Tuesday, October 3, 2023

One year later, and 180 pounds later

26M. SW: 450lbs CW: 270lbs GW: 199lbs

As the title suggests, over the past twelve months, I have lost 180lbs. I never would’ve dreamed of being successful in losing weight, so I hope my story can help and motivate others just starting their journey.

Last October, I made the decision to try yet again to lose weight, after numerous previous attempts. I would always stick to a diet for a few weeks and then fall right back into old habits. Not sure why this time was different, but it was. I began to count calories, which is a method I had tried previously. I used an online tdee calculator to determine my maintenance calories, and then tried to be at least 500 calories below that. I think the biggest thing for me this time around was that I didn’t restrict myself from certain foods. I simply tracked the calories and ate the food as long as it was within my caloric limit for the day. Honestly, the first month of my weight loss journey was eating Taco Bell power bowls and bowls from chipotle. Easy, and relatively low calorie as far as fast food goes.

I then decided to make more food for myself at home, along with quite a few frozen meals haha. I know macro wise, frozen meals aren’t the greatest, but it was an easy way for me to track calories easily, and have quick meals. When I do make food, I find ways to make it lower calorie when possible. 96/4 ground beef has been a lifesaver, along with keto buns and fat free cheese haha. This has been my main method of eating. Simply altering recipes to be lower calorie. Looking at every nutritional label for the product I needed, and buying the lowest calorie one.

Apart from this, nothing I did this time around was special. I still at cheat meals once in awhile. I did cut out drinking, which saved me a lot of calories on something with no nutritional value. Exercise wise, my job has me walking 8 plus miles a day, which has been my main source of exercise. I’m at the point where I would like to weight train more, which is my next step in my journey.

It feels great to be in the final stretch of my journey. By this time next year, I would be thrilled to be at my goal weight, in which case I would then be looking at skin removal surgery, since even at this point, I have quite a bit I wanna get rid of.

If anyone has any questions or wants me to share a certain aspect of my journey, please ask away. I am more than happy to share anything. I would love to help anyone just starting out on their journey answer any questions they may have. I am in no way an expert, but will try to help anyway possible. To anyone just starting out, if I can do it, you can too. You got this!!

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Sabotaging my weight loss after being rejected post 12kg loss and feeling quite dejected and disgusted with my body

I am currently 68 kg at 162 cm for context. So despite paying for a dietician I haven't lost more than 1 kg since mid summer. I also got rejected around then after getting undressed in front of someone that expected me to be less fat/more toned (didn't catfish them at all) after my weight loss, and honestly I always end up ruining my diet and overeating when I am thinking about what happened. Ofc it's just a me problem but I am paying and have nothing to show for it and thinking of giving up because my fat distribution is just weird and I can hide it with clothes anyway. I was really happy for losing the weight I put on since 2020 and honestly maybe I am delusional but I didn't think my body was that unattractive. Now I can't help but notice how disproportionate it looks and it makes me want to purge again just to hurt myself in some way for being. I understand that's my ED affecting me and above reddit pay grade.

Just a small rant past 3 am. The bright side is that I am trying to stick to good eating habits like not skipping meals, eating plenty of fiber and drinking a lot of water because I think they helped me lose or at least maintain my weight and helped with my bulimia too. I need to get back on track and it's long overdue. It's been more than 2 months. I should be over it by now :/ and I am quite embarrassed because I know I am doing this to myself and I am being a big baby!

Please shake me hard.

Edit: But anyway, slay, because I dropped a skirt size and got a cute dress :3 so win overall.

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How do I act?

My boyfriend is very sensitive about weight gain, he weighed more in the past but managed to lose a lot of weight and even if he isn’t the fittest at the moment he is good. I don’t care about his weight and every time he mentions he gets annoyed that he gained weight I don’t know how what to say ,I want to support his weight loss journey because he wants it but I don’t want to be saying that he should lose weight. He gets in a really bad mood at any gain and I have tried to say it’s not a big deal before because I genuinely meant it but he got annoyed at me by saying he didn’t need anyone to console him and that he doesn’t want to talk about it anymore. The problem is that I could even not mention it but he will come to me to vent when any change happens and while I don’t mind just listening I can see that he is in a bad mood and I just want to cheer him up. How should I act and what should I do or say to support him?

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35 Healthy Apple Recipes Packed with Fall Flavors

We say apple, you think pie—and rightfully so. There’s nothing like a slice of warm apple heaven on a crisp fall day. But to really make the most of your orchard harvest, consider apples in a parfait for breakfast, as a side to a sandwich or even whipped into a sweet smoothie bowl. Apple recipes are just as versatile as apple varieties!

