The biggest challenge in managing our diabetes is controlling our weight. But fortunately we have three roads that will take us there.
Cheryl, who is my friend and colleague at HealthCentral, traveled one of these roads. I have traveled the other two. Each of them have been a great trip.
A couple of weeks Cheryl wrote “How I Defeated Obesity and Diabetes” for the obesity area of HealthCentral. Gastric bypass surgery is the road that worked for her.
Since Cheryl knew that I had defeated obesity via other means, she asked me to round out the picture with my experience. Our intention is to provide a comprehensive roadmap of the three ways that we know from our own experience that will work for controlling obesity.
Cheryl has written many posts for HealthCentral about surgical ways to manage weight. I have also written a couple of posts here, more recently at http://www.healthcentral.com/diabetes/c/17/154007/reverses-bariatric/.
I once considered surgery to manage my weight. But instead I took the other two routes that are available to those of us who have diabetes.
Eight years ago, just as a new diabetes medication became available, I started taking it. Like all medications, this one has side effects, and one of those side effects is that people taking it can lose a significant amount of weight.
Shortly after Byetta became available in 2005 I found a doctor who would prescribe it. I wanted the weight loss side effect, and I got it. I still remember the day I first stepped on the scale at that doctor's office. It showed that I weighed 312 pounds, which on my 6'3" frame is a BMI of 39.0.
Byetta worked so well for me that I wrote a book about it, Losing Weight with Your Diabetes Medication. When I took Byetta, it was the only diabetes medication that could lead to significant weight loss (an older drug, metformin, is generally weight neutral, although some people lose a few pounds when they take it).
Byetta is the first of a new class of drugs called GLP-1 agonists, and since that time two more drugs in this class have become available. They are Victoza and Bydureon. Recently, the Food and Drug Administration approved two drugs specifically for weight lost, Belviq and Qsymia. You don't have to have diabetes to get a prescription for either of them, but I don't know from my experience how well they will work for losing the big amount of weight that many of us need.
I told my doctor that my goal was to bring my weight down to 195 pounds in the next two years. I have known for a long time and have written that setting a goal -- and telling other people about it -- is crucial to success. I chose that goal because for me a weight of 195 pounds is the high end of a normal BMI and was what I weighed when the U.S. Army discharged me from active service half a century earlier.
While my doctor's comments showed that he thought that my goal was over-ambitious, in fact I reached it and more. Before two years on Byetta had elapsed, I had brought my weight down to 180 pounds and decided to stop taking Byetta. I wanted to manage my diabetes without any drugs.
Success, right? Not quite. Losing weight is less than half the battle. Keeping it off seems to be harder to do than losing it. In fact, many diets lead initially to weight loss, but almost always rebound to weight gain.
Since I wanted to keep off the pounds I had lost, when I stopped taking Byetta I turned to the other proven road to weight loss and management. I turned to a very low-carb diet in 2007 as soon as I was persuaded that it was safe. A big, comprehensive review that Gary Taubes published that year as Good Calories, Bad Calories was the key for me.
I have carefully followed a very low-carb diet since then, so successfully that I have had to recalibrate my goals two more times. Eventually, I set a weight goal of 156 pounds, based on studies that show a very low normal BMI has the least cancer risk. And 156 pounds just happens to be exactly half the weight I carried when I began this journey.
Surgery, drugs, and low carbs are the three ways that work. I doubt it any other means will work in the long term for people with diabetes. Certainly, willpower or self-discipline alone doesn't take us there, as Gina Kolata demonstrated in her book Rethinking Thin.
Losing 156 pounds wasn't easy, but it was the best thing that I ever did for myself. It changed my life. Not only is my health much better, but my personality made a 180° turn to becoming more outgoing. I am more active and travel more. I reversed a whole slew of complications, including sleep apnea, fatty liver, frozen shoulder, and arthritis. I no longer take any diabetes medication, and in fact the only drug I take for anything is Synthroid for hypothyroidism.
In conclusion, I will share my least favorite photo with you. Someone took this at a gathering in 2005, just before I started to take Byetta.
A very low-carb diet may be the road less traveled. But for me it has made all the difference.