I have a number of posts in the hopper about weight gain during pregnancy, pregnancy nutrition, how I managed to fight off (and then succumb to) some sympathy pounds myself, New Year’s resolutions, and some other posts unrelated to being pregnant or being a new parent. I haven’t posted any of them (yet) because we had a rough pregnancy, and then because being a new parent is much, much more time-consuming and enervating than I ever would have possibly imagined.

Losing weight is simple but it isn’t easy. It requires a certain amount of dedication, but getting fit mostly requires a good routine, and it’s hard to keep to any kind of routine when you have two babies to feed, change, play with, and otherwise look after. There are two of us and yet sometimes Amanda and I still feel outnumbered. Before they were born I was walking on our treadmill just about every morning before work, recording everything I ate, weighing-in every day, and losing a nice steady 8–10 pounds every month until last Fall when I stagnated.

After the boys were born I started to put on weight at almost the same rate, gaining about a pound a week through the holidays. Some of it was a change in routine, or because we ordered-in a lot more, but I’m sure some of it was due to stress, too, since high-calorie foods are very comforting.

I said above that our pregnancy was “rough” but I should probably elaborate a little.

Our Terrible Pregnancy

We’d[2] been trying to get pregnant for nearly two years before we finally did, with a couple of half-starts and false-positives[3]. When we bought our house in May 2011 we kept the second bedroom mostly empty and referred to it as “the nursery” before we moved in. So even before we were actively trying we were at least planning to have children.

Amanda and I had both seen a number of fertility doctors after the first year, and nothing was really wrong with either of us. We both lost some weight and exercised more. I started taking supplements to increase the count and motility of my sperm, and there was talk of my having surgery to remove a varicose vein that could be heating things up too much “down there,” but I never got the surgery. Amanda was (and still is) young enough that age wasn’t a major consideration, and everything just appeared to be working normally. Still, we weren’t getting pregnant.

When I was younger I assumed that you have unprotected sex once and BAM – you get pregnant. The real world doesn’t work that way, though. There are only a few days per menstrual cycle where a woman can actually get pregnant (although sperm can live for over a week inside) and not every woman actually releases an egg every single month. So right away the odds are against us. How did the human race ever proliferate before ovulation calendars and timed abstinence?

Nonetheless, sometime in October 2012 we finally got pregnant. We tested with two different brands of pregnancy test[4], and then Amanda got a blood test that confirmed it. I just happened to be working from home (for some other reason) the day the doctors called and we both heard the good news together while standing in our bathroom.

We found out a few more weeks in that we’d be having twins. When it rains, it pours.

We got each other a lot of baby-related gifts for the holidays last year. Amanda got me a “World’s Greatest Dad” mug and a Minnesota Twins t-shirt (that says “Dad 1” on the back – I brought it to the hospital and changed into it on the day they were born). I got her a bunch of kitchy pregnant t-shirts that said things like “Baby Bump’s First Christmas” and “Two For the Price of One”. We bought cute onesies and books for “the babies” (we wouldn’t know their genders until mid-February or so). I had two onesies made. One said “Buy One” and the other one said “Get One Free.”

There were complications almost immediately, but thankfully most of them were painful for Amanda but not harmful for the babies. All of the books, pamphlets, and doctor’s warnings will say things like “Some pregnant women may experience…” and then some symptom. Amanda is “some pregnant woman” – she experienced almost every pregnancy complication a woman can. Terrible morning sickness? Check. Swelling in the belly because of extra fluid that needed to be removed with a needle once a week for the first five weeks? You bet! We spent the better part of Christmas 2012 in the ER because of some bleeding that turned out to be cervical polyps, caused by hormones and only tangentially related to being pregnant. Still, you’re pregnant and you start bleeding, you get your ass to the hospital, major holiday or not.

Because of our history and because Amanda is by her nature private and a bit of a worrywart, we only announced the pregnancy to our families after the customary twelve weeks[5], on Christmas day when everyone on my side of the family was gathered together back in Philly, but waited another month to make the big public announcement to our friends, coworkers, and social media sites at sixteen weeks. So on Monday, 21 January 2013, we announced this to the world:

We’re pregnant! With TWINS! Due on the 4th of July. http://t.co/1DIigapo

— Jough Dempsey (@jough) January 21, 2013

Thanks for the kind words, everyone. Amanda announced the pregnancy by changing her Facebook status pic to this: http://t.co/sybl2CKv

— Jough Dempsey (@jough) January 21, 2013

Two days later I posted the last article I wrote for this blog before this one.

The Incident

This is the first time I’ve written about the worst day of my life. Before I delve into this personal horror story I’ll:

a) warn that you may not want to read this if you’re pregnant or planning to ever become pregnant, and

b) remind you that this story has a happy ending (although we didn’t know that it would at the time).

I was standing on the El platform at my station on the way to work when I got a call from Amanda who just got to work herself. She said that she thinks her water broke as she was stepping out of the car. She felt a gush and her pants were soaked. She said she called the OB first and they told her to come in. I told her I’d meet her there, left the station and started walking to the OB, emailing my office on the way to say that there was an emergency and I’d be late. We just announced that Amanda was pregnant a few days before, so I didn’t have to elaborate.

I got there first (since the OB office was near home) and waited while Amanda drove in from the suburbs. I called her and we talked on the phone for a minute, trying to reassure her that it could just be urine from her bladder being pushed out by the babies, which I’d read about online as something that happens pretty frequently.

At this point a sense of dread was already emerging, but we’d already seen other complications that affected Amanda but not the babies, so I remained optimistic that this was just another hurdle that we’d have to suffer, some minor indignation that Amanda would experience and then we’d move forward. As I waited for her I started to doubt this more and more.

She got there a little while later and we waited, not knowing how serious it was. They finally saw us and examined Amanda, swabbing the remnants of fluid to look for “ferning” which is a sign that there’s a leak. Our regular doctor wasn’t in, but the doctor on duty smiled, looked up at us, and said “it is amniotic fluid.” The discrepancy between the news (bad) and her demeanor (cheerful) was confusing for a second, but after a moment it sunk in and Amanda started to hold back tears and asked it it was bad, and if there was a chance we could lose the baby. The doctor said yes and we both broke down crying.

They did an ultrasound and found that the fluid around Twin A (the one closest to the cervix) was low. Ultrasounds are too low-resolution to see the tear or spot where the fluid is leaking.

Fluid levels in the amniotic sac being low is dangerous not only because the fluid acts as a cushion to protect the baby, but also because the baby breathes the fluid in and pees it out (gross but true) and this stimulates lung and kidney development. Having a rupture is more dangerous, because it means that infections and things that the baby would be otherwise protected from in their little isolated chamber can now reach them.

They sent us to the labor and delivery ER at a major downtown Chicago hospital. I drove us there in the snow, praying they were wrong, and hoping there was still a chance to save Twin B.

I dropped Amanda off so I could park the car and got stuck in the hospital driveway. Aerosmith’s “Dream On” was playing and it felt like the universe was taunting me.

I left the car with the valet and met Amanda in the lobby. They took us up to the labor and delivery department and the sinking feeling in my chest started to lower to my guts as I realized they were walking us to a nearly-abandoned wing. They put us in a huge corner room away from everyone else (probably in case we started to cry loudly) and then we waited.

While we were waiting we talked about being strong for Baby B, already resigning ourselves to maybe losing another baby but pressing on to do the best we could for both of them. We cried a lot. Mostly we just waited, praying please, please, please let them be okay.

A resident finally came to see us. He said that once the amniotic sac breaks there’s very little that they can do, and that they can’t save Twin B if Twin A’s bag broke because everything’s connected. The bag around Twin A had a “pre-term premature rupture of membranes” (PPROM) which is to say it sprung a leak prior to thirty-seven weeks of gestation. We were only at week seventeen, and their chances of survival outside the womb at that point are virtually none. Even if they did survive, they’d likely have all sorts of developmental complications and wouldn’t live a good life.

The rupture, he said, was likely caused by an infection that weakened the amniotic sac, and thus waiting meant that Amanda was at risk for getting an infection that could potentially get septic and cause her to lose her uterus, which would mean we’d never be able to have children at best, and could cause Amanda to die at worst.

He explained our options would be to wait to deliver the babies, or to perform a “dilation and extraction” or “D&E” procedure which is tantamount to an abortion. Basically they’d open up Amanda’s cervix and pull the babies out in pieces.

Since we were intent on keeping these babies, and the options presented both sounded horrible in different ways, we waited to talk to the attending specialist and to see our OB. He said if we waited and did nothing that Amanda would go into labor within 24–48 hours and maybe we could hold them briefly before they died.

