Walking

Holy crap walking hurts.

OK, so I've been using the FitBit One and coming up with 3000 steps a day, sometimes 4000 steps.  Considering my physical shape previously I was kind of happy.  Then my doctor told me that she wanted me to add about 500 steps a week until I came closer to the 10,000 steps a day that everyone seems to recommend (including FitBit themselves).

Kind of short aren't I?  So, I thought about creating a "route" in my neighbourhood that was about 2 kilometers long.  Not a really long route but enough to challenge me.  It worked out that if I went to the end of the subdivision, turned around and walked back it was almost exactly 2 kilometers long.  So, armed with my FitBit I took my walk.

By the time I got home I was exhausted.  Sweat was poring out of every pore in my body.  My legs felt like they were on fire.  I was freaking exhausted.  Utterly spent.

3000 steps.  

That's what it added to my total.  And people are trying to do 10,000 steps a day?  Seriously?  That's doing this trip at least twice a day (three times on slow days).  I almost broke down and cried at that point.  

There needed to be another way.  So, in the afternoons at work I would leave the office and instead of turning left to go to the drugstore to pick up a liter of water I would turn right, walk around the block and get to the drugstore from the other direction.  OK, that's another 1000 steps.  Next?

Every hour or couple of hours (depending upon meetings) I would get up and walk around the floor.  I work in a big building and a circle of the floor is actually 300 steps.  3% closer to my goal.

Shopping?  Picking a spot farther from the store front.  Groceries?  Wander around the store looking for new items that meet your dietary needs.  Go up and down every single row in an effort to get some extra steps in. 

Status for September 7th

• Weight - 337.3 lbs
• Blood Sugar - 6.3 mmol/L

Salt

Salt is my enemy.

After a number of weeks I discovered that carbs (both simple and complex) aren't as big an impact on my blood sugar as I thought.  The bigger impact is salt.  If I have the same combination of macronutrients, but one meal contains a higher salt content, my blood sugar seems to go up.  I'm not sure why.

Salt also seems to slow down my weight loss.  If I have a high sodium day (or two) then I seem to actually gain weight.  I burn more calories than I eat, but I end up gaining weight.  This is most definitely water and not "fat" as even the weight of the food doesn't add up to what I gained in weight.

As a result, I have needed to very carefully watch the sodium intake and, when I am close to the limit for the day (2500 mg) I start drinking water.  Lots of water.  I know, this sounds counter intuitive, to prevent water weight gain drink more water, but the act of drinking water seems to draw the salt out of my body and that prevents me from gaining water weight.  Or at least as much weight as I would otherwise.

So, how much water to drink?  The 8 cups of water per day is a myth.  There is no evidence to state that 8 cups of water is a magic number.  It's a target, but I believe that there is a better target:  the colour of your urine.  Yup, I said that.  If your urine is pale yellow to colourless then that is the correct amount of water.  I have found, through drinking lots of water, that the amount of water I need to drink varies on a day by day basis.  I am personally closer to 10 cups of water being the correct amount, indeed on some days it is even higher while on other days it is lower, but at least I have a starting point and that is important.

Salt = bad

Water = good

Simple words but they seem to be true.  For me at least.

Status for August 30th

• Weight - 342.1 lbs
• Blood Sugar - 7.4 mmol/L

Macronutrients

I've got the tools (calorie counting, activity monitoring, glucose monitoring) and now I need to take action.  I started by putting into MyFitnessPal exactly what I was eating for every meal.  Everything.  At the end of a couple of days I took a look at the numbers that MyFitnessPal thought I should be targetting and where I actually ended up.

Wow, my food intake sucks.

I had too many carbs (keeping blood sugar too high), too much fat (look at my weight) and not nearly enough protein.  I mean, seriously not enough protein.  Time to become a part time nutritionist.  My exposure to nutrition over the past 50 years has been quite minimal.  I knew about carbs, fats and proteins, but not really what they were used for and how much of each I should have.  The information was out there, I just never paid attention to it.  Well, now was the time.

