Thirty years ago I started writing a book about diets. The idea was to beat the nutritionists at their game, to eschew ‘diet’ foods and fads, and get back to guiltless eating. I wanted to show how wholesome eating, including all those foods you were told were bad for you, could have a much better effect. Then I had a health scare, a non-malignant growth saw my weight plunge. It resulted in a major operation to remove a section of colon and six months off work. I didnt need to diet anymore.
Doctors gave me no advice about diet or exercise after the operation. I found I gained weight far too easily. Over the next ten years I went on two successful diets, and suffered two unsuccessful attempts to keep the fat at bay in between times. At my heaviest I weighed a whopping 91.8kg. At that weight I was teetering beyond the overweight and plunging into the uncharted territory of obesity.
I managed to convince myself that I should go into old age a ‘little bit’ overweight. I resolved not to worry about weight anymore.
Then I contracted flu. I treated this as I’d always treated niggling ailments. I took decongestant tablets and worked through it, but this time my symptoms didn’t go away. February turned into March and March into April. I didn’t get better; in fact I got much, much worse. I developed a debilitating cough and a fever. My energy levels sank so low that I couldn’t easily climb the stairs in our house.
Eventually I was persuaded to visit the doctor. I was prescribed antibiotics, but the cough continued. My doctor told me to drink sugary drinks to ‘keep my strength up’. He said that if it got any worse over the weekend I should go straight to casualty. By Monday I still felt weak. My cough hadn’t gone away. I’d developed a chest infection and a urinary infection. I couldnt even stand up in the doctors consulting room. I had to sit down to get my breath. My doctor took a urine sample and spotted that there was a lot of sugar in my blood. A blood test confirmed it. I was diagnosed with diabetes type 2.
DIABETES TYPE 2
Diabetes makes it much more difficult to shake off infection; it saps your energy. I had all the symptoms.
Diabetes type 2 is a serious illness. It is exacerbated by taking too much sugar, but these days we think that diabetes type 2 is brought on by obesity, eating too much of anything. It is triggered when fatty deposits block the islets of Langerhans in the pancreas, that block the release of insulin.
It is these rather romantically named cells that secrete insulin. And it is insulin that regulates our metabolism and flushes glucose from the system. If left unchecked diabetes type 2 can lead to some very nasty complications, including amputations of the hands and feet. But, it is so prevalent that a newly diagnosed sufferer is not referred to an NHS specialist. I was given metformin pills, told to reduce my sugar intake, avoid bananas (!!!) and instructed to take more exercise. The inference was that the illness could be managed, but not cured. It was hinted that I could lose weight, though no one said this was anything but optional.
I’d spent so much time researching diets by then that I knew I could successfully lose weight. At that stage it was merely a straw to cling to. I started trawling the Internet for suitable diets for diabetics. Pretty soon I started to realise that many researchers were suggesting that the casue of my illness had been my obesity. And at that time stories were beginning to emerge about a ‘miracle’ cure for diabetes 2. That cure was simply to lose weight – and lose it fast.
My doctor hadn’t told me about this ‘cure’. She’d predicted that I would need drugs to manage the illness for the rest of my life, migrating from metformin, which would stop working eventually, to having to inject insulin. My natural cussedness stimulated me to fight against that prognosis. It forced me to think harder about a new diet, one that I could maintain for the rest of my life.
I realised that I wouldn’t merely be required to lose weight. I would need to lose weight fast, before I caused any further damage to my organs. Most importantly, I’d need to keep the weight off forever. This was the regimen I’d never been able to crack in the past. But a potentially debilitating illness is an excellent motivator. I went back to my books. I read scientific journals. I downloaded medical research papers.