From Fuji and Honeycrisp to Gala and Golden Delicious, these fall fruit all-stars are bountiful in flavor, rich in fiber and perfect additions to your weight loss plan. Embrace apple picking season and celebrate the autumn harvest with these healthy and delicious apple recipes.

1. Healthy Apple Pie

healthy apple pie

It’s got that flaky, buttery crust you crave. It offers the goodness of apples and hints of cinnamon in every bite, like a proper slice of pie should. This recipe is missing one thing: added sugar. Instead, all that natural sweet flavor comes directly from the source—fresh apples that are peeled, sliced and baked into a healthier dough. Made with whole-wheat pastry flour for added fiber and light butter for less fat, this classic fall dessert is both palate-pleasing and waist-friendly, making it one of our favorite healthy apple recipes.

Get the Healthy Apple Pie recipe.

2. Apple Pie Yogurt Parfait

healthy apple recipes

Cool and creamy Greek yogurt is layered with a warm combo of apples and spices for the perfect parfait to start your day sweet or enjoy as an afternoon treat. For some crunch and extra protein, sprinkle chopped walnuts or sliced almonds on top; then dive in—spoon first.

Get the Apple Pie Yogurt Parfait recipe.

3. Fall Spinach Salad with Apple Vinaigrette

healthy apple recipes

Crunchy apple slices, crisp spinach leaves, vitamin-rich radishes and creamy goat cheese join nutritional forces to create a colorful salad that’s as healthy as it is satisfying. Juicy pomegranate seeds add a burst of tartness and the combination pairs perfectly with the tang of homemade apple vinaigrette dressing.

Get the Fall Spinach Salad with Apple Vinaigrette recipe.

4. Simple Slow Cooker Applesauce

healthy apple recipes

If you’ve got lots of extra apples from your last picking, this is the recipe for you: a dozen of these sweet fruits slow-cook to about 14 servings of good-for-you applesauce. Flavor the apples with cinnamon, nutmeg and a little apple cider vinegar, but be sure to leave the skin on: much of the nutrients reside in the outer layer. Skip the sugar—no need with this delicious recipe—and let the slow cooker work its magic.

Get the Simple Slow Cooker Applesauce recipe.

5. Grilled Chicken Sandwich with Apple Slaw

Grilled chicken sandwich

Freshen up the Nutrisystem Grilled Chicken Sandwich with a homemade apple slaw topper. All you have to do is mix together coleslaw mix, match-stick sized apple slices, light mayonnaise and black pepper. Stack the slaw mix between the buns to bring a little crisp and crunch to every sandwich bite.

Get the Grilled Chicken Sandwich with Apple Slaw recipe.

6. 2-Minute “Baked” Cinnamon Apples

healthy apple recipes

The name says it all: two minutes and two ingredients are what you need for this super simple snack. Just slice an apple, sprinkle cinnamon, pop in the microwave and voila—farm-stand taste in no time. For extra sweetness, add stevia or monk fruit. Want to add an Extra? Drizzle a little maple syrup or dollop fat-free whipped cream on top.

Get the 2-Minute “Baked” Cinnamon Apples recipe.

7. Creamy Apple Cinnamon Smoothie Bowls

smoothie bowl

Super popular smoothie bowls get a seasonal twist with this creamy, dreamy recipe! Apples and cinnamon bring the flavors of fall; frozen bananas add potassium and thickness; Vanilla Nutrisystem Shake Mix packs in the protein and fiber. With energy-boosting nutrients in every spoonful, this smoothie bowl is the perfect meal to kick-start your day or provide an afternoon power boost.

Get the Creamy Apple Cinnamon Smoothie Bowl recipe.

8. Air Fryer Apple Chips

healthy apple recipes

Ready-to-eat apple chips at the supermarket are expensive. DIY versions using a food dehydrator take forever. Enter: the air fryer. In just eight minutes, one medium apple seasoned with cinnamon and nutmeg morphs into sweet, crispy chips that weigh in at less than 100 calories per serving.

Get the Air Fryer Apple Chips recipe.

9. Instant Pot Apple Cake

instant pot cake

The Instant Pot has been called the Swiss Army Knife of kitchen tools for a reason: it’s a modernized pressure cooker, but it also sautés, acts like a slow cooker, steamer, food warmer and yes, dessert baker. Just place a springform pan filled with sliced apples, whole-wheat flour, spices and a handful of other ingredients into the Instant Pot. In one hour, you have an apple cake that’s moist, cinnamon-flavored and satisfyingly delicious.

Get the Instant Pot Apple Cake recipe.

