End of Medical Study

For the past two years, I've been a participant in a medical study called CALERIE. The point was to measure what happens to a person (specifically, their metabolism and how fast their body ages) when you restrict the amount of calories they eat.

Research on this topic began in the early 80s, and it has since been proven pretty solidly that lifespan increases and illness decreases when calories are cut. Primitive organisms were the original experimental model, and then mice (I believe they cut the calories by 50%), and then when that worked they moved on to larger animals. Here's an article explaining a study that began in 1989, following monkeys with a diet restricted by 30% of normal calories. They've been studying these monkeys 20 years now, pretty much just seeing how long before they die... and it's a long time. The findings have been pretty incredible - a multitude of benefits seem to be associated with eating less.

In fact, there are people who already voluntarily restrict calories in attempt to live longer. It used to be a fringe trend, starting in the 90s, but now it's more mainstream. Most of the people dedicated to this lifestyle look like skeletons to me... but hey, maybe that's worth it if you live longer...?

So this CALERIE study was designed to test the aging/calorie link in humans. The goal was to create a calorie deficit of 25% of each subject's normal consumption (any more restriction than that was deemed unsustainable in reality, and too difficult on the subjects). There are two ways to create a calorie deficit (which means you consume fewer calories than you burn). One is to eat less, and one is to burn more calories. Phase I of the CALERIE study was a six-month study, and they tried three methods of calorie restriction. Method 1 restricted food by 25%, Method 2 added enough exercise to create a 25% deficit, and Method 3 was a combination of less food and more exercise.

At the end of Phase I, they found out that it's very very hard to exercise enough to burn 25% more calories than you normally do. Say, two hours in the gym. Every day.

Unsurprisingly, that method was very hard for people to stick to.

The combination method (more exercise and less food) still required people to spend about an hour in the gym, as well as diet. That also turned out to be difficult, and complicated logistically. So they settled on the food-only method. I would argue that it's still very difficult to do, but at least it's less time-intensive, and simpler to keep track of, and overall the most efficient method of calorie restriction.

So enter Phase II of the study, a two-year commitment to eat 25% less than you normally do. I signed up for the study, made it through the screening process, and was randomly assigned to the restricted group (as opposed to the control group, who really lucked out because they got paid the same amount for not changing a thing about their eating...).

At the beginning, I thought it was going to be easy. "They're paying me for this?" I thought, "and all I have to do is write down what I eat, and cut out the chips and cookies? Well bring it on!"

For the first month of study, they provided me food to eat. They do this to help you start the new habit of eating less - the meals they provide are sized to the amount of calories that you are allowed (or, your "calorie prescription" they call it). So you don't have to worry about calculating anything, you just eat the prepared food. I missed having chocolate (not part of the prepared meals...) but in general, it was easy peasy.

And life was going fantastically. From April to June, (two months) I had gone from my starting weight of 180 to a weight of 165. I felt better, I looked better, and what wasn't to like? By November (seven months), I was down to 160. I was on track, I weighed just what I was "supposed to." I was in the proper "weight zone" on the graph. According to the study directors, if I stuck to the 25% restriction, I should settle out at about 152 in a couple more months.

Now I have to tell you people, I have never weighed 152. Maybe for two weeks once when I was 12, as I rushed past that number during a growth spurt. So I was always skeptical that I would get to that weight. But I had no reason to doubt it - the trend line was going that way.

But here is where it fell apart.

In January of 2010, ten months in, I stopped losing weight after hitting a low of 157. I also started to really feel the pressure of recording everything that I ate. For someone so data-driven as I am, having to know and be aware of the calories of every single bite going into my mouth really bothered me. I never had to control my calories or my weight before, and having to control that area of my life was really making me become obsessive.

And also once I stopped losing weight, I went outside the approved "weight zone," because I was still supposed to be losing weight to get down to 152. So then every time I went to the study office to weigh in, I was told I was overweight. Hearing that for months in a row really started to influence me as well.

So it got really hard, really quick. But I am nothing if not an overachiever, so I tried really, really hard to stay on track.

I am ashamed to say that I would just not eat - I'd decide to basically starve myself rather than see a number on the scale that was too high. In fact I recall a time that I didn't eat for five days. But dang it, that number was correct when I weighed in on the scale.

The problem with that, as you may have guessed, is that it is unsustainable. Even if you don't eat, the weight you lose is mostly water, so you gain it right back when you start eating again.

