Updated March 2020

Weight Loss Case Study

I saw a patient a few weeks ago for weight loss and diabetes reversal who told me he was on the keto diet, had lost 10 pounds initially and then plateaued.  His diabetes A1C blood test dropped from 10.6 to 9.5, but without further changes.  I asked him how many grams of carbohydrate he was consuming and he told me he wasn’t sure, so I did a detailed dietary intake and estimated that he was eating on average 250-300 grams of net carbs (grams of carbs minus grams of fiber) daily.

Although this was much better than the 500+ grams of carbs he was eating before, which is not unusual for many of my Indian and East Asian patients who consume large portions of breads, rice and other grains, it was far higher than the threshold for nutritional ketosis, which is typically 50 grams or less and in many patients 20-30 grams daily is the threshold.  He was consuming nearly 10 times that!

The Pitfalls of Self-reporting

Despite being a health champion who is diligent about his eating habits,  I occasionally have to go through periods of intensive monitoring to get back on track.  It might be a vacation or some stressful period that throws me off track.  The minute this happens, I fire up my nutrition tracking app and start tracking some key numbers which I’ll discuss in a moment.  These are digital tools that help keep me accountable.

Human beings have incredibly poor recall when it comes to providing estimates of anything they may be doing on a regular basis, like eating food or spending money.  That’s why we have multiple products on the market developed to help people track their physical and financial health.  The majority of new patients who I see in the clinic who self-report they are “eating healthy” or eating “low carb,” are usually grossly inaccurate.  They are shocked to learn how quickly macronutrients add up throughout the day.

Another gap in nutritional self-reporting are the dreaded “BLTs,” which stand for bites, licks and tastes.  Parents are especially familiar with this behavior as we finish off a few of those leftover chicken nuggets, goldfish crackers, sweets, etc.  Our parents may have taught us to never waste food, so instead of dropping these BLTs into the trash where they belong, we dump them into our fat cells.

Remember, always choose the trash over your own fat cells!

BLTs somehow mysteriously never make it into the tracking data but easily account for enough caloric damage to raise blood glucose, cholesterol and body fat.  They will also keep you out of the fat-burning state we refer to as nutritional ketosis.

Some people think by chewing quickly or maybe swallowing a whole piece of junk food during a pantry raid might somehow allow the food to escape digestion and absorption into the blood stream, but unfortunately our bodies are smarter than that.  You may not enter those nibbles and bites into your nutrition calculator, but like a frugal accountant, your body will track and store every single ounce of food you put in your mouth.

Some Key Numbers to Track

1. Nutrition:  There are countless nutrition tracking apps and tools on the market now to help with weight loss and overall health goals.  In my book, I recommended Myfitnesspal which is still great, but I’m now starting to recommend Fatsecret to more patients since there database is still robust, but more vetted.  Other popular apps include Cronometer and LoseIt to name a few.


My hardcore engineering patients often report back to me on the precision of these various tools, but frankly the simple act of tracking what you put in your mouth is more than half the battle.  If you’ve been struggling with your weight or other health goals, just make yourself accountable in some way.

2. Activity:  My patients often over report how much activity they think they are getting also.  “I can’t sit still.”  “I’m sure I get over 8,000 steps daily.”   Once again, until you track it, I won’t believe it.  Use your fitbit, apple watch or other favorite wearable and be sure you are not just focusing on total number of steps, but making sure those steps are distributed throughout the day.

I’d rather have you take your 10,000 steps and distribute them throughout the day rather than just do them all in 1-2 sessions. 

The concept of getting short “bites” of activity throughout the day is often refer to as activity or movement snacking.  Snack” on short walks, squats and lunges throughout the day instead of chips and cookies.

Activity snacking is great at burning blood glucose, cholesterol, and body fat.  It helps interrupt the damaging effects of prolonged sitting.

3. Weight/Waistline:  Some experts don’t recommend checking weight too often.  I disagree.  I usually check my weight twice daily and it has been a powerfully intuitive exercise.  I can literally “feel” it when I’m eclipsing my target weight and immediately self-correct.  It is incredible as we age how quickly our weight/waistline increase from dietary excursions.  Read this important post about waistline and body fat.

4. Sleep:  Most wearables nowadays that track activity also track sleep, although their accuracy is highly variable.  There are better monitors emerging on the market that claim to accurately measure depth of sleep which to me is even more important than duration.

I’d rather get 6 hours of shut-eye with adequate deep phase sleep, than 8-hours of mostly lighter-phase sleep triggered by factors like stress, alcohol or sleep drugs such as Ambien.

5. Heart Rate:  I often check my resting heart rate and closely monitor heart rate during and after exercise.  These numbers help me track stress levels and cardiovascular performance.  To learn how to use heart rate to help you manage stress, be sure to check out this page.

6. Exercise/Activity Times:  I track my one mile times closely on runs.  If you’re a walker, pick a set circuit around your neighborhood or a track and then time how long it takes you to complete.  If you’re a hiker, how long does it take for you to get to the top of Mission Peak, the PG&E trail or whatever your favorite route is where you live.

I track my heart rate alongside my running time and my running cadence (steps per minute) to see if I’m getting faster at a lower heart rate, while maintaining good form (dictated by my cadence).  Be sure to read my 2 part series on exercise for more information on how to get fitter using your heart rate and some key foundational exercises.  Part 1 specifically addresses heart rate.

7. Home Blood Markers:  I do go through periods of monitoring my blood glucose and ketones to see if I’m keeping my insulin levels low and burning body fat. Lately I’ve been using the Ketomojo blood glucuse/ketone monitor since the ketone strips are more economical.  I also did a detailed write-up on continuous glucose monitors (CGMs) here, another powerful health and wellness tool for specific individuals.


There are an endless number of health markers on the market that can leave individuals confused.  Health tracking is big business and not all of these advanced markers provide value, so starting with a few easily accessible ones can help keep you on track.  I think of them as training wheels.  Once I’m in my optimal zone of health, the training wheels come off and I can intuitively tailor my food and activity levels accordingly.  I discourage individuals from becoming overly obsessive about their numbers since that can generate “tracking stress” where even occasional deviations in goal numbers cause anxiety.