10. Pumpkin Pie Applesauce

healthy apple recipes

I mean, why not? Apple meets pumpkin in this awesome sauce so you can enjoy two quintessential fall flavors in one tasty snack. Just toss apple slices, pumpkin pie filling and a slew of spices—cloves, cinnamon and nutmeg—into a crock pot. Add stevia and vanilla extract for sweetness, then let it stew for about five hours. If you can’t wait that long to sink your spoon into this hearty applesauce, cook it on the stove instead for 30 minutes. If you prefer a smooth texture over chunky, pour it in the blender and puree.

Get the Pumpkin Pie Applesauce recipe.

11. Chocolate Caramel Apples

caramel apples

Yes, you can have chocolate on your apple, and you can certainly drizzle caramel on it, too. But the decadence doesn’t end there: Before the gooey combo hardens, top your fruit with crushed peanuts for some protein-packed crunch. Then sink your teeth into the sinfully delicious treat without an ounce of guilt.

Get the Chocolate Caramel Apples recipe.

12. Air Fryer Apple Almond Butter S’mores

healthy apple recipes

It looks like s’mores. It’s got graham crackers and gooey marshmallow, like good s’mores should. But with almond butter instead of chocolate and slices of apple in between, this inspired twist on the campfire classic is a little sweet, a little salty and a lot healthy. Plus, there’s no need to stoke any flames for this s’more: Just three minutes in an air fryer and the creative concoction is complete.

Get the Air Fryer Apple Almond Butter S’mores recipe.

13. Air Fryer Baked Apple

healthy apple recipes

Sometimes you just need good ole’ comfort food to get you through a rough afternoon. Or maybe you’re needing something sweet at the end of a not-so-sweet day. This baked apple will do the trick. Simply split the fruit in half, scoop out some of the flesh and spoon in a tasty trio of walnuts, raisins and spices mixed with a smidge of butter. Twenty minutes in the air fryer and out pops a soft and sweet treat that can help soothe your soul, and still keep your weight loss on track.

Get the Air Fryer Baked Apple recipe.

14. Booze-Free Appletini Mocktail

healthy apple recipes

No matter how slow you sip, many alcoholic drinks serve up lots of calories and sugar, without any nutrients. Not the best combo when you’re trying to lose weight. Enter the mocktail: fun and fancy drinks that are light on calories but big on refreshing flavor. This appletini mixes 100% apple juice with chopped Granny Smith apples, lemon juice and a little Stevia for a tangy take on a happy hour favorite.

Get the Booze-Free Appletini recipe.

15. Apple Pie Chia Pudding

apple chia pudding

Indulge in the tantalizing Apple Pie Chia Pudding, a scrumptious and wholesome breakfast option. This delectable masterpiece layers unsweetened applesauce, maple vanilla chia pudding and cinnamon-spiced apples, resulting in a harmonious blend of flavors and textures. Crowned with crunchy walnuts, this nutritious delight is sure to satisfy your cravings. Enjoy the essence of a freshly baked apple pie in every spoonful!

Get the Apple Pie Chia Pudding recipe.

16. Air Fryer Apple Cinnamon French Toast

Air Fryer Apple Cinnamon French Toast

French toast is a delicious and easy-to-make breakfast dish that can seem fancy but is actually simple. Elevate ordinary whole wheat bread with fresh apples, ground cinnamon and applesauce for a healthy and flavorful brunch. Using your air fryer eliminates the need for oil and stove mess, making it even more convenient. Enjoy this tasty treat and start your day with a satisfying meal!

Get the Air Fryer Apple Cinnamon French Toast recipe.

17. Easy Apple Crisp

apple crisp

Imagine indulging in a delicious and effortless apple crisp recipe. Warm apple slices, rich in flavor, topped with a delightful crumbly topping, making it a texturally satisfying treat. This recipe features Nutrisystem’s popular Granola Cereal and only requires a handful of simple ingredients. Enjoy the convenience and scrumptiousness of this delightful dessert, perfect for any occasion!

Get the Easy Apple Crisp recipe.

18. Slow Cooker Apple Butter

Slow cooker apple butter

Embrace the flavors of the season with our easy-to-follow recipe for homemade apple butter in a crockpot. Making apple butter at home in your crockpot or slow cooker is a breeze. With just apples, maple syrup, and an array of warm and flavorful spices like cinnamon, ground cloves, nutmeg, allspice and vanilla extract, you can create a healthy and delicious treat.

Get the Slow Cooker Apple Butter recipe.

