Weight Gain, Diabetes Control, TRT, Creatine - I am a special unicorn.

[bobmen10000]

TLDR
I gained around 15 lbs since November, I don't think it is due to food consumption but I have never retained this much water for such an extended period of time. Am I dying? Or am I just really dumb and fat?

My diabetes went into overdrive in November, I cut out a ton of processed sugar/carbs (300 grams or show), started a new medication and my A1C is 5.5 from a high of 8.7, so back to normal; however, along the way, I have gained 13 to 15 lbs. I don't understand how. First, I know that everyone underreports what they eat, so fine, but I cut out 1000 plus calories day, started to weight train again and am managing bare minimum cardio - which a lot for me. My diet is shitty but it is nearly identical to my previous super diabetic self save that I replaced candy, soda and little debbies with protein shakes, bars and low calories Atkins "sweets" full of stuff that is technically fiber but probably not. There is no way, as bad as I may be at mentally keeping track of calories, that I am eating in such a surplus.

Most of the weight gain was within a few weeks of cutting out the excess sugar, between mid November to mid December - amounts to about 10 lbs. In mid December, I started back on TRT and started to take 3-5 grams of creatine on workout days (4 or so days a week.) I gained about 5 more pounds. My doctor (nurse practitioner) says my metabolic bloodwork looks fine (within my normal ranges), I don't have edema, my heart and lungs sound fine and I show no signs of distress except I have gained over 5% body weight in under 3 months, which almost certainly has to be water unless I ate a few whole turkeys around Thanksgiving. I am at a loss. Furthermore, my EGFR is significantly lower than in the past but since it is above 70 I was told not to worry; my Creatinine level is borderline high with minute amounts of protein in my urine. I am convinced my kidneys are failing and heart is about to explode; the nurse practitioner thinks I am overeating and not being honest but she also didn't believe that I ever consumed so much sugar in the past. She is a pretend doctor and I am barely a functioning middle-aged-man so her opinion carries more weight.

Screed aside, anyone have any ideas about why I 1) gained the weight and 2) can't flush it out of my system.

[mgil]

What’s your water intake like on a daily basis?

Coffee?

[bobmen10000]

What’s your water intake like on a daily basis?

Coffee?

My fluid intake is 64 ounces, likely closer to 100 but I don't keep very good track anymore. I drink way too many zero (low calorie) sugar alcohol flavored drinks like Gatorade zero and not enough actual water. No coffee but I do have 16 to 32 ounces of monster zeros a day for caffeine

I am never really thirsty/parched even after working out; the only time I feel an urge to drink is first thing in the morning, and even then I am not really thirsty it just become a perfunctory act of drinking a gatorade zero then an energy drink. No coffee but I do have 16 to 32 ounces of monster zeros a day for caffeine. All of the above has been pretty standard for me over the last 5 years or so. The low cal/zero energy drinks are a point of contention - as in I should stop drinking them - for my doctor(s) but again they have been a diet staple for many years.

[mgil]

64 ounces of water is a good start. Possibly bumping that to 96 could help. I try to avoid energy drinks nowadays since they just have too much shit in them regardless of sugar. Occasionally I’ll have a Red Bull since they seem to be the least offensive.

Have you had the big hormone panels pulled?

[bobmen10000]

64 ounces of water is a good start. Possibly bumping that to 96 could help. I try to avoid energy drinks nowadays since they just have too much shit in them regardless of sugar. Occasionally I’ll have a Red Bull since they seem to be the least offensive.

Have you had the big hormone panels pulled?

Not sure what you mean by big hormone panel. The TRT clinic ran a hormone panel but it was pretty much just measuring total and free test, I had a much more comprehensive lab results from six months earlier that covered everything from ferritin to cortisol and they used some of that information, I think - which I assume was to save me money or they just didn't care; I have a follow up panel that will include total and free test, estradiol and I think FSH coming up in early March.

[Philbert]

TLDR
I gained around 15 lbs since November, I don't think it is due to food consumption but I have never retained this much water for such an extended period of time. Am I dying? Or am I just really dumb and fat?

My diabetes went into overdrive in November, I cut out a ton of processed sugar/carbs (300 grams or show), started a new medication and my A1C is 5.5 from a high of 8.7, so back to normal; however, along the way, I have gained 13 to 15 lbs. I don't understand how. First, I know that everyone underreports what they eat, so fine, but I cut out 1000 plus calories day, started to weight train again and am managing bare minimum cardio - which a lot for me. My diet is shitty but it is nearly identical to my previous super diabetic self save that I replaced candy, soda and little debbies with protein shakes, bars and low calories Atkins "sweets" full of stuff that is technically fiber but probably not. There is no way, as bad as I may be at mentally keeping track of calories, that I am eating in such a surplus.

Most of the weight gain was within a few weeks of cutting out the excess sugar, between mid November to mid December - amounts to about 10 lbs. In mid December, I started back on TRT and started to take 3-5 grams of creatine on workout days (4 or so days a week.) I gained about 5 more pounds. My doctor (nurse practitioner) says my metabolic bloodwork looks fine (within my normal ranges), I don't have edema, my heart and lungs sound fine and I show no signs of distress except I have gained over 5% body weight in under 3 months, which almost certainly has to be water unless I ate a few whole turkeys around Thanksgiving. I am at a loss. Furthermore, my EGFR is significantly lower than in the past but since it is above 70 I was told not to worry; my Creatinine level is borderline high with minute amounts of protein in my urine. I am convinced my kidneys are failing and heart is about to explode; the nurse practitioner thinks I am overeating and not being honest but she also didn't believe that I ever consumed so much sugar in the past. She is a pretend doctor and I am barely a functioning middle-aged-man so her opinion carries more weight.

Screed aside, anyone have any ideas about why I 1) gained the weight and 2) can't flush it out of my system.

To recap, your weight gain started when you realized your diabetes was out of control, started a new drug, increased protein intake, and replaced the sugar in your diet with sugar alcohol? Were there any other simultaneous changes? And is the protein in your urine completely new?
A few thoughts: Cardio causes mild proteinuria.
Creatine supplementation can raise serum creatinine slightly without any change in actual kidney function. We estimate GFR (thus egfr) by assuming your muscle mass and creatine turnover from age, weight, ethnicity, and sex. If those assumptions are incorrect then the number is also incorrect. If you really needed to know, a 24 hour urine creatinine allows you to calculate creatinine clearance based on actual production rather than assumed production, but what are you going to do with that information anyway?

[KyleSchuant]

My diet is shitty but -

I think you know what to do, you just don't want to do it.

[bobmen10000]

My diet is shitty but -

I think you know what to do, you just don't want to do it.

I am fat and need to lose weight, diet is full of junk, albeit a lot less sugary junk at the moment. Morbid obesity is not a new condition but the inability to flush out water weight is a new thing. Cleaning up