Occam's Razor

One year later: my healthier living update

About a year ago, I wrote that I would periodically keep you abreast on my journey of weight loss and healthier living. (Actually, I wrote this mostly to remind myself so I would not slip.) Based on previous attempts at dieting, I discovered a truth: taking weight off is relatively easy. Keeping it off is harder. So how am I doing a year later? How am I doing after about nine months of Weight Watchers, giving up Weight Watchers because I wasn’t learning anything new and am now all on my own? Did I balloon to the size of Orson Welles (or for that matter Kirstie Alley)? Did I make it back to the same weight I was at when I was married and was a skinny thing? Did I yoyo back and forth? What great wisdom have I learned that I should share with the rest of the world?

A year later, I find myself within a couple pounds of where I was when I left Weight Watchers. That part is good. When I weighed myself on Monday, I was one pound above what is considered a healthy weight for my height. That part is not ideal, but being one pound overweight is better than being twenty three pounds overweight, which is where I was when I began my journey in January 2009.

So I can say I succeeded, with an asterisk. My goal was always to take off a chunk and then maintain it, since that was where I had failed many times before. The asterisk means that I slipped a bit. Over the holidays, I indulged too much, exercised too little, and not coincidentally, I also picked up five pounds. I knew what to do (start counting using Weight Watchers points again) but it took me a month or so to find the wherewithal to do it. When I did, it worked reliably again and the pounds came off. Yet, once I lost the few pounds I put back on, I found little incentive to keep reducing. Getting back to the weight when I was married continues to be an elusive and perhaps not very important goal.

Nevertheless, maintaining a near healthy or healthy weight for a year is a genuine accomplishment. I went back to some bad habits, but not all of them. When I wasn’t counting points on a sheet of paper, I had a good idea how much I could realistically eat and not gain weight.

I am usually fastidious during the week. For example, for breakfast this morning, I had one cup of Cheerios with skim milk and a cup of blueberries. This carried me over nicely until lunch. I packed a banana and a cup of grapes to have with lunch. When I eat at the cafeteria at work, four times out of five I am getting a soup and salad for lunch. It’s nearly automatic. My sweet tooth will not wholly be denied. I try to fit in one chocolate treat, which often means a bag of Dark Chocolate M&Ms, a favorite. My salads are quite low fat and full of healthy vegetables. I skip salad dressing and garnish the top with just a little cheese. Dinner, at least when I am eating alone, often consists of an entrée of from the diet part of the frozen food aisle. Lean Cuisine gets a fair amount of my business. Many of their entrees are quite tasty and reasonably healthy. (I particularly enjoy their Shrimp and Angel Hair Pasta, one of the best diet entrees ever, except for the sodium.) Their main value is portion control. I may supplement it with some bread, add in a banana or some other fruit. If my sweet tooth calls, have a 1-point Weight Watchers Fudge Stick.

On the weekends, I am more lax. On my Fridays off, my wife and I still engage in the fatty practice of breakfast at Silver Diner. Once or twice a month doesn’t make it a bad habit. Instead, it’s a treat. Otherwise, I have given up most restaurant eating. Recently, someone at work has been leaving out chocolate Easter eggs and I confess it is hard to pass them by without doing some grazing. I do binge at times, but not egregiously.

Over the last year, I have also been challenged by other physical problems. It is hard to follow Weight Watchers when you are having vein or tarsal tunnel surgery, and two hospitalizations these last two months hasn’t helped either. It is much easier to be good when your life is not topsy turvy.

My doctor is still not happy because my cholesterol level is still elevated, but not dangerously (110 bad cholesterol). He would like me to eat a lower fat diet than I do, but my diet is markedly lower in fat than it used to be. It would be difficult to excise too much more fat from my diet, but if driven by necessity I am sure I could. In my near future, I may end up on statins or other drugs to reduce cholesterol. Over the last eighteen months or so, I have also developed an irregular heartbeat. It is likely though that dieting has reduced heart problems rather than caused them.

