Thursday, March 03, 2011

Medically supervised starvation

Alright, so, in my update on the cancer situation, I mentioned the docs want me to go on an emergency, medically supervised starvation diet; so that I can lose 60-100lbs in 6-9 months; to reduce the risk of operating on the cancer that is impinging on my airway.

That's an awful lot of weight, in not a lot of time; and I've got a massively screwed up endocrine system and metabolism.

I gained over 400lbs total, losing over 240lbs interspersed, for a net gain of 160lbs in four or so years, while on a level of intake and exercise that in a normal person with a properly functioning system should have seen me losing weight the entire time.

This is not a problem that can just be solved with "normal diet and exercise"

So, they are suggesting some fairly extreme measures; and I thought I'd break that out from the main post to talk about just exactly what that means.

The first thing is, because my medical issues are already preventing weight loss with normal diet and exercise; they've declared the lapband is medically necessary, and are working through the BS with the insurance company now...

Unfortunately will take a couple months, and the insurance company is going to make me jump through some hoops; so Ill have to start on the extreme restriction, without surgical help, while I'm waiting.

The problem is that my current basal metabolic rate is so suppressed by the endocrine problems, that I literally need to go into medically supervised starvation for this to work; reducing my total caloric intake to somewhere around 800 to 1000 calories per day.

If you remember how Christian Bale starved himself for "the machinist"; he was eating 500 to 800 calories per day, and he weighed 1/3 what I do, and is 2" shorter than me.

A normal person, just sitting around doing nothing, will burn between 9 and 11 kcal (what we normally think of as calories) per pound, per day. This is why the recommend daily diet for the 184lb "statistical man" is 2000 calories.

Even someone in a coma will burn about 4kcal per pound per day. That's just the energy expenditure needed to maintain body temp, and to keep the blood flowing, and the organs operating.

My hormonal regulation is so screwed up, right now I'm burning between 5 and 6 kcal per pound per day (closer to 5 than 6... something like 5.2 or 5.3 average).... About half "normal", and just slightly higher than someone who's in a coma.

My current homeostatic intake level (the amount I can eat without gaining or losing weight) is about 2000-2400 calories a day (and yes, it really is that variable. My bodys self regulation is entirely broken. For someone my weight with a "normal" metabolism it should be about twice that, and should only vary about 200 calories with normal activity).

With this calorie restriction, I'll only be taking in about 2 calories per pound per day; or about 1/3 of my homeostatic intake level, at 800-1000 calories per day (and 1/4 to 1/5 a "normal" intake level).

That's the medical definition of starvation.

At my current basal metabolic rate, without any exercise, I should lose an absolute minimum about 2lbs every five days, possibly as much as 3lbs every seven, or even 5lbs every ten; resulting in 4-5 months to lose 60lbs, and 7-9 months or so to lose 100lbs.

The docs and I agree, that with my body type and bone and muscle structure, my weigh loss goal should be 280lbs at 15% or under bodyfat, with no loss (and hopefully some gain) of muscle mass.

The hope is that as the weight comes off, and with proper medication, my basal metabolic rate can be returned to something approaching "normal"; and that my weight loss will actually accelerate over time.

Given that on this 800-1000 calorie intake level, a "normal" metabolic rate that would put me at an 1800-2300 calorie deficit per day at my 280lb goal weight (never mind todays weight); that is entirely possible.

Also with medication and weight loss, I should be able to exercise more again... though not much given the extreme calorie restriction. I need to heavily bias the diet to protein (basically take in just enough fat and carbs to survive, and all the rest protein) and do both aerobic and anerobic excercise (bike and weight machine circuit) just to guard against muscle mass loss.

The total process to get from today to 280, at todays metabolic rate, and an 800-1000 calorie per day diet (assume a 1000-1600 calorie per day deficit) should take between 14 and 21 months.

If my metabolic rate were to improve to "normal", and assuming light exercise burning an additional 200 calories every other day (that's really not much at all), and rating only from my goal weight (I should burn much more than that every day until I reach my goal, so that's a worst case minimum) it would take somewhere between 9-11 months.

So... anywhere from 9 months, to 21 months... Or if we take the worst case healthy estimate, and the worst case unhealthy estimate and say average them out, say somewhere around 16 months.

Of course none of that takes into account how much water I'll be losing as the edema subsides, and the excess dependent fluid retention stops; and as my overall fat tissue reduces, losing even more water.

It would surprise me if at least 20% of the total excess weight wasn't excess water, even with the lasix. That's 36lbs that I don't have to lose calories for, or between 60 and 120 days less time.

All that, is why my docs are pretty sure I can lose at least 60lbs in 5 months, and at least 100lbs in 9; and somewhere between a year and a half and two years to reach my total goal.

Dietarily, what that all means, is that I'll be alternating between a liquid protein supplement diet, and three or four very small meals a day (possibly with 2 small snacks, depending on exactly what I've eaten that day in terms of total calories vs. total protein); consisting mostly of grilled or pan seared lean chicken breast, beef tenderloin, pork tenderloin, tuna, and shrimp.

That may sound good, but it's going to get pretty damned monotonous. I know, I've done it before.

Because of my high muscle mass in comparison to most (especially to most on extreme calorie restriction), I need to concentrate heavily on lean protein to avoid muscle catabolisis (muscle mass loss through dietary protein deficiency), and on high iron meat sources in particular to avoid anemia (also I'm going to have to take iron, b vitamin, and calcium supplements).

Not much in the way of side dishes... Maybe a couple ounces of cucumber, or a couple ounces of roast potato... Maybe one piece of bread, or 1/2 cup of cooked rice or 1/2 cup of cooked pasta in a day. Maybe a slice of cheese a day. Maybe an egg or a couple of egg whites.

...And by small meals, I mean 4-6 ounces protein and two ounces of starch/fruit/veg each; and nothing to drink with them (you drink 20-30 minutes before, and 20-30 minutes after, but not during).

Basically, what all those 100lb nutritionist aerobics freaks have insisted for years we should all eat, but no-one does other than them.

Oh and forget about having an entire beer, or for that matter more than a few ounces of fluid every half hour to hour.

If you're a small woman, this diet may sound familiar to you; as it's probably what you eat normally.

I'm not a small woman. I just have to eat like one.