I have short-term success health story to share. Using keto + OMAD (one meal a day) + tracking CICO (calorie in calorie out) + exercise, I slowed down my diabetes and lost significant weight (24 lbs) in 11 weeks. My concern is that it is actually too fast. This is something I have to keep up and maintain, for the rest of my life, and extend this to long-term success.
My Stats and Background
Male, in 50's, 5'10". My ideal weight is likely 160-170 lbs, which was what I was in my 20's. Then every decade, my weight has gradually went up. When I started my diet in on December 1st, 2023, I was at 201 lbs; so around 35-40 lbs over weight. As of today (February 17th, 2024), I'm at 177 lbs. I still like to loose 10-15 more lbs, to get to 160-165 lbs.
I was likely pre-diabetic for many years. I had high triglyceride for more than 20 years. When I started to measure HbA1C in 2016, I was at 6.0%. Then it stayed around 6.0% to 6.3% thru 2022. These are all signals that I was pre-diabetic, but that seriousness or urgency didn't register with me.
Then in November 2023, my A1C shot up to 6.9%, which is diabetic range. This was my wake-up call. Actually, during summer of 2023, I noticed I had some unusual health effects. On multiple occasions in mid-afternoon, I got so tired that I could not stay awake. I incorrectly thought I had the flu. In hindsight, it was likely insulin/sugar crash.
Previous Diet
I always ate 2 meals a day, since college. I skip breakfast; eat lunch and dinner. This is like 18:6 intermittent fasting (IF). This means 18 hours fast, with 6 hours eating period for lunch, dinner, and snacks.
For meal, I ate a lot of carbs (white rice, brown rice, noodle, pasta), along with protein and veggies. After meal, I ate fruits. And between meals, I snacked on processed foods (potato chips, pop corn, cookies, chocolate, ice cream, boba tea, etc). Often, after eating a big meal, I would still eat desert or snack afterwards. Although I was not truly hungry, I didn't feel full either. So I just snacked as a habit.
Although this high-carb diet is not healthy for me, the intermittent fasting (IF) very likely helped me from putting on weight. And it took 20-25 years to gradually put on the weight. And gradually got me to diabetic state.
Result
11/29/2023 | 2/2/2024 | 2/17/2024 | |
Weight | 201 lb | 181 lb | 177 lb |
Body Fat | 29.9% | 26.2% | 25.4% |
Hb A1C | 6.9% | 6.1% | - |
Average Glucose | 151 mg/dL | 128 mg/dL | - |
Triglyceride | 1240 mg/dL | 283 mg/dL | - |
Comment | Started keto | Blood test after 2 months | Current weight |
In around 11 weeks, I lost 24 lbs. This is 2.2 lbs per week. And I lost around 3-4" from my waistline.
Method
I believe all of these have an effect in controlling my diet and help me lose weight. They all work hand-in-hand:
Keto
OMAD (one meal a day)
Counting calories: CICO (calorie in calorie out)
Exercise
Keto: My Past Experience
I tried keto or low-carb diet for weight loss multiple times previously. I had some short term success. But I never really stayed on the diet. I can point out multiple reasons why:
I didn't have incentive. Once I achieved some weight loss, I thought job well done, goal completed, and went back to normal diet.
I didn't track or keep to low enough carb.
I didn't count calories and ate as much protein/fat as I want.
I would over eat to try to get that 70-80% calories from fat.
I tried 5/2 keto (5 days keto, 2 days normal), when I found it difficult to completely cut out carbs.
Traditional keto diet is to get calories based on the following macronutrients: 5% from carbs, 25% from protein, 70% from fat. This is quite high in fat. This was based on original keto diet to manage symptoms of a neurological disorder or other therapeutic reasons (reduce inflammation; improves cognition, memory, and general brain health).
There are also some low-carb high-fat folks who claims eating more fat will in fact reduce blood lipid cholesterol. That argument lacks supporting data.
There is also Atkin's diet, which limits carbs but does have not have limit on protein and fat. And then there are related diets like paleo and carnivore diet; somewhat similar but with other criteria.
The issue with these alternative diets is that info is quite fragmented. There is definitely some basis behind these diets, as many have experienced positive results. However, detailed studies and facts are lacking. So many proponents have suggestions and believes that are based more on faith or circumstantial evidence, rather than science.
Hard to say what is right or wrong. And everyone has different needs. Diet, metabolism, health concerns, and goals all vary. For me, to control my diabetes, I need to go low-carb and lose weight.
