Joslin Diabetes Center dietary guidelines for Type 2 who are obese

I'm thinking about going back to Green Mountain in December, nearly a year since I went the first time. I want to show off my progress, and to have the opportunity to spend a week focused on exercise. I want work closely with one of their fitness experts, someone who will be straight with me about what I'm doing, how I'm doing it, etc. I'm getting to the point now that its taking more to get my heart rate up (which is great!), but I'm still too heavy to get really going. My knees are still holding me back. And I think I'm still holding me back as well...not pushing myself in the right ways.

So while I was on the Green Mountain website, I saw a reference to their connection with the Joslin Center for Diabetes in Boston, MA. Out of curiosity, I went to their website and did some poking around. And while there, I came across their dietary guidelines for those who are Type 2 and overweight or obese.

Basically, I've been very nearly doing what they say to do.

• Protein should take up 20% - 30% of daily calories, which is higher than was recommended in the past. I've been eating about 30% because I'm quite tall and need it to help manage hunger. I choose leaner proteins, like fish and poultry, but I do eat a little lean beef and lamb once a week, and I have eggs for breakfast every morning. My cholesterol is exceptional, so I'm not so worried about high cholesterol. I also include a lot of legumes as a source of protein, because they also provide carbohydrates and fiber...more about that in a bit.
• Keep carbohydrates at 40% of caloric intake per day, but they say to make the bottom limit at around 130 gms. of carbs per day. This is a new low for diabetes guidelines. Out of personal experience, if I go above 150 gms. or carbs per day, I stop losing and start gaining weight, and my blood sugar starts to go up. But they also want us to take in a minimum of 25 - 30 gms. of fiber a day, with 50 gms. per day being closer to what we should shoot for. This means that if I'm restricting my carbohydrates, that I need to add high fiber choices from other food groups, such as legumes, fruits and vegetables. Also, eating that much fiber in a day mean a whistle-clean colon, but it takes time to work up to the 50 gms. per day.
• 30 - 35% of calories should come from fat, with less that 300 mg/day of saturated fats. This is slightly higher than my daily goal of fat intake, but probably closer to what I'm achieving. I found some really good extra virgin Greek olive oil recently and have been anointing everything with it!

They are recommending a modest rate of weight loss, one pound every week or two. And their exercise recommendation is 2.5 to 3 hours a week at a moderate intensity, using a mix of cardio, stretching and resistance.

So I guess I'm right on track. It's just a matter of not losing focus and not backsliding into old patterns. I have made major changes in how I live, and my body is slowly moving in the right direction. At this rate of weight loss, I'll achieve my goal in a little over two years. I wish I could do this faster, but I am seeing the benefit of losing at a slower rate. My skin is really not hanging off me. The fat is loosening up (some parts of me are quite squishy!), but my skin is still fairly tight, even after 40 lbs. of loss. So I've decided not to worry about my skin shrinking. I'll just stay focused to toning my muscles. By the time all the excess fat is gone, I should have some nice muscles to show off.

It's time to reassess

I've officially lost my first 10% of my body weight. Besides having lost 40 lbs., what have I achieved so far:

1. I am completely controling the type 2 diabetes - My last A1C was at 6.3, down from 6.9. This is great! I'm that much closer to having control over insulin resistance, which should make weight loss that much easier. My goal is to get my A1C under 5.5, which is the top of the normal range for non-diabetics.
2. My cholesterol levels are also in a much better range - HDL is just over 40 (supposed to be over 50) and LDL is 86. I don't know how much I'll be able to raise my HDL level, but the ratio between the two is pretty damn good! It's supposed to be over .4, and I'm at .465.
3. I'm exercising regularly, a routine of weight resistance, flexibility and cardio. I exercise four to five times a week, 60 to 90 minutes each time. I'm concentrating more on cardio for fat-burning effect. I'm seeing success in my efforts to build up my quads, in order to preserve my knees more, and my shoulder strengthening therapy is paying off and I'm back on with biceps and triceps, but only with lots of reps and 3lb. weights.
4. My blood pressure is under control with medication. I have found the medication that is working for me with minimal side-effects. I don't like the side-effects (excess edema around the ankles, and it costs me $80/bottle!), but once I lose enough weight, this will all go away as well.
5. I am consistently managing depression. I get out often for that hour of direct sunlight every day. I make sure to connect socially, face to face, with people outside of my immediate family, at least twice a week. (Unfortunately, the 'virtual' friendships that I maintain online, as much as I totally enjoy them, don't do as much for me emotionally as the more palpable variety.) The exercise really helps (and I'm beginning to feel a euphoric effect with cardio), and I'm taking SAMe, which might be stirring up my ADD just a little more, but it really helps me be alert and active all day. I'm also seeing some leveling off with mood-swings.