Think about these options. Either they’d induce labor, in which case Amanda would have given birth to both babies who wouldn’t have survived for more than a few minutes to a few hours, or she’d willingly abort them and have to live with that[6]. Amanda was terrified of giving birth to babies that were doomed to die, of having the happy moment she’s been dreaming of turned into a twisted nightmare. At the same time, we couldn’t willfully abort them if there was anything, anything at all we could do to save them.

We waited for another hour and our regular OB came to see us. She confirmed the resident’s grim outlook and gently pressured us to make a decision because time was running out. She said that one of the best prenatal doctors in the world, who has been on boards appointed by the president and who has won all sorts of awards would be in to see us along with her team.

She left us alone to think about and discuss our options and we waited for a few hours holding out hope that the world-renowned specialist would have better news for us. I searched the internet for answers, hoping to find news of how our babies could get out of this alive.

In the meantime, neither of us had anything to eat or drink. They didn’t want Amanda to have anything in her stomach in case she had to go to surgery.

We finally saw the specialist, Dr. G, who arrived with her resident and the first resident we saw, plus another doctor plus a counselor and at least another nurse or two. They sat around us and reiterated what we’d heard before. We asked every desperate question we could think of – is it possible the bag could reseal? Are there any other options? Can we save Twin B by removing Twin A? Is there any chance at all for us having a positive outcome?

Their answers were dire. No, the bag can never heal or reseal. D&E or inducing labor are your only options (and if you don’t induce, labor will happen naturally within 24–72 hours, so you may as well induce or abort). They said the chance of keeping the babies was around two percent, but based on what they’ve seen they didn’t think it was even that good.

They stared at us and waited for us to make a decision. What would you like to do? We didn’t know. Are you absolutely sure it was amniotic fluid? Are you sure there’s a rupture? Dr. G asked if we’d like to do another ultrasound to confirm. We did.

Amanda couldn’t even look at the screen. She burst into tears upon hearing their heartbeats on the monitor. The fluid was indeed low.

They left us alone again to confer and decide, with the implied pressure of making a decision, and the doctors were getting more annoyed as the day went on.

We called our parents. We cried some more. We tried to decide what to do.

Finally, after it was too late to go to surgery that day, they brought us some water and a couple of turkey sandwiches, which we didn’t really eat much of.

Eventually we decided to leave and take the night to think about it (with the instructions to rush back should Amanda go into spontaneous labor).

I searched frantically for information online. I found some success but mostly sad stories at the pPROM support site. We were physically and emotionally exhausted. Amanda was still pregnant, and stress on her is stress on the babies.

The owner of my company texted me to see how we were, and put me in touch with his doctor who’s a bigwig at the hospital. He called and suggested I talk to Dr. G. Things were looking hopeless. We went to bed really early and in the middle of the night Amanda asked me to hold her. We cried some more. We prayed. We cried.

On Friday morning I called every high-risk pregnancy doctor in the Chicagoland area. I explained our situation over and over trying to get an appointment for a second opinion, trying to find someone that could help save our babies.

While I was calling other doctors Amanda’s OB called to suggest that we schedule the D&E for Monday, just in case we decide to go that route so that it’ll be on the schedule and we’ll be able to do it. Amanda said she’d do that and then got off the phone. It felt like getting a phone call from the Devil. I called the hospital where my urologist was based. They said they could see us in two weeks. I explained that it was an emergency, that we were told we only had 48–72 hours. They said they’d call back within the hour. They called back a week later saying that they could see us the following week. Gee.

I called another practice affiliated with a different major Chicago hospital. They told me they didn’t have any appointments available and I broke down crying, begging them to please see if they could fit us in. I was placed on hold and a few minutes later was told that if we could be there within the hour Dr. H would see us. We jumped in the car and went to see the doctor.

Dr. H did an ultrasound and found that the fluid level was low but not dangerously so. He said that while Dr. G was technically right in that the bag won’t heal like a skin wound it does sometimes close up and reseal. He agreed with the assessment that we only had a two percent chance of success, but thought we could afford to wait as long as Amanda didn’t show signs of going into labor or having an infection[7]. We told him what Dr. G said about sepsis. Dr. H was incredulous, and said that would only happen if we were in a third-world country without access to medicine. He said they’d monitor Amanda and if we wanted, he’d like to follow-up on Monday. We said we would and so we switched doctors to the new practice.

All of the other doctors at our old practice (and at the hospital) were entirely focused on managing the negative and not at all interested in helping us save our babies’ lives. Dr. H, and other doctors we met in the new practice, seemed to be all about what we could do to mitigate the risks (keeping in mind that a lot of it was out of our hands) and doing everything possible to give our pregnancy the best chance that it had.

The day after The Incident was the first and last time we saw Dr. H. He moved away shortly after we started going there, but we’ll always be grateful to him giving us hope, which gave us strength to persevere. We asked him what he would do, and he was the only doctor we’ve ever asked that of who actually told us. “If it were my wife? I would definitely wait and see.”

We weren’t out of the woods yet, and were still scared about what could happen, but we left Dr. H’s office with some hope that we could save our babies. Amanda was prescribed bed rest and for both of us to avoid other people as much as possible.

We Became Shut-Ins

The first couple of days and weeks after The Incident were terrifying. At first we were just waiting for something bad to happen, looking for signs of infection. Amanda went on sick leave. I was in the middle of a big project at work but thankfully they let me work from home and use some of my vacation days as FMLA time so I could take care of Amanda who wasn’t supposed to go up and down the stairs or really get out of bed any more than she absolutely had to.

An infection would mean that Amanda would likely go into labor and we’d lose both babies. There is very little chance of stopping labor once it happens to save Twin B. At 25 weeks their survivability would go up to the 80th percentile, and after 30–32 weeks (depending on which statistics you follow) well into the 90s. So we had to just hang in there, one week at a time.

I can’t even begin to describe the horror of just waiting for something bad to happen for seven weeks. We never left the house except to go the doctor’s for a weekly checkup and ultrasound. We had groceries delivered. I’m sure the Peapod guy had a good story to tell about the customer who always greeted him wearing a face mask and gloves. Sometimes I’d go to the supermarket (also wearing a mask) extremely early in the morning when I was less likely to run into anyone else. I washed everything well, including myself, whenever I had to interact with Amanda.

To keep hydrated and keep fluid levels up Amanda was pounding down watered-down cranberry juice, which also helps ward off urinary tract infections. We took her temperature several times a day to make sure she didn’t have a fever.

It worked, or at least seemed to. The fluid levels increased. Every week we’d find out the measurement of the largest measurable pocket of fluid in each amniotic sac. As the weeks went on we’d even see one of the boys sucking his thumb or them touching each other through the membrane between the bags.

There wasn’t much else I could do other than take care of Amanda, make sure she had pregnancy-safe food to eat, plenty of fluids to drink, and to keep her spirits up as much as possible. As the weeks went on we grew more cautiously optimistic, but never any less vigilant. For the first few weeks Amanda wouldn’t look at the ultrasound screen because she couldn’t bear to see them in case things went bad. She’d start crying when hearing their heartbeats. Those first few moments before they found each heartbeat every week was especially anxious. After the first week the doctor came in to discuss the ultrasound results along with a “coordinator” from the hospital who was just there to assess Amanda’s well-being and to try to talk us down from the ledge.

I read that watching funny movies and comedy TV shows sometimes helped a pregnancy’s outcome, so Amanda tore through various seasons of comedies on Netflix.

It was impossible to enjoy the pregnancy, however, and because something terrible could happen at any time, we avoided buying things for the babies or decorating the nursery for a long time.

Around twenty weeks we found out that we were having two boys[8]. We didn’t tell anyone until after they were born.

A week before The Incident we went to a furniture store to order two cribs, a chest of drawers, and a book cubby for the nursery. We were ordering pretty early, but one of the items was on backorder, so they said it could be 6–8 weeks before we got everything delivered, which was actually perfect for us as it would give us time to do some decorating in the nursery.

Naturally the day of The Incident I got a call saying that the furniture came earlier than expected and when would we like it delivered. At that point we couldn’t take having two cribs in the house in case things took a turn for the worse, so we put off delivery until after 30 weeks when they would be more likely to survive even if Amanda did go into early labor.

Hospitalized

At week 25 Amanda was admitted to the hospital as a matter of routine to administer a series of steroids and intravenous antibiotics, just in case. The antibiotics would help prevent infection, but were also known to delay premature labor, and scientists don’t know why, but it does. Maybe it only works due to how the numbers are crunched, but we were willing to try anything that could be thought to help as long as it didn’t do any harm.

The steroids are for the babies. They speed up lung development in case they’re born early. Most of the benefit occurs within the first 24 to 48 hours, but studies show that there may be longer-lasting benefits for weeks after. There are two rounds spaced apart by 24 hours, in two courses – one at 25 weeks and then another 24 to 48 hours before Amanda would go into labor. How good are doctors at predicting when a woman will go into labor? Not very. But we’ll get to that.