It appears that there actually is a Recommended Daily Allowance (RDA) for protein.  The Institute of Medicine reviewed a lot of studies and came up with a simple formula for the RDA:

0.37 grams per pound of body weight

Simple as that.  So, I took my weight, multiplied by 0.37 and then compared the result to what was in MyFitnessPal and here is where I encountered a difference of opinion.  MyFitnessPal said that 15% of my calories should come from protein.  The Institute of Medicine said that number was closer to 22% of my calories.  Which one to pick?  I chose the Institute of Medicine and moved my protein count up to 25%.

Now, if you go to body builder sites they will up that 0.37 grams to 1 gram or even higher.  That would mean that 60% or more of my calories came from protein.  Heck, I was having a difficult time hitting the lower limit of 15%, moving to 60%?  Not ready for that step yet.

Fats?  Well, there doesn't seem to be a whole lot of consensus about fat.  I moved it to 30% to try to minimize the impact of fat since each gram of fat accounts for 9 calories compared to 4 for either carbs or proteins.

Carbs?  Well, carbs end up going into my blood stream pretty quick so I needed to try to smooth out the sugar spikes in my blood by keeping my carbs to no more than 45% of my calories. The Institute of Medicine said to consume at least 100 grams of carbs per day, so I was in no danger there.

So what did I end up with?

• Protein - 25% (or more)
• Fat - 30% (or less)
• Carbs - 45%

Time to see what I can do with these numbers.

Status for August 23rd

• Weight - 343.5 lbs
• Blood Sugar - 7.8 mmol/L

Blood Sugar Monitoring

My first meeting with the nurse involved some information about Diabetes and an introduction to a glucose monitor.  In my case the Bayer Contour Next EZ.  A very simple monitor that had only a few functions.  Yes, there was an advanced menu function but there wasn't a lot in terms of reporting.  After all, if's a tiny device with a simplistic display.

I looked all over the place for blood sugar monitoring software.  Bayer has some, but it isn't available to Canadians.  There are other companies that manufacture the software but it is either expensive or limited to just a few manufacturers devices.  

And then came Glooko.

Glooko is a both a cable and an application.  The cable connects your glucose monitor to your iPhone.  The app on your iPhone uploads the information to the Glooko website.  The cable is compatible with a variety of different monitors and does a very nice job of grabbing all of the statistics on the monitor and uploading them.  The website provides a variety of different graphs and gives you a very good idea of where you are in terms of blood sugar, both the highs and the lows.

It doesn't link with either FitBit or MyFItnessPal, but I don't mind.  The graphs showing where I am, where I am trending, more than make up for the missing connectivity.

OK, I've got all the tools.  Now what?

Status for August 16th

• Weight - 349 lbs
• Blood Sugar - 8.3 mmol/L

I Have To Be Fit

Sure, not only is diabetes a factor, but I need to lose weight in order to help keep the diabetes under control.  Losing weight and becoming fit.  Seriously?

OK, so after picking myself up I decided that I would make an effort to become more fit.  But what does that really mean?  What do I have to do in order to become fit?  Well, here is where a lot of research goes on, reading articles on fitness, reading information on different types of exercise and taking a look at what I have been doing, or rather not doing, for the past 5/10/20/30 years.

At the beginning I decided that walking was probably the thing for me that was probably most likely to be followed with regard to an exercise pattern.  Why walking as opposed to running?  Less impact on the knees, my right knee in particular.  Considering the "accident" at Universal Studios in 1999 my right knee has been weaker than my left and tends to become inflamed and very sore under stress.  Running would put a lot of stress on the knees and, to be honest, I would feel ridiculous running for, oh, 50 feet and then walking for 500 feet.

But how do I track the walking?  Do I count every step I take during the day and put it into a spreadsheet at night?  Or, considering how techie I seem to seem to be leaning with everything, do I go for a pedometer?  A high tech pedometer?  So I took a look at some of the more popular items:  FitBit, Nike and Jawbone.  Why these three?  Because there are apps associated with all of them.  My criteria were rather simple, but very effective in narrowing down the list:

• if it is to be worn on the wrist, it needs to fit my big wrists
• it needs to have a mobile app associated with it

Simple, but it tossed out the Fitbit Flex and the Nike+ FuelBand and the Jawbone Up as they all rely on being attached to your wrist.  I checked out the maximum size of the various bands and none of them were large enough to fit around my wrist.  All of them were too small by at least half an inch.  So, what did that leave me with?  The Fitbit One  It fit my simplistic criteria and, as an added bonus, it interacts with MyFitnessPal so that my calorie burn throughout the day is transmitted to MyFitnessPal and it tells me if I should be eating more calories or not.