Then I was in a quandary. I had to weigh in once a week. I knew from experience that I lose at a rate of two pounds a day if I don't eat (and the fact that I know that, is a testament to how badly I let this study mess with my head). So do the math - if I'm eight pounds overweight, I have to not eat for four days before weigh-in. If I was six pounds overweight, I had to not eat for three days. Now I kept thinking to myself, "I'll just get down to that weight and they STAY THERE, so I won't have to do this again." But as I said, you go right back to your previous weight because the loss isn't real - it's only water.

So do the math. Fasting for three days to make weight, then weigh in. Eat normally for three days, go right back up to previous weight. But recall that you have to weigh in every week - so you have four days left until next weigh in. And so then you have only one more day to eat before you have to start fasting again.

You can imagine this did not end well.

The turning point came one particular morning, and I remember it clearly. I woke up, and I really didn't feel very good. But I went to study headquarters anyway to weigh-in. I stepped on that scale, talked to the nutritional counselor as usual for a little while just to check in, and left early because I was feeling worse. On my way out of the building, I stopped to use the bathroom and get a drink of water. I just felt so tired and dizzy, so I went in the handicap stall and laid down on the floor. Twenty minutes later I looked up and realized that I must have fallen asleep.

Right then I realized I was being ridiculous. Of course I didn't feel well, and of course I passed out on the bathroom floor - I hadn't eaten for three days. And before that, I had only eaten for four days, because the week earlier I had done the same thing. I was putting my body through the wringer - and here's the catch - for NOTHING. Because all I could think was that the number on the scale was still too high.

Ladies and gents, we have a problem.

I am too smart to not see what was happening. When I stopped enjoying food, when I started thinking of my meals in 100-calorie increments, when I started feeling guilty for eating, when I started weighing myself twice a day compulsively, when I would eat junk food and be in tears while eating, when I would specifically say no to outings with friends because I'd have to eat high-calorie foods - these are not healthy things.

Trying to cut my calories by 25% created an eating disorder, plain and simple.

So in September, around the eighteen month mark, I called it quits. My weight had bounced around a bit, and I was back at about 163. So in total, for all the frustration I put myself through, I weighed essentially no differently than I had the previous November.

Ugh. SO not worth it.

I am pleased to say I have dropped as many unhealthy habits as I could. I weighed myself once a day as required, but no more. I stopped writing down everything I ate, and refused to feel guilty for eating. I never starved myself ever again.

Even though I had decided not to worry about restriction anymore, I still continued with the study. They can still use the data, after all. And so since I was still involved with the study, still weighing in every two weeks, it was still always in the back of my mind. I still knew the calories in things, I still cooked with lower calories in mind, I still always had a niggling feeling I was failing. Failing because without trying to restrict my calories, my weight started to creep up. From the 163 last September, I am 169 as of today. Still, I'd like to point out, that is down from the starting weight of 180, although nowhere near the fantasy eating-disorder-creating "goal" of 152.

And today - well, today is a beautiful day.

Today I am officially done with the study. Yesterday was my last day as a part of the study, and I was released from the hospital where I had to stay for two nights for testing at 8am this morning.

It's only appropriate that I end with a graph. Here is my weight, taken almost daily for the past two years. Highlighted points are the starting point of 180 on April 30th 2009, low point of 157.4 on December 9th 2009, and ending point of 169.0 today April 13th 2011. In the middle, around days 430-530 (June - September 2010) you can see the wild swings that occur when you misguidedly try starving yourself...

I am so, so thrilled to be done. Even though for the last six months, and really for the last year, I haven't been following the 25% restriction, I still have had to deal with the mental and emotional aspects of this study. Had I known what this would be like, I never would have signed up. Maybe given some time, I'll have a different perspective and can see the benefit, but for now I just have to give a hearty "take a hike" to the whole experience.

Evidence from monkeys or not, longer life is only useful if you enjoy the living. Carpe diem, and pass me a brownie!

Medical-Study Approved Breakfast Round #2

A while ago I wrote a post on a light, healthy breakfast that I might make on the weekends. To fit with the medical study I'm in, I shoot for less than 500 calories for breakfast. I thought I'd share other options for breakfast that I'm experimenting with. 

My normal is still a cup of yogurt mixed with a crunchy cereal, or fresh fruit.