While she was there they’d monitor the babies a few times a day with a doppler ultrasound machine, which were these plastic circles attached to straps that went around her back and had to be placed as specific angles to read the babies’ heartbeats. Sometimes the two rates would synchronize and it meant that both monitors were reading the same baby, same heartbeat. Some nurses were especially bad at setting it up for two heartbeats. I got to be pretty good at it. Of course as soon as you’d lock onto one the other baby would shift and it would stop reading. It was somewhat comical, our little rascals wiggling around in there.

So Amanda was in the hospital for the better part of a week, and after seeing her in there for a day I went back to the office (at first secluded in a room and wearing a mask whenever going to and from, and then once Amanda got the green light to matriculate back into society we both were able to go out into the world again, which we did cautiously). After testing to see if there was any fluid leaking, and a swab didn’t show any ferning, Amanda was discharged and the OB appointments continued like any other pregnancy.

Those weeks after week 25 were still scary because we still didn’t know what would happen, but at least after passing that milestone we knew they had a much better chance even if Amanda’s water did break again and they were born prematurely. The entire pregnancy was like walking out onto a frozen lake, knowing that the ice was thin, and just not being sure if the next step would be the one where you broke through the ice. We just hoped when (not if) we did, we’d be closer to shore.

Babiestime

Around 4am on Wednesday, May 8, 2013 Amanda called me from the bathroom. She was leaking again, at 32 weeks. We called the doctor, rushed down to the labor & delivery triage, and they saw us right away. The trip to the hospital wasn’t anything like I pictured it would be. Mostly we were quiet. It was so early that the roads were empty.

They took Amanda back and made me wait in the waiting room so they could ask her questions about whether she feels safe at home. She later told me that she kept asking for me, but they had a checklist of things they first had to ask her. When they finally called me there were at least half a dozen people around her. Amanda was crying and there was blood on the gurney, Amanda’s gown, and even on the floor. The fluid was indeed amniotic and the blood was from her cervix dilating. They brought us down to a labor & delivery room in case the babies were coming soon.

While we waited they gave Amanda the second course of steroids in case the babies were born within 24–48 hours.

They put a doppler ultrasound around her belly again and didn’t see any signs of contractions. They planned to move us into an antepartum room to wait until Amanda started to go into active labor, so I went home later in the afternoon to grab some things for her since we still should’ve been two months out from having the babies so we never got around to packing a bag and leaving it in the car.

We waited around for two more days in antepartum with the baby heart rate monitors strapped to Amanda’s belly the whole time. Sometimes an alarm would sound because the babies’ would “decel” meaning that their heart rates decelerated, which is usually a sign of contractions (the uterine muscles contract, the babies slow their breathing for a bit in anticipation of being born). They’d move Amanda around and they’d come back up again.

A decel would mean every nurse on duty would rush into the room and flip on the lights shouting and moving Amanda, and usually happened when we were both sleeping (I certainly don’t miss sleeping in hospital recliners), startling us both awake. It was more preparation for having babies than we realized at the time.

In any case, by Friday afternoon they didn’t think Amanda was going to go into labor anytime soon, but her OB wanted to keep her in the hospital now for the duration of the pregnancy. I planned to go back to work on Monday and just come to visit her at work every night.

The hospital had a special “date night” meal for patients and their guests on Friday nights, and we enjoyed a romantic hospital dinner together while wondering how long we’d be able to keep our two little buns in the oven. Every week meant more development, a better chance of their ability to thrive in the inhospitable world outside the womb.

Sometime after midnight the babies decelled again but this time instead of watching the monitor return to normal and then leaving, the nurses had me pack up everything and moved us to a little room full of equipment in labor & delivery a few twisty corridors away.

No one said anything about Amanda going into labor, but two hours after we got there Amanda started to have excruciating pain, mostly in her back. A doctor or a nurse would check-in once an hour, but we mostly just waited together in that little room. Amanda moved to a chair so she’d be more comfortable, and eventually fell asleep a little.

We kept asking if she was going into labor and they said they didn’t know. Meanwhile the pain in her back was getting worse and worse. She was experiencing something I’d never heard of before: back labor. She didn’t feel contractions exactly but felt an increasing pain in her lower back that would surge and then fall off (but still hurt between surges) so we started timing those. They started to grow more frequent and it was clear that those were labor contractions.

After another shift change one of the doctor’s from our OB practice, the only doctor we’d seen only once previously, arrived to deliver the babies. It was time.

She asked if we wanted to do a natural birth or Cesarean section, with plusses and minuses for each. We wanted to do a natural birth, although because we had twins there was a possibility of a hybrid birth as well, with one being born naturally and the other requiring a C-section, depending on position, etc.

Just in case, they brought us into a large operating room with the brightest lights possible. There were at least fifty people present – including a full team of doctors, nurses, and assistants for mother and each baby. The NICU teams usually don’t come down until later, but they hung around waiting since the babies were so premature and they expected a very fast delivery.

Amanda was in labor for two and a half hours before the doctor called it and said we’d have to switch to a C-section. They kicked me out to do prep and I made smalltalk with the nurses and staff in the hallway while trying not to break down crying for fear of Amanda and the babies’ health while they gave her a spinal anesthetic to keep her immobile from the torso down.

They finally let me back in, and I sat behind a big curtain holding her hand while the doctor performed the surgery. Eleven minutes later our son Atlas was born, and a minute later Ezra came out screaming[9]. As the babies were pulled out the doctor called to me so I could stand up and see them.

The day my sons were born was probably the second scariest and also happiest day of my life. Both boys were born eight weeks early and weighed around four pounds at birth. They were dark red and had tons of hair matted to their heads. Atlas had to be on an assisted respirator for about six hours, wearing a mask like Bane in The Dark Knight Rises. Ezra was in the NICU for four weeks and Atlas for five (which is a story for another time).

We were terrified for them before they were born, scared about their progress and survival while they were in the NICU, and frightened of breaking them when we first brought them home. I still have anxiety about them being okay, and sometimes wake up abruptly in the middle of the night and go check on them.

I still feel a little shell-shocked by the whole experience. Can you get Post-Traumatic Stress Disorder from a horrible pregnancy? I should probably talk to a professional about it. Sometimes I think I hear them crying when I’m at the office.

Seeing their adorable little smiling faces or hearing them baby-talk or laugh does alleviate a lot of my anxiety but that doesn’t stop me from checking-in several times a night to make sure they’re still breathing while they sleep, especially now that they can turn over and sleep on their stomachs.

So Many Babies

Having two babies sometimes feels like having ten. When they’re both crying it’s just total bedlam, and a baby’s cry has the tendency to feel as though it’s piercing through the center of your skull.

They’ve gone through phases over the past eight months of sleeping really well, and then not sleeping well. Or one would sleep well while the other didn’t, and then vice-versa. I don’t think we’ve slept well since Amanda got pregnant.

We had them both in the same crib for their first four months at home, as having them in your bedroom is said to reduce the risk of Sudden Infant Death Syndrome (SIDS) which is yet another thing to worry about. Basically I’m just never going to stop worrying.

Having babies is great, though, despite all of the horror and anxiety. They’re little people with preferences, personalities, and feelings, probably far more fully-realized than we usually give babies credit for having.

Against the odds, we made it through. We are the 2%. I don’t know if the prayers worked or we just got lucky, but either way we are truly blessed, and grateful for these boys each and every day. I hope I’m not doing irrevocable harm to their psyches when I tear-up sometimes while holding them.

Routine

We’re just now settling into a bit of routine with them, although I’m sure as soon as we get used to their current behavior they’ll hit another developmental milestone and everything will change again. Despite my body craving carbs and fat during one of the harshest Chicago winters in many years I’ve been slowly losing weight just by counting calories and recording everything I eat again. I’m sure the pace will pick up once I’m able to get more exercise.

At the very least, once the boys start to crawl[10] and then walk I’ll be burning calories chasing after them.

This particular Fall a number of various events have made it harder to eat right or get exercise. It’s the busy season at work so I’ve been spending more hours working. The shift to Standard Time means that it gets dark earlier. The weather has gotten cold very quickly, so I don’t take walks as much outside. My wife started a new job so I don’t have a couple of uninterrupted hours in the morning to walk on the treadmill while she’s sleeping anymore. Plus, there are a few other personal issues that have come up that take my time and attention away from Clean Livin’, or require me to eat & run more often.

I can come up with any number of reasons[1], but what it boils down to is that I’ve slipped. Luckily I have so many healthy habits that they haven’t all fallen by the wayside. I still weigh-in every day. I still record everything I eat (even the unhealthy, high-calorie foods).

