The elephant in the sitting room…

Scott wrote a comment on my post a couple of days ago that makes a good opening as I shift gears a bit:

Chuq, do you think the weight gain triggered the sleep apnea or did you have apnea first, which led to weight gain? Sleep apnea shows itself as a lot of different symptoms — it’s great that you decided to get to the core problem.

And the answer to that is complicated, and the experts are still figuring all of this out.

But first, a few notes before I dive in:

  • I am not a trained medical professional. I am an interested layman who’s been trying to learn as much about this as I can because it interests and affects me. Do not use me as your medical doctor replacement.
  • Be careful who you believe on the internet. Including me. There’s a lot of bullshit out there, some of it spouted by loonies, some of is published by people who want to sell you crap, and some of it published by people funded by large companies who want to sell you crap. Be wary of who you believe.
  • If they use the words “easy” or “foolproof” run away fast. Or toddle. Or waddle. Or whatever it is you do, as fast as you do.
  • If you are offended by someone making fat jokes, well, sorry. It’s okay. I’m fat. I can do this….

There does seem to be interesting research (also here) coming out that indicates that sleep apnea, and that inadequate sleep can both be a trigger for obesity. There are now some studies showing particularly strong links to inadequate sleep prior to the age of 5 being linked to obesity later in life. If you burn your candle at both ends, it seems to affect your metabolism, and your body is more likely to go into a defensive mode where it tries to collect fat.

Weight gain and apnea is a particular conundrum, because it looks like the apnea leaves you in a state of chronic exhaustion, and that exhaustion mucks with your metabolism and slows it down, which encourages fat storage. And as your weight goes up, it can enhance the apnea, creating a nasty feedback cycle. Apnea does a lot of other things — if you’re always exhausted, you’re rarely functioning at your best. Your mental processes slow down, you don’t think as clearly, your reaction times slow down — you know that feeling you get after an 18 hour day or pulling that end of project all-nighter? When you hit that point where no amount of Red Bull brings the edge back, and you have to think twice about how to tie a shoelace? Apnea takes you to that point and leaves you there is it strengthens. It saps your energy, meaning you’re less likely to exercise, also encouraging weight gain and muscle loss. You end up stressed; when you’re exhausted, you’re more likely to feel negative and unhappy and the stress and anxiety pile up.

Ultimately this all turns into a negative feedback cycle. And let’s not forget that there are strong correlations between apnea and insulin resistance, which leads to diabetes. And it all tends to happen slowly, over time, so you don’t really see the results until you’re far into the process.

I’ve always been hefty. I’m 5’8″ but with a seriously heavy bone structure. As a sophomore in high school, I wrestled at 142, and in good shape it was a struggle to meet weight. If you look at a recommended weight chart, a 25 year old at that heigh with a large frame is suggested to sit in the range of about 145-170. A 15 year old still developing and in good physical shape hitting that range is sort of off the chart, so one word never used to describe me is svelte. or petite. I exited high school about 175 in decent shape, and then got lazy. I was 280 on my 30th birthday. My doctor and I have done some work reconstructing my weight profile, and I started gaining about 7-10 pounds a year out of high school, and just kept it up, until close to the end at Apple when I hit that point where it spiralled and I put on about 60 pounds.

When I left Apple, I weighed 380. Today, four years (and a month) later, I weigh — 385. That in itself is a victory of sorts, but not a complete on. In those four years, I gained at least 20 pounds (maybe more; I stopped weighing) and joined the 400 club, and then lost it again. And then in 2008, I took of 35 pounds, only I wasn’t trying to, and that was one of the things that caused me to go get tested and we caught the diabetes fairly early on; I know I wasn’t diabetic in early 2007 when I got tested. I seem to have flipped this particular switch in late 2007. Since I and my doctor both know I’m was a good candidate for diabetes (as well as having a family history of seriously high cholesterol) we’ve kept a fairly close watch over time while I tried to figure out how to get the weight loss. Unfortunately, in 2008, my dad got sick and I spent much of 2008 helping mom deal with that, and then deal with the funeral, and then deal with the estate, and I never got around to the tests until fairly late in the year, when in all honesty I already knew. I emailed my doctor and suggested we should do some tests, he agreed, and the numbers came back seriously sideways. We retested and added in some other checks, the urine test came back “HEY! YOU CAN MAKE POPSICLES FROM THIS!”, and that was that.

Diabetes, according to a friend of mine, is nothing much at all to worry about, but you have to keep a very close watch on it. What he means by that is that as long as you take it seriously and pay attention and manage it — it really isn’t a big deal. he’s right. That’s a whole set of discussions for down the road, but suffice it to say, the best control I can put on the diabetes is to get the weight off and keep it off. Right now I’m controlling it by managing my diet and with some drugs, but the goal state here is to manage it by diet alone, and that means getting in better physical shape, getting the weight off, and eating a diet that keeps the body in balance. I’ve made good progress on that third part; I’m still struggling with the first two.

it’s complicated.

In talking with my doctor about all of this over the years, and with my therapist when I was in therapy, and with nutritionists, I’ve learned a lot about what makes me tick and where my struggles come from. Bad lifestyle habits don’t get fixed overnight; if you try to fix everything all at once, I can pretty much guarantee you’ll fail. One of the best pieces of advice my doctor gave me was to grab one thing I felt I could fix, and fix it, and keep working at it until the habit was relearned, which takes weeks. Try to do too many things at once, and as soon as you muff one, or you hit a patch of stress, or something comes up — you fall back into the old habits and lose it.

