Drugs, metabolism, weight, and health

I’ve had a rocky road health-wise since a workplace injury in 2004 led to permanent partial disability, and medical retirement with a fused spine and damaged sciatic nerve.  To deal with the resulting 24/7/365 pain, I was prescribed multiple drugs that helped, but also ‘zombified’ me to a certain extent.  If I took the quantities prescribed, I found I not only couldn’t think creatively – I actually underwent a change in personality.  I tapered off the dosage until I found a balance between pain control and feeling like a human being again, and stayed with that.

In 2009 I suffered a heart attack, likely due at least in part to the aftereffects of my 2004 injury, and underwent quadruple heart bypass surgery.  The cardiologist prescribed a different set of drugs for that, including one that, while it helped my heart, also had the effect of causing severe, uncontrollable weight gain.  (Later, another doctor would tell me, “You can almost watch a patient on [that drug] expand sideways.”)  I ended up putting on well over 100 pounds in the course of a year.  Diet and exercise – the latter limited by my earlier injury – did almost nothing to help.  Only terminating my prescription for that drug stopped the weight gain.

It took a thoughtful, dedicated physician in Nashville to isolate the problem.  By then, thanks to multiple drug interactions, my metabolism was pretty much shot.  With his help I went through my prescriptions and cut out more than half of them, including all daily pain management medication (although I kept a supply for bad pain days).  I now take each day only those drugs essential to my heart and circulatory health, and I’ve learned to live with a higher level of pain.  Unfortunately, my metabolism has not ‘reset’.  I’m still carrying around that extra weight, and find it almost impossible to get it off.  (For example, my wife helped me stick to a 1,200-calorie-per-day restricted diet.  Guess what?  I gained three pounds in the first week – and I wasn’t cheating!  Scratch that option . . . )

I’ve slowly but surely come to the conclusion that if I don’t get rid of the pounds, they’re going to get rid of me.  They’re adding to the load on my heart, bringing me to the point of being pre-diabetic with serious (and worsening) insulin resistance and showing most of the symptoms of metabolic syndrome, and putting additional strain on my injured spine and damaged nerve.  I’ve got to do something drastic, or face death within the next year or two.  It’s as simple as that.  The risks involved in doing something are more than offset by the risks if I do nothing.

It seems the best alternative short of bariatric surgery is to try water fasting.  I’ve been encouraged by the work of Dr. Jason Fung in Canada, among others, which has produced remarkable results in some (but not all) people, and I’ve read extensively on the benefits and dangers of fasting.  (A good introduction to the subject may be found here, if you’re interested.)  I’m aware of the real risks involved in so drastic a diet, but since bariatric surgery results in equally serious risks, I think they’re acceptable under the circumstances (particularly given the alternative if I do nothing).  If fasting helps to not only lose pounds, but also reset my metabolism, as it’s claimed to do, then so much the better.

I’ve been preparing for this step for some time, with the invaluable help of my wife, Miss D., who’s been very supportive.  I’ve just undergone the most extensive series of blood tests I’ve ever had in my life, to analyze just about every aspect of my metabolic, digestive and circulatory health and provide me with a baseline of where I am now.  (To my amazement and indignation, my medical insurance is quite happy to cover the tens of thousands of dollars it will cost for bariatric surgery – but it won’t cover blood tests to help me fast!  I have to cover those costs myself.  Oh, well . . . gotta sell more books, I guess!)

I hope that today will be the last day I eat solid food for at least the next 30 days.  This initial period will show me what my body will tolerate.  There are a number of options.

  • If I can make it for as long as 30 days without eating, I’ll re-evaluate at that point, with more blood tests and medical consultation.  If I can continue, great;  otherwise I’ll eat for a while, then tackle another 30-day fast.
  • If my body proves incapable of handling that long a fast, I’ll find out what it can handle, then work at fasting for that length of time (say, a week to ten days), interspersed with roughly equal periods of (light) eating.
  • If blood tests and other indicators show that fasting is making other problems worse, I’ll have to re-evaluate the whole thing, of course.  However, given the success others have had with this approach, I’ll hope for the best.