My exercise is reasonably consistent, but at a lower level than when I weighed twenty pounds more. When I ate too much, I tried to make up for it by exercising more. Exercise is still a good idea, and I typically hit the health club three times a week as well as walk up many staircases. While beneficial, if you want to maintain a healthy weight, excessive exercise has no particular advantage. If anything, burning those calories makes you want to eat more. One of the lessons I have learned is that although you need enough exercise, you do not need to go overboard. If you are concerned about having and maintaining a healthy weight, calories matter more. In general, Americans consume far more calories than we need. I have trained myself to demand fewer calories than I used to. If you are struggling with this problem, I suspect you can too.

So here’s to me and my mostly successful first year, and here’s hoping a year from now if I write about my adventures in healthy living and weight loss again, I will at least be where I am now. Perhaps I will find the impetus to take off another fifteen pounds and literally be the man I was when I was married. It would make a good goal for my 25^th wedding anniversary in October.

May 12th, 2010 at 07:38pm Posted by Mark | Life 2010 | no comments

We have to go, and go, and go

Friend, do you suffer from BPH? If you are female, I can definitely say no. For you have to be born male to get BPH. Men generally discover by the time they are forty or so one inconvenient truths about middle age men, specifically they cannot get through the night without shuffling a couple times to the bathroom to go Number One. If this sounds like you, congratulations, you are a normal middle-aged male. You also have Benign Prostatic Hypersplasia. With a name like that, you can see why urologists prefer to say you have BPH.

If you have BPH, your prostate is swelling to an inconvenient size. This is good news in a way because it means you are still producing testosterone. It also probably means you do not need to reach for Viagra in order to be intimate with someone. Your prostate is swelling because testosterone is causing your prostate to create something very similar, DHT or Dihydrotestosterone. Your prostate has been producing DHT since puberty, but over time, it has the side effect of making your prostate swell. Your prostate is a gland that provides most of the fluid when you ejaculate. Your prostate is also inconveniently located just below your kidneys. When it swells, it tends to constrict the urethra, making it harder to go and also harder to fully empty your bladder. So your bladder rarely fully empties, which means you tend to go more often and when you go it can take a while. This condition can also contribute to urinary tract infections.

I, like most men my age, feel part zombie because my bladder inconveniently wakes me up throughout the night. On a good night, I will only shuffle to the bathroom once. On a bad night, it can be up four or five times. I must have developed BPH at an early age because this has been a problem of mine for at least twenty years, and I am 52. It generally arrives in men by age forty, although it may develop so gradually that it seems normal, which in fact it is.

The good news is that if you suffer from BPH you probably do not have prostate cancer. That’s why it’s called benign. If you are a smart man, you will have regular physicals. Your doctor will place his fingers into your colon and feel your prostate. It can be enlarged, and if it feels smooth like a balloon that is good. If when he presses on it he detects nothing hard, it suggests there is no cancer. That won’t solve your frequent urination problem, however.

I learned all these things this week because my employer invited a urologist over to talk to us about BPH. She came with all sorts of very clinical illustrations and actual pictures taken at Reston Hospital by special cameras that slide up your urethra. The lecture was actually interesting. Just as interesting as the lecture was listening to my fellow middle-aged men in my room. It is nice to know I do not suffer alone. This is not the sort of thing guys tend to share with other guys, or even their significant others. I am sharing it here in part to spread enlightenment.

Moreover, at least the men who attended the lecture are not morons. Many men avoid physicals simply because they want to avoid the prostate examinations, which can be embarrassing and uncomfortable. Sensible men, like those of us at the lecture, realize we have a condition. We also know that prostate cancer affects most men in life, although many die unaware that they have it, as in most cases the cancer grows very slowly. We do not consider ignorance in this area a virtue.

These same men thirty years earlier might have been bragging about their bedroom conquests. Now we come with bags under our chins and eyes and receding hairlines (well, not me, at least not yet). It was remarkable how straightforward and clinical we could be in a group setting when given the opportunity to question a urologist at length. Will surgery cause impotence? Will drugs to treat it cause impotence? Can BPH be cured? Do some men not get BPH? (Answer: yes, those who die young and who stop producing testosterone at an early age.) Our main concerns were “Are we likely to get prostate cancer?” and “Will we ever be able to sleep through the night again?”