How I Start To Slip

At first maybe I’ll grab some food on the run, or not calculate my caloric intake for dinner until the next day. Then maybe I miss recording a meal. Then miss recording a day. Then I get busy with other things and don’t do any research or writing for this site.

So far no matter when I’ve slipped a little (or a lot) I’ve still weighed-in. I think of all of my Clean Livin’ habits, weighing myself and then recording it are the easiest things to do. After four and a half years weigh-ins have become ingrained in my daily routine. Sometimes I forget to weigh in when my routine changes, but barring a day or so every few months where I don’t weigh-in, I have a solid record, and can at least see when I gain weight rather than lose or stay the same.

It’s hard to gauge gaining or losing weight when you weigh in every day, though, because you do go up and down even when you do everything right and are on a trend of losing weight. I think my threshold for thinking “Shit, I’ve got to do better” is going over a five pound mark. For instance, I was down as low as 254.4 a couple of weeks ago (so close to 250!) and then a few days ago weighed-in at 260.0, after going up and down a pound or so here or there for the past three weeks.

So that was a wake-up call. The hard truth is that losing weight takes conscious effort and attention. You have to think about it a lot more than you may want to, and stick to your daily budget most of the time. Sometimes it’s okay to go over budget, but not most of the time. When those indulgences become more frequent than eating right, you’re going to gain weight again. I don’t know about you, but I’ve worked too hard and come too far to backtrack now. Fuck that noise.

Back On Track

It’s not like I haven’t written about derailment or plateaus before. When it happens, no matter how many reasons I have no one to blame but myself. A slip can be just the kick in the pants you need to refocus your weight loss efforts, no matter how cold it is outside.

I’m not sure how long it’ll take me to lose the next ten pounds (some of those pounds… again) but I know it’s doable. I’ve done it for weeks, months, years now.

Losing weight may be harder as the weather grows colder, life gets busier, and habits slip by the wayside. Plan for weight loss to be slower then, but as long as you’re aware of the difficulty and consciously plan means and exercise, you can hunker-down and do it.

Update: Slipped on Posting Here, Too

Speaking of slipping, I originally had this post set to publish in late November and haven’t finished it until just now. Everything else still stands, and now that the holidays are over and I’m back to focusing on weight loss, updates should be more regular once again.

I was interviewed by WalkJogRun.net for their podcast a few weeks ago, but there were audio issues so today they posted a transcript of the interview along with some photos from Clean Livin’.

I’ve previously written about WalkJogRun and it’s a great site for plotting the distance and path of my walks, and better yet, finding a great walking or running route when you’re traveling. They also have a fantastic iOS app and their podcast is always full of great information. I talked to Caitlin of WJR about Clean Livin’, my history of being a fat guy, and about my weight loss success over the past four years.

Being interviewed has given me the bug to start a podcast. Any interest in hearing me prattle on about Clean Livin’ for 15–20 minutes a week?

You can read a transcript of the interview at the WalkJogRun blog.

I was really close two weeks ago, and then my wife and I went on vacation to San Francisco. In my hubris, I was planning to try to lose weight while on vacation, but the best laid plans often go awry when you’re faced with eating every meal out. I figured that I could eat an extra 500 calories a day without gaining weight, since I usually maintain a deficit of 800–1000 calories. Sounds easy, no? I started out okay, but those bowls of cioppino, loaves of sourdough bread, and mission burritos aren’t going to eat themselves[1].

So I can’t say that I did my best. Sure, I continued to log what I ate and count the calories, but after the first few days I stopped worrying about it. When I came back I logged my weight and found that I’d gained three pounds (although I lost the first pound a day later after I flushed out all the salty restaurant food and lost the water I was retaining).

It took me a few more days to get back into the swing of Clean Livin’, but as of this morning I weighed-in at 261.8 lbs, which put me down below the ¾ mark.

You’re in my sights, 250 pounds.

Or…

You could just shrug it off, go for a walk, and eat better next time. Everyone has a favorite unhealthy food – their own personal kryptonite. For me, it’s hamburgers, beer, Chinese food, pizza, and other savory, often fried, things. My wife is really into noodles. You may have a sweet tooth for ice cream, or like salty snacks like potato chips and pretzels. Maybe it’s all of the above. Whatever your vice, let’s say you ate some of it and now you’re feeling bad about yourself.

Embrace the Process

When you eat too many calories at a single meal, you’re not failing at the process. Occasional slipping is part of the process. So don’t despair and think of it as a setback or problem. You’re not on a diet, you’re making better choices for the rest of your life. Depriving yourself of any enjoyment of food is only going to last so long. Rather than eliminate everything you enjoy eating, you just want to cut back on the unhealthy things. Then eat them sometimes. It’s okay.

How well you’ll fare with your healthier lifestyle in the long-term is largely dependent on how you handle failure in the short-term. The good news is that unlike most things in this world, how you think and feel about things is entirely within your own power (although it doesn’t always feel that way). Seriously, you’re in complete control of your own attitude. So you can either choose to despair and gain weight again or shrug it off, do the right thing most of the time, and succeed. You fall down. You get up. And so it goes.

Bruce Wayne: I wanted to save Gotham. I’ve failed.
Alfred: Why do we fall, sir? So that we can learn to pick ourselves up.
Bruce: You still haven’t given up on me?
Alfred: Never.

– Batman Begins

Hair of the Dog

So, you had a few drinks, appetizers, dinner, and dessert out with friends last night and now it’s the sober light of day and you’re beating yourself up about it. You’ve totally blown it, right?

Maybe not totally. While your body is still processing all of those extra calories you can force it to burn those first by exercising the next morning. So don’t wallow in guilt, get out there and walk, run, or lift heavy things. That extra energy hasn’t yet been stored as fat, so you can burn it off by exercising your muscles which will consume those calories rather than make you fatter.

Even if it’s too late, it’s never really too late. Just eat better next time. One meal’s not going to hurt you. The worst part about restaurant food is all of the salt anyway, so give yourself a day or two to recover from the excess sodium that makes your body retain fluid.

Finding Inspiration

My wife and I went to the Chicago Botanic Garden on Saturday to walk around, look at flowers, and take pictures on a gorgeous Chicago summer day (sunny, clear, a little breezy, low 70s). As we were exiting the vegetable garden I saw a giant pumpkin and remembered having my picture taken with it the last time I was at the Botanic Garden back in April 2007. I remember being shocked and ashamed to discover just how fat I’d gotten when I first saw the photo.

Here’s that photo from 2007 and another one that was taken on Saturday. Sure, that was five years ago, and I actually gained more weight between April 2007 and when I started my Clean Livin’ in June 2008, but I’m still probably over 150 pounds lighter now than I was when that first photo was taken.

It’s helpful to consider how far you’ve come whenever you slip a little. One meal isn’t the end of the world, and you can usually make it up or at least try harder later. Give yourself a pass now and again so you don’t have to feel like a failure.

Of course, there are some BMI range and personal history milestones left to come:

• 262.5 pounds – 3/4 of the way down from my starting weight of 451+ pounds
• 250 pounds – over 200 pounds lost, and a nice round number
• 240 pounds – dropping from “obese” to merely “overweight” on the BMI scale
• 200 pounds – my base goal for now – will need to re-evaluate once I reach it – but also moves me into the upper range of “normal weight” based on BMI

Getting my weight down to below 275 feels almost as significant to me as being below 300, but maybe only because it’s been so long in the making. I reached my previous weight-loss milestone post a little over two years ago, although what really happened is that I maintained a weight of around 300 pounds for two years, and then gained 15 pounds back, and now have lost 40 pounds in the past four months. So here I am 27 months after my previous milestone celebrating another 25 pounds lost.

A Little Perspective

According to Wikipedia, a Scottish caber weighs about 175 pounds. While I’ve never picked up a caber, they sure do look heavy. I suppose that from now on whenever I reach a milestone and say I’ve lost the equivalent of [blank] that most people will have no real idea of how much that is exactly.

Since people rarely lift things that weight more than just a few pounds I’ve run out of reasonable comparisons. I know that 175 pounds is more weight than most whole persons, so maybe I should just pose for photos with people weighing what I’ve lost so I can point to them and say “There. See this guy? I’ve lost this much.”

What’s Next?

Weighing under 275 pounds was my goal for Labor Day so now that I’ve reached it five weeks early, I’m re-setting my weight loss goal to 262.5, which is 3/4ths of the way to my overall weight goal. It’s a little ambitious, but even if I miss it, at this rate it won’t be by much. I’m losing about ten pounds a month, so losing 12.5 pounds in five weeks isn’t that unreasonable.

Because everyone loves before & after photos, here’s one of me playing pool (badly) about a month into my Clean Livin’, back in July 2008:

And then to contrast and/or compare, here’s one from July 2012 (last week):

For the past few years I’ve been getting an annual physical that includes a blood test for various vitamin concentrations, a blood glucose test to screen for diabetes, and a lipid panel to test for cholesterol levels. The lipid panel has to be taken after you’ve been fasting for at least twelve hours because fat in food you’ve recently eaten can artificially raise your triglycerides and throw off the results.