I’m telling you all this, not in order to solicit sympathy, but to help other readers who are suffering similar problems.  I’m aware of at least a dozen of you who are facing the same sort of problem.  I hope I’ll succeed in tackling mine, and if I do, I hope that’ll encourage you to tackle yours.  For the rest of my readers:  I hope this will help you realize that there are people who are not sick because they’re fat – they’re fat because they’re sick.  There’s a big difference.  I’ve seen and experienced some of the contempt directed at fat people, and it hurts – particularly when one isn’t this way out of choice.  Please keep that in mind when you see someone who’s obese.  They may have problems about which you know nothing.  As Scout reported Atticus Finch’s words in ‘To Kill a Mockingbird’:  “One time he said you never really know a man until you stand in his shoes and walk around in them”.  I’ve often wished some of those making the rudest, most dismissive comments could spend a few days in mine.  I don’t think they’d enjoy the experience.

Tomorrow morning it’s cold turkey – or, rather, no cold turkey for me!  I’ll be grateful for your prayers and good wishes over the next few months.  If this works, I hope to be a considerably slimmer, healthier, happier me by this time next year.  I’ll let you know how it goes.



  1. I've had my issues with pain and excess weight, though nothing like yours. Sciatic pain can be a bitch. Currently my weight isn't bad, though my doctor says another 20 pounds off would be good, and my sciatic pain is in a low pain cycle. For what it's worth, you do have my support.

  2. Peter, do what you feel you need to do.

    If you end up looking for another way, I recommend going to FreeTheAnimal.com and vegetablepharm.blogspot.com to check out Resistant Starch and The Potato Hack.

    I can't claim success following this approach, but I'm in my early days with 100 pounds to lose. I think gut health is worth checking into regardless of weight loss.

    Richard Nikoley is an asshole, but he has important things to say sometimes.

  3. Everybody is different, but the only diets that I've ever lost weight on were low-carb diets. Calories didn't matter – I can eat all the vegetables, eggs, bacon, beef, and cheese that I want as long as I stay away from sugar and grains. Unfortunately, I really, really like sugar and grains….

  4. You have my deepest sympathy – Although I didn't get to the verge of death the way you have, I too got hit with a mysterious (mysterious, because at no time did any of the various doctors at the VA mention the possibility of my (many) prescriptions causing horrendous weight-gain.
    I went from 180 to 320 pounds in a period of about 6 months – have spent the last few years trying really hard to lose it, and have only managed to creep down to 285! Cannot exercise – too much pain when I try, due to various damage to my spine and limbs (Amazing how much damage you can collect in a Naval career…); all anyone at the VA has ever suggested is that I need to diet – since I ALREADY have reduced my food to only one meal (a small one, mostly protein) per day, this has not been helpful.
    I'd never heard of a "water diet" before – now that you've mentioned it, I'm going to google it and see if it would give me hope.
    Thank you.

  5. Good luck to you!

    I feel fortunate that I don't have the pain issues you do – while I have some pains, I'm sure you'd be eager to trade yours for mine!. Nor do I have the screwed-up metabolism, so I can actually exercise and eat less/better, and lose some weight…though, being in my mid-50's, it seems I have to work twice as hard to get anywhere with it.

  6. Have you considered a low-carbohydrate low-sugar diet? Not saying this to tout it as some sort of ultimate tool, or even throwing my support behind it. Just wanted to know if it's something that was considered before a more drastic approach?

    Regardless, I wish you luck and good health.

  7. Peter, I yo-yo with my weight to an unhealthy degree- +/- 80 lbs 3 times in the past 5 years. I sympathize with your struggle, and adding in the health issues really complicates things. One of my brothers has had 5 back surgeries, and is facing the prospect of a 6th, but he's told me long-term use of some medication, including narcotic pain killers, goes hand-in-glove with metabolic issues.
    Please let us know how this works out. It sounds like it will be a real exercise of will, and I wish you the best!

  8. Good luck with your fast. If it works well, I'd also suggest looking at a low carb, high fat (LCHF) diet. Like the fasting, it maintains a state of ketosis. Unlike fasting, it's a sustainable diet with plenty of variations. Despite the popular emphasis on meats, most recommendations I've seen include about 65% of calories from fats, with roughly 25% of calories from protein and 10% of calories from carbohydrates.

