Maintenance strategy

!st day of maintenance!  

In short, here is my starting plan:

• Weight range target:  120-130 (currently 125 whohoo!)  Of note, I have a body composition dexa scheduled in Jan which may refine this. 
• Calorie plan: go up about 100 calories/day
• Food content plan: move out of ketosis. I'll add carbs in the form of whole foods, mostly vege's.   I think moving out of ketosis will cause some water weight gain. 

Any feedback welcome!

Below is a freakishly long back story that might be interesting to a minority

My cholesterol shot up between the 6 and 12 month lab work.  My cholesterol has never been affected by my weight, not even the last time I was at a healthy BMI.  My LDL (the bad) typically runs 140-150, which is elevated but not enough to get me treated with meds.  

The 12 month LDL was a freakin high 437!  My total was 497!  HDL was a bit low at 45 (normal for me) and trigs were fine at 75.  

The huge irony here is that I am a credentialed lipidologist (yes! that's a thing!) which means I am who a patient  sees when cholesterol is abnormal. When I saw those crazy numbers it put me into a state of inappropriate giddiness that rendered me useless at work for the rest of the day.  

After repeating the cholesterol tests and ruling out the usual reasons for a rapid rise in cholesterol, my pcp referred me to the other lipidologist in our system.  Her first clinical insight in email was "OH MY GOD! I have NEVER seen anything like that! Are you ok?" She was inappropriately giddy, too! We are lipid nerds. 

In the absence of the usual causes, this extreme change in LDL cholesterol is pretty much unheard of. My buddy lipid nerd and I both think that there is a hefty amount of genetics (maybe more than one type) that were triggered in response to VSG dietary changes.  For what it is worth, my bariatric surgeon/program has never seen anything like this. 

There is decent clinical evidence of very high LDL in anorexics but you still have to have the right genetics for it to occur. It isn't hard to imagine my body thinking I am anorexic.  When anorexics "refeed" (a horrible term) their cholesterol returns to normal.  If they don't refeed, they are treated with medication although it isn't known if this population really has elevated heart attack/stroke risk.  

The impact of a ketogenic diet on cholesterol numbers has not been adequately studied for me to say anything backed by science.  However, from a theoretical standpoint, there is a way for ketones to enter the cholesterol synthesis pathway which (again) could be exaggerated by underlying genetics.  For the record, even tho I was eating low carb, my diet was not high fat so my numbers were not driven by bacon 

We are hoping that eventual increase in calories and getting out of ketosis will reset me back to my normal.  Mutually, we decided not to use medication. The deliberate decision not to use medication in a setting of total cholesterol of almost 500 feels reckless and gave us both fits of the giggles.   

If you made it to the end, I proclaim you a junior lipidologist!

Shel

First of all, congratulations again for your achievement!!!  The journey begins and you are being very wise, I think, in your approach.

Second of all, now that you have accorded me the position of being a junior lipidolgist, all I can say is Wow!!!  It will be interesting to follow up and see what transpires.  

All is well here food wise.  Not one iota of moving the bones though unless you count rearranging a bedroom that entailed a LOT of 'discussion'.  

Scale down .5

Happy Sunday everyone.

Fascinating Shel! I actually worked closely with a lipidemiologist (MD), a RD, a RN and a pharm D in our COURAGE program - program based off of the COURAGE clinical trials. Our role in the program was to exercise test the participants (usually a treadmill test) and then set up an exercise program for them. They had repeat treadmill evals at 6 and 12 months and met with us every 3 months to discuss progress. Sadly, the program did not make us any money (not reimbursable) and is now defunct. I am a full fledged cholesterol nerd, no Jr. about it!

My surgeon took me off Atorvastatin 40 at the time of surgery - surgeons love to be able to say the surgery allowed the patient to get off XYZ medications. I had lost 100 lbs. in the past and had told my surgeon that unfortunately my cholesterol levels didn't really change much and I wasn't able to go off them at that time. One month values actually showed improvement in my lipids (probably from the essential starvation diet the first month post-op) but by 6 months they had gone up too high again - all except for my triglycerides which were 33. I have been back on Atorvastatin 20 since then. I will have a re-check mid January - anxious to see where I am at then.

I can't believe your LDL was 437! Yikes! I would think genetic factors for sure. I know mine is somewhat genetic related as well.

It will be fun to follow your numbers and see what if anything they will do for you!

Bummer that you had to restart the atorvastatin.  But, as you know, that isn't unusual.