I had a “holy shit” moment this year when I got my results back and found my total cholesterol and LDL (the “bad” cholesterol) were both high for the first time. When I dug up my results from the last two years it’s clear I should’ve been concerned about this sooner. Last year I was right on the cusp of having high cholesterol and didn’t think anything of it. My doctor even warned me about it in her letter accompanying the results, but I paid it no mind, probably because it was just under the normal range.

Here’s how my cholesterol has crept-up since 2010:

This year, though, my doctor’s letter contained an implied threat: if I couldn’t get my cholesterol down through diet and exercise alone in three months, I’d have to start taking statin drugs. Challenge accepted! Statins are a prescribed medication that have various side-effects and other nasty business of which I want absolutely no part. Could I really reduce my cholesterol naturally? I was determined to try.

What The Hell Is Cholesterol, Anyway?

Cholesterol is a waxy, fat-like steroid found in every cell of your body. About 75% of your cholesterol is produced by the liver, and you get the other 25% from the food you eat. Your cells need cholesterol to function, and they get cholesterol delivered to them via the bloodstream. If a cell has enough cholesterol, then the cholesterol globules continue through your body until they’re reabsorbed by your lower intestines where they’ll go back to your liver to be recycled.

When you have an abundance of cholesterol in your blood, though, that won’t be accepted by cells and is more than the liver can re-process, your body will start to store it throughout the areas where your blood travels, usually throughout your arteries, gunking up the walls of the little tubes your blood flows through. Yes, even your blood can get fat. Then it will start to build up in the heart, which can impair its function and eventually cause a heart attack.

The problem with having high cholesterol is that there are no symptoms until you have your first heart attack. Getting a cholesterol screening can help diagnose potential issues while you still have a chance to remedy the situation.

Cholesterol is a kind of fat and can be screened by what’s known as a lipid panel or lipid profile (“lipid” being the fancy scientific term for “fat”).

A lipid profile typically includes measurements for:

• Total cholesterol
• High-density lipoprotein cholesterol (HDL)
• Low-density lipoprotein cholesterol (LDL)
• Triglycerides

An extended profile (which is much more expensive, and not typical) may also include:

• Very low-density lipoprotein (VLDL)
• Non-HDL

However, most cholesterol testing doesn’t include a full lipid panel, and instead only measures LDL cholesterol and total cholesterol, and then the results of the others are calculated from those. If your initial cholesterol screen looks like you may have high cholesterol, your doctor may order a more complete profile.

Cholesterol levels are measured in mg/dL, or how many milligrams of each cholesterol lipoprotein are contained in a deciliter of blood. When I refer to “points” or “levels” I’m talking about a measurable quantity of mg/dL. For reference, Americans, a deciliter is a little less than half a cup. The average human body contains about five and a half quarts of blood (depending on size different people will hold more or less blood in their body). So the cholesterol test takes a sample and then projects how much total cholesterol you have.

LDL vs. HDL

Low-density lipoprotein, or LDL (“bad” cholesterol) is a fatty protein that transports cholesterol through the bloodstream when your cells reject its delivery (because they have enough). It’s “bad” because it deposits excess cholesterol in the walls of arteries, or wherever else it can. It just stuffs it wherever it’ll fit.

When that happens white blood cells attack the LDL and try to digest it, but are unable to, so the LDL is converted into a toxic, even waxier substance called plaque, which builds up in arterial walls and makes it harder for red blood cells to carry oxygen through those parts of your cardiovascular system. Plaque tends to build up over time, and eventually can cause a rupture, on which a blood clot can form and if that clot breaks free and travels to the heart, can cause a heart attack.

High-density lipoprotein, or HDL (“good” cholesterol), scavenges LDL cholesterol and returns it back to the liver where it can be broken down and essentially recycled for when it’s needed again. HDL also scrubs the walls of your blood vessels so that plaque doesn’t form.

It’s long been thought that higher levels of HDL in your blood prevented heart attacks, but new research conducted in May 2012 suggests that raising the HDL levels of people with low HDL doesn’t lower their chances of getting a heart attack, probably because of other factors that lead to heart attacks, such as a sedentary lifestyle and poor diet.

While HDL alone may not be the panacea for your heart’s health, higher levels of HDL are beneficial mostly because they control the levels of your LDL cholesterol, and that’s good.

Triglycerides

Triglycerides are the main form of fat in the body. When you consume excess calories, food is broken down into triglycerides and stored in your fat cells (adipose tissue) where it may be used again when you burn more calories than you take in. Triglycerides are packed together in the liver and wrapped up inside the strands of very low-density lipoprotein, or VLDL, and then go on their way through your bloodstream until they’re tucked neatly away in one of your body’s fat stores.

It’s not currently known how high triglyceride levels in the blood affect the heart. Part of the reason is that high triglycerides tend to occur when you have other risk factors for heart disease, like high LDLs or high blood pressure.

There is also a direct correlation between alcohol consumption and high triglyceride levels. Drinking more than one drink per day for women, or two drinks a day for men may raise triglyceride levels considerably. Of course, if you’re trying to lose weight you’ve already cut back on drinking alcohol for the calories alone.

How Can You Lower Your Cholesterol?

Besides medication, there are some all-natural ways you can lower your cholesterol:

• Aerobic Exercise
• Diet
• Supplements

I wrote them in that order so they wouldn’t have the acronym “SAD.” By fighting cholesterol on all three fronts you may have a better chance of lowering it, and thus lowering your risk of heart disease.

Exercise Lowers Cholesterol

So how does exercise lower your cholesterol? Exercise raises the level of your lipoprotein lipase (LPL) enzymes[1] which in turn attach to triglycerides to essentially remove them from the bloodstream, thus lowering your triglyceride levels too.

Exercise also increases the size of both LDL and HDL cholesterol, which means that the LDL can’t nestle into the tiny nooks & crannies of your heart and blood vessels.

While there’s a direct correlation between exercise (especially aerobic exercise like walking, running, or otherwise moving your body without resistance) and lowering cholesterol, researchers aren’t quite sure why exercise works, but they know it does.

A 2002 study at Duke University Medical Center found that more intense exercise lowers LDL cholesterol far more than moderate or light exercise. People who exercised more vigorously also raised their HDL cholesterol. Win-win. So you have to push yourself harder to have a greater effect in lowering cholesterol.

Foods That Lower Cholesterol

In addition to exercise, certain foods are known to help lower cholesterol.

• Oatmeal – Oats contain a substance called beta-glucan which absorbs LDL cholesterol and removes it from your body. If there’s any one magic bullet for lowering cholesterol, oats are it. If anything, since the 1980s when the FDA allowed oat-based foods to carry a health claim, additional research has proven that above all other foods, oats can lower cholesterol by as much as 20%.
• Fish – Especially those high in omega–3 fatty acids, like salmon, herring, sardines, and tuna, can lower your cholesterol. Sure, you can take a fish oil supplement, but you gotta eat, and adding more fish to your diet can help lower your cholesterol and provide healthier proteins than red meat or poultry.
• Flax Seed – Flax is like a wick that soaks up that bad cholesterol and removes it from your body. Add a tablespoon or two to your oatmeal, yogurt, or other healthy food, and you probably won’t even notice it’s there. Flax seeds are also high in omega–3. Do you see a trend? Fiber and omega–3 fatty acids work to reduce cholesterol.
• Chia Seeds – You know those novelty terra cotta Chia Pets that grow little greens? Eating the seeds rather than planting them may help reduce your LDL. Cha-cha-cha chia!
• Olive Oil – Not only does olive oil help to lower LDLs, but because it’s a monounsaturated fat it doesn’t lower your HDLs, so a little olive oil in your diet can help you in more ways than one.
• Avocado – Speaking of omega–3 acids, avocados are loaded with the stuff, and taste great when mashed up with a little lime juice, onion, cilantro and salt. I could probably eat guacamole every day.
• Walnuts – Also high in omega–3 fatty acids (unlike most other nuts), which can help slow down the growth of plaque in your arteries. Other nuts, like almonds, pecans, pistachios, and peanuts also help to lower cholesterol, mostly because they’re high in fiber, but none are as effective as walnuts.
• Blueberries – The high level of antioxidants in blueberries have been found to reduce cholesterol… in hamsters. However, they taste great in oatmeal, so it’s worth trying (plus blueberries contain numerous compounds known to be beneficial).
• Red Wine – In vino veritas… and it has been found to lower cholesterol, too. Only the red wines, though, ladies. Your chardonnay, while delightfully crisp and oaky, won’t have much effect because white wines do not contain a chemical known as a flavonoid, which has a protective effect that makes your heart and arteries less able to accept LDL cholesterol for storage. The flavonoids are stronger in red wine because they come from the grape’s stem, seeds, and skins, which are skimmed out of white wine earlier in its fermentation process. The tannins in red wine also suppress the peptide responsible for hardening arteries. As beneficial as red wine can be for your health, it still contains a lot of alcohol and therefore should only be consumed in moderation (one glass per day for women, two glasses for men).
• Dark Chocolate – The darker (i.e. containing more cacao) the better. Dark chocolate also contains flavonoids (as well as 300 other chemical compounds known to cure a great many ills both physical and psychological).