I've been losing weight at a rate of 5 lbs./month. This is healthy and safe, but I'm not satisfied with this rate, of course. I wish I had lost twice as much weight by now. I've been bumping into a series of plateaus, life has been busy, I'm having some personal family issues that I'm dealing with now that are really taxing, and there are moments when I'm dangerously close to giving up.

But I really, really don't want to give up. Giving up is absolutely not an option. By mid-January, I will have been actively working on weight loss and optimum health goals for an entire year. I want to break past the 300 lbs. by then and want to have achieved a 50lb. loss. It's my goal for the next year as well. I need to refocus, do some tweaking and manage my motivation so I don't lose momentum.

What I propose to do first is to really tweak my diet. Here in Kazakhstan, it is my biggest challenge. The range of fresh vegetables is depressing! I have to be creative, and I have to stay on top of it at all times. This last week I found some of the last of the sorrel, zucchini and eggplant, some cauliflower, mushrooms, peppers, tomatoes and I'm now seeing lots of winter squash. There's always beets and carrots, parsley and basil. It's going to have to do. At the supermarket, there's frozen brocolli, green beans, yellow wax beans and peas. I have started some bok choy in my AeroGarden (but it's not growing very fast), and I've got brocolli sprouts going. I had been avoiding fruits because of the type 2 diabetes, but I think since my A1C is so much better, I'm going to start eating apples on a daily basis. They are plentiful here.

I was reading about eliminating gluten from the diet. I'm not allergic to it, I don't think, but I just wanted to see if doing this for a short period of time, three weeks, would have any effect on me. It will also help manage some recent urges to binge on bread. I made some really amazing bagels this last week and while they were completely healthy and fat-free, I gained about eight pounds in the last few days!

Another thing I'm considering eliminating from my diet for the next three weeks is all animal products. Again, this is to manage some of the recent binging. Butter has crept into my diet again, so I have to get on top of that. I've been eating a lot of beef, chicken and lamb recently, eggs, cheeses, salami. I tend to use more salt when I'm eating these things. So animal products are banished for now. I'll continue to eat fish, when I can find it, as well as pro-biotic yogurt, which will help with my digestion. I've been having a lot of intestinal stress recently, which seems to affect my rate of weight loss as well.

I'm still taking my SAMe, as well as cinnamon capsuals to manage blood sugar, and a blend of vitamins and minerals that aid with diabetes. It's getting really cold here, so bean soups are a regular meal these days. I'm back to including brown rice, quinoa, millet, buckwheat and steel cut oats in my diet. A really good olive oil is the only fat I'll use. And water is a constant. Since I'm trying to eliminate unproductive caffeine as well, I stopped drinking coffee. I'm still taking green tea tablets, however. At night, before I go to bed, I'm drinking a generous cup of chamomile, made with two tea bags, so I can get a start to a good night's sleep every night.

I'm going to take a week or two off from exercising, except for the stretching and low-intensity walking. I just need a mental break from it. I'll reassess my routine after the break, to see what I can do to mix things up.

I love cardio!

Well, not exactly...at least not at the moment, because I'm really sore! But earlier this evening, I was walking around the indoor track at the gym, and I was using my little mp3 player with Cardio Coach loaded on it. I'm still on level one, but I'm up to four miles of walking now, and tonight, at about mile three, I was so into what the trainer, Sean O'Malley, was saying, and I felt so focused and actually, for the first time, felt really good about doing cardio. That was a milestone for me. A huge one.

By the way, I'm just six pounds away from breaking past 300 lbs. That's my goal for this month, to finally weigh less than 300 lbs. And never again weigh that much, ever. And I am willing to exercise my brains out for it.

I went to the gym tonight with my husband and son. My husband works so much that we hardly have time to be with him. And my son is off school for the next week and I decided he needed to see both his parents exercising and to join us. My husband belongs to an exercise group that does circuit training. He's lost 20 lbs. since July. He's experiencing his first plateau, ever. OMG! It's like no one has ever had a plateau before. All he would ever say to me in the past is something about calories in, calories out. He didn't believe in plateaus. Till now.