  9. Best of journeys with this one, Peter. I'll include you in my prayers.

    'Fat, Sick and Nearly Dead' is a documentary that may help. Knowledge is power, and this bit of information helped save my dad from an early death. It might form part of the puzzle for you as well – there isn't necessarily a catch all that works for everyone, but reading of your situation I thought the information in that documentary would help you help your body to heal.

  10. In the comments above I see gut health and low carb diet… my thoughts exactly! We've been taking the whole family to a holistic doctor (chiropractor) for about a year now…

    A year ago the regular doc's told us to rush our 2 year old to the hospital as he may have leukemia. Two days later they didn't know what it was, but thankfully not cancer. After 6 months, they still didn't know what happened, but the GI doc did accidentally communicate his gut had some issues.

    Now make sure you work with your doc, but I highly recommend you find a good holistic doctor to address the things the main stream doc's wont! Our whole family had intestinal parasites, yeast and fungus problems in our guts. Within two months I've become a better father and my kids behavior has improved drastically!

    So at a minimum, try adding some lacto-fermented veggies (sauerkraut and pickles) to your diet…

    You can also check out the GAPS diet… http://www.gapsdiet.com/ -We've done a modified version of this… hopefully all this helps!
    God bless!

  11. Peter,

    I hope this works for you.

    Diets don't seem to work most of the time long term.

    Probiotics / gut bacteria seems to do something. Lots of bs in this area. Regular medical research is only beginning for this.

    No carb diet seems to be effective.

    Accupunture may help with the pain. Not all accupunterists are created equal.

    Mindfulness / meditation Aldo can help deal with pain. Seems to be 3 schools. Jonn Cabot zinc for medical, Buddhist, and business see sylli that came out of Google.

    Another anon

  12. After I had heart valve replacement, I was put on a strict diet of very low carb (slice of wheat bread a day MAX, and limited protein (the proverbial palm of hand portion). Gawd – I was hungry. I did lose 35 lbs in less than a month though. I can leave sweets alone, but I dearly love bread. Giving that up really hurts.

    I've since gained most of it back – never knew that beta blockers had that possible side effect. Next exam, I'll ask the doctor if he could switch out the med.

    I hope and pray you can find a way to deal with the new diet. Not an easy thing to do, but you have the ultimate motivation – this or else.

  13. @Anonymous at 11:56 AM: I'm afraid I can't name it. I did once or twice in other forums, only to be threatened by the manufacturer for 'spreading unfounded rumors' – this despite having been told by five doctors, including two physicians, a neurologist, a cardiologist and another specialist that it was, indeed, to blame, and they'd seen the same side effect many times before. In order to avoid complications I can't afford, I'd rather not fan the flames. However, I will say it's a heart medication, it begins with 'L', and its listed side effects include weight gain. I'll leave you to draw your own conclusions.

  14. I have fasted. Great for weight lose. However, it messed up my metabolism, big time. I hope you are not going to make the situation worse.

    I have had the most long term success with very low carb diet. Richard K. Bernstein, M.D. probably has the best insight into the metabolic syndrome (diabetes) I have read. After being called a crack-pot for years by the ADA and most of the medical community, the current research is showing that he maybe on to something.
    Web site link: http://www.diabetes-book.com/

    If you haven't done a worming/cleansing protocol you might want to try one. It can be quite enlightening!

    The biggest hurdle is going to be changing your gut bacteria to a more healthy blend. The current research is showing that our sugar/grain craving maybe due an over-growth of gut bacteria that processes sugar/grains sending signals to our brains to feed them.

    I wish you the best of luck in keeping off the weight you do lose.

  15. "If I can make it for as long as 30 days without eating …"

    You won't, and that's because your body's glycogen reserves will drop low enough that you'll want to binge on carbs.

    It's even worse if you have a glycogen storage disorder, especially the kind that makes your limbs hurt like hell until glycogen levels come back to semi-normal.

    I'd focus on maintaining a sufficient glycogen level that allows you to lose weight while preventing a hard crash.

