Weight Loss — If You’re Overweight
To achieve this, weight loss must be gradual. If you are targeted to lose 25 pounds or less, I suggest a reduction of 1 pound per week. If you’re heavier, you may try for 2 pounds per week. If just cutting the carbohydrate results in a more rapid weight loss, don’t worry—just enjoy your luck. This has happened to a number of my patients. Weigh yourself once weekly—stripped, if possible, on the same scale, and before breakfast. Pick a convenient day, and weigh yourself on the same day each week at the same time of day. It’s counterproductive and not very informative to weigh yourself more often. Small, normal variations in body weight occur from day to day and can be frustrating if you misinterpret them. Generally speaking, you won’t lose or gain a pound of body fat in a day. Continue on your low-carbohydrate diet, with enough protein foods to keep you comfortable.
Let’s say that your goal is to lose 1 pound every week. Weigh yourself after one week. If you’ve lost the weight, don’t change anything. If you haven’t lost the pound, reduce the protein at any one meal by one third. For example, if you’ve been eating 6 ounces of fish or meat at dinner, cut it to 4 ounces. You can pick which meal to cut. Check your weight one week later. If you have lost a pound, don’t change anything. If you haven’t, cut the protein at another meal by one-third. If you
haven’t lost the pound in the subsequent week, cut the protein by one third in the one remaining meal. Keep doing this, week by week, until you are losing at the target rate. Never add back any protein that you have cut out, even if you subsequently lose 2 or 3 pounds in a week.*
If you’ve managed to lose at least 1 pound weekly for many weeks but then your weight levels off, this is a good time for your physician to prescribe the special insulin resistance–lowering agents described in Chapter 15. Alternatively you can just start cutting protein again. Continue this until you reach your initial target or until your visual evaluation of excess body fat tells you that further weight loss isn’t necessary. The average non pregnant, sedentary adult with an ideal body weight of 150 pounds requires about 9 ounces of high-quality protein food (i.e., 54 grams of pure protein) daily to prevent protein malnutrition. It is therefore unwise to cut your protein intake much below this level (adjusted for your own ideal body weight). If you exercise strenuously and regularly, you may need much more than this.
Once you’ve reached your target weight, do not add back any food. You will probably have to stay on approximately this diet for many years, but you’ll easily become accustomed to it. If you required one of the appetite-reducing approaches described in the next chapter, do not discontinue it.
*This may not work for girls or women with polycystic ovarian syndrome (PCOS). They may fail to lose weight even on a near-starvation diet (see Appendix E).
SOME FINAL NOTES Reduce Diabetes Medications While Cutting Protein or Losing Weight
While you’re losing weight, keep checking blood sugars at least 4 times daily, at least 2 days a week. If they consistently drop below your target value for even a few days, advise your physician immediately. It will probably be necessary to reduce the doses of any blood sugar–lowering medications you may be taking. Keeping track of your blood sugar levels as you eat less and lose weight is essential for the prevention of excessively low blood sugars.
Increased Thrombotic Activity During Weight Loss
During weight loss, many people unknowingly experience increased clumping of the small particles in the blood (platelets) that form clots (thrombi). This can increase the risk of heart attack or stroke. Your physician may therefore want you to take an 80 mg chewable aspirin once daily during a meal to reduce this tendency. The aspirin should be chewed midway through a meal to reduce the possibility of irritation to the stomach or intestines. Alternatively you can use vitamin E
in the form of gamma tocopherol or mixed tocopherols. The dosing would be 400 mg one to three times daily depending upon your size. It need not be taken during meals, as it won’t irritate your gastrointestinal tract.
Elevated Serum Triglycerides During Weight Loss
When you’re losing weight, fat is “mobilized” for oxidation—i.e., to be burned—and it will appear in the bloodstream as triglycerides. If you see elevated serum triglyceride levels as you’re losing weight, it’s not something to worry about. Your triglyceride levels will drop as soon as weight loss levels off.
Supplemental Calcium May Help
There is recent evidence that calcium supplements (1,000–3,000 mg daily) may facilitate weight loss by inhibiting the accompanying slowdown in metabolism that may occur when you lose weight. As indicated previously, I recommend calcium supplements that also contain vitamin D, magnesium, and manganese. This supplement has also been used to successfully treat the dysphoric mood and carbohydrate craving in women who suffer from premenstrual syndrome.