19. Apple Pie Bars

Easy Apple Pie Bars

Indulge in this delightful fall-inspired dessert that combines two classic baked goods. Enjoy the delectable flavors of apple pie infused into a blondie bar that is dairy-free and gluten-free. Whether you are searching for a delectable treat to serve at your fall dinner party or a wholesome snack that captures the essence of autumn, look no further than this Easy Apple Pie Bars recipe. It’s the perfect go-to for all your autumn cravings.

Get the Apple Pie Bars recipe.

20. Apple Pie Blended Overnight Oats

Apple Pie Blended Overnight Oats

Enjoy the delightful flavors of apple pie with a unique twist – a no-bake version! Tickle your taste buds with our guilt-free Apple Pie Blended Overnight Oats recipe, perfect for a healthy and satisfying breakfast. This trendy meal prep option features a handful of simple ingredients, including Nutrisystem Maple Brown Sugar Oatmeal, nonfat Greek yogurt, chia seeds and Vanilla Nutrisystem Shake Mix for extra protein.

Get the Apple Pie Blended Overnight Oats recipe.

21. Apple Pecan Yogurt Toast

Apple Pecan Yogurt Toast

Start your day off right with this delicious and nutritious Apple Pecan Yogurt Toast! Whether you enjoy it for breakfast, dessert or as a snack, this easy-to-make recipe is perfect for satisfying your cravings. Made with crusty sourdough bread, creamy custard, chopped apples and crunchy pecans, it’s a delightful twist on the popular TikTok trend. Best of all, it’s Nutrisystem-approved and packed with the goodness you need.

Get the Apple Pecan Yogurt Toast recipe.

22. Healthy Apple Nachos

Healthy Apple Nachos

Fill up on fresh fruit with this sweet healthy apple snack recipe that’s perfect for your weight loss plan! Apple nachos are the new trendy treat that should be on everyone’s healthy menu. With a layer of crunchy, thinly sliced apples, a drizzle of nut butter and a few tasty toppings, you can create a unique and beautiful dessert that you’ll want to enjoy all season long. We’ve created a couple other variations of this recipe, including Baked Cinnamon Apple Nachos and Pretzel Date Apple Nachos.

Get the Healthy Apple Nachos recipe.

23. Air Fryer Apple Fritters

Air Fryer Apple Fritter

Let’s be real, apple fritters are like a fusion of “rustic” donuts and apple pie. Their imperfect shape adds to the charm, packed with fresh apples, soft dough and delightful hints of cinnamon and sugar. We’re simplifying the recipe and tweaking ingredients to make this delectable treat fit into your weight loss plan.

Get the Air Fryer Apple Fritter recipe.

24. Apple Pie Cinnamon Rolls 

Apple Pie Cinnamon Rolls

Savor the delightful combination of your top two sweet treats in a mouthwatering dish. Indulge in the delightful fusion of apple pie and decadent cinnamon rolls, brimming with fresh and fragrant flavors. Rest assured that this guilt-free delight perfectly aligns with your healthy weight loss plan.

Get the Apple Pie Cinnamon Rolls recipe.

25. Cinnamon Apple Parfait

cinnamon apple

Dig into the delightful flavors of autumn with our scrumptious Cinnamon Apple Parfait. This diet-friendly recipe not only satisfies your taste buds but also keeps you healthy this fall. Experience the perfect blend of warm cinnamon and fresh apples, complemented by the creamy and tangy goodness of Greek yogurt.

Get the Cinnamon Apple Parfait recipe.

26. Warm Mulled Cranberry Apple Cider

Warm Mulled Cran-Apple Cider

Get cozy with this guilt-free Warm Mulled Cranberry Apple Cider throughout the entire autumn season. Immerse yourself in the delightful blend of cinnamon, cranberries and apples for a nourishing and comforting beverage. This sweet drink is the perfect companion for chilly evenings, adding warmth and coziness to your seasonal celebrations. Enjoy this flavorful autumn treat that’s sure to satisfy your cravings!

Get the Warm Mulled Cranberry Apple Cider recipe.

27. Cran Apple Chia Jam

Cran Apple Chia Jam

Rejoice in the delightful taste of our Cran Apple Chia Jam, an exquisite spread for your breakfast toast. Bursting with vitamins and natural sweetness, this seasonal jam can be easily prepared in minutes and refrigerated for a delightful addition to your autumn mornings. Elevate your mornings with this scrumptious and nutritious cranberry and apple preserve, perfect for fall.

Get the Cran Apple Chia Jam recipe.

28. Slow Cooker Apple Cranberry Crumble

Slow Cooker Apple Cranberry Crumble

Prepare to be blown away by the incredible taste of our Slow Cooker Apple Cranberry Crumble! This mouthwatering dessert, packed with the perfect combination of sweet Granny Smith apples, tangy cranberries and a hint of cinnamon, will surely satisfy your cravings. With simple ingredients that you likely already have in your kitchen, this easy and healthy recipe is a must-try.