WHY WEIGHT LOSS IS SO DIFFICULT
Slowly it began to dawn on me that I hadn’t been quite so blameworthy in regaining weight after my operation and past diets. This is a common problem. The general rule at that time was that the faster you diet, the faster you put weight back on. When you diet your metabolism drops right down – you aren’t eating very much – so your body doesn’t have to work so hard. It’s a good way of preventing death if you happen to expereince a famine, but thats rarely our problem today. After I’d reached my target weight, with a low metabolism, I’d simply begun to reload those adipose cells that store the fat. Once built up – generally in youth – adipose tissue cells, the sacks that store fat, never dissolve. They just get bigger or smaller. Whats worse we used to think of them as inert cells, simply storage. But now we realise they are very active sells, storing all sorts of rubbish along with the fat, that contribute to our ability to fight off infection.
In addition, once we lose weight, we can’t simply go back to eating what you used to eat. Our old diet was designed for a bigger person. Even if you went back to eating what most people would consider to be a reasonable diet, the likelihood is that this healthy new diet would be too much for me at first. The body adapts to weight loss byt reducing the metabolism long term. So part of weight loss, and I now realise the most important part is maintenance. During the maintenance stage, once you are well on the way to your target weight, we need to re-train the metabolism, getting it back to a healthy pitch, otherwise we will put on weight. The conundrum is that a natural consequence of successful dieting is a low metabolism, that is also a natural trigger for weight gain. But the worst is over in a few months. After that its simply a question of vigilance.
When we lose weight it is difficult not to lose some muscle mass as well. So the first role at the maintenance stage is to re-build the muscles. Ironically that results in a slight weight gain, which can be very disconcerting if it is not expected. I now weigh all my clients, every time they visit, using dual energy bioimpedenace which provides a measure of fat mass, muscle mass and strength. Simply looking at weight is not enough.
If that isn’t enough our brains also try and force us to pig out. When we reduce our eating, especially if we don’t eat a balanced diet, every pore in our body is trying to regain those lost nutrients. If you have any emotional wobble, if you suffer from stress, if you get ill, your gut will release hormones that can make you ravenously hungry. At the same time emotional signals will be released which tell us to eat in order to feel better. We call this comfort eating. What I discovered is that it wasn’t a fault of my willpower. The gut might actually be screaming for vitamin C, but our brains are just as likely to interpret that signal as an urgent need for chocolate cake.
Cell biology doesn’t easily distinguish between hunger and stress. Our adrenal gland releases exactly the same chemicals whether we’re being chased by lions, being hammered by our boss, or if we’ve simply skipped lunch. This is a biological fact that most diets ignore. The stress of hunger is treated in the same way as the stress of a lion – part of that signal says ‘eat sugar’, because glucose (pure sugar) is the fuel that gives us the energy to think quickly and to run away! The brain requires glucose every minute of the day or night. Without it we die. The outcome is that if we don’t eat a balanced menu from day ONE of the diet, we become more vlunerable to attacks of the munchies somewhere along the line. THat is why fad diets, exclusion diets and one type food diets are simply unworkable, they put furrther stress on the body, just when it needs all the good nutrityion it can get.
DISCOVERING THE EXPONENTIAL
Over the next few weeks nothing except diets and metabolism captured my imagination. I was still ill, so confined to light duties. I had loads of time to read. Eventually I settled on an approach which combined the very low calorie ‘Newcastle’ diet[i] I’d heard would be beneficial for diabetics, with an idea I’d gleaned from the very scant maintenance research, to add back calories slowly. The Newcastle diet, which at the time was simply a pilot study – uses packaged products, powdered milkshakes and soups. I wasn’t going to put factory produced products into my body, so I started from scratch, devising nutritious recipes that would, I hoped, be more effective and better tasting than processed ‘diet’ foods. I’m pleased to say that The Newcastle Diet is now a recognised diet for diabetes and has shown very good results in large scale studies. But it still uses packaged products, which in my view are not a recipe for health.
Part of dieting is learning a new routine – and I certainly didn’t want that routine to be simply mixing a powder with hot water – ugh!
