Dear Jasmine 1 August 2018


Well, it feels like forever doesn't it! 4 months have passed as I've been completing part of my medical school internship in New York and also applying for my first ever doctor job in New Zealand (and getting my first choice, hooray!) and thus heavily neglecting any blog writing.

While I was away I continued to receive messages and read them and ponder them (and there are more than the ones below, I'm sorry I figured answering a few was better than answering none and I hope to get to the rest!), but just wasn't able to put any time aside to draft a response. I thank you for your patience in waiting for these replies and I hope the time that has passed has given all of you more clarity too! Although your need for my answer is probably gone, I think others will still find value in your questions.

Without further delay, the second edition of Dear Jasmine.

 

Dear Jasmine,

Thanks for sharing your knowledge with the world and spreading such a positive message. I can honestly say that reading your blog has helped me immensely. :)
I remember you mentioning that you probably suffered from metabolic syndrome and were insulin resistant, and that you healed yourself by following a ketogenic diet. Could you tell me a bit more about that? Did you follow a specific plan? How long did you follow the diet before you saw improvements in your overall health? I think I might be dealing with similar things as you used to, and I'd be really thankful for advice.

Sending you alllll the good wishes from Amsterdam to New York

Dear Amsterdam,

First of all, thank you! I always love hearing positive feedback (and I suppose any feedback) on anything I've written. It makes things so much more meaningful for me when I get to hear that the time I've spent has meant something to someone! That's really at the heart of why I bother posting anything on instagram or this blog at all - I like to think I'm making people's lives incrementally better in some small way.

Yes, you're right. When I was very overweight, my hba1c (when I actually went to the doctor - which wasn't at my biggest or unhealthiest) was 42. This is a measure of your blood sugar levels over the past 3 months, and essentially anything over 40 is not good and over 50 is type 2 diabetes (41-49 is "pre-diabetes" i.e. something is already wrong but you're not quite at the diagnostic point). I avoided the doctor as my health worsened, I wouldn't like to think how high my hba1c actually got. I knew things were not good but I was still not ready to change, at the time of that blood test.

The story of when things started to "click" is long and unclear. There was a day I really remember things snapping into focus (12 March 2012) but there were a lot of events in the lead up to that moment that contributed. I saw a dermatologist privately for a skin rash I was having that wouldn't stay away. While I was there, she gave me a print out on metabolic syndrome. I read it and realised it was literally describing me (I already knew my cholesterol ratios were terrible at this point too), and it scared me. The lifelong consequences of metabolic syndrome are dire. It essentially meant, I was finding myself in one of the highest risk categories of obese people I could possibly be in. 

I also started having many symptoms of PCOS, which is also associated with obesity. None of these things on their own inspired me to change overnight, but it added to the series of events that I think eventually helped me get there.

When I first started out, I just wanted to lose weight. I followed some fad diet off the internet. After a few months I learnt that this was not sustainable, despite the initial weight loss of around 10kg (22lb). I spent hours everyday reading forums and articles. I found www.marksdailyapple.com and learnt about the importance of whole food and transitioned from my fad diet into "primal" eating, which has an inbuilt 80/20 rule i.e. always building in 20% of eating whatever you want. I still think Marks website is a fantastic resource and live by many of the things I learnt back in 2012. In fact, I'm probably still 80/20 primal even now without even realising that I do it. I lost most of my weight eating this way (although a lot of the time I was 95/5 i.e. I was eating "primal" 95% of the time and having less treats than I do now). Eventually, my weight loss stalled. This is when I found keto. I lost the last 10-15kg with keto. I still use keto now on and off as necessary, but I follow no prescribed eating plan. I've learnt enough along the way to just use tidbits of knowledge to manage myself as best I can. Maintaining weight loss is HARD work. I use to think maintaining must be the easy part but it really isn't. I've found my body has no weight setpoint. You know how most people can eat basically either good or bad within reason and their weight will sort of hover in about a 4kg window? Mine does not do that. Any change for the worse results in a REAL weight gain rather than a transient fluctuation, so that's been hard. I'm hopeful that after many many years of being a lower weight my body will reset homeostasis to this size.

To answer your specific questions: No, I didn't follow a set plan. I read a lot and learnt how to work it all out myself (it's very doable). I started seeing results basically immediately when I went keto. In fact, the results were so fast it was almost scary. However in the long term, keto is quite an unsociable way of eating and most people eventually want their life back and the freedom to eat what everyone else is eating. But I think it's a fantastic tool and would still recommend it (and still use it).

Nowadays, my hba1c is consistently 30-35 (completely normal) and my cholesterol ratios are all stunning. I'm also no longer centrally obese (you can work out your waist:hip ratio to quantify this). My blood pressure is textbook 120/80. Essentially, I no longer meet any of the metabolic syndrome criteria. There's too much to say in one answer about why I think low carbohydrate diets are one of the best ways (not the only way) to fight metabolic syndrome and insulin resistance, but here are some links to get you started:

A study on ketosis as a regulator of obesity and metabolic syndrome

A good article explaining some of the outcomes of ketogenic diets and comparing this to exercise

Peter Attia is a doctor who has a great website where he posts all about his own experimentation with ketosis plus about new research

 

I hope this was of some use!

SIncerely,
Jasmine

 


Dear Jasmine,
Hi cutie :)
I have some things that make me feel bad,
I am a 25 year old girl,and I work as an assistant in an office,where it is very important to dress well, look pretty, I know im not ugly,But all my life I've been fat, and every day I feel very bad, for how I am and how I look.
I've been in the gym for a while now, and this last month I went with a nutritionist and he put me on a diet,
I do not see any change, I'm still weighing the same and the clothes are the same.
It is very difficult to have a strong mind with this lifestyle

How hard was it for you to get it?
What was / what motivates you?

because more than I try to get ahead there's always something that discourages me.