Figure: Breakfast example - varies based on contents of my fridge and pantry on any given day.

Calories: yogurt (100 cal) + 1/2C. Fiber One cereal (60 cal) + 1/4C. raisins (130 cal) = 290 cal and 14g fiber.

But when I have time I like a change of pace, and I've found a nice portable option is muffins. (They also freeze well - hi Grandma!) Muffins can be tricky, because they CAN be just little cakes - pretending to be healthy, but full of sugar and fat.

However I noticed on the back of my crunchy cereal box, there was a recipe for fiber muffins. That can't be all bad, right?

Figure: Inspiration strikes!

This is a recipe for fruited bran muffins, with All-Bran cereal, banana, molasses, chopped apple, and blueberries. Yum!

Figure: A little smaller than my usual muffins. A good portion of the batter didn't make it into the cups...

Calories: two muffins = 320 calories and 10g fiber

Then I got really fancy, and decided to try orange fruit cups. This is a recipe from Cooking Light, from the subscription I get (hi Grandma again!).

Figure: Gourmet is what that is, I'm telling you.

Actually it's not so hard, you just chop up whatever fruit you have (must include oranges, though), pop it in the orange halves, dust with cinnamon sugar.

Calories: get this, it's only 80 calories per cup. Fruit! It's amazing!

And finally, here's what I made this Sunday - cinnamon-spiced bananas.

Figure: Add bananas, brown sugar, vanilla, and cinnamon to pot. Heat.

 The bananas simmer down into sweet gooey loveliness, a warm topping for whatever strikes your fancy.

Figure: Reduction de banana, you might say. 

Now you might suspect I put it on toast, or yogurt. Or perhaps I whipped out some organic fiber saltines, or, I don't know, slivers of toasted oat and flaxseed. (What would a sliver of flaxseed even look like?)

But come on, it was Sunday.

I had it over ice cream. For lunch. :)

But still! The calories: 1C. banana heaven + 1/2C. vanilla ice cream = 422 calories.

Ice cream as calorie-conscious brunch? It's a stretch I'm willing to make. :)

Month 18

I've been involved in a medical research study for 18 months now! All the way back in April of 2009 I started this study, and I can't believe I've come this far. This study is looking into the effects of diet on aging, which is why it is two years long. They have to let you age a little. :)

You also have to, well, diet. You have a certain amount of calories per day to eat, and I try to stick pretty close to that. This leads to some pretty rapid initial weight loss, and then a longer-term trend downward. But then it got harder. About a year in, I realized that my weight had leveled off, and it was really difficult to lose any more weight. The problem was, the study still wanted me to lose five more pounds to be in the target range.

I tried and tried. (And Christmas got in the way there too, which will foil almost any healthy eating plan!) It just got so mentally frustrating to track every calorie, and to always be thinking of the lowest-calorie choice when buying lunch or dinner out. I just wanted to eat without thinking, without scrutinizing, and without feeling guilty if I saw the scale go up.

And of course, being frustrated didn't help, so I finally sort of gave up. And since I was doing all I could to try to lose weight (with the results being to only stay steady), "giving up" meant that pretty quickly I gained weight back. Ack!

So I had to talk to the nutritionists at the study, and explain my frustrations (and my sudden uptick in the weight chart...). They assured me that this study is not supposed to make you develop an eating disorder, and that really what they want is data - not for me to feel angry or irritated with constant mental exhaustion.

And then since the pressure was off, and that mean number on the scale wasn't personal anymore, I felt more comfortable. I went back to doing what I knew - eat fruits and veggies, fiber, cook healthy meals instead of swinging by the fast food place. Understand what is in your food, so you can make healthy choices. If you indulge one day, just be mindful the next day. Consistent behavior is key - restricting your eating then pigging out isn't going to help anyone.

So now I'm back to where I was. I've still lost a total of 20 pounds since I started the study, but I'm no skinnier now than I was last November.

But I'm okay with that. I think maintaining a healthy weight (which I am) is a more important life skill than dieting. When I finish this study six months from now, I want to feel confident that I have eating patterns and a lifestyle that works for me in the long run. And if two years isn't the long run, I don't know what is...

Medical-Study-Approved Breakfast

You might remember that I am enrolled in a medical study, where I have to write down what I eat and stick to a certain amount of calories per day. (Well, supposed to. I don't always... but at least I faithfully report I ate more than I should!)