I'm really trying not to be snarky about it...

Ok, so, at first I didn't want to go to his group because I thought I would feel intimidated. But today, I made up my mind to go. I can't keep up with them, I know that. But I can do my own thing, something that is just as effective for me, and still be there, exercising. And that's what I did, five minutes of warm-up and stretching with them, then I did some of my own weight training routine, and then I went to the track to walk. When they were done in the gym, they met me at the track and ran some laps, and I continued walking. My son walked with me some, ran with his dad some, and then sat on a bench to watch us. And after I finished my fourth mile, he brought me a glass of water. He's already whining about having to go back on Monday evening, but we're going to do it.

I just realized that I exercised just as long as the circuit training group. Well, maybe someday I'll join in with them. But it looks really boring to me. I'd rather go dancing.

What a long, strange trip it's been...

I'm sitting next to my suitcases, in preparation to fly back home to Kazakhstan tomorrow. As I think back over the last three months, I see that the activity of life in general has a way of muscling in on my concentrated efforts at achieving optimum health. Well, not so concentrated over the last month. This road wellness takes a lot of effort to stay on track consistently. I've never been one to remain consistent and focused on anything for very long, so I'm breaking an old habit of giving up and re-wiring my brain to stay on course.

Hauling 50 lb. suitcases has done me in this week! My knees are in pain, my shoulder is aching, so much for physical therapy and cortizone shots. I feel old and feeble. I need one of those strapping young men, like a personal porter, to carry my bags for me. Yes, that's it, a strapping young man to do my bidding...oh, the thoughts I'm thinking!

Ok, so I went to my women's retreat. If you're at a crossroads in your significant relationship and are wanting the relationship, and yourself, to grow up and expand, you need to go to the women's retreat put on by the Marriage and Family Health Center of Loveland, Co. This retreat is not for the faint of heart! Be prepared to do some serious emotional work. It's like concentrated therapy, very fast moving and profound. I learned a lot about myself, looked squarely in the face of my life and how I do things, and came out with a new sense of purpose for myself. It was a very enriching experience, plus, I met and befriended a lot of amazing women and have come away from the retreat with a whole new support network. Additionally, if you ever wanted a safe forum to discuss and learn more about sex, this is the one!

By Wednesday morning, I'll be back home and starting a fresh routine of exercise. I've got some planning to do while I'm on the plane. My injuries are going to be limiting my fitness opportunities. I need to stay with walking, but increase it to three hour-long walks a day at an RPE (Borg Rating of Perceived Exertion Scale) between 12-14 (somewhat hard). Once my knee starts feeling better, I'll switch in different activities for the walking, like my Shimmy and Core Rhythms DVDs, and my rowing machine. If I'm really serious about losing weight, I have to be really committed to a higher level of cardio exercise.

For weight training, I've got some modifications to do for my arms (no more than 5 lbs.) and continue with my physical therapy exercises to strengthen my rotator cuff. I've also got to continue with strengthening my quadraceps. The pain I'm experiencing will go away with Aleve over the next few days, and I won't be prone to as many strains with more weight loss, but strengthening those muscles is of utmost importance to avoid further injures to my knees.

My food choices are more limited in Kazakhstan, especially with cooler weather setting in. I'll have to get my spinach started in my Aerogarden, and see if I can find frozen vegetables that will meet my needs. Winter squash will be showing up soon, which is an excellent source of dietary fiber, as are beets and cabbage, which are ubiquitous in Russian cuisine. I also have to stock up on meats for the winter. When it get's icy outside, that's not the time I need to be slipping around at the market parking lot with my bum knee.

I'm still weighing in at 314 lbs. My weight went up (by 10 lbs.!) over the last month, due to a lot of eating out and my exercise tapering off while traveling. But once I cut that off, it dropped back down again. I look forward to breaking 300 lbs. soon, I hope before Christmas. I'm not feeling anxious about that number any more. And once I break it, I will have lost nearly 50 lbs. and 30% of my goal will have been achieved!

Ok, I'll chat with you in a couple of weeks, after I've gotten past the jet lag and gotten the house in order, and more importantly, back into my routine.