Get the Slow Cooker Apple Cranberry Crumble recipe.

29. Apple Chicken Cobb Salad

Apple Chicken Cobb Salad

As autumn season arrives, it brings a bountiful harvest of fresh, delectable fall ingredients. Indulge in this delightful seasonal salad, the Apple Chicken Cobb Salad. Enjoy the juicy diced apples, tomatoes and avocado, accompanied by grilled chicken, hard-boiled egg and the autumn superfood, butternut squash. All these delectable elements are combined over a bed of crisp Romaine lettuce and topped with your favorite dressing. Discover the flavors of fall in every bite – a perfect blend of taste and nutrition!

Get the Apple Chicken Cobb Salad recipe.

30. Cinnamon Spiced Baked Apples

Cinnamon Spice Baked Apples

Calling all sweet treat enthusiasts! Indulge in the ultimate (and super simple!) fall apple recipe. These Sliced Baked Apples are the perfect solution for your sweet cravings. Soft and sweet, they are an absolute delight. With just five common ingredients and three simple steps, this recipe is incredibly easy and incredibly satisfying. Your taste buds will thank you for the heavenly flavor, and your kitchen will be filled with the delightful aroma of apple and cinnamon.

Get the Cinnamon Spiced Baked Apples recipes.

31. Turkey, Apple and Swiss Waffle Sandwich

Turkey, Apple and Swiss Waffle Sandwich

Kick your morning with a hearty and scrumptious waffle sandwich that’s perfect for brunch. This delightful breakfast treat combines the timeless flavors of turkey, apple and Swiss cheese. Made with Nutrisystem Buttermilk Waffles, this breakfast sandwich is as delicious as it is satisfying. Start your day right and indulge in this meal packed with flavor and goodness.

Get the Turkey, Apple and Swiss Waffle Sandwich recipe.

32. Apple Peanut Butter Monster Mouth

Apple Peanut Monster Mouths

Need an easy and healthy Halloween treat? Try making these adorable and delicious Apple Peanut Butter Monster Mouth snacks! All you need to do is spread peanut butter on two apple slices, add a row of nuts as teeth, and voila! Perfect for Halloween parties or whenever you’re craving something sweet but nutritious. Say no to seasonal sugary treats and opt for this delightful alternative.

Get the Apple Peanut Butter Monster Mouth recipe.

33. Savory Brussels Sprouts and Apples

Savory Brussels Sprouts with Apple

Craving fall comfort food? Try this guilt-free and delicious Brussels sprout and apple dish! Not only are Brussels sprouts easy to cook, but they’re also packed with health benefits. Bring this flavorful dish to your fall gatherings and savor the season’s finest flavors without worrying about added calories. Embrace the goodness of Brussels sprouts and enjoy a tasty, nutritious treat!

Get the Savory Brussels Sprouts and Apples recipe.

34. Slow Cooker Cranberry Applesauce

Slow Cooker Cranberry Applesauce

Get the Slow Cooker Cranberry Applesauce recipe.

35. Filling Fennel Apple Salad

Filling Fennel Salad with Apples and Celery

Looking for a delicious and nutritious side dish? Look no further than fennel! With its fantastic crunch and delightful licorice flavor, fennel is a versatile vegetable that can serve as the perfect base for a mouthwatering salad. Discover how to make a delectable fennel salad featuring crisp celery and sweet apple—a great choice for those on the Nutrisystem program and a perfect complement to any meal.

Get the Filling Fennel Apple Salad recipe.

For more creative ways to get healthy with your apple recipes, check out our recipe section on The Leaf for the latest updates!

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NSV: I fit my suit!

About two years ago I bought a suit off Amazon to be my first suit for my first big boy job. And because it's Amazon, it arrived and was a size too small. I could squeeze my arms in there and as long as I barely moved, I could wear it with minimal discomfort. I felt a little bit like a sausage but the suit still managed to look very dapper on me.

For about a month before my increasing weight gain meant it was no longer comfortable to wear at all.

I had enough time to buy a better fitting larger suit. But at my heaviest I barely fit in that either and the Amazon suit was so small, I literally could not fit my arms into it at all anymore. That was a bit of a sobering moment.

This weekend is a holiday in my religion and I put the Amazon suit on - and it fit like a glove. Even better than when I bought it. I wore it to a holiday celebration and an aunty told me I looked like a groom, all dapper and handsome. This was a good week.