As a fellow lipid nerd, here is another detail.  I had NMR advanced lipid testing done and the ldl particle was somewhat discordant with ldl-c.  I still had a boatload of particles but it would have suggested an LDL-c of about 300 rather than over 400.  Apparently, LDL-P is generally quite discordant in anorexics but generally concordant in ketosis. Someday, I will see if I can find the studies where those results are reported just for fun. We have no idea (and will never know) what it means that mine wasn't all the way concordant or discordant.  

I have not had the advanced testing - would be fun to find out though! Just for fun, I think I may schedule a bod pod analysis. I think the only DEXA scans in the area are for bone mass - not sure if locally people are trained to determine % body fat. Love science!

Very interesting stuff Shel on the cholesterol. Mine was always 260-280 with the LDL being high. I took statins for years. Had the muscle ache side effect but didn't realize it until the dosage was upped. I always thought the aches were due to being obese. I think taking the statins actually made me fatter because it hurt to move around.  Anyway I went off the statins before wls.  After wls, my cholesterol dropped some and at some point I started taking fish oil twice a day.  My total cholesterol is still high - maybe 230 but the HDL is as high or even greater than the LDL. My doctor says he has never seen that but thinks its ok.   One year I did an experiment and ate no eggs or shrimp and other supposedly high cholesterol foods. It make no difference. So I guess i attribute the dramatic increase in HDL to the fish oil plus overall healthy eating. 

Anyway, I find all this stuff fascinating and look forward to hearing how it all goes forward.     diane

Latest studies show dietary cholesterol doesn't really affect lipids so much - so go ahead and eat your shrimp and egg yolks - great low fat, lower calorie protein choices! Fish oil capsules have not been show to reduce incidence of heart disease but have some other health benefits - I quit taking them per my cardiologist but do include fatty fish, mainly salmon in my regular diet.

HDL will increase with weight loss and exercise and cessation of smoking. Mine increased just a smidge with increased exercise level and weight loss but not what I would have hoped - dang genes!

First order of business today is a huge shout out to Michelle in reaching GOAL.  AT CHRISTMAS, no less!  You've done an incredible job so far and I'm thrilled you're part of this group.  I know very little about lipids - cholesterol as I have no family history of issues. Fascinating findings and convo though!!  

A suggestion on upper weight - 128 might be easier to manage.  Personally, when I hit my upper limit I always diet down a little past my goal weight, which means I'm looking for about a 5 pound loss.  After the first magical year or so in  maintenance when I lost weight very easily, I've found it me takes me about 6 weeks to lose 5 pounds (with 500 calorie daily reduction) and that's about as long as I ever want to be back in diet mode.  Yes it was really easy to return when I was new to maintenance, but as I get further out I find it more daunting, so about 6 weeks of weight loss behavior feels achievable.  

I haven't weighed for the past three days and I'm sure my scale has little positive to report. Husband's family left yesterday with no one maimed or killed so that's success! Interesting emotional reaction on my side. It was after they left that I got rather binge like. Drank several alcoholic beverages and ate a lot of sweets. I think it was when I could finally let my guard down and soothe myself, even though my soothing technique was not a healthy one. 

Today I remain in my jammies.  Still not tracking my food but for better or worse I'm continuing to give myself room to breathe so I'm not fretting.  My food choices look a little better but I'm still seeking that full feeling today.  Old comforts don't die easily, even if they're seen less often these days! And it physically hurts too!  

Wishing all of you a calm and peaceful Sunday.

Glad you survived the relatives and can now relax some! Interesting that it takes about 6 weeks to lose 5 lbs. - sounds about right but also sounds like a long time. How come it only takes a week to gain that 5? Lol!

Lol gaining 5 remains incredibly easy!  And yes the 6 weeks accounts for -3500 reduction weekly and includes a few days of slightly higher (maintenance level) calorie intake.  

So basically it's the old 'rule' of it taking 3500 cals to gain or lose a pound. For me it's largely true. And the weight loss stair steps too. I might not lose any weight in the first few weeks and then I see a better loss. 

Hard truth - the further out you get, the harder it gets to stay in weight loss mode!  In my opinion, you need to keep those time as brief as possible (while minimizing hunger and deprivation) to ensure you don't procrastinate (procrastination usually leads to additional pounds).  

So kudos to Kairk for losing so much weight so far out from surgery. That takes tremendous commitment.  I bow down to you my friend.