    I suggest picking up a blood glucose meter and some test strips so you have numbers to go with how you're feeling, allowing you to figure out precisely how many carbs you really need to reset.

    That could be as easy as keeping a supply of powdered (not liquid) Gatorade on hand so light carb loading goes a bit easier.

  16. I wondered if someone would recommend a ketogenic diet, and someone did, so I have a bit more to add …

    Try to locate some ketone test strips or a ketone testing kit — this may be a bit more difficult than finding blood glucose testing supplies since you may need to talk with a pharmacist or GP to obtain them.

    There is a cheaper option, albeit less accurate — Miss D can simply tell you when you smell like you've been painting the house, and you can adjust your regimen accordingly. 🙂

    Otherwise, if your cardiologist suggests statins, it may be possible to rely on "natural statins" — nattokinase and K-vitamins would be worth looking into with his assistance.

  17. Peter, our very best wishes and prayers for you and Miss D. When the tough get going….it's time to get moving.

  18. Fasting wrecks your metabolism, just a fact. When your fast ends your body will keep your metabolism slowed down to try to put the weight back on, metabolism will stay slow for ab extended period of time.
    The key fact here is your pre-diabetes and insulin resistance. The only cure for this is to limit or end your body's use of insulin, which s done by severely limiting carbohydrates. If you want to understand the mechanics of this check out Gary Taubes, and/or Micheal Eades. Dr.Mary Vernon is the past president of the American Bariatric Association and her practice consists mainly of treating diabetes through diet. Youtube has a lecture by her at a Kansas college in 4 parts.
    Weight gain is a symptom of diabetes, not a cause. I work in a medical field where the majority of out patients are type II diabetics. A significant minority are thin.
    Bariatric surgery is a false hope, with many complications, some of which don't appear later in life, including loss of kidney function. What these patients are fed post surgery in a low carb low calorie diet, you can adopt the diet with out the surgery, though holding calories that low is dangerous for your health.
    There is a great deal more to this that can be covered in a comment, I urge you to check the references I mentioned. Best wishes

  19. You and Miss D. have my best wishes! I wish you all the success in the world, and will be on the lookout for updates.

  20. market-ticker.org. He has a diet that not only works, he has given in to some type 2 diabetics and they have reversed under the diet.

    I keep all fructose, sucrose, anyose sweetners out of everything I eat or drink

    Karl has some pretty good numbers and decent research.

    Like reading your tales so don't leave this coil just yet.

  21. Good luck, sir. I have not had much luck with fasting, my metabolism does its best to keep those fat cells going. Like many that have already commented, I have done better on a low-carb diet. I'm 90 pounds lighter and no longer diabetic. No bread, no sugar, no fruit, just green leafy vegetables, eggs, meat, nuts and cheese.

  22. Thoughts and prayers for you and yours, Peter. I've no advice to give (not knowledgeable enough), but my father has similar issues. Let us know how it goes. I'll see if I can't get him to try out what works (he's a stubborn man, my dad. Runs strong in the family).

  23. I would recommend reading Joel Fuhrman, either Eat to Live or The End of Dieting. He also has a book on fasting for health, I haven't read that one, but absolutely would if I were considering fasting.

    With his methods I've lost over 80 pounds since mid August, without going hungry–probably less hunger than when I was gaining weight. The basic diet is non-starchy vegetables in unlimited quantities, (minimum 1 pound cooked, 1 pound raw per day) unlimited beans and legumes (minimum 1 cup per day) unlimited fruit, limited whole grains and starchy vegetables, and almost no meat, dairy, processed grains, processed sugar or processed oils. This is very close to the diet that Penn Jillette went on to lose 100 pounds in a few months (and where I heard of the diet from)–and his personal diet expert says that fasting is easier for people used to this type of diet. My wife was a Type 2 Diabetic–she is partially on this diet, and had to stop taking her diabetes medicine because her blood sugar is now lower and more stable without it than when she was on it. Dr Fuhrman claims that his diet is also helpful for heart disease beyond the benefits of weight loss. I have no evidence for or against that, except that none of his claims that I can test have turned out to be exaggerated.

    I hope you can find something that works as well for you as this has for me.

