In January of 2015 I lay in a hospital bed being infused with powerful antibiotics to subdue a massive infection in my lower leg. Over the previous couple of weeks I had traveled across the country by air. I returned home with what I believed to be the flu, or something similar. I felt terrible. As my illness seemed to improve, my leg began to swell, and turn red. It was painful with any pressure. Although my symptoms were not typical, I thought that I was looking at a deep vein thrombosis, a blood clot often associated with sitting for long periods, like on an airplane. As a clinically experienced RN, I knew this could be a life-threatening emergency. I contacted my physician and went in to the clinic right away.
My physician was stumped. He didn’t think my symptoms were a DVT, but agreed that the swelling certainly looked like one. He sent me immediately for an ultrasound to rule out clots. The pain from the pressure of the ultrasound sensor was terrific. I returned to my doctor’s office after the ultrasound, to find out that the results were negative. My leg was getting bigger and redder, and the pain was getting worse. We made the decision to go to the emergency room, where almost immediately I was given a CT scan, which was also negative. Finally, a consultation with an infectious disease specialist was arranged. They recognized what was going on as profound and acute cellulitis, a subdermal infection that, like a DVT, can be life-threatening if not responded to quickly. I was immediately started on high doses of intravenous antibiotics, and overnight the pain and swelling began to subside.
I was in the hospital for several days. On one afternoon, one of the medical residents stepped into the room.
“I have some lab results for you. Your hemoglobin A1c is 9.7.” Hemoglobin A1c is a marker of serum glucose levels used to diagnosis type 2 diabetes. Normally, it should be less than 5.3 percent. My findings meant that I was diabetic, and had been for some time.
“Uh oh!” I replied.
“Yep, you’re diabetic.” He paused. “Do you have any idea how much you weigh?”
“Mmm… the last time I checked it was about 394 pounds.” It had been at least several months since I had checked. One reason was that it was difficult to get a good weight reading on scales that weren’t designed to measure someone my size. Another was that after 40 years of struggling to manage my weight, I was more or less giving up. I was tired. It seemed as though there was no approach to weight loss that I could follow. The research results were abysmal, and they still are; nearly everone who loses a significant amount of body fat fails to continue weight loss or to maintain the loss they have had.
“Well, I don’t know how long ago that was,” said the resident. “You weigh a lot more than 394 now. You might want to start thinking about bariatric surgery.” Bariatric surgery, usually referred to as weight-loss surgery, was the most drastic approach I could conceive of. Originally intended to save the lives of people who were at risk of imminent death as a result of massive obesity, these surgeries were becoming common, even for people without severe complications of high body fat. I had always considered myself to be nowhere near the size of person who needed surgery. But here I was, lying in a hospital bed, at over 400 pounds. I was beginning to realize that I was that guy. I could remember seeing people who were that size, thinking “At least I’m not that big. That guy should do something.”
I was determined that surgery was not a reasonable approach for me. For one thing, bariatric surgery carried a high risk of complications requiring further surgical interventions. For another, I had witnessed many cases of bariatric surgery patients who, for want of a better term, relapsed. They eventually discovered ways of consuming large enough volumes of calories to regain, and surpass, the weight they had lost. I think that for many people, bariatric surgery offers life-saving help that can make them healthier, and for some, even start them on a lifelong path of healthful living. But I knew that this was not for me. I had spent many years studying health behavior, and I knew that what I needed was a change in the way that I lived. I had underlying issues contributing to my poor health choices—far more than I knew at the time—and for me to become the person I wanted to be, a different pathway was needed.
Like many people, my life with obesity began at puberty, though the gears were already moving long before that. I was one of the fat kids in middle school, overweight enough to not be able to participate in sports in high school, and through my early adult and middle-age years, I became more and more obese. I started counting calories in the 1970s, and did aerobics in the 1980s. I ate alleged-to-be-healthy frozen meals. I drank meal-replacement shakes. I ate grapefruit, cottage cheese, and celery. I ate nothing but meat and high-fat dairy. I counted calories. I ate a vegetarian diet, and then a vegan one. I ate six small meals instead of three large ones. I listened to subliminal messages. I learned early on that there are different approaches to losing weight, if that is your goal, but that they were all difficult to follow. For me, they seemed impossible. And none of them were otherwise concerned with health.
About 2012 I watched the movie Forks Over Knives and learned about a whole-food, plant-based approach to diet. I had been vegan for at least six years before then, but eating favorite junk foods that were technically vegan, plus the growing field of made-to-be-delicious-and-vegan processed foods, I continued to add pounds. I was intrigued by the approach recommended in Forks Over Knives. True to my standard practice of choosing the most rigorous approach to anything, I read all that I could find about plant-based eating. I chose to follow a plan that was highly regarded for nutrition, and largely restricted grains and starches. I followed the plan as closely as I could–according to my interpretation–for over a year, and lost about 60 pounds. Eventually, I learned to use the loopholes in the plan (every way that you can conceive of eating healthfully has loopholes that experienced dieters have learned to exploit) and found myself eating huge quantities of foods that common sense would tell you I should not have been eating. Then I found myself sliding off the plan, getting tired of its restrictions. For the next few years, I would follow the plan for a few weeks or for a few days, but I was less and less able to stick with it. Always, I would give in to a meal or just one bite, and that would send me into a spiral that would have me eating piles of wings, cartons of ice cream, baskets of burgers, and boxes of Asian carry-out. I did a lot of eating in secret, sometimes eating several meals worth of food at once. Even when I was uncomfortably stuffed, I would continue to eat until I simply could not stuff in any more food. I would then be physically miserable and angry with myself. But the next day I would do the same thing. My lapses might last for one week, for several weeks, or for months. More and more, I found myself giving up. I gained back the weight I had lost, and continued to become heavier. Nevertheless, I kept trying to follow my plant-based diet.