If these foods have anything in common, it’s that they’re high in calories. So moderation is key. Try replacing some other food you were going to eat with these heart-healthy choices and you’ll be lowering your cholesterol in no time.

In addition to eating these special foods, though, improving your overall diet, eating the proper number of calories, and getting ample nutrition is going to be the most effective in preventing various diseases.

Foods High in Cholesterol

It’s not all sunshine and oatmeal. There are a number of (primarily animal-based) foods that contain a lot of cholesterol, such as:

• Egg Yolks – While egg yolks only contain 1.5 grams of saturated fat, eggs have become the poster child for high-cholesterol foods. Of course, eggs have many other health benefits (I’ll write more on how great eggs are later).
• Red Meat – Steak, hamburgers, pork, bacon, etc. are all high in fat and dietary cholesterol.
• Dairy Fat – Dairy fats like butter, cream, cheese, and even whole milk contain cholesterol.
• Shellfish – Shrimp, lobster, oysters, and mussels are all high in cholesterol.

While the dietary cholesterol you ingest doesn’t become “serum cholesterol” in your bloodstream, consumption of saturated fats may stimulate cholesterol production in the liver. It’s long been considered a given that the type of fats you consume influences the types of cholesterol you produce.

My dietician suggested that I reduce (or eliminate) my consumption of the above foods, but there is an abundance of research to suggest that a diet high in saturated fat has no correlation to increased blood cholesterol levels. I expect we’ll see more research in this area in the near future.

Since there are no obvious health detriments to reducing your consumption of saturated fat, however, why not reduce your intake to be on the safe side?

Do Any Vitamins or Supplements Lower Cholesterol?

I’ve been taking Benecol Smart Chews which are essentially a concentration of plant stanol esters. Sounds tasty, no? Plant stanol esters are naturally occurring in vegetables, fruits, nuts, and other natural whole foods, but in such limited quantities as to have little effect on the body. The refined, esterified, and hydrogenated stanols bond with LDL proteins and remove them from the bloodstream. Sterol esters have a similar effect, but are partially absorbed by the body, and thus raise levels over time. Studies suggest that this may be a problem so I’ve stuck with the stanol instead of the sterol esters.

Statins

I’m not down on statin drugs, as they can help reduce cholesterol for a lot of people who can’t rely on exercise and diet alone to reduce it. I just try not to take any more medication than I absolutely have to, and am trying to hold back the march of time on my body. For people who need them, I’m sure that statin drugs are a godsend.

Statin drugs work by blocking production of an enzyme in the liver that is responsible for producing cholesterol (the enzyme is called HMG-CoA reductase, or as it’s known to its friends, “3-hydroxy–3-methyglutaryl COA”).

Statin drugs are the most common prescription drug in the world. Some statin brands prescribed include Lipitor, Crestor, Zocor, Mevacor, Altocor, and the comically named Lescol (for less cholesterol?), Livalo (live a little longer?), and Pravachol (which, uh… prevents cholesterol?). Whatever the brand name, these statin drugs actually provide different statins, so if one doesn’t work another may work better for you. Lipitor recently fell out of patent protection and therefore a generic may be prescribed in its place (although in Summer 2012 the generics aren’t much cheaper than the brand name drug).

Station drugs are known to have some fairly serious side effects, though, including nausea, dizziness, cramping, diarrhea, constipation, headaches, and bloating due to gas. Lovely. The worst side-effect seems to be myositis, or inflammation of the muscles, which can cause injuries when trying to exercise. None for me, thanks.

So How Did I Do?

After improving my diet, adding copious amounts of foods known to help lower cholesterol to my diet, chewing Benecol with each meal, and increasing the amount of exercise I get each day, I gave blood again for another lipid panel.

Here are my cholesterol levels after my most recent blood test:

My total cholesterol reduced by 56 points, and my LDL cholesterol went down by 40 points in three months[2]. Oddly, my HDL, the “good” cholesterol, also decreased, which is typical for those taking statin drugs but unusual for people who achieve lowered cholesterol through diet and exercise alone, especially since exercise is known to lower LDL and raise HDL cholesterol. Puzzling.

I’m not stopping now. While my total cholesterol is now well within the “normal” range you can’t really ever get your LDL too low, and I’d like to lower my LDL as much as possible while raising my HDL even higher.

I’m going to re-check my cholesterol in four months to see how I’ve been progressing, and I’m going to pursue lowering my cholesterol as a good excuse to lose weight and get healthier, and continue to act like my cholesterol is high. After all, heart-healthy foods like oatmeal, avocados, salmon, sweet potatoes, blueberries, walnuts, and olive oil aren’t exactly hard to fit into your diet, because they’re delicious.

Being diagnosed with slightly high cholesterol was just the kick in the pants I needed to get back on track with my Clean Livin’. I’ve lowered my cholesterol by 56 points naturally, yes, but I’ve also lost over 30 pounds in the same interval.

In the interim I got busy with life, stopped writing here, continued to remain active, but otherwise stagnated for almost two years. When I started trending upwards again I decided to redouble my efforts, get back to basics, and work the program that I know is effective… when you actually do it.

Some things I do every dang day:

• Walk on the treadmill (okay, I do this almost every day).
• Ride my bike to work during the week (most days, about 8 months out of the year).
• Weigh-in and record my weight.
• Log everything I eat or drink that isn’t water.
• Assess my caloric intake at the end of the day.

Stat Me Up

Anniversaries are good for celebration, but also a good time to reflect on pass successes and stumbling blocks. Since life is a continuum and every day is a new Start Date you can’t fail, just not succeed as fast. As long as you’re alive, you can be a bit healthier than you were yesterday.

Here are some numbers to consider on the fourth anniversary of when I made the decision to improve my body, get healthy, and help others do the same:

• Weighed-in just over 1,200 times (which means I missed about 250 days due to travel, or missing a day or two here and there).
• Since I got my Fitbit in February, 2010, I’ve walked over 3,500 miles.
• Starting weight: over 451 lbs (since that was the max of the scale that couldn’t weigh me when I started – but considering that I was measurable less than a week after I started, I couldn’t have weighed that much more than 451).
• This morning’s weigh-in: 287.2 lbs. That means I’ve lost 163.8 pounds, or a 36.32% decrease from my former body weight. That’s about the weight of a full keg of beer[1]. Have you ever tried to lift a full keg? They’re heavy. Now imagine wrapping yourself with that much weight and carrying it around every day.
• My current goal weight is around 200 pounds. I’ll re-adjust when I get closer. If my calculations are correct, when this body drops 88 pounds you’re going to see some serious shit.
• At an average of –1 lbs / week, I should hit my goal by the beginning of 2014, which is a bit later than I’d originally planned, but of course if I can lose more faster I will.

It’s still a little shocking to me to see pictures of how I looked four years ago. I wish I thought of taking progress photos, or at least a “before” picture, when I started down this road, but here’s a photo of me from Thursday, 19 June 2008, three days into Clean Livin’. I’m in yellow, sitting on the steps at Daley Plaza by the fountain with some of my co-workers at the time (I wish I had a better quality image, but I think this was taken with someone’s old cell phone):

And to contrast and compare, here’s a full-body photo of me from our trip to the Milwaukee Art Museum last week (wearing, now that I see the picture, a shirt that’s too big for me):

It stands to reason. When you’re away from home or work you have less control over your environment, are probably not cooking for yourself, and the joys of discovering new foods or enjoying halcyon reminiscences too delicious to pass up.

Even the word “vacation” conjures images of freedom, excitement, and enticing new experiences. It’s a time you want to play instead of work, relax instead of be active, and let the tautness of routine slacken as the lassitudes of recreation multiply.

Or, if you’re me, you run yourself ragged walking around your vacation spot for ten hours straight without taking any downtime to relax, eating junk food from carts on the street as you go.

