I started a new diet, designed for insulin resistance. My insulin levels overreact to carbs, causing my blood sugar to crash, which makes me more hungry for carbs, and it's a vicious cycle.

So, I can still eat carbs, but I have to link each serving of carbs (15g) with a serving of protein (7g) to maintain normal insulin levels. I can have unlimited protein to satiate my hunger, but no more than 30g carbs per meal. And I must balance that with plenty of fresh vegetables. Of course, all in all, keeping my total calorie consumption around 1600cal per day.

So I'm eating lots of chicken and turkey breast, fish, lean meats, eggs... and trying to limit sugary foods. I get most of my carbs from sandwich bread or dinner rolls, toast, etc. Fresh fruits in moderation. I love vegetables, so I have no problem eating lots of those.

I am very active at work (lots of walking and lifting) for 3 nights per week. Plus 2-3 additional days per week, I am spending about 30 min swimming and/or water jogging, 30 min playing raquetball, and about 15 min lifting weights.

My starting weight was 116. After the first week, I gained 3 pounds... which I am assuming was either water weight or weight from entering "starvation mode." I think I was only eating 1200-1400 cal the first week, so I increased it to 1600 and I'm losing weight easier.

It's been roughly 3 weeks, and today I weigh 113. My goal is 110, but 108 would be even better. My weight gain was mostly brought on by steroid use (medical kind, not anabolic... I was on dexamethasone) so it has been a challenge losing the weight in my midsection.

Does this sound like a healthy diet/lifestyle to you? Recap for those who don't remember me... I am a female, 31, 5' 6" tall with a very small frame, and typically weigh around 108-110 when I am "healthy." I have an autoimmune disease, so I tend to disappear when I'm ill, and always make a comeback when I'm feeling better and ready to get back in shape.

Thanks in advance to anyone that can offer advice!

Sounds like you're doing everything right, to me. I would be doing more weight training and less of the aerobic work, especially being a female and in your line of work. (For preventative and performance benefits, in that order).

Your diet looks pretty reasonable. Nice and clean.

Except when you say "sandwich bread", "dinner rolls" and "toast", what kind of bread are we talking about? You should probably stay away from anything that isn't whole grain. (Check the ingredients for enriched flour (= crap), just "flour", multi-grain or any combination thereof. Also, any added sugars. Try to stick to bread that is just whole grain flour, or if you can stomach it, rye or sprouted breads). You should also try to get most of your carbs from sources like vegetables and legumes, except for periods around (1h before-1h after) exercise.

The preceding paragraph is all "in an ideal world" stuff though and overall it looks a lot better than you usually see in these sorts of posts. It's certainly an excellent start, and it sounds like it's working for you, so good job.

Thanks! I did my research on bread and just bought some whole grain wheat. Are you telling me it's not going to be very tastey? LOL.. I love bread, please don't take away my bread. I figure as long as I stay under 30g carbs for each meal, I should be okay. This book I read, "The Insulin Resistance Diet" says there is a 2 hour window after eating carbs. It's either going to be used as energy, or stored as fat, and your body makes this decision within 2 hours after eating. So as long as I don't eat more carbs than my body needs for energy, it shouldn't be stored as fat, and of course I try to stay active so the carbs are used for energy.

As for the weight training, I know I've explained this before, but I'll say it again... I am too embarrassed to do much weight training with all those men around. They STARE. And they try to "help" me. I don't want their help! They only make me nervous and flustered and frustrated, and I end up leaving early because they scared me off. Sometimes they even follow me into the spa or the pool and bother me there. I wish I would have gotten a membership at Curves (for women only) but it's too late now, I already paid. I'm just too shy to go in there, and for whatever reason, I attract weirdos. Oh, and they tell me how I'm "doing it all wrong" as if that's going to make me relax. I can't do anything right when someone is staring at me and making comments! I could probably figure out the equipment if I had some privacy. Sorry-- just had to vent a little.

Aww. What a bunch of douchebags. You must be pretty, is what that is. Me, I rarely look up from what I'm doing, and anyone who tries to talk to me is about to have their entire existence called into question by the look on my face.

Those are neat excuses and all, but uh, if you wanted to, you could figure out a way. A $50 (new, you could get them cheap or even free used) set of dumbbells would be enough to last someone your size a couple months of luxurious at-home weight training.

But once again, ideal world stuff. It's your life.

