoid putting ourselves unprepared into situations with the potential to start us spiralling out of control. For my part, there are things I will avoid for the rest of my life, from MacDonalds to alcohol and umpteen unsavoury stops in between. Except, truth to tell, every second Saturday morning around 10am, I pull into MacDonalds at Eye, just outside Peterborough. en route to visiting my mother. I invariably order up a large coffee, no milk, no sugar. And that’s all. Their coffee (in the UK, at least) is very good, and it’s a convenient place on the journey to pause for a minute or two. I certainly never hear myself ordering up a Big Breakfast or a Sausage and Egg MacMuffin to accompany my tasty beverage. I simply don’t want their foul food. It doesn’t cross my mind that I might. It’s a useful little test, though. Long may I continue passing it!

But I seem to be avoiding talking about this bogieman, don’t I? I’ll press on. Bear with me.

So, you have to change your behaviour to lose weight, and amend your lifestyle to keep it off. I have advocated, and still do, radical dieting, because I believe it’s important for our fat person’s self-esteem and motivation to pile in hard and see ongoing and substantial results in a reasonably short period of time. As I wrote in my last blog, with the 224 lbs I had to lose (just over half gone, now!), it would have taken me a decade at the rate a nutritionist advised to reach the weight she was telling me I needed to be. Didn’t make sense. Hence I continue to walk (or rather trot down) the radical road. I also mentioned in my last blog that I’d had really nasty pancreatitis some years ago. I was told at the time that the pain levels associated with that particular illness are as bad as it gets, on a par with (quote) ‘some cancers and major abdominal gun-shot wounds.’ Pain relief was something of an issue. The staff at the first hospital I was in were incredibly stingy with the injections because they didn’t want me to get addicted to morphine, irrespective of the fact that I was suffering in mortal agony I can not begin to describe. When I was transferred away from their dubious care to the hospital which actually cured me, and to which I am ever indebted, the attitude was ‘you’re in agony and will be for some time while we get you sorted out. Take all the pain relief you need. We’ll deal later with any problems arising.’ It’s a similar deal with the diet: get the weight gone, tackle the lifestyle changes to help ensure it works. Kushti?

So what is it I’m worrying about with this ‘the diet and the damage done’ stuff?

I’m concerned that I might, in my ignorance, have exposed myself to a couple of significant problems, most particularly that I might have done some long-term damage to my metabolism as a result of switching on the so-called starvation response. Since I have now twice severely restricted my calorific input, this handy primeval survival mechanism has, presumably, kicked in and as a result my body no longer needs the, say, 2500 calories it once required every day in order just to maintain a steady weight. The problem is, if this mechanism is in operation, I don’t know how to switch the bloody thing off again when I approach my target! So, target is achieved, I resume regular eating, and, even allowing for SCDM, I come out of my comfortable ketosis and, as a direct effect of the continuing starvation response, I wake up to encounter an ongoing and nigh irresistible heightened craving for highly calorific and probably sweet foods? Is this what I have to look forward to?

Given that I’ve already done this weight loss thing once, and then stupidly increased my weight subsequently, could it be that my dang fool metabolism never reset itself back to its default position? Was that in itself sufficient to open once and for all an unclosable door and to propel me through it to ongoing record fat and weight gain?

To extend my paranoia even further, could it have now happened that, by engaging in a second bout of radical weight loss for a lengthy period, I might have depressed my metabolism still further from an already low level? And how reduced is reduced, anyway?

I don’t know, and I don’t really know that I want to know. [Yes, I do. Ed] I do, however, know that it’s of significant concern to me, and in the dark moments it’s just not the same as hearing my reassuring confident, competent gastroenterology consultant all those years ago telling me not just relax and that we’d ‘deal later with any problems arising.’

Everything I said at the beginning of this about how I was confident I could manage to maintain once I reached target? Whistling in the dark, really. I’m absolutely not prepared to let myself yo-yo, but could this end up being a real struggle for the rest of my life? My homo sapiens head is definitely in the right place to get the weight lost once and for all, but could it be that there are things happening deep down in my lizard brain which are working away trying to subvert my good, conscious determined intentions. And how the hell do I fix that one? Got a pill, anybody? [Note to self: much more research called for. Get digging! In the alternative, see below.]

I used to have an Irish consultant geriatrician friend who counselled her heavy old customers that ‘there were no fat people in Belsen, you know’, which I translate as meaning ‘eat less, you greedy gobshite’. Very to the point – and downright tasteless - some doctors can be; but that was her regular line, so I report it. (Which reminds me of a joke I was told by a nurse whilst she was curing me of the pancreatitis: Q. What’s the difference between god and a doctor? A. God doesn’t think he’s a doctor.). I also used to have as a client a charitable organisation which provided residential care for elderly Jewish survivors of the Nazi death camps, many of whom I met over the years. I remember only one of them being fat. The rest were frail, elderly, but quite evidently regular-sized. Surely – apart from every other consideration - their dietary privations, over an inconceivably longer period than mine, were incredibly worse than what I am voluntarily putting myself through: their starvation responses would very much have been switched on. Am I worrying myself about nothing? Then again, my father-in-law survived the Soviet Gulags (wasn’t the last century a corker, eh?). It was every bit as bad as you’d read in Solzhenitsyn (if anybody these days still read Solzhenitsyn. We should). Now, Władek, bless him, did have weight issues and he eventually developed diabetes. Lived in freedom until he was 84. But equally I met plenty of his old Polish Air Force pals who never plumped up, and these were blokes that loved to eat and who certainly knew how to drink. Polish spirit, anyone?

Where to turn? So I continue worrying…. but I remain completely determined to do whatever it takes to avoid that accursed weight gain rebound. Remember, one of the aims of this blog is to hunt down effective strategies to ‘kiss goodbye to yo-yo you. Yo-yo me, too! And this point’s really got me pondering.

Then again, it appears there is a serious body issue beyond my control which, irrespective of my intention and behaviour, is likely to determine whether or not I’m going to start piling the pounds back on despite my will. According to a study recently published in the Journal of Clinical Endocrinology & Metabolism, we’re talking here about my levels of the appetite-related hormones leptin and ghrelin. Which is interesting because I’ve only lately learned that I have leptin and ghrelin at all.

Now, however, I am absolutely desperate to have low leptin and high ghrelin. They are this year’s must-have levels. Quandry: should I rush round to the doctor now and get my bloods done? Can’t do anything about it, but at least I’d know where I stand (or fall). As Neil Young’s compadre Stephen Stills wrote all those years ago, ‘paranoia strikes deep’!

Apparently we each respond to this potential rebound thing in a way which is ‘predetermined by (our) own characteristics.’ Handy.

Ana Belén Crujeiras, lead author of the study and a doctor at the University Hospital Complex of Santiago tells us that ‘Some obese or overweight patients who gain more weight following a diet could even be identified before they embark on their weight-loss therapy, just by looking at their plasma levels of these hormones.’

Now she tells me. So much, potentially, for my good intentions….

Doctor Crujeiras goes on to explain that more exhaustive studies in the future should result in the ability to design individual weight loss programmes which would guarantee no more yo-yoing, assuming the punters ate sensibly thereafter. I.e., like what I’ve already committed to do (is there anyone up there listening?).

Which is all gung-ho and jolly dee for the future but, bloody hell, WHAT ABOUT ME?

Till next time,

Your panicky old pal,

Fred