Fast-forward to 2015, and the scene in the hospital bed.
“Do you know what you need to do?” asked the resident.
“Yeah, I know what I need to do.”
Once again, I went to work on staying plant-based. I worked hard at it, but not with any more success. After that first infection, the infections became more and more frequent. My physician gave me an open-ended prescription for antibiotics so that I could start them as soon as I saw symptoms.
“If you feel like you need a harder punch,” he said, “just come on in and ask one of the nurses for a shot of ceftriaxone (a more powerful, faster-acting, intramuscular injection of antibiotics).”
My glucose levels got worse. By the fall of 2015 I was taking oral medications. By the end of the year my doctor had increased them to the maximum dosage. I started tracking my glucose levels twice per day. They were running in the range of 250 to 450 mg/dL (13.9 to 25 mmol/L, for my non-US friends). They should be under 120; in fact, they really should be under 100.
By the end of 2016 it was rare for me to see a glucose level under 250. The only way that I would get that is by fasting overnight, then getting up and going for a long walk (at least a couple of miles) before I tested. A partial list of things that were going on:
I don’t want to give the impression that I was always miserable or even generally unhappy during these years. That would not be true. I fell in love, for some reason the most wonderful man in the world fell in love with me. He asked if he could marry me, and then, he did. One of my main motivations is that I want to spend every possible moment with him, and not leave him caring for someone who is chronically ill.
Essentially, I was giving up. I believed that what was happening was what happened to most people: every few years add a new, chronic disease, and a handful of new medications, while giving lip-service to diet and exercise. It was the story of getting older in America.
I still do not know what flipped a switch for me. As the year rolled from 2016 to 2017, I decided I needed to get back to work on myself. I knew that I could not keep doing what I was doing if I wanted to live. But I recognized that I needed to try something different if I wanted to change. I decided to get back to basics. I dusted off my copy of Forks Over Knives and watched it. I listened more carefully to the details of the diet being proposed by Dr Esselstyn and Dr Campbell. I was still convinced that I needed my more restricted plan, but maybe, I thought, I can use the Forks Over Knives approach as a way to ease myself into it for the long term.
I went to the Forks Over Knives and Engine 2 websites. In retrospect, this was the moment when everything changed. Rip Esselstyn had just published his new book, The Engine 2 Seven-Day Rescue Diet. There was a challenge to sign up for (I did) and a Facebook group to join (ditto), which at the time had only a couple of hundred people in it. It now has over 35,000.
I read what Rip was proposing. The diet was whole-food, plant-based, but had some important differences from what I was struggling with. It included any plant-based food in any quantity, except for avocados and nuts. Vegetables, fruits, whole grains (wait, what?), pulses (lentils and beans), and starchy vegetables such as potatoes, sweet potatoes, and corn (really?). The plan required complete abstention from added oils, salt, and sugar. I remember thinking that if I ate this way, a few things would happen:
I made some important decisions. First, I decided that Rip’s diet was far better than what I was eating, which was anything I wanted interspersed with a few days of plants. Second, I decided that I would trust the plan to work for me. Third, I decided that for one week, I would follow the plan absolutely, with not one bite of off-plan food. Fourth, that I would not tell anyone what I was doing unless I had some great results and they noticed the changes. Fifth, that I would participate every day in the Facebook group, posting what was going on with my eating and how I was doing on the plan.
I weighed in at 365 pounds, probably about 70 or 80 pounds below my highest weight (from the 2015 hospital stay).
I opened my eyes, and I jumped. I ate a potato (more like a few pounds of potatoes, but we’ll save that).
In two days, my glucose levels dropped into the normal range.
In the first week, I lost 14 pounds.
In six weeks, my hemoglobin A1c lowered to 6.6%. My doctor stopped my medications, and my glucose remained normal. Three months later, it was 5.1% (normal range). Three months after that it was 4.7%.
My one-week journey, as of today, has been well over 18 months. I now (June 2018) weigh 245 pounds. A partial list of things that have changed:
It is important to know that while these last few paragraphs read as though I just decided to make a change and that was it. Of course, it was far, far more complicated than that. There were many factors involved in this process, and I am still transforming myself. I will write more about all of these things, in time.
Diet is just one of many factors that involved with morbid obesity and poor health. After I dropped below 300 pounds I began increasing my level of physical activity, and eventually began running. I became a part of an incredible and supportive group of men who are on a similar pathway to me, and their help continues to be invaluable as I become the person I wish to be. I will write much more about this part of the process, as well. Just recently, I completed a life-changing event, the Leadville Trail Heavy Half. This event is a 15.5-mile race along one of the toughest trails ever created, rising from 10,200 feet above sea level in the town of Leadville, Colorado, to 13,185 feet at the top of Mosquito Pass. I will write a recap of that race soon.
I am not yet done with this journey. In truth, the destination has changed. I am not going where I thought that I would, and I am not getting there in the way that I thought, either. I hope you will keep reading as I put down my insights, my experiences, some recipes, and other things that I believe are important as you formulate how you want to reach your health goals. This is only the beginning.