Edit: Oh, and some plain wholegrain stuff is very tasty. Just depends on the brand, really. Experiment. And even if it's not, you'll get used to it.

Don't worry. Whole wheat bread tastes better. (At least I think so.)

To smooth out the blood sugar and insulin spikes when eating meals with carbohydrates, you may want to consider looking up glycemic indices and glycemic loads. For example, you can them up at The Glycemic Index .

Be aware that glycemic load depends both on the glycemic index and the amount of carbohydrates. Boiled carrots have a high glycemic index, but do not contain much carbohydrates, so would not produce a high glycemic load. Pasta usually has a low glycemic index, but if you eat a big plate of it, you could be eating a high glycemic load due to the amount of carbohydrates.

According to most height / weight charts, 118-120 is the lower end of the "ideal" weight range for a small framed female of your height (the high end of that range would likely be around 133).

Of course, weight alone says nothing about fat versus lean tissue. You could be light, but have a high percentage of body fat and very little muscle, in which case you would want to make sure that you gain muscle while possibly also losing body fat. Since muscle is dense and heavy, gaining muscle may increase your weight, even though you may be losing fat.

This also means that an "overweight" person could actually be healthy if s/he has a body fat percentage that is in the non-overfat range (typically 10-24% for women and 5-17% for men, with the lower end being for athletes).

First of all, THANK YOU for the info on the Glycemic Index, that is VERY helpful!!

Secondly, I know that my BMI is bordering on the range of "underweight" but I'm not even close to being underweight. (I know I have had to explain this numerous times, so forgive me for being repetative.) I have extremely small, thin bones. My 11 yr old child has bigger bones than I do. I have virtually no muscle because the medication I was taking, breaks down muscle, and I am very sedentary when I'm ill. Any amount of weight that I have is "fat" weight. I bought one of those fancy Taylor scales that measures your BFP via BIA technology, and it says 31%. (God, I hope it's wrong.) I don't have any recent pictures that show my body (at least none appropriate for this forum) but trust me, if you saw me in person, you'd say I could stand to lose 5 pounds. (Or more.) I am a very small person with a lot of body fat.

About lifting weights at the gym, one of my male friends told me to wear baggy clothes. So I wore a sweatshirt. Have you ever tried to work out in a SWEATSHIRT? I about died from heat exhaustion! On a much happier note, I went to the gym again last night (in my normal attire), and was able to lift weights for 30 min without being bothered. Maybe it depends on the day of the week. Mostly older folks were there on a Friday night. I think the younger ones were out drinking.

I do have dumbbells for home use, but that's not really going to help me reach my goal as far as toning my glutes. I'm doing mostly leg and back exercises at the gym because those are my weakest areas. I can barely lift patients anymore because my legs and back are so weak. Before anyone suggests squats/lunges -- I tried, and I injured myself. I'll wait till I actually build some muscle before I do that again.

So anyway, I will try to increase the weightlifting, but I was told you can't build muscle while trying to lose weight. The small amount of time I have spent lifting weights has been for the purpose of toning. Once I get rid of all the overlying fat, I'll work on regaining muscle mass, and then weights will become my focus, not so much the cardio. (Sound good?)

Thanks again for all your help!!

Those scales are often wrong, but they can be used to measure progress in a relative sense (i.e. is the fat percentage going down over time?).

If the 31% is true, that means that, at 116 pounds, you have 36 pounds of fat and 80 pounds of lean. Losing 8 pounds of fat would leave you at 26 pounds of fat and 80 pounds of lean for 26% body fat, which is still relatively high.

For comparison, a 125 pound woman with 22% body fat would have 27.5 pounds of fat and 97.5 pounds of lean.

You could try a loose fitting (i.e. somewhat oversize) shirt that is not a sweatshirt if you are concerned about that type of thing.

Given that the lack of muscle strength is affecting you functionally (with respect to lifting patients), you may want to consider whether to emphasize strength gain first and fat loss later (if necessary). Increased muscle will increase your base metabolism (even when not exercising), which will make it easier to lose fat. Lack of lean mass, as you say you now have, will likely make it very difficult and frustrating to lose body fat, due to your very low base metabolism.

I don't think my self-esteem can take strength gain first. You mean get fatter, then try to lose it after building some muscle? I am so disgusted with my reflection right now, there is no way I will purposely gain more weight. I know muscle burns fat, but it's that in between stage that would discourage me. I think if I burn off the fat first, then gain muscle, I won't risk losing muscle when I lose fat. Does that make sense?