Status for August 9th

• Weight - 353.5 lbs
• Blood Sugar - 9.4 mmol/L

Counting Calories

OK, so we've established that I've got diabetes, what do I do next?

The most obvious answer is to watch what sugars I eat.  Since this is the age of the Internet I immediately went to Google, looked up calorie tracking tools and decided to use MyFitnessPal.  Why MyFitnessPal?  A number of reasons:

1. A website/mobile app combination.  For me it was important that there was both a website that I could go to and a mobile app that I could use.  My family eats out a lot and being able to see where I am with regard to following my diet was extremely important to me.  MyFitnessPal has both a smartphone app and a web site that sync with each other.  While the reporting out of MyFitnessPal is limited depending upon the platform, I have high hopes that there is a mechanism whereby I can pull the data out and do my own reporting.  What reports I need I'm not sure, but I'm confident that I will find something I want that MyFitnessPal doesn't provide.
2. A large database of foods.  MyFitnessPal says that they have over 2 million items in their food database.  I believe them.  However, in many cases the foods are duplicated because someone couldn't find the other entry that was in the database.  In some cases, because the information is entered by users, not all of the nutritional information is valid/correct.  I wish there was some way to weight the information and if it is wrong get it removed from the database.  Or, maybe there is and I just haven't seen it.  (I am getting old you know.)
3. A suggested guideline that I could modify.  I wanted to have the ability to change the ratio of carbs/fats/proteins without having to following someone else's prescribed percentages.  Everyone is different.  Everyone has different requirements.  Something that wasn't flexible enough for me to change to meet my criteria was not going to suitable for me in the long term.
4. An enthusiastic community.  The community boards on MyFitnessPal are filled with people who are having issues and need help and they are getting that help by other MyFitnessPal users.  Whether it is just someone to talk to, compare notes with or help with issues, someone is always there to provide assistance.  While I have never been a "social" person, I find myself contributing to the conversation even if it is just to submit a "Proud of you, keep up the good work" type of comment.  Seeing those comments actually helps more than I had originally thought.

So, I had a tool.  Now all I needed to do was use it.

Having Choices

We all have choices.  Making the right choices is the difficult part.

Back on July 30th my doctor told me (and I am paraphrasing her here) "Don, we're all dying, but you're dying a little bit faster than the rest of us."  Essentially she told me that I have Type 2 Diabetes and that it was borderline as to whether or not to treat with drugs/diet or with Insulin.  In conjunction with this I was overweight and that losing weight would also be a good thing for my diabetes.

Was it a surprise being diagnosed with diabetes?  Both yes and no.  No in the sense that I was overweight and I drank a lot of pop (soda for you Americans).  But, yes, because I guess I was always under the delusion that it would never happen to me.  Well, I guess it did happen.

I had a choice.  I knew for a long time that I was overweight.  I chose not to do anything about it.  It was easy to just continue my normal lifestyle, a not very good lifestyle, and continue eating my way to an early grave.  The discussion with the doctor was figuratively a slap in the face.  It suddenly clicked in my brain that I was killing myself and I was letting myself do it.  Suicide by food.

So, I made a new choice.  I actually made a number of choices:  lose weight; lower my blood sugar; get more fit.  That what this blog is about.  The choices I am making and what impact that is having on my life.  Since I started this late, not on July 30th but in September, the first few posts are going to have some retroactive stats in them so that people understand the full scope of changes.  Stick with me and you'll see the changes, for better or for worse, that are occurring in my life.

Stats as of August 2:

• Weight - 355 lbs
• Blood Sugar - 10.1 mmol/L (via blood test)