On the latter question, there is hope. There are drugs to treat BPH of a class called Alpha-blockers. They relax the smooth muscle of the prostate and widen the urethra channel. (Flomax is probably the best known, but ask about Hytrin or Cardura because they are available as generics.) However, they might cause ejaculatory dysfunction. Another class of drugs, the 5-alpha-reductase inhibitors will also shrink the prostate, but not very much, and can cause a diminished sex drive if not outright impotence. For many men, fear of the latter makes us think that getting a good night’s sleep is highly overrated. (On the other hand, our wives may secretly be relieved.)

There are also surgical alternatives, including a microwave procedure and vaporization of part of the prostate with a laser (Greenlight Laser). Some of these can be done on an outpatient basis.

You may also want to embrace a prostate-healthy diet. Unsurprisingly, it is probably not a diet you will like, as it emphasizes lower amounts fats and eating soy. The diet will probably do nothing for your BPH, but it does reduce the risk of acquiring prostate cancer, which for men is something akin to breast cancer in women: to be dreaded and prevented if possible.

If you have BPH, and most men of a certain age do (but may not be aware of it), it’s good news in a way. It means that you are a survivor. A few generations ago, you were likely dead from something else by the time it became a problem. Today, you likely have a few decades of life ahead of you. You just have to decide whether to treat it or not. The condition can become so chronic that you end can up in an emergency room because you are unable to void your bladder. You probably do not want to reach that stage, so at some point you will want to have a deeper conversation with your doctor about BPH and perhaps see a urologist for a better diagnosis. You should also want your doctor to regularly give you a PSA (Prostate Specific Antigen) test. If you are developing prostate cancer, it will probably detect it, plus it can be used to help determine the severity of your BPH.

I know I will be talking with my doctor about drugs for BPH during my next physical. I hope that any side effects will be mild on me. I know I sure would relish a night of uninterrupted sleep again.

October 22nd, 2009 at 10:08pm Posted by Mark | Advice | no comments

The Ten Percent Solution?

One of the reasons to read The Huffington Post is to get your celebrity kicks. I have to confess I don’t care too much about what celebrities are doing, Jewel Staite being the possible exception. Yet, it was on Huffpost that I read about the latest celebrity yo-yo dieter, in this case the actress Kirstie Alley. For a while Alley was a spokesman for Jenny Craig, which was not only financially remunerating for her but also allowed her to lose seventy-five pounds. She eventually parted ways with Jenny Craig to come up with her own diet and sell her own dieting book. She would be wise not to write any for a while. Alley put the seventy-five pounds she lost back on, and an additional eight more pounds to boot, for a total of eighty-three pounds. Now she plans to take it off again and get back to the svelte 140 pounds or so she was when she did Cheers. Good luck Kirstie.

Alley is an egregious example of a yo-yo dieter. She has plenty of company but the rest of us struggle with our weight without the glare of publicity. I too have struggled, though thankfully I never got more than twenty-five pounds above a healthy weight. I have tried a number of diets over the years too, including the Carbohydrate Addicts Diet and the South Beach Diet. For a time, both diets looked like solutions for me too. Both were ultimately a waste of my time and money.

It is too early for me to claim victory. I have claimed it before only to find myself slacking off and find the pounds had returned. However, I have reached a milestone, losing ten percent of my weight in about five months. No, I was not on Jenny Craig, which would make little sense in my case as they market primarily to women. Nor was it Nutrisystem. I am on Weight Watchers. I have this simple advice for Kirstie: if you really want to lose weight and actually keep it off, try Weight Watchers this time. There is no guarantee you will succeed with Weight Watchers either. However, I can say that after following their program these last few months I can see the results on my scale and in the extra number of free belt notches. Moreover, I have a realistic expectation that this time I will keep it off for good.