I'm on track to lose 5lbs this month, despite getting sick and temporarily eating at maintenance. I'm close to 20lbs off. If I keep it up, I'll get the 30lbs off by the end of the year. I suspect it will probably not go that smoothly until the end, but I'm hoping that I can at least get to the 25 mark before it starts getting really tough.

The rules tell me I need to give advice on how others can do what I am doing, so I'll just share what I'm trying to do:

900-500 kcal average deficit every week, with a goal daily calorie intake of about 1300 kcal. I use volume eating, I mostly stopped eating grains, rice and potatoes. I get my carbs from vegetables, fruits and dairy. An average split of 50% carbs, 25% fat and 25% protein. I cook 90% of my own meals, with occasional snacks for meals or take out once every few weeks.

I am still recovering from illness (covid), but I was walking at least an hour per day for the first month and a half of weight loss, which greatly exacerbated the loss at first. I have since been recovering and slowly rebuilding my exercise tolerance.

I have medical issues with many foods, unstable blood sugars and physical disability. This includes two endocrine disorders that make my BMR lower than it should be for my height and gender. But I've found a good deficit where I am not constantly starving and also not constantly fatigued (I tried 1200 at first, bad idea). It's been a lot of trial and error, but so far, it works.

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Lipedema: a holistic approach

MANY women suffer with lipedema, impacting their self-esteem, affecting their weight and making them feel hopeless. Consensus until recently has been that liposuction is really the only “cure”. By trying to really understand how it develops and progresses, I'm hoping to figure out how to holistically target it to not just prevent progression, but improve symptoms.
Not medical advice, not a professional, talk to your doctor etc etc. I'm coming up with my game plan based on what I have written here, and I’m sharing it in case it can help others!
Here's what I've learned:

Stage 0.
From birth, we overproduce fat cells in certain areas of subcutaneous adipose tissue (SAT) due to our genetic mutations (we lack genetic features which put a brake on the process), and at the start, that's all it is- thick-looking legs. But at some point in life when fat cells rapidly grow and multiply e.g. puberty or pregnancy, we start to see problems caused by this imbalance in adipogenesis (fat creation), characteristic of...

Stage 1.
Fat tissue needs to be accompanied by new vasculature (like any other organ/tissue) in order to supply it with oxygen. But our capillaries are abnormal due to genetic differences in our connective tissue (as an aside, most of us have diagnosable hypermobility), including our blood vessels. Essentially, our capillaries are fragile with poor elasticity and much more permeable than normal.
Unfortunately, blood pressure for all mammals is highest in the legs. Since our leg capillaries are fragile with poor elasticity, they experience even higher blood pressure and it doesn't take much for them to burst. I'm sure you bruise easily... if only that was the only problem. They dilate to try to cope with the high pressure, but they're really bad at constricting again (poor elasticity), hence many of us also have a condition called POTS.
But the permeability is the main issue- we leak fluid from them into the 'interstitial space' like crazy. That fluid is supposed to get absorbed by the lymphatic capillaries in the area and shuttled away to be cleared out of your body, but that's a whole a lot of strain to put on the system, so it runs a little slow. Small amounts of fluid hang around in your legs, small enough that you may not even notice it, and if you do, it's generally fixed by elevating your legs to help out your lymphatics. Your skin is smooth, you don't think there's much of a problem other than that your legs ache a lot.
But even those small amounts of fluid are a problem. Cells in your body called cytokines start sending out a warning signal that this is happening, which causes white blood cells to flood to the area and cause inflammation. In response to the inflammation, your subcutaneous fat cells start to undergo numerous harmful changes (remodelling), including becoming much less metabolically responsive- they refuse to be accessed for lipolysis. Some areas of inflamed fat form fibrosis around them in an attempt to repair themselves- a hardened outer layer, which you can start to feel as little nodules which may be as small as grains of rice. If this inflammation becomes chronic, it leads to...

Stage 2.
The chronic inflammation is incredibly damaging. It causes insulin resistance, especially in the abnormal fat, impacts on mood, increases pain and discomfort, and reduces mobility. All of these things further promote fat accumulation, growth of fat cells and, of course, the growth of the fibrotic nodules.
Inflammation and fat expansion also reduces oxygen supply to the cells (hypoxia), resulting in acidification (peroxidation), which promotes fibrosis, and increased oxidative stress- at this point, areas of your fat may be noticeably cool to the touch due to hypoxia. Hypoxia causes hardening of the nodular fibrosis and the fat becomes even more metabolically inert. You notice that your fat is dimpled like a mattress and if you do not have obesity in other areas of your body, it's becoming clear to you that this is not normal fat. This becomes even clearer as you progress into...