Sincerely,
Mae

Dear Mae,

The most important thing with changing your lifestyle is the reason for doing it. And I'm not sure your reason is in your best interest. You need to try to say GOOD things about yourself. It is so much easier to look after yourself and make good choices when you love your body. When I was in the part of my journey where the most change was happening, I had a very strong image in my head of who I wanted to be. But I didn't put my current self down in doing that. I just imagined my strengths even stronger, and my potential realised.

Try this: Think of all the good things about yourself. Now imagine who you want to be in a year. Ty to line those things up and plan what aspects of yourself to nurture and what things you could adjust.

I viewed my "journey" as a whole person transformation, it wasn't really about the weight! (But I didn't know that at the time)

You will get there, just start with how you think about YOURSELF and the rest will follow.

Sincerely,
Jasmine


 

Dear Jasmine,
I have been battling binge eating for 16 years, I’ve lost and gained weight so many times. I successfully lost over 26kg for my wedding five years ago and was in the healthy weight range for the first time in my adult life. Since then I’ve regained it and then some, ballooning to 116kg when 40weeks pregnant (getting back to 86 within 6-7 months). I’m now pregnant again and my weight is skyrocketing. I feel disgusting and unhealthy.
My question is - I love the idea of mindful eating and the non diet approach but given my history I get scared that my set point is stuffed so if I try that approach to a healthy lifestyle and healthy weight I’ll just end up 90kg for the rest of my life. Not a bad thing in itself if I’m healthy but I want to return to running and want to minimise a few personal health risks I have.
What are your thoughts on the intuitive eating approach for long term weight management?

Sincerely, more yos than a yo-yo

Dear yo-yo,

I love this question, and I think it's a super important and complex area of weight loss. Long term weight loss is actually still very rare and poorly studied. Even with weight loss surgery such as gastric sleeves, up to 2/3rds of patients can regain all of the weight within a few years in some studies. It's also something I personally struggle with.

So far, I have not managed to maintain my weight loss with intuitive eating. I've discussed this with my own GP at length, who recently said to me "I can't comment on this any more than you can, because there's no research and your experience is all we have". Basically, as I mentioned above, my set point is non-existent. Any change in my eating from my normal "monitored" eating leads to weight gain, and it stays around (not just a short term gain). In reality what this means is that everytime I go on holiday (basically the main times I attempt to intuitively eat) I gain weight, and I then struggle for a long time afterwards to lose it again. Over the past 2 years this has lead to a stepwise weight creep. I gained a few kg in America in 2016, never really lost it, gained a few more in Bali, didn't lose it, gained a few more kg in Japan, never really lost it, gained a few more kg in Asia, never really lost it.... you see the pattern. I maintain my weight at home by taking an active interest in what I'm eating, but whenever I go on holiday and try to eat intuitively, it evidently doesn't work for me. Obviously, I'm not happy about this. All over social media there is this idea of intuitive eating and rejecting macros and rejecting calorie counting. Which I completely agree with... if you're an average person. What I've come to realise is that I'm no longer an average person (in this regard at least... very average elsewhere, I assure you). Being someone formerly obese now living the life I'm living, I'm in a small category of poorly understood human physiology. I don't LIKE how it is, but I've had to accept that this is how things are for me (at least for now... I hold out hope that my body might eventually reach a new set point). Once I realised I am not in the same category as the people who do intuitive eating, it took the pressure off me. Ultimately, the most important thing for my long term health is that I keep this weight off. If I have to monitor my food to do it, I will. I basically don't know anyone else who has lost as much weight as I did without surgery, so I have very little rolemodelling to go off, but this is the place I reached within myself. Whether you want to look at the obesogenic environment we're in, the epigenetic changes that have occurred meaning a lot of our weight is already determined at birth and even moreso at puberty, or a myriad of other factors that are beyond our control, the only one that is in my control is what I eat and what exercise I do TODAY. I don't like that this is the case, but medicine has not come far enough for there to be any other answer. As far as I see it, this is now something I MUST do to maintain my health and unfortunately that means going above and beyond the "average" person. Does anyone else care that I have to work extra hard, just to maintain? Hell no. People are still in the mindset that weight maintenance is exactly the same for everyone, but this just plain is not true. People who are skinny for life despite eating junk are not actually secretly eating salads the rest of the time (and the converse extreme example - you are not just some willing glutton who overeats for fun, stuffing yourself even when full and never considering your weight). There are very complex environmental and genetic factors at play. Why are some thin people not very hungry? Why are some thin people very hungry but don't gain weight? Why are some people so pre-occupied with food? Why do some people barely think of food? We can't argue with eachother, resenting only hurts us. The ONLY answer is to take responsibility for the cards we've been dealt and make the most of it. *I* care how my life turns out. *I* care that I don't end up diabetic. *I* care that I maintain my fitness and health. It's up to me to do the most I can. Some of it is beyond my control, yes, it's harder for me to stay the same weight, yes, but I don't think that's a reason for me to not give it my best (within the realms of what is good for my mental health).

I am still trying to lose some of the weight I have gained on holidays over the past few years, but with a lot more of a relaxed approach and to be honest, it doesn't feel much different to "normal life" for me anymore.

My views on this may change, but for now I'm trying to find that fine line between giving it as much effort as it needs (which is more than an average person) but not so much that I feel resentful of it. I'm not aiming for perfection, just happiness and health.

SIncerely,
Jasmine