And it's not even the WEIGHT that bothers me. I wouldn't mind weighing 130 if it was evenly distributed. But it's not. It ONLY goes to my stomach/hips/butt/thighs (and a little in my face) and no where else. That's due partly to genetics, and partly due to the insulin resistance. And it's not normal body fat. It's causing stretch marks and cellulite, and just looks unsightly. I know I'm 31 and a mom, and I can't look 18 forever, but geez... I feel very unattractive at this point. If I had a boyfriend, I'd make him keep the lights off.

About the scale.. I don't think it's working. The other day it said my BFP was 25%. Then I ate a pear and it said 29%. I lost half a pound a few days later and it said my BFP was 31%. I'm hoping it's no where close to that. If I had to guess, I'd say I was around 25%, which is pretty normal for a woman my age.

I'll try to take pictures today if I can, but I don't know if I'd be brave enough to post them. I'm definitely not "overweight" -- but I'm pudgy and jiggly... or "skinny fat" as you guys call it. I know I can lose it, I always do... but my skin will probably never be as firm and smooth as it used to be.

At the beginner level, it is often possible to gain muscle while losing fat. Indeed, some beginners mistakenly get frustrated by gaining weight even though they are losing fat when it is really due to gaining muscle because they started or increased exercise.

Body fat measurements can vary significantly over the short term. To improve consistency, try measuring at the same time (e.g. in the morning before eating breakfast or exercising). Then record. See if there is a long term trend, while ignoring short term fluctuations. Remember also that the absolute number may be off.

If you really are at 25% body fat (which is only a little high for a woman), and your waistline is not more than half your height, but you are too weak to function in your job, then it is hard to see why you put the priority on the slightly too high body fat over the much too low muscle you have.

Increased exercise and increased muscle will also likely help you against the insulin resistance, since more exercised muscle means more places for blood glucose to go.

Also, weight training and increased muscle may stimulate bone growth, or fend off bone weakening. Given what you describe about your current low bone mass, you are probably at high risk of osteoporosis, which can be a significant disability that limits your ability to exercise.

tjl, my guess of 25% body fat, is just that -- a guess. I read that 25% was "normal" for women my age, and I think I'm "normal," so that's why I chose that number. I am 66 inches tall, and my waistline is 27 inches. (It's normally 24.)

The way I see it, it's not like I have 50 pounds to lose. I am only 3-5 pounds away from my goal, and THEN I said I would focus more on building muscle mass. I can lose that weight in less than a month. It's more important (to me) to get to my ideal weight first, before proceeding into something I know nothing about. (Weight training.) Most people say it's counterproductive to restrict calories and expect to gain muscle weight. If I'm going to work on building muscle, I want to be able to FEED my muscles, and not have to worry about muscle wasting while dieting. An experienced person could probably lose weight/gain muscle if they tried, but someone like me would be setting themselves up for failure. So first things first. I only have a few more pounds to go, it makes more sense to reach one goal at a time. I am almost there, I don't want to lose my focus.

I took some pictures, and unfortunately I didn't take any BEFORE I started the diet, so you can't see my progress thus far. I looked about 4 months pregnant before I started this diet, and now I only look 3 months along. Almost all of the bloating from the steroids has gone away, but I'm still left with little areas of fat and the atrophied muscles. I am seeing improvements, but I also see lots of room for more improvement.

These were taken this morning, before any meals, weighing 113.5 lbs.



What bothers me about my stomach there, is the contour. My stomach is normally flat, with good muscle tone. While I don't have a "gut" -- it's still not the way I want it to look.



What bothers me there, is the fat in the "saddlebag" area, and most of all the cellulite, which was not AS noticeable before. I think if I firm those muscles and lose that extra fat, the cellulite will be LESS noticeable. (I'm wording that carefully because I do realize it will never "go away".) I have a bit of an "hourglass" shape, which I don't mind, but I think the weight over my hips is too much for my small frame.



My stomach looks "okay" from the front, but what bothers me in that picture is the "love handles." They say that's the hardest place to lose weight, but I've done it before, so I want do it again.

Now THIS is what my stomach looks like when I weigh 108-110 pounds, what I WANT to look like again:





And also you can see the weight gain in my face...