Here is the problem with virtually all the diets out there: they may succeed in helping you lose weight, but they will do little to help you keep it off permanently. That is actually fine with the diet industry. They do not want you to keep it off permanently. If you do, they have lost another customer. No, they would much prefer you take it off, get sloppy, put it back on, then give their diet another go around. If you cannot, well, there are plenty of other diets to choose from, and they need your money too.

Any diet will let you lose weight if you follow it. Only a few though have a decent track record helping you keep it off once you have lost it. Weight Watchers is a big commercial company too, and I am sure they get their legions of yo-yo dieters too. Nonetheless, if you want to lose weight and keep it off, you should stop the Jenny Craigs, the Nutrisystems and the Slim-Fasts and do Weight Watchers instead. After you lose the weight, you will at least have a decent chance of keeping it off permanently. This is because Weight Watchers is one of the few diet companies out there whose business model involves not only helping you lose weight but helping you keep it off once you have lost it.

How hard was it for me to lose ten percent of my body mass? You might expect I spent much of the last five months eating celery and carrot sticks, but that is not the case. Mostly I ate things I already liked. In many cases I ate less of what I already liked, and changed portion sizes and ingredients so that what I ate was less caloric, higher in fiber and lower in fat. Did I suffer? If I had to rate my suffering level with Weight Watchers compared with any other diet plan, with 1 being no suffering to 10 being massive suffering, Weight Watchers was about a 3. Most of the other diet plans were in the 7-9 range.

How was this possible? Mainly, I watched what I ate, exercised portion control and kept track of what I was eating. With Weight Watchers, you learn to practice a few simple rules like “eat the filling foods first”, manage hunger through small snacks, assess the impact of what you are eating through their Points system, and eat your daily point allocation. If you want to eat more, exercise more. They have a way to calculate your bonus points via your exercise level. There are also extra points you can use over the course of a week on those days when you feel you are suffering too much. Truly, it is not that hard. Are you listening Kirstie?

Since you can eat at least some what you want, you may find yourself like me getting creative. I eat the filling foods first, but I also find creative substitutes for other foods I enjoy. Whole wheat bread is healthy, but still has more calories per slice than I would prefer. A high fiber English muffin though is only 100 calories. Cut in half, with a teaspoon of butter on each half and you have something quite tasty and dense in your stomach for less than 200 calories. It comes down to choices. The big greasy slice of pizza may be out but an occasional Lean Cuisine pizza may be okay. After a while you may find, like me, that you don’t need to count points anymore because you eat many of the same sorts of foods you used to and you know what and how much you need to stay on track. In any event, the weekly weigh in helps enforce discipline that may be lacking. I think it is essential in keeping you honest.

I am not entirely there yet, but I am close to the point where my new eating habits are becoming automatic. I now find that although I could have fancier things to eat for lunch, I want a salad. I can dress it up in a way where it is filling and satisfying. My weight loss coach was very pleased when she recently announced that I lost ten percent of my weight. She said this is a key indicator of people who can develop the habits to keep the weight off permanently. By the way, unlike many yo-yo dieters you should lose weight slowly. About a pound a week is ideal. Have patience. If you lose a pound a week, in a year you weigh fifty pounds less and you are much more likely to keep it off too.

I am planning to keep losing weight even though I passed the ten percent threshold, with the goal of getting my weight down to the day I was married, which was probably the last time I was at that weight. Then I will do my best to stay there. I will use my blog, in part, as a reminder to keep at it.

I hope you can learn from my experience. I think celebrity diets are a waste of time. Find a diet program that works with your eating habits and has some track record for helping you keep the weight off once you have lost it. There is no painless approach to weight loss but plans like Weight Watchers are the only ones that have any realistic chance of succeeding in the long term.

If your freezer is full of food from Jenny Craig or Nutrisystem, you might as well chuck it because these diets at best will only succeed in taking off weight for a while. Keeping weight off permanently and developing new habits, like eating better and exercising more, is what you really need. A diet is only one component for reaching this goal. You need long-term health. This is a completely different game, but it is the only plan worth having.