It seemed to me that gently adding calories once you’d reached your desired weight was too late in the process. I eventually settled on an approach that makes use of a very common mathematical curve – the exponential. We are normally used to seeing a graph where things exponentially increase, like seedlings from a parent plant, or the profits of Google. But I was interested in exponential reduction. Even if you are not mathematically minded take a look at the graph below:
The red line shows the dieting graph we all traditionally aim for, a nice steady decrease in weight, occasioned by a nice steady calorific intake. Most dieters don’t achieve this. As a dieter loses weight they need to reduce calorie intake as well, in order to continue to lose at the same rate. Reducing calorie consumption at the end of a long diet is hard and often leads to the plateaux that many dieters complain of. It’s hard on the spirit, and it’s harder on the body, pressing the metabolism into even more sluggishness from which it can take several years to recover.
Now take a look at the green line. This is the dieting pattern that I wished to emulate. It describes exponential reduction. This means a rapid weight loss at the beginning of the diet, followed by ever decreasing weight loss as you reach your desired target. Notice that this diet gives the metabolism time to recover from the shock of the diet. I figured that some of the worst challenges of dieting might be mediated by this regimen.
I assumed this would be the slow route, because at the end of the diet I would be losing weight slowly. But I hadn’t realised that I could handle a low-calorie diet in the first few weeks and get a head start. Neither did I realise how efficacious that diet would be. There would be no danger of yo-yoing from low to high calories. At the end of the low calorie phase, I’d simply need to add back calories gradually, while still losing weight.
In the end I decided to add back food groups rather than calories, concluding that it would be easier to manage portion sizes for life than calorie counting.
Like all good scientists, I experimented on myself first. In the first nine weeks of my pilot diet I lost 13kg, that’s over two stones. My pancreas gradually started working again and I was soon able to give up diabetic drugs. According to the NHS, there is no such thing as a cure for diabetes. I’m officially in long term remission. Several years on, my weight is normal, my diet is healthy (but not cranky) and my blood glucose results are normal.
The transformation was very satisfying; very quickly I started to look and feel better. Because weight loss is loaded at the beginning of this diet, it is definitely the quickest route to the land of the svelte and active. Without meaning to, I’d happened upon the fast track!
RETRAINING AS A NUTRITIONIST
It was at this stage that I decided to go back to university and re-train as a nutritionist. I studies at St Mary’s Twickenham and then took up the offer of a combined taught and research MSc in clinical nutrition and eating disorders at UCL Division of Medicine in London. At an age when many women are thinking about retirement, I found myself attending one of the best medical faculties in the world, and listening to experts on nutrition and metabolism. I now specialise in women over 50, women who, like me, have a lot stacked against them. The reduction in hormone output occasioned by the menopause is often associated with weight gain. And because our whole metabolism changes, almost overnight, we often find that our old diets no longer work for us.
At university I took the opportunity to refine my ‘seat of the pants’ diet design using hard scientific data. I now know why my diet worked so well for me and why it works for my clients. I also started tackling the maintenance stage of the diet. For many of my clients keeping the weight off can be more difficult than losing in the first place and my practice is now focuseed on long term support.
It is in middle age that long term, life threatening diseases, like diabetes, cancer and cardio-vascular disease start to take hold. Losing weight is a sure fire way of managing a long list of conditions and increases our risk of preventing the really serious ones. Being overweight can exacerbate muscle and bone weaknesses, it can make us feel unloved and un-lovely and induce depression. Some scientists are now suggesting that poor diet is implicated in diseases such as dementia.
Being healthily thinner and stronger will likely extend your life span by some years, but it can extend active life by decades.
At the same time friends and colleagues asked if I’d help them lose weight. By helping these people, not all women, but mainly over 50 I gradually gained the confidence to open a clinic. I am very grateful to my guinea pigs, including my husband, Mike, for their support and suggestions. This blog is the culmination of many years’ experimentation and study. I hope I can help you too.
[i] Newcastle diet: Professor Roy Taylor at the University of Newcastle initiated this research. When I started following the diet, only a pilot had been published. This paper gives more extensive results of a recent study. Michael E J Lean, Wilma S Leslie, Alison C Barnes et al., (2018) Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet 2018; 391: p 541–51.