  24. I just started a low-carb diet again. I lost 30lbs on one a few years ago, but then stalled and after falling off, I put the weight back on and added more in the last few months.

    But I did just find this article on the Protein Leverage (http://www.science20.com/deconstructing_obesity/the_protein_leverage_hypothesis-156539) It is some interesting research that actually came out of zoology rather than nutrition research. Seems protein is the key nutrient and animals will react differently when they aren't getting enough, from migrating, cannibalism, and in humans overeating carbs and fat if the protein sources are diluted. And it is true, protein in our diet usually comes with a lot of carbs and/or fat attached.

    So, while I've been maintaining ketosis, I've added concentrating on meeting my protein requirement (.37 x weight (lbs), for USDA min) and those grams should be met even on low calorie diets for weight loss, cut the carbs and fat not the protein. (0.8 – 1.4 x weight(kg). Basically, as we get heavier we starve even more for the protein, which prompts more eating in hopes of getting the protein needed. Even though that higher carb/fat intake can lead to weight gain, diabetes, etc.

    I'm experimenting with using protein isolate (low carb/low fat) to make sure I go over my protein needs of about 100 grams/day.

    I can't say it will work…yet, but I'm hopeful and just being off carbs has changed my mental state.

  25. Very best of luck with your battle Peter.

    Never met you, and probably never likely to. I am a long time lurker & first time commenter here. I will remain anonymous, but know that I visit daily. I find myself drawn back again and again as I enjoy your stories and share many of your opinions and views.

    The world is most definitely a MUCH better place with you in it.

  26. Peter, you seem to have been having troubles at the NRA AM last year and I totally understand your issues. My wife and I both have had bariatric surgery – she had Roux-en-Y about five years agl, and I had the Gastric Sleeve done last October. My wife has dropped 150 lbs and I've dropped 90 lbs. Both of us eat a lot of protein, and we've cut carbs significantly. My diet is pretty close to the Atkins diet in what I eat, my wife is more liberal (little L) with her diet. But it got rid of my pre-diabetes, high blood pressure, sleep apnea, and other early-onset problems. My wife was extremely obese, very diabetic, sleep apnea, and had a number of problems related to her weight and diabetes. All gone, some in a matter of days. The surgery is not that drastic as it may seem, but it is a life-altering event/change that you must realize. Contact me, or look for a good bariatric support group in the area for more answers.
    And good luck with your choice, whatever it may be.

  27. Peter, I feel for you man. I've struggled with weight all my life. I am currently on a drug to supress metastatic prostate cancer that screws with blood sugar levels, kicking me over into technically low end diabetic. Fatigue and weight gain is also very common. .

    I strongly suspect current official diet advice will come to be viewed as cultic quackery.

  28. There's a place north of me that does a really good job with water fasting. They've been at it a long time. http://www.healthpromoting.com/

    One caveat with ketogenic diets is that it ain't just meat and fat. To do it right you need a LOT of leafy greens. Think up to a couple of pounds a day. Very limited fruits.

    Also, be aware that not everybody will turn the urine test strip purple when they're in ketosis though that's the easiest and cheapest way to go. If you thing you're on the right track and you're still not seeing purple, you can get a dual blood glucose meter that also reads ketones. This can be useful, though the test strips are about $4 each. But some people do a better than usual job of making sugar from protein, and they may need to fine tune protein intake.

    You want to spare lean body mass as much as you can. Losing muscle is not a good thing, and it gets harder to get it back as we get older.

  29. I'll keep you in my prayers, sir. And I'd like to "second" your wish that those who judge and condemn out of ignorance first try walking in the shoes of their target. Chronic illness and pain suck, pardon my french, and judgemental, ignorant jerks are the frosting on the awful cake. Well, maybe the sprinkles. Government control over pharmaceuticals and treatment decisions…that's the frosting. May the DEA have a circle in hell reserved for it. I'll shut up before I start ranting… God bless. 🙂

  30. My 2 cents. I had a quad bypass in Jan. I'd already lost 30lbs from my high weight, mostly by cutting soda and carbs. Since the surgery I've lost about 10 more. I'd like to lose another 20, but I'm not going to sweat it.