It's really not so hard to keep your calories low when you realize that: fruits, veggies, and fiber = low calories, and fat and oil = lots of calories. If you just skip a brownie, you can have an entire plate full of veggies. Or bowl full of strawberries.

So I thought I'd share a recent medical-study-appropriate breakfast. If I divide my calories about evenly per day and account for snacks, I get about 500 calories for breakfast.

Figure: Just look at all those fresh foods. And all that color!

Figure: First, we chop away. Miss Outlier loves her Cutco knives.

Figure: Then, we sautee. Items that take the longest go first (potatoes, onion) then the tender veggies go next (yellow pepper, green pepper, red pepper, mushrooms), then the finishing touches (salt, pepper, green onions).

Figure: Then, we eat! Add an egg, cooked in all those delicious sautee juices, and fresh tomatoes for topping. Glass of cold milk and we are good to go.

And the total for all that?

Potato: 177

Onion: 32

Peppers: 33

Mushrooms: 5

Green Onions: 16

Oil for sauteing: 72

Egg: 78

Tomato: 33

Milk: 62

Total calories: 507

Easy and delicious!

On Hunger

I am ten months into the medical study I am enrolled in. I have lost exactly twenty pounds, and I feel great. In this study if you follow the program, your weight is supposed to level off by twelve months. The problem is that I still need to lose at least 5 more pounds, ideally more like 7 pounds, to be at my "leveling off" weight.

At the beginning it was easy to lose weight. I cut out the huge amounts of junk food I was eating (typical student food, free pizza everywhere) and it was no problem to see the weight come off. But now my body has adjusted to the new, smaller amount of good food I'm eating. So if I eat even a little more calories than I am burning, those extra calories add up and the numbers on the scale aren't going to budge. I need to really be careful that I am eating just what I need to be full, and not pigging out on dessert and big restaurant meals.

Five pounds in two months. I can do that.

So I am really trying to pay attention to my body - to eat when I am hungry, stop when I am full. I am finding that most of the time when I reach for food, it's not because I'm actually hungry. It's because I'm bored, or I am avoiding doing work, or I want to take a break from doing something else, or it's simply available (free cake someone gave us in lab today is a case in point). Or it's a habit - something to munch on while watching TV. Or it's just "time to eat." It's 12 noon, gotta have lunch - 6pm, let's get dinner on the table.

I don't want this to feel like a diet. I don't want it to be forced. Because if I feel deprived, I just want cake even more. I want this to be sustainable. So I'm practicing listening to my body - hungry? Have food. Feel full? I've had enough. I like what one of my friends said - when you sit down to a meal, think to yourself "This is not my last meal. I will eat again."

I think this is good. I think it is going to take a while, but I can learn this.

Meeting Goals

Today I happen to be very pleased with myself. I've always been a self-driven type of person, and it pleases me when I meet goals I set for myself (it's also good to meet goals other people set, such as schoolwork goals, but that's not as fun). Today I have met two goals at once - booyah!

You might recall I'm in a medical study that tracks how many calories I eat, and that monitoring has led to some weight loss. I've been continuing to try and make healthy choices, and I am pleased to say that I have lost (and kept off for a couple months now) exactly 20 lbs. Yea!

I feel much better, and my graph looks good too...

And, to make today even better, I have met my savings goal. I am fortunate to have parents who impressed upon me the importance of being prudent with my finances, so I have always tried to spend and save wisely. My goal for this semester was to gather $1k in savings, and as of this morning (with a few cents of interest putting me over the edge....) I have $1000.01 in my savings account. I know that seems like a small amount to anyone who has a real job, but it means a lot to me. My credit card is paid in full every month, I have a chunk of money invested, and I have started a (quite small so far) retirement account.

Onward and upward!

Studying is Good for the Waistline

This year I have been enrolled in a medical study, and I've been given all sorts of tools to help me eat healthier. I was fed healthy food for a month, which was lovely, and now I have been given a Palm Pilot loaded with software to record my meals (which then can show me my calories and nutrition info for each day), and I have a nutritionist assigned to help me integrate good choices about food into my regular habits.

I also do a ridiculous amount of walking, not having a car. And finally, I've been working really hard this semester and studying tends to not leave much time for going out for rich meals and desserts.

Also as part of this medical study I get a very fancy scale with which to measure my weight once a week.