June 17th, 2009 at 07:32pm Posted by Mark | Sociology | no comments

The Agony of the Feet, Part Two

I am feeling a bit like Peter Pan these days. Peter Pan was the only male I knew who regularly wore green stockings. I understand that during the Middle Age, men also wore stockings. These days though men who wear stockings are either getting in touch with their feminine side or suffering with vein disease. In my case, it is the latter.

The agony of my feet, which I described more than four years ago, never totally went away. In recent months, it has gotten considerably worse. It was manifested in numbness in my right foot (on a good day) or a constant aching and burning feeling in both feet (on a typical day). More recently, it has sent me scurrying to various physicians (podiatrists, neurologists and vein specialists) to see if I can do something about it. I now know that since I have varicose veins I have vein disease. Vein disease means that the veins in your leg have a hard time returning blood from your feet to the heart. It affects many Americans sometime in their lives, more as people age, as you might expect. In the typical case, your legs feel heavy and mostly unconsciously, you spend a lot of time with your legs propped up on chairs and stools. In the latter stages, walking becomes painful and even sitting with no pressure on the feet still hurts. I seem to be approaching the latter stages.

After doing some fancy tests, my neurologist also confirmed I have tarsal tunnel syndrome. It is like carpal tunnel syndrome, except it applies the feet. I also have neuropathies at various places in both feet as well as possibly in my leg and spine. This means that certain nerves are not doing a good job of communicating with my brain. These too are common with age. In many cases, people simply ignore them.

What to do about these conditions? That is still being triaged by my team of doctors, so the extent to which I can find relief is unclear. Vein disease never goes away, however removing veins from the leg usually results in more blood pressure in the remaining leg veins, often alleviating symptoms, at least for a while. Legs in the vein though are not limitless and the veins cannot be restored to normal functioning. At some point you either have to deal with a lot of discomfort or pain or do what I am doing: wear thigh high compression stockings and hope they relieve the symptoms. These compression stockings essentially provide more pressure to the feet and legs making it easier for veins to do their job. This results in less blood pooling in my feet and legs and, I am happy to report, a lot less misery during the course of my day.

Of course, these taupe stockings I now wear are hardly a fashion statement. Fortunately most of the time they are easily hid underneath jeans, but there are certain times of the year when wearing jeans is not desirable. Nor are they terribly comfortable to wear, feeling at times like vices on my legs and itching my thighs. I suspect in time I can get used to them, but I do not want to. Putting them on is quite a challenge and can leave me sweating because they require a significant amount of agility and force. If vein surgery means I can ditch the stockings I am all for going ahead with the surgery.

My mother had varicose veins. To my knowledge, she never had any veins removed, although she probably should have. In her last days in the nursing home she was, like me, wearing these Jobst compression stockings. Varicose veins seem to be largely heredity, but are often manifested by too much standing or stooping. She did plenty of that chasing after my seven siblings and me. She often said we gave her grey hair. It is more likely we gave her the varicose veins.

For now, these support stockings are a relief more than a burden. As annoying as they are to put on and wear around, they beat going around all day with tired, aching and burning feet. As my vein specialist suspected, they are also identifying the root of my foot problems. It appears that my poorly functioning veins are at the root of my tarsal tunnel syndrome and probably helped create my neuropathies. As best I can figure out, because of my suboptimal veins, my legs and feet have suffered from high blood pressure for years, and this has been wearing on the various nerves, bones and tissue in my legs and feet. I still have some numbness in my right foot but I am hopeful that it will recede as vein pressure in my legs improves.

My point in whining about this is mainly to draw attention to vein disease. If you have varicose or spider veins, or find yourself habitually propping up your feet, or your feet regularly feel tired, or worse, numb, aching or burning you should not do what I did and largely ignore the problem until it becomes acute. Rather seek early medical attention so you can avoid neuropathies as you age and problems like tarsal tunnel syndrome. I wish someone had drawn it to my attention. I have been dealing with it so long I assumed everyone propped their feet up after walking for a while. If you spend prolonged hours at a desk or in front of a keyboard, you should also consider footrests for your feet. A combination of these strategies may make your life livable again.

May 30th, 2009 at 11:49am Posted by Mark | Life 2009 | no comments