This was taken the same night of the above picture in the lavender swimsuit when I weighed 108 pounds.



See, I don't look underweight, even though my BMI said I was.

And a picture of me back in November while I was still on the steroids, weighing around 116-118 lbs...



Can you tell how much fatter my face is there? And can you see there is absolutely NO muscles left in my arms? Just fat. My face isn't quite so "puffy" now that I'm off the dexamethasone, but it's still not back to normal. My arms are still "mush."

So anyway, I know most people here already knew what I looked like, but wasn't sure if you did. Now maybe you'll have a better understanding of my goals. A few more pounds to shed, and lots of toning is needed. When I say "build" muscle mass -- I don't expect to have big muscles. I would never look like a fitness model even if I tried. I just want to be able to FEEL some muscle and not just "mush."

Actually, while it is usually counterproductive, you're a little confused. It's actually the beginner who can probably do both. A more experienced trainee will find it much more difficult, if not impossible. It's not what you know, it's what your body knows. :P

Okay, I believe you're not anorexic. I never suspected it to be the case anyway, though.

You can do it either way you want. "Slim down" and then "tone" or start weight training more seriously while doing somewhat less cardio. You have that luxury, imo, because you're not all that overweight. Just be aware that if you're really worried about muscle wasting, there's a hierarchy and it goes "just reasonable restriction of calories" (maximal muscle wasting) -> "reasonable restriction of calories + cardio" (moderate-minimal muscle wasting) -> "reasonable restriction of calories + weight training +- cardio" (minimal-to-no muscle wasting).

You might find it a little more difficult to stick with a plan that includes more weight training (for strength, not endurance) because it's new and scary, but your results will very probably be better in the long term if you start now. But, as you and I have both said, you aren't carry enough extra weight for it to matter all that much.

I don't really think of swimming as "cardio." I know it is, but it's also resistance training, is it not? As in, similar to weights? When I tried the elliptical, I lasted 5 minutes, but that about KILLED me. I was ready to stop after 1-2 minutes. I was very short of breath and felt very close to fainting. Running, jogging, stair-steppers, ellipticals -- THAT is cardio to me, and I can't do that yet. Even while playing raquetball, I have to sit down and rest every 20 min or so. Swimming doesn't make me lose my breath, I don't get overheated, and I don't feel faint. I do get "sea sick" though, just dizzy and nauseated from looking at the water, so I can only actively swim for 10 min at a time. Out of the hour I spend in the pool, I usually do about 10 min of backstroke swimming, 20-30 min of water jogging and/or aquatics, and the rest is just frolicking in the water with my son. You really think that's too much cardio? And how much weight training per week would you suggest?

Also, how long between sets should I wait? Men are asking me to get up after one set for their turn, and it's like "geez, I just sat down." I usually only wait about 30 seconds before I start the next set. Is that too soon? I feel like telling them to wait their darn turn and leave me alone.

PS: I am loving the 100% whole grain wheat bread!! I bought the "thin sliced" so it's only 37 calories per slice.

I didn't say anything about too much cardio (at least I don't think I did). You're doing what you can and that's good enough. If you're still in that sort of condition, then I wouldn't actually recommend any weight training. I'm kind of wondering how you're able to do it at all, unless you're using those tiny pink 1lb dumbbells.

Tell men to **** off. Or, I guess if you want to be reasonable, you can just swap sets. A lot of people do this. You go, I go, you go, I go, until one or both are done. Sounds like you're talking about machines, though, and they suck. You know what I would do, if I were you (and by the way, I'm no expert - I just read a lot), I would get a good bodyweight routine going for now. That can work quite well for beginners, will probably be more effective than what you're doing at the gym and best of all, can be done in the comfort of your own home.

The amount of rest you want to get between sets can vary depending on a number of things. Generally as a beginner you'll want to rest 30-60s between sets, as a very rough guideline.

I just want to reiterate something though: all this talk is, once again, of theoretical ideals. Really, simply eating less and moving more is enough to get the job done for most people, and especially in your case, I think. So don't get caught up in all of this nitpicking, is what I'm saying. If you suddenly stop making progress (plateau), then, yeah, start over-analyzing, but until then, it's all good and you're doing great. I just think you ought to shore up your strength conditioning a little, is all.

I gotta go do stuff now, but when I come back I'll show you some interesting articles on different bodyweight stuff you can do, if you like.