Stage 3.
As the cycles of inflammation, fat expansion and hypoxia continue, the nodules begin to adhere to each other and to your healthier fat tissue, creating large, lumpy, painful masses. Your skin begins to thicken (fibrosis) and you start to develop large, visible folds of skin and fat, which may protude and put pressure on joints as well as harming your mobility and balance. The loss of elasticity in your thickened tissues reduces blood and lymph flow, causing the tissue to grow, and the inflammation and fibrosis begin to cause serious damage to your lymphatic vessels.
Your body is supposed to grow new lymphatic vessels and strengthen existing ones in response to inflammation, but oxidative stress has reduced your rate of autophagy (that's when your body kills off damaged cells to allow the nutrients to go to healthy ones and to building new tissues), and so your body is unable to do this, ultimately resulting in...

Stage 4.
The edema accumulates, since it can no longer be transported away from the area, and you develop lipo-lymphedema, or lymphedema secondary to lipedema.
--------------------------------------------

Okay so it paints a pretty grim picture, BUT it does tell us what sorts of things we need to target holistically in order to slow progression and improve symptoms, and avoid surgery for as long as possible. I've tried to split them up into broad categories.

Reducing and preventing inflammation.
• Insulin resistance (which promotes inflammation) can be improved by restricting carbohydrates, strict intermittent fasting (18/6) and weight loss. PPARy agonists (cinnamon, clove and cacao) can promote insulin sensitisation.
• Cytokine signalling which tells the white blood cells to come and make inflammation can be significantly dampened by supplementation of MCT oil daily up to 20ml (but start much lower).
• Suppressing the NLRP3 inflammasome also suppresses the release of cytokines, and can be achieved via restriction of carbohydrates and supplementation with DGL liquorice.
• Adiponectin activates anti-inflammatory factors and reduces proinflammatory cytokines. Levels of adiponectin can be increased through daily omega 3 intake, myo-inositol, whole-day fasting and mild to moderate exercise (preferably water based, walking only with compression support), as well as through including gingerol, turmeric and capsaicin in your diet.
• Vigorous aerobic exercise and overexercising should be avoided, as it actually promotes chronic inflammation (and lactic acid + oxidants, causing further damage).

Reducing oxidative stress and improving lymphatic function.
• Increasing autophagy through intermittent fasting can circularly reduce oxidative stress in tissues and improve lymphatic function.
• Supplementation with short and medium chain fatty acids (MCT oil and apple cider vinegar) provides energy directly to the mitochondria without having to first pass through a damaged or overworked lymphatic system. The mitochondria are then more able to improve & create new lymphatic vessels.
• Hyperbaric oxygen therapy can help stimulate the growth of new lymphatic channels.
• Activating microcirculation (which is damaged by inflammation) increases the oxygen supply to tissues. This can be promoted through supplementation with B-complex vitamins, butcher's broom, ginseng, horse chestnut, witch hazel and omega 3 fatty acids (always check for drug interactions). It can also be promoted by hyperbaric oxygen chamber therapy, dry brushing, and consuming tea (black or green), and by massage.
• Promote oxygen supply to the area with anti-oxidants. Diosmin (with hesperidin) is an antioxidant which is excellent for capillary health- it increases the total number of functional lymphatic capillaries, improves frequency and intensity of lymphatic contractions, improves lymphatic drainage, supports microcirculation, and increases venous tone and venous elasticity.
• The fluid which leaks from blood vessels should be addressed at every stage of the disease with combined decongestive therapy (CDT). The best daily protocol is 30 minutes of vibration therapy (oscilating vibration plate) to improve venous and lymph circulation, followed by manual lymphatic drainage by a professional or 20 minutes simple lymphatic drainage at home to clear out the fluid, and then compression. CDT can actually strengthen your blood and lymphatic vessels.
• With compression, aim for moderate (15-20 mmHg) at night and up to 30-40mmHg in the daytime.
• Elevation of your legs reduces strain on the lymphatic system to shift the excess fluid.
• Compression pumps can promote lymph drainage and may improve SAT quality, reducing fat fibrosis (pantsuit type is recommended).
• Gentle swimming or water aerobics promotes lymph drainage and feels GREAT on your legs.

