Disclaimer: I am not a doctor, physician, nurse, biochemist, scientist, or anyone with expertise in the fields I write about. Please do not take anything on this blog as advice, especially medical advice. Always do your own research and fact-checking, and consult a physician before taking any medical steps.
Since I was a little kid, I was self-conscious about my weight. I was usually bigger than others in school—probably not big enough to be “obese” but it was definitely noticeable. Furthermore, I was always very intelligent, and I used this as an excuse never to exercise. Of course, I thought that I would be doing intellectual work and that exercise was unimportant. Then, when I was 16-18, I lost a bunch of weight, without even trying. My parents and relatives blamed this on a growth spurt, and I didn’t know better. I now believe this was the first manifestation of my hyperthyroidism (specifically, Grave’s Disease) that would go undiagnosed for another six years.
That didn’t last long though, because hyperthyroidism does make you burn more energy, but it also makes you more hungry. That, along with a habit of stress-eating from childhood and a penchant for eating foods that tended to make me more hungry, led to a gain of nearly 40lbs from senior year of college and the first couple of years afterwards. I then went on a ketogenic diet. I shed pounds. My long-term major depression abated. I exercised because I wanted to. It was great. But unsustainable. Because around Christmas time, I “let myself indulge,” and I haven’t recovered to now.
I had to go to the psychiatric hospital earlier this month, following a major suicidal and self-harm episode, and they did a standard lipid panel. The results woke me up from my carb coma: high LDL, borderline-high triglycerides, borderline-low HDL. I was shocked and scared. These numbers wouldn’t be so bad in someone who was 50. But I am 23. My father has type-2 diabetes, and my mother is fairly severely dyslipidemic, despite being on a statin.
Being a nerd, I read a lot of papers and listened to many talks and podcasts on health and nutrition. So I’ve tentatively written down a few principles I hope to diet and exercise by. Note that I do not believe these principals dogmatically, but rather, I think the evidence most supports them right now. I hope to make more blog posts covering why I believe these things.
- Consumption of sugar and excess consumption of starch (i.e., most carbohydrate) lead to peaks and troughs in serum insulin. In persons with the propensity, this can also lead to insulin resistance (making your pancreas work harder to produce more insulin), leptin resistance (not feeling full as quickly or as often), dyslipidemia, and eventually type-2 diabetes.
- The alternative hypothesis on weight gain explains more cases of obesity than the null hypothesis (that a calorie is a calorie and obesity is a function of eating too much and exercising too little).
- The food industry and governmental organizations have together created a culture of a diet high in carbohydrate and low in fat. This is bad and has created the ills of the standard American diet.
- The food industry and governmental organizations have together helped to create a culture of a diet high in carbohydrate and low in fat. This is bad and has created the ills of the standard American diet.
- Most processed food is addictive, or at least habituating.
- Fructose consumption—independently of other sugars—is the major contributor to fatty-liver disease
- The omega-3 fatty acids DHA and EPA and are helpful for treating dyslipidemia.
- Exercise is not helpful in losing and maintaining weight, because the marginal caloric loss of most exercise just doesn’t compare to the energy found in food, and because exercise generally increases one’s appetite. But it is helpful in limiting insulin resistance and dyslipidemia. (It is not as helpful as diet, though.)
- (This is the one I am least sure about, and where, in my view, the evidence is most contradictory.) For most persons, saturated fatty acids and mono-unsaturated fatty acids (MUFAs) are better than poly-unsaturated fatty acids, in general (excluding alpha-linoleic acid and the aforementioned omega-3s). Some persons, especially with the APOE4 variant of the APOE gene and certain variants of the CLOCK gene might have a lower tolerance for saturated fat. One good way to test this might be to go on a high saturated fat diet long enough to become adapted and to test lipid levels to see how they have gone, since some 2000 gene variants are implicated in hypercholesterolemia.
With this in mind, and after consulting several of my clinicians, I came up a plan to tackle my diet:
- Take a more detailed lipid panel so I can know the effect of my diet.
- Stop consuming seed oils and focus more on olive oil and animal fats.
- Consume more omega-3 oils by consuming more fish and possibly taking a supplement.
- Consume more “whole foods,” i.e., not processed food, with added sugar.
- Increase Potassium and Sodium consumption.
- Try out each of these diets for 2-6 weeks (depending on how long I feel it takes me to get adapted), accumulating what works as I go along:
- Limit all mono- and disaccharide consumption to fruits, vegetables, and at most one glass of milk a day. (Cut out all added sugar and limit my consumption of “natural” sugars severely.)
- Increase my meat and fat consumption. My hope is that this will lead to more satiety and make me less likely to want to eat more carbohydrate or snack throughout the day.
- Consciously limit carbohydrate below 100, 80, 50, 30 g/day, total not “net.” (I may not try each of these for the full two weeks, if I feel that the marginal effect is not worth waiting for.)
- At this point, I will take another lipid panel and see if the saturated fat consumption is exacerbating my dyslipidemia. Based on that, I may go to a more fat-based diet (which will involve basically mainlining olive oil) or increase carbohydrate. I will have to get more protein from lean meat.
- After this, continue the experimentation. Some ideas I have:
- Try out several variants of intermittent fasting to increase autophagy.
- Try carb-cycling (5 days of increase carbohydrate consumption followed by 5 days of “strict keto”).
- Try carb-loading (eating a lot of carbohydrate in one bolus before an intensive aerobic or anaerobic workout).
- ??? Whatever I find that is appealing and scientifically-supported (or at least mechanistically possible to help).
In the midst of this, I shall have to “exercise more.” Yes, that is very vague. I have a bike which I will continue to ride. And (fingers crossed) I should be able to buy enough free weights for a home gym soon. But one way or the other, my depression and lethargy being what it is, I’m not holding my breath that I will immediately be able to exercise much more.
Time will tell whether this helps.