I’ve been making good progress managing my weight loss over the past few months, so the prospect of a vacation both excited and worried me. The wife and I visited New York City over an extended Memorial Day five-day weekend. New York is one of my favorite places to visit, and a big part of that is the food. Whenever we go to New York there are a bunch of things that we plan to eat that you just can’t get in Chicago, or at least it’s different enough that we enjoy the New York version:

• Pizza – No one does pizza like New York City, especially at the few and far between coal oven establishments. You can debate which style of pizza is best but when you imagine pizza in your mind, you’re probably thinking of New York Style Pizza.
• Bagels – There are a few places in Chicago to get passable bagels, but great bagels are so common in New York that it’s rare if they aren’t good. Also, you can’t really get bialys, the bagel’s weird denser cousin, anywhere else.
• East Coast Chinese Food – Americanized Chinese food is available throughout the country, with various regional differences. New York Chinese food offers a nostalgia for the Chinese food of my youth in Philly.
• Street Food – In Chicago it’s illegal to cook food in a truck and serve it (there are food trucks, but they have to prepare their food elsewhere and then sell the food from the truck, and there are so many restrictions that you can’t count on a truck having a permanent outpost, so they roam from place to place and post their current and upcoming locations on Twitter. Lame. In New York you can eat any kind of food you want, cooked in a cart or truck on the street. The same cart was there yesterday, and the same cart will be there tomorrow. There are some NYC staples like “chicken over rice” that doesn’t seem to exist elsewhere, and common stuff like falafel, kebabs, tacos, etc.
• Papaya Drinks and Grilled Hot Dogs – I don’t know why this combination is only prevalent in New York, but Gray’s Papaya and Papaya King (and half a dozen lesser imitators) serve a combo of grilled natural casing hot dogs and a papaya drink that’s just out of this world, and a very cheap meal. Gray’s Papaya has a “recession special” that offers two hot dogs and a papaya drink for under $5.
• Dirty Water Hot Dogs – Sure, Chicago may be the hot dog and sausage capital of the country, but there’s nothing like getting a dirty water hot dog (usually made by Sabrett) on the street, topped with mustard and sauerkraut.
• Shake Shack – The West Coast has In-N-Out, other cities have Fatburger, Five Guys, Steak & Shake, M Burger, and other local burger joints, but there’s just something about Shake Shack’s burgers that really draw the crowds. We waited about 50 minutes from the time we entered the line until we were actually eating a burger. I’m still on the fence about whether or not it was worth it, but it is a tasty burger. Shake Shack just expanded into Philadelphia, so I expect they’ll continue to open new locations.
• Knish – Ah, the potato knish. I’m sure you can get them elsewhere, but the fresh round baked, not fried, knish from Yonah Schimmel’s Knishery on Houston are just not available anywhere else in the country.
• Deli – Your city has delis too? Not really. You haven’t had a good deli sandwich until you’ve gotten some house-cured corned beef or pastrami from a reputable institution, like Katz’s Deli on the Lower East Side[1]. Other cities have delis, and most supermarkets have a “deli counter” where they’ll sell you some sliced cold cuts, but none really do it like New York, and those that do call themselves “New York Style” delis.

I didn’t mean for this post to turn into a list of unhealthy but delicious things that are available in New York City, but there you go. I’m sure I forgot some New York City street food staples too.

When you’re trying to lose weight, though, walking around New York is like navigating a minefield. There are delicious and cheap foods everywhere and you have to walk by one of those carts every twenty paces. I think I did pretty well, considering.

How To Mitigate The Damage While Still Enjoying Your Vacation

• Walk Around – Walking around a new place can be a lot more interesting than walking around the same streets over and over again at home. While walking alone won’t make up for an extra two thousand calories, it helps mitigate the damage caused by eating poorly.
• Share the (Caloric) Load – If you’re traveling with a friend or partner you can reduce your caloric intake by sharing the foods that are higher in calories. Some things are easier to share than others, of course, and convincing someone else to go halfsies may take some doing.
• If You Can’t Share, Spread It Out – A single hot dog and bun is like 300 calories (and not much more if your toppings are comprised only of low-calorie items such as mustard and sauerkraut or onions), so if you eat one and then have a slice of 300–400 calorie pizza a couple of hours later, you’re spreading it out over time, and hopefully walking off some of those calories in-between.
• Don’t Spend More Than You Make – Just like when you’re home, you should set a budget and stick to it. I set my caloric budget while on vacation to the amount of calories it would take for me to maintain my weight. I figured if I could break even throughout the course of my vacation, I’d call that a “win.” It’s harder, however, to have an accurate calorie estimate of foods you don’t prepare yourself, so while away I tend to try to over-estimate everything as a worst-case scenario. Pizza isn’t going to be consistent between pizzerias, or even between slices from the same pizzeria. Do the best you can.
• Choose Your Battles – Since you’re still operating under a budget (albeit a looser budget, most likely) you should be smart about how to spend those calories. When you consider the opportunity cost that eating one thing precludes eating something else (in terms of space in your stomach let alone calorie budget) be sure that you’re choosing to eat something that’s highly caloric that you’ll truly enjoy. Save up throughout the day for that one meal for which you’ve made reservations. Pass on the soft serve from the truck and walk the mile to the artisan ice cream shop you saw on TV. You don’t have to deprive yourself, just make sure that if you’re going to pound down the calories that you’ll actually be enjoying the experience.

Easier Said Than Done

So how’d I do?

On the morning of the day we left I weighed in at 290.8 lbs. The morning after we got back I weighed in at 298.0 lbs. Oops. Since I was counting my calories while away I knew that there was no way I ate an extra 25,000 calories over the course of a week over what I burned, so something else had to be accounting for the extra weight.

It took me five days to get rid of my vacation weight (and another couple of days to be sure I kept it off and I didn’t just dip below it due to water balance changes):

Totally worth it.

Before I can address the real answer, though, I’d like to rephrase the question to: “How do you change from being overweight and out of shape to being fit and healthy?” The real answer is easier to understand now: By becoming a fit person and then acting naturally. Your body will catch up.

Of course, that’s not quite it either. The real question is the follow-up “Well… how do you do that?”

It’s a decision. Losing weight is simple, but it’s not easy. I’ve struggled with writing this post because it’s hard to explain. I think I’ve found a shortcut, though. If you change yourself you’ll change your body. If you start to change your body, you’ll change yourself. Either way you’re going to be on the road to being fitter.

I could prescribe exactly what you should do – certain things like walk two miles a day, or track everything you eat, count your calories, and only intake so many per a daily budget. There are innumerable specifics that would likely result in your weight loss, at least temporarily – but that wouldn’t be useful to you in the long term because doing those things would be outside your nature, and eventually those habits that aren’t yours will fade away. You won’t keep up my habits. You have to make them your own. Losing good habits and re-introducing bad habits has happened to me, too. Any time you try to fight nature, even your own, nature wins every time.

Instead, I’ll offer this general bit of advice that will lead to your inevitable success. I believe this advice is pertinent to success in all things, not just weight loss or general fitness, but I’ll talk of it in these terms. In order to be a success, you must:

Make Things Harder Than They Need To Be

We live in a culture of convenience. Every product, service, program plan, diet, exercise regime, class, and so forth are meant to make your life easier. Work is treated like a four letter word. Companies are happy to take your money so that they can help you do less work. Unfortunately for you, you’ve been conditioned to be fat, dumb, and happy. I can’t help you with the latter two.

Losing weight is like swimming against the current. You have to fight against every impulse, instinct, societal convention, the food service industry, and even other people’s expectations. You’re basically a salmon, except that you don’t have a spawning ground to look forward to once you reach your goal. Although, if you get fitter along the way, maybe you do.

What does it mean to make things harder than they need to be? It means walking when you could drive. It means taking the stairs instead of the elevator. It means cooking instead of eating out or ordering in. It means taking ten steps when five will do. Squaring the corner instead of rounding it. Doing things yourself instead of relying on someone else (or a machine) to do them. It means when you come to any fork in the road you need to take the path that sucks.

Granted, I haven’t given up every convenience. I still use TV remote controls (given modern electronics you kinda have to – most TVs and media players don’t have many buttons anymore). I like to eat out sometimes (sometimes too often). I have texted my wife from a different floor of the house rather than go talk to her. Doing those things doesn’t make me any healthier, though.

If I know what the Right Thing is, and it’s not that hard to do, why don’t I do it all the time?

I fail whenever I try to deny myself something I want. I fail when I give into despair instead of acknowledging my setback and moving on.

How to Resist Temptation

Don’t.

If you give up everything you enjoy you’ll never keep up with it. Oh sure, you can sacrifice what you enjoy for a while, but eventually your old habits, the things you want to do while you’ve been doing things you don’t want to do, will come screaming back with a vengeance.

You’re never going to succeed if you punish yourself to get there. The “yo-yo diet” effect of losing weight and then gaining even more back again (lather, rinse, repeat) is a common theme in most diets because they’re all about giving up stuff you like to eat. That sounds like a shitty life to me. No thanks.