But for my own curiosity, I've been weighing myself daily. And being the data-driven person I am, it's impossible to have a data set and not be able to graph it. So beginning on April 1st this year:



But then, what fun is that? Much more interesting:



What interests me with this is that it looks like I'm going to settle out at just above 160, which is what I was before I started undergrad. But more importantly, I FEEL better. I'm sleeping better (of course, that could be because of no longer worrying about graduating...) and I have more energy, and I'm satisfied with eating less food.

And hey, just in time for swimsuit season doesn't hurt either...

Last Meal

One of the cool things about being a grad student is the abundance of research studies going on all around.

I think all college campuses get those flyers about sleep studies - recruiting volunteers to record how long they sleep, sleep less, or sleep more, come in overnight to be monitored while sleeping, hand over your firstborn, whatever the research requires. My campus has these in abundance, papered everywhere. Not so much the "you sleep too much" kind. Mostly of the "we want to study you because we CAN'T BELIEVE YOU ARE STILL ALIVE with the amount of sleep deprivation" variety.

But I think graduate-heavy and medical-heavy schools in particular have a cooler variety of research studies recruiting volunteers. If I see one that looks interesting and pays enough to be worth my time, I'll rip off the contact info and volunteer.

I trained on the next generation simulator intended for NASA astronauts to use to learn and practice how to run the manipulator arms on the space station. It was a bummer because there were two joysticks and hand control sets, with the dominant ones for the right hand. I generally choose to be left handed. I asked if I could switch the controls, but I was told that since on the space station they are, um, BOLTED DOWN, I couldn't really be moving those around. However it turns out I am really good at inspecting nose cone tiles, and maneuvering space-walking astronauts around on the end of the arm. I am not so good at moving tools around. Hey, if you've got to lose something, better it's not the astronaut, right? By the end of the study I had earned the highest grade of achievement that the simulator awards - whatever that means. I don't really think "Master Flight Controller" is gonna earn me any points at NASA....

I did a short, two hour study on hand-eye coordination and depth perception. I had to thread needles with one eye closed, stare at checkered grids, and other slightly dizzying tasks. They wanted me for this study because just like I'm almost even between dominant right and left hands, I'm also almost even in which eye is dominant. Remember the archery? I'd do the eye-dominance tests repeated times, and half the time get the right eye and half the time get the left.

And then last year I saw an advertisement for a really well-paying, interesting looking medical study. It turns out there is a six week screening procedure. I made it through the screening procedure, and they handed me a check for an amount half my monthly stipend just for getting through that!

The reason it pays so well is that it's long - two years. Of course, since I'm chained to my lab chair getting a PhD, I know I'll be around that long. The study centers around food - they provide food for you to eat for the first month of the study, and then after that you can eat whatever you want, they just want you to write it down. And come in once a month for a blood draw.

So the month of provided food starts tomorrow morning, and lasts through April.

And what was I doing tonight? Making a batch of brownies, of course. Of which I had four helpings. :)

Spate of Good Things

Life is being a darling to me today. I just have to share!

1) My total of RA interview requests is now up to 11. This amount, I have been told, is extraordinary. Competition is quite high for these jobs (ahem, free rent) and most people only get two or three interviews. Most people who are current RAs had to apply for a year or two in a row before they got a spot. So, yeah, I'm flattered all these kiddoes think I'm such hot stuff. :)

I've had quite a few interviews, with quite a few left to go. I'm getting better at them as I go - which stories to tell, how to answer tougher questions on depression and alcohol policy. I am confident I will get at least two offers. I have my favorite dorm so far, of course, and I'm hoping for that one - but really, I am excited any way it turns out!

2) I got to see an NBA game on Sunday. Woot! It was SO close, within a few points the whole game. Home team lost, but it wasn't for lack of cheering...

3) I have finished screening and been accepted into a research medical study. Doesn't take much effort on my part, and it pays out five grand over two years. Got a $700 check just for making it through screening. Can we say vacation money? Have to keep from spending it on those Craftsman tools I've had my eye on...

4) I was nomianted for both President and Chair of the Halls for next year in my current dorm. Of course, I plan to be an RA next year, so that's not going to happen. But I was flattered I was nominated for both those things - it's nice to be appreciated!

5) I have only two more sets of experiments to go before I have collected all the data I will need for my thesis.

6) I shot my first round in archery above 40 (out of 50) yesterday. Bull's eye three times out of five arrows!