    Thing is, while recovering a "nutritionist" came in and told my wife all of the usual BS: "no salt, cut the fat, but you have to have some fat, etc." Seriously, I was laying there thinking "Are you even listening to yourself contradict yourself?:"

    Once my surgeon released me I went to my cardiologist to get cardio therapy set up. And HE told me, "The nutritionist at the therapy clinic will tell you all kind of stuff. Its ALL wrong. Cut the carbs and sugar out of your diet, eat healthy veggies, some fruit and some meats. Don't worry about fat, don't worry about salt."

    In other words…the Adkins diet was pretty much spot on.

    Now, I know for some people salt IS an issue, because they start retaining water. But not so much for me. I know I could lose that last 20lbs if I'd give up completely on bread. I've cut way back…but just haven't been able to give it up. SIGH

    If what you're trying doesn't work…I'd suggest reading "Why we get fat and what to do about it" by Gary Taubes. It's a pretty damning indictment of our food health police since 1960 and gives great advice on livable diets.

    Thank you for sharing. I'm having trouble to adjusting to all of my meds too, although not nearly as bad what's happened to you.

    God bless on your quest.

  31. I strongly suspect current official diet advice will come to be viewed as cultic quackery.

    Scientific diet advice is that people are eating fucking too much, and of the wrong things. Like too much sugar (because, as one processeed food expert put it: "When in doubt, add sugar").


    Weight gain is a symptom of diabetes, not a cause. I work in a medical field where the majority of out patients are type II diabetics. A significant minority are thin.

    Then why does it precede diabetes?

    Also, being fat isn't the problem with diabetes. Being physically inactive is. Fat people may have trouble walking, but we all know where they should excel – water, and bicycles.


    Interesting thing is that Atkins just recapitulated advice from 1930's, when low-carb diets were advocated for diabetes (there wasn't insulin yet) and weight loss.


    Also, if you're tough, but unable to exercise much, one way of making the body expend calories is cold. But again, it takes a single-minded person to lose weight by thermogenesis, and I'm not even sure it's safe for those with heart conditions. Certainly temperature shocks are not, they make even hearts of healthy people go a little wonky for a short while. Gradually getting cold should be fine I think, but it'd be wise to ask a cardiologist..


  32. More unsolicited advice: cut the carbs. Lean meat and veggies. Some cheese and eggs and plain yogurt (no fruit and corn syrup added) also. Whenever you're hungry, eat something with a bit of fat. Eat all the bacon you want; fry it in its own grease, no canola oil or sunflower oil or any of that stuff. If you must have cooking oil, use olive. When I get chicken I get it with the skin still on and fry it that way; the skin produces all the needed grease. No potatoes, no sugar, no bread, no corn, none of that stuff. Absolutely no sugar added to anything. Drink your coffee or tea black. No restaurant meals because they add sugar to everything. Try it for a week and see how it goes. If you aren't starving or ill by the end of it, keep it up another week or two for clearer results. You will lose weight and have more energy.

    This is pretty closely related to the paleo diet but it's something I worked out on my own as a result of health problems. I ended up becoming significantly more healthy than I was before the problem surfaced, solely as a result of dietary change.

  33. My own experience with Fung has been extremely positive. His book – the Obesity Code – became available on my side of the planet in March, and following the rules laid out in the final section have allowed me to lose a significant chunk of weight. I seem to be sleeping better too. It's only been six weeks, but because there are no complicated rules to follow ( you simply don't eat during the fasting phase) it feels like something I could follow in the long term.

    That said, The longest I have gone completely without food is 48 hours. Please do blog here on your 30 day progress.

  34. I struggled with my weight for years. I'd be inclined to listen to Clinton J. I started with GAPS and went Paleo and dropped 50 lbs. in three months. That was in 2013. It has stayed off because I continue to eat that way.

  35. Dennis

    Hate to tell you this, and it was bummer finding out, that after 50 it is harder to loss weight. There went mine plan. 🙂 The only way I have to losing weight is to stop eating and that is very hard to do. So good luck to you and be careful, those evil drugs we take can start to have weird effects when you lose weight.

    May the Lord be with you in this trial.

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