Much better is to adjust your desire. Change what it is that you want. Remember that scene in The Matrix when Morpheus was explaining the nature of what being The One and how that works in the Matrix?

Neo: What are you trying to tell me? That I can dodge bullets?
Morpheus: No, Neo. I’m trying to tell you that when you’re ready, you won’t have to.

A lot of weight loss advice I’ve read suggests getting rid of unhealthy snacks when you’re trying to lose weight – literally throwing them away – because if you don’t have them in the house, you can’t eat them, right? While there’s a certain logic in that, you can’t really fool yourself into doing the right thing if you really want to do the wrong thing.

If you’re trying to avoid the foods you really enjoy eating because you know that they’re bad for you, you’re doing it wrong. You can always eat the unhealthy thing later. It’ll be there. They’ll make more.

When you’re just starting out doing is almost as good as being. It’s hard to make new habits, but if you can keep the momentum going for a few weeks to a month you’ll start being what you’ve been doing. You’ll be the success you’ve been pretending to be.

When you’ve truly embraced Clean Livin’ you won’t need to avoid the bad foods because they will no longer be a temptation. I’m the guy who can eat a single potato chip. Fear me.

<Lawrence extinguishes a match between his thumb and forefinger. William Potter tries it and burns himself.>
William Potter: <screams> It damn well hurts!
Lawrence: Certainly it hurts.
Potter: What’s the trick then?
Lawrence: The trick, William Potter, is not minding that it hurts.
— Lawrence of Arabia (1962)

Willpower

The word “willpower” comes up a lot when people talk about dieting.

Your body burns fat far more efficiently than it stores it. Metabolically speaking, losing weight is a lot easier than gaining weight. You just have to let it. As soon as you create a caloric deficit (eating less food than your body needs to power itself) you’ll burn fat (well, sometimes you’ll also lose some lean muscle mass, but we’ll ignore that for now). The system works if you work the system. Your body is burning calories just to keep you alive. You burn calories even while sleeping, although not nearly as many as being more active.

Remember Newton’s first Law of Inertia: a body at rest tends to stay at rest, and a body in motion tends to stay in motion. He wasn’t talking about a human body, but it still applies. Keep your body in motion.

The best part about Clean Livin’ is that it’s not a diet. It’s a means of replacing bad habits with better habits without missing the bad. Diets have a shelf life, like any fad. Diets have an assumed end date. I mean, you’ll just diet for a while and then you can stop, right?

Clean Livin’ means eating healthily and being more active… forever. Well, most of the time. Hey, why not try it just for this next meal. Just for today. See if you can do it through the end of the week. We tend to have an “all or nothing” mentality, especially where our diet is concerned.

It’s hard to do the right thing all the time. It’s much easier to do it at any particular moment it’s at the forefront of your mind.

Make The Right Thing The Easy Thing

There are some simple and easy things you can do to immediately improve your health that stack the deck in your favor.

Some “right things” that are easy to fit into your life:

• Walking – Adding just 30 minutes a day of extra walking is usually pretty easy. You don’t even have to do it all at once. Take a five minute stroll around the block before you eat lunch, or walk to the store down the street instead of driving there, or hop on the treadmill for 15 minutes twice a day.
• Easy Elimination – Cut out bad foods you won’t miss. There were a lot of unhealthy foods that I ate and didn’t even enjoy very much. If you choose to eat something that’s unhealthy, and it’s going to count towards your daily budget, at least make sure it’s worth it. If you eat unhealthy things you don’t even enjoy that much, cut them out! It’s easy to eliminate the foods that are just there for convenience (especially at the office when you may not even choose them) and spend those calories on something you’d prefer to eat. Make the most out of your calorie budget. Don’t squander those precious calories on something you consider less than delicious. For instance, I used to drink a few cans of Coca-Cola per day, and eat a bagel or muffin every morning. I’ll still have a bagel from time to time, but it was something I could eliminate and not even miss.
• Easy Additions – Rather than concentrating on what you can’t eat, just start planning meals around vegetables, beans, and other high-nutrition food. By the time you get to the meat or fish you should already have a healthy meal. Then you can more easily reduce your portions.
• Get Moving – Whenever you need to do something, ask yourself “Could I do this while moving?” Pace around while on the phone. Get up and walk around during commercial breaks. Use the bathroom on a different floor. Park at the end of the lot. Wash dishes by hand. Fold your laundry. Read while standing.
• Cook – Buy real food from the outside aisles of the supermarket – fruit, vegetables, fish, meat, dairy – and then cook it yourself. Not only will you know better what you’re eating while you likely eat healthier food, but you’ll also burn calories while cooking it. By keeping fruit on-hand you’ll also have a readily available snack for when you feel peckish.
• Drink Water – Drink lots of water to flush out your system. Pound down that water. If you drink soda, get a Sodastream instead of buying bottled soda and make your own fizzy water. Replacing sugary drinks with water will not only hydrate you to help you lose weight, but water (even carbonated water) has zero calories. Plus, drinking a glass of water before, during, and after meals will fill you up more than you’d think.
• Start Slow – You didn’t put excess weight on in a day, so it’s going to take time to take it off, too. Don’t make a thousand changes at once. Make a few small, easy to live with changes first and then add a few more in a little at a time, like when adding dry to wet ingredients while baking.
• Shrink Your Plate – This one sounds stupid, but if you use smaller plates you’ll probably eat less, and it’ll look like you still have a full plate. I use 8" salad plates for most meals even if I’m already serving a fixed portion size. They’re a good size without being too small.
• Write It Down – Before you start restricting your calories, just log everything you eat without concern for how many calories it all adds-up to. If you want to get a little helpful reinforcement you can share your food log with a dietician or even just post it on your blog. The simple act of writing everything down may make you think twice about what you choose to eat. Or not, but at least it’ll make you more aware of what you’re putting into your body. I tend to keep a log in a text file in my Dropbox so it’s available everywhere, but if you work better writing in pen on paper, Field Notes notebooks are small, cheap, and sturdy. The best note-taking system is the one you have with you.
• Make Things More Delicious – Add some umami to your food to increase the flavor while increasing nutrition and decreasing overall calories.

Redefining Failure

Do or do not. There is no try.
— Yoda

You can’t really fail at this. Even if you don’t do everything right you’re going to make yourself healthier just by paying attention to what you eat, attempting to be more active, etc.

Let’s say you set a goal to go to the gym every day after work. We’ll ignore that setting a goal like that is a bad idea, but you’re just starting out so you’re likely to keep it up for a couple of weeks out of excitement and momentum. Eventually, though, you’ll miss a day. Maybe you have to work late, or you’re meeting friends that night at the time you’d usually be at the gym, etc. You haven’t failed. You just missed that one time. It’s okay. Instead of beating yourself up about it, just go tomorrow.

If you find yourself always putting today’s workout off until tomorrow, maybe you need to find a new workout. Some activities are more fun than others.

Most important, though, is that you can’t change the past. You ate poorly for lunch? It’s not over! You can still eat better for dinner. Don’t give up because you slipped up. Doing the wrong thing is part of the process of doing the right thing. It’s built-in. You don’t need to feel bad about it. Just do the right thing next time. And the time after that, and the time after that you may screw up again, so pick yourself up, dust yourself off, and get back on that bicycle.

What Success Means

Keep your eye on the prize. You’re doing this because you want something. Maybe you want to feel better. Maybe you want to look better. The key word in this is you. You can’t do this for someone else. You have to want it for yourself.

Start slow. It’s a marathon, not a sprint. You can make small changes and those will compound like interest into bigger savings down the road. I don’t just mean a longer life (although there are innumerable statistics demonstrating just that) but a better life as well.

I guarantee[1] that once you make even a few simple changes that you’ll begin to feel better after only a few weeks. Looking better may take a little longer, but you have to be patient. Even small positive changes add up over time.

How To Set Goals

Let’s say you need to lose 40 pounds. So what’s your goal? It’s not to lose 40 pounds. Your goal is to lose 1–2 lbs per week, or to create a calorie deficit of 500–1000 calories per day. Your goal is to eat right for your next meal. It’s hard to plan far into the future, but it’s easy to plan for a few hours from now. Doing the right thing now means a payout toward your goal later.

I’m not saying you shouldn’t be mindful about your overall goal – just that smaller goals are more realistic and also more likely to be goals you can achieve.

Beware of setting deadlines to your goals too. I was going to write “unrealistic deadlines” but deadlines in general are probably a bad idea if it’s a particular date and not a range. For example, saying “I need to lose 20 pounds by our vacation to Mexico so I can fit into this swimsuit” isn’t realistic. Losing four pounds in the next four weeks, though, is perfectly doable. The more you have to lose, the farther your finish line, and the further in the future, the hazier the goal. Work for now, plan for soon, and you’ll be prepared for the future.