What the ...?

It's just been five days since I last posted an entry, and I've surprisingly dropped down to 314 lbs! That's an all time low since I began my journey here. I wish I could say it was because I kept to my new limits of 60 gms. of carbohydrates a day and 60 gms. of fat. I wish it was because I actually increased how much cardio I was doing on a daily basis.

The only thing I've changed is that I started taking a pill for my blood pressure, and I started taking capsules of Ceylon cinnamon bark after each meal and a daily vitamin pack for diabetes that includes chromium picolinate. I did drop carb intake down to 100 gms. for most days, but the last couple of days, I've had some serious carb cravings and yesterday, I totally strayed off course while we were out shopping for school supplies and new clothes. I at just over 2100 calories, went over on sodium by 35%, and took in nearly 200 gms. of carbs. And then lost an additional 2.5 lbs. since yesterday. We did walk a lot all over town and went miniature golfing after everything, but I wasn't tired at all by the end of the day so I didn't expect to have burned off that much. In fact, I totally expected to have gained weight this morning.

Today I'm heading back to the supermarket to load up on fiberous vegetables. I'm not going to lose the ground I've gained here!

Pardon me while I head for the elliptical cross trainer again this morning...

I know it's been over a month since I wrote last, but it is the summer, after all. We're not supposed to be online so much. We're supposed to be out enjoying the summer months.

Whatever! It's been smokey here in Northern California and I haven't been able to go out much. And when I have, it's been for not very fun things, like running errands and going for medical appointments or shopping for school supplies.

And speaking of medical appointments, I'm now being tested for PCOS. It may explain why the weight loss has come to yet another standstill. I've not been able to get past 317 lbs. for weeks and weeks now. I'm changing up my diet in order to deal with this. Even less carbs (down to 60 gms.), and really make sure they're all low on the glycemic index, really limit the saturated fats and increase the Omega 3 types of fats. And I need to increase how much cardio I'm doing.

I spoke with Beth the fitness coach on Monday. We talked about caving to cravings, and how important it is for me to keep a tight rein on my indulgences now, and how I'll be able to loosen things up the closer I get to goal weight. It's all perspective, I guess. If I can plan for indulgences wisely, space them out a bit farther for now, then I may keep my forward progress on a more consistent basis. The reward will be breaking this insulin resistance, resolving the diabetes threat, and getting off of blood pressure medication altogether.

I'm up to 15 minutes on the elliptical trainer now, but it really hurts my knees. I'm having to back off on that, doing just 5 minutes at a time over several times a day. If I do 5 minutes every hour over 12 hours, that's 60 minutes a day on that thing! I'm going to attempt that this week and see how strong my quads can get working out like that.

I also went to my orthopedist yesterday, who gave me a shot of cortizon in my right shoulder. I have really strained the rotator cuff, so I'm off of most upper body exercises that involve arms for now. I'm using 2 lbs. weights on rotator cuff exercises to strengthen the rotator cuff for now and will be going to a physical therapist very soon for further work. I've also got to take 2 Advil twice a day to help with the inflamation. Once I get the all-clear, I can get back to my regular upper body and core exercises that involve my arms, probably in a couple of months.

I'm feeling confident that I'll be moving forward with weight loss again in a short period of time. I have to feel confident, because backsliding is OUT OF THE QUESTION!!! I am on a path towards optimum health and wellness, and I'm in command of how good I can feel, inside and out.

Working on the inner woman

With both my feet firmly planted in my mid-life crisis (my sister says I've been in one for the last ten years, but frankly, I'm just a seeker), I'm going to attend a women's retreat in September, one that I've wanted to attend for the last eight years. This is the first opportunity I've had to do so. You can read about it here. It's put on by the Marriage and Family Health Center from Evergreen, Colorado. They do it twice a year, once in Marin County, CA (along the Pacific coast) and once in Loveland, Colorado.

After the life-altering experience at Green Mountain, I am looking forward to sharing with a company of women who are like-minded, wanting to change their perspective on life from the inside out. I'm ready to rekindle my spiritual nature, to move forward with purpose. I have a lot of mental and emotional energy ready to be channeled into something much more meaningful.

I have wanted my exterior view to be more in alignment with my authentic self. I don't think I can achieve that without knowing who that really is. Maybe once my inner being is fully realized I can be at peace with my body image.