Try to pick up a mountain, and you’ll fail. Pick it up one rock at a time, and it’ll take a while, but if you keep at it, you’ll find you moved it. Slow and steady. My last year at Apple, I was on the burger and fries diet — five, six times a week (at least). Whatever was fast and didn’t require thought, since I only allowed myself 15 minutes for lunch, including acquiring it.

Today, there’s very little to complain about in my diet. One of the most effective tools in fixing a diet is the food diary, where you track everything you eat. Since i decided I needed to get serious about this, I spent a week tracking what I ate and did an analysis of it. The good news: I was right, I was eating to maintenance (no gain, no loss), and the food ratios where just about where I expected them to be. The bad news: the total calorie count AND what I thought an appropriate was an appropriate calorie range for maintenance were off by about 20% — I was eating more calories than I tallied mentally, but I also had the goal number off — so in practice, the result was accurate but the scale was off. That’s easy to recalibrate. The food ratios were just about where I expected them to be, more or less 30% fat, 35-50% carb, the rest protein. That’d be a great diet — unless you’re diabetic. As a diabetic, that’s too many carbs, and one of the diabetes drugs I take works by encouraging the liver to sequester blood glucose (i.e., stuff it into fat cells); hence losing weight with that going on is even more complicated. So I have to change that ratio to something more like 30% fat, 30% carb, 40% protein. Thank god I like deli sliced turkey…

There is, in our culture, this weird aspect that can best be described by the words “Just say no”. it drives me crazy sometimes, because it’s incredibly naive — and it doesn’t work. It doesn’t work with kids and drugs or alcohol, it doesn’t work with kids and sex (or priests and sex, or married adults and sex, or…). And it’s embodied with weight with things like “just put less on your plate” or “you just need to walk 15 minutes a day”.

Here’s the hint: if it was THAT SIMPLE, all of us would be thin and healthy, okay? Notwithstanding that I take full responsibility for some bad choices I made, if you look around, there’s a huge obesity epidemic. there are more things driving that than being lazy and eating badly. Wherever the western diet gets introduced, obesity and diabetes follow. Here in the states, the combination of the western diet (heavily processed foods, carb heavy foods, fast food places everywhere, sweetened soft drinks, etc, etc) AND a culture of “don’t walk, get in the car” the obesity issue is magnfied. In places like Canada and New Zealand where there’s still a culture of “go outside and play”, it’s a lot less prominent. Just saw a study the other week where the average New Zealander takes twice as many steps per day as the average US person. And it shows in the average waistline.

I’m convinced that we’re going to find that there’s a direct link between the growth in usage of high yield corn syrup and many of our societal issues here. I would non be surprised if we end up coming to realize that this is our generation’s tobacco, and if you’re old enough you remember when the tobacco companies spent megabucks telling us it really was healthy. Where my mother’s generation in many ways died of lung cancer and deal with emphysema, our generation and the kids growing up today are as likely to die of heart attacks and strokes and suffer from diabetes. The evidence is still being built — but I expect it’ll happen, with the mega-food companies fighting it the entire way. At least until they can find a graceful exit strategy to convert their processed foods back to sugar.

In my case, there are a couple of things that have complicated this further. One is that I’m wired to eat under stress. When I stress out, I eat. That’s not something that “put less on your plate” remotely deals with. You deal with it by learning how to not be stressed. Which, if you’re stressing out about your weight, is an interesting challenge.

The other thing is a piece of biology. There are two hormonal signals tied to eating. One is the hunger signal, which tells you to eat. The other is a second signal called satiety, which is actually the trigger that tells you you’re full and you to stop eating. You start eating when you’re hungry. You stop eating when you’re full. In my case, the satiety trigger is sluggish. I don’t get the signal as quickly as the average person. That means that you eat longer, which means you tend to eat more, before you stop. Which means more calories.

All of which, I guess, is a long-winded rant on the stupidity of our culture that goes after simplistic answers to things that clearly are complicated and difficult. We set ourselves up for failure — and then beat ourselves up when we fail. And then go eat a donut to make ourselves feel better, which is okay because we suck and we deserve to be fat and everyone hates us. And so the cycle starts again.

I’ve spent a lot of time trying to understand it in the context of myself. I’m now ready to make a serious stab at the core problem — my weight — because I believe I’ve finally dealt with all of the OTHER things that tie into it and complicate it and get in the way of dealing with it or trigger it, whether it’s a crappy diet because I was so tied to my job I didn’t allow myself enough life to eat properly, or stressing myself out over things that honestly didn’t deserve to control my life that much, or any of a dozen other things that all pile on and get in the way, like, oh, if you’re a stress eater and your dad is dying, losing weight just doesn’t hit the top of the priority list…

The reality is — this stuff’s all incredibly complicated. It’s a different path for everyone. Maybe I’m finally on mine. Maybe not, but I know I’m closer to it if I’m not there. And that’s why I’ve started writing about this — not because it makes my situation any easier, but because maybe it’ll help you find your path a little faster and easier. And even if not, it never hurts to know that you’re not alone in the struggle, right?

(the last few days have been heavy and deep. thanks for sticking with me. we’ll switch gears and go lighter for a while, but we’re not done here, not remotely. And if you have thoughts or questions, drop me a note….)