Keto Limits
There is a camp of keto practitioner that believe the following. This is more aligned with my needs and thoughts:
Carbs are a limit. < 20g net carbs per day to enter ketosis. This is the only macro that matters for ketosis.
Protein is a goal. Protein is vital to maintain muscle mass. And since body cannot produce protein (unlike carbs and fat), you want to meet the protein macro.
Fat is to satiate. Body uses fat for energy on ketogenic diet. But where does the fat come from? If your goal is to lose weight, you want body to burn body fat, not fat from food. Should not over-eat fat. This is contrary to some keto proponents, who believe in higher fat is better method.
I started with strict 20g net carbs limit daily, to ensure I entered ketosis. It was a struggle for 1st week. This always happens when trying something new and of course cutting carbs completely.
After couple weeks after I'm used to keto, I start to each fruit: either 1 fruit (orange, apple, or pear) or 1 serving of berries (blueberry, raspberry, strawberry). With the fruit, I kept to around 30-50g net carbs per day. This is not strict keto.
OMAD
Because I always skipped breakfast, I was basically on 18:6 intermittent fast for last 20 years. When I started keto, I continued 18:6 for many weeks. Both keto and IF suppresses hunger. Then it was quite natural to extend the fasting to OMAD (one meal a day). I basically eat dinner around 3-5 pm. And then sometimes I eat a snack right after. So technically, my IF period varies between 21:3 to 22:2.
CICO (Calorie In Calorie Out)
Keto and IF are great to control hunger and food intake. But to lose weight, still have to eat less calories than burned. This means tracking food intake, plus activities that use calories.
Food tracking app enables calorie counting. This is for calories of food intake. Plus counting macro- and micro-nutrients to meet low-carb or keto targets. And then app needs to either estimate activity calories or import that data from fitness tracker.
I know app tracking for food is tedious. I still suggest this, particularly at the start of the diet. Once you are aware of how much to eat, then can possibly drop this logging. For me, the process of logging food makes me aware and think about how much I'm eating. This helps me not to over-eat.
For the first couple weeks, I weighed my food. Once I have a baseline and reference, I did not continue that strict measurement. Something like 10-20% error is good enough for my needs.
I'm aware of these 3 commonly used food tracking apps: Cronometer, MyFitnessPal (MFP), and Carb Manager. You can test out these apps quite easily.
Cronometer: I like Cronometer's database. I find it easier to find the food of interest. Cronometer is keto friendly. And it can import data from Garmin.
MyFitnessPal (MFP): MFP is very popular. Advantage is that it integrates well with Garmin. It can export food intake to Garmin, which other apps cannot do. I believe there is some collaboration and agreement between Garmin and MFP. Other apps can import activity data from Garmin, but not export to Garmin. Unfortunately, MFP database is a mess. And I spent a lot more time finding the right food with complete data. Also, MFP is not as keto friendly as Cronometer.
Carb Manager: Database is similar to Cronometer, and much better than MFP. However, it requires paid premium membership to connect to Garmin. So not for me.
For exercise + activity tracker, I used my Garmin Vivoactive 4 watch. Note that exercise and activity calories are different. This is important because you need to know what setting to use in your food tracking app.
Exercise calorie is where user specifically start exercise mode, such as run, walk, strength training, elliptical, rowing machine, treadmill, etc. Activity calorie is just general activity where body is using calorie. This can be walking around at home, walking around at the office, walking to/from parking lot, walking while shopping, etc.
Both Garmin and Apple Watch will log both exercise and activity calories. However, some other fitness tracker might only track exercise calories, but not general activity calories.
CICO Calculations
Cronometer has the following calorie target calculations:
Target = BMR + Activity Level + Exercise + Imported Activity + TEF - Weight Goal
Here is what they mean and what I used:
BMR (Basal Metabolic Rate): This is based on sex, age, weight. For me, this is 1650 kcal.
Activity Level: If you don't have fitness tracker, you need to estimate your activity level. If you have fitness tracker, it depends on whether the tracker counts exercise calories only, or exercise+activity calories.
Supposedly, for tracker (like Garmin) that logs exercise+activity calories, this should be set to 0.
If tracker only logs exercise calories but not general activity, this should be set to Sedentary (+20%) or some other setting.