Preventing and lessening the changes in SAT.
• The damaged fat is metabolically resistant, but the metabolic shifts that occur from burning glucose to burning fat on a ketogenic diet may reduce this.
• Include antifibrotics in your diet- turmeric, (european) blueberry, coffee, CDE, resveratrol, quercetin and EGCG.
• Manual lymphatic drainage releases lipid peroxidation products from tissues, mitigating the effects of oxidative stress and helping to prevent further fibrosis.
• Textured elastic compression garments (either non-medical grade or custom flat knit) can provide a gentle anti-fibrotic effect to hardened skin, SAT, and nodules. PitPaks or chip foam quilted compression pads may be placed inside of compression garments you already own to address hardened areas of tissue. Bulkier quilted compression with more irregularly textured filling, such as chipped foam, foam strips, or cherry pits, can be useful, but are best suited to wearing at night or during pneumatic compression treatment.
• Vitamin E supplementation can mitigate the fibrotic effects of lipid peroxidation.
• Massage & manipulation targeting SAT remodeling. Quadrivas is very effective in reducing number of nodules and their fibrosity, as well as leg volume, but is difficult to access. Deep tissue massage techniques, such as myofascial release, or the Chinese massage technique of Tui Na, have similar effects. Percussive massage guns may be of some use.
• Astym therapy, Graston technique, and compression reduction techniques have been shown to reduce fibrosis in lipedema fat and increase blood flow to the tissues.
• Cupping negative pressure massage in the direction of lymph flow may remodel SAT in lipedema- vigorous treatment produces hematomas (bruises), but after several weeks, tissue tightens and skin becomes smoother. This may be through activation of stem cells in connective tissue, or regeneration triggered by injury giving rise to more stable and functional tissue.
• Far infrared radiation (FIR) reduces fluid buildup, reduces inflammation and improves microcirculation. It's also anti-fibrotic to hardened skin and possibly fibrotic fat tissue at higher intensities. You can actually buy a device for at-home treatment.
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Other comments:
In one study, a form of vacuum cavitation therapy, which is non-invasive, produced similar improvements of SAT remodeling to liposuction in women with lipedema, when performed 2x/week over 3 months. The study was carried out by some legit researchers, but only limited information was included in the publication as it was intended to be essentially inter-departmental, and it has never been peer reviewed or had any attempts to replicate it. I may shoot them an email asking for additional information, I'll update if I get a response.
http://lib.pt.cu.edu.eg/11-Zoheiry%20July%202013.pdf

One redditor reports being consistently able to break down the fatty tissue of his girlfriend's genetic lipomas using a hitachi-style corded vibrator. Lipomas have varying degrees of fibrous changes, but they're in the same category as lipedema in being an adipose tissue disorder involving overgrowth of pockets of fat, so it may be worth an attempt when it comes to SAT remodeling, especially if you're going for liposuction and need as many nodules as possible to be able to fit through the cannula easily. On the other hand, it may not be that the fat was broken down at all, just that circulation is improved and her body was able to then break down the lipomas itself.
https://www.reddit.com/r/Lipoma/comments/10mrtdi/update_vibrator_post_no2/

Shockwave therapy may be more effective than manual lymphatic drainage after liposuction for lipedema.
https://www.hindawi.com/journals/ecam/2021/9956879/

Here's a weird set of facts. Short and medium chain fatty acids might also be useful for fibrosis (nodules and thickened skin). Chronic use of exogenous ketones (such as MCT oil) reduces markers of fibrogenesis/fibrotic remodeling (creation of new fibrotic tissue) in the liver, kidneys and heart. Acetone (ACV, i.e. apple cider vinegar) also ameliorates diet induced fibrosis in the heart. Keto prevents fibrosis in the liver. Keto and exogenous ketones are being investigated for use in other fibrotic disorders. The key link between MCT oil, ACV and keto is that they all supply the mitochondria with a lot of ketones. Mitochondrial dysfunction is a characteristic of lipedema, and it all makes me think that we may just have a tendency to create fibrotic tissue, and our mitochondria don’t step in to prevent it. Giving the mitochondria enough ketones may actually prevent formation of new fibrosis and thus progression of lipedema.

We are chronically deficient in vitamin D and may need 4x the recommended dose as a supplement. Vitamin D reduces progesterone, which has got to be helpful seeing as our gene mutation means we struggle to break progesterone down, leading to high serum levels, which has some involvement in our disease.

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Monday, October 2, 2023

Any other analogies for weight loss?

I was cooking the other night while thinking about weight loss (as you do) and an analogy came to mind.

When you’re trying to reduce pasta sauce down it’s boiling but there is a lot of water in the pan. It’s hard to see progress but if you are patient and leave it bubbling, it’s going to eventually lose enough steam to thicken up. It’s not possible to remove water from anyone spot in the pan, it’s the whole pan or nothing. Eventually a lot of the excess water is gone and then suddenly it’s goes from being too watery to just right.

I thought this matches what happens with weight loss quite well. The slow progress, the patience, not being able to spot reduce and achieving the most noticeable change the further along you are.

Are there any other things in day-to-day life that are good analogies?

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