Initially I used 0. But it didn't match my Garmin's daily calorie estimate of 2000 kcal, which is based on RMR (Resting Metabolic Rate). Plus, I don't think this BMR limit is realistic as I have difficulty meeting this. So I set this as Sedentary (+20%), which is 330 kcal. Now 1650+330 is aligned with Garmin's RMR. And I believe this is more accurate.
Replace with Imported Activity: I still do not know what this feature does. By default it is On. With this setting On, the Activity level calorie is lower than with setting Off. t seems to be some estimate that Cronometer does to that Sedentary (+20%) calories. The difference is around 150-250 kcal. I set this to Off, so the total calorie in Cronometer is closer to Garmin.
TEF (Thermic Effect of Food): This is optional. This is energy used to digest the food you eat. If turned on, you get a bonus allocation of around 150 kcal. If you want to be more strict, you can turn this off.
Weight Goal: This is up to your goal, on how quickly you want to lose (or gain) weight. And it also depends on how much you eat and if you can meet the target. If you always fail to meet the target, then this is not a good setup, as you will get into bad habit of always failing your goal. I used -500 kcal per day, which translates to losing 1 lb per week.
My overall calorie target looks like this:
Target = BMR + Activity Level + Imported Activity + TEF - Weight Goal
Target = 1650 + 330 + around 500 + 150 - 500 = around 2100 kcal
Imported Activity varies daily. I used 500 kcal in example above. It ranges between 300 to 700 kcal. And sometimes on weekends up to 1000 kcal. It depends on the exercise I do and the duration. My Garmin watch tracks this, so something I don't have to have to manually track. I do monitor this daily, because I want to expand my exercise calories as much as possible.
Some days I am over by 200 kcal; other days I'm under. If I hit my target (which is -500 kcal deficit), I should be losing 1 lb per week of fat. In reality, I'm have lost 2.2 lbs per week. I'm not complaining.
As to why there is discrepancy, the initial weight loss likely included water weight, as keto (or low-carb) diet causes body to release stored water. Plus there is quite a bit of estimation in the entire process, in the amount of food intake, body metabolism, activity calorie, etc.
The calculation itself is just an estimate. Turning Replace with Imported Activity On vs Off will cause a delta of around 50-250 kcal. And TEF (Thermic Effect of Food) is another 150 kcal. Once you go through this exercise, you will realize that the food intake calories also has error. I don't weigh my food all the time. There are definitely errors there. When I eat steak or pork chop, how much fat remain or trimmed from the edges? There is definitely error, likely 10-20% off. So this is not an exact science. But it gives me a general idea on how much I'm eating.
In addition, the process of tracking food really makes me think about my food intake and helps me control what I eat and how much I eat.
Exercise
Throughout my life, I exercised off and on. Although I was never dedicated, I go to the gym periodically, typically once a week to couple times a month. This was just to reduce stress. And I mainly did elliptical, stair master, treadmill, and some weights. For weights, I mainly focused on arms and shoulders, because I thought it will make me look better.
Now, I want to lose weight and also to prevent muscle loss. So I focused on working largest muscles, in legs and core. That means squats, bench press, lat pull-downs, etc. Think squat is a great exercise. It works both muscles and cardio. Dead lift is also great, but I didn't do that to prevent exacerbating my back issue.
Below is data from weight lifting session. The first 20 minutes or so was bench press. The last 20 minutes was squat. My heart rate went as high as 157 bpm during the squats. I had to take breaks to keep my heart in my chest. Just great cardio plus working the muscles.
One thing to watch out for is food consumption after exercise. This was a problem I always had. The more I exercised, the more I ate. I noticed that if I burned off 500 kcal during exercise, I basically put that 500 kcal back in food. So must burn more calorie than intake. I realized if I burn > 700 kcal in exercise and I cannot eat extra 500 kcal in single meal, then I will be in deficit. Something to monitor and be aware of.
Conclusion
Keto + OMAD + CICO + exercise worked for me to lose weight this time. Except for CICO, I tried keto, 18:6 IF, and exercise previously. But the effort was not integrated. And I was never successful in sticking to the routine. This time, the difference is just having single mindset and integrating all these methods, along with CICO.
As mentioned previously, everyone has different needs, issues, or goals. Everyone has different diet history, body metabolism, health concerns, and goals. Keto works for me, but doesn't mean it is right for everyone. On the other hand, IF, CICO, and exercise should be available to everyone. So try it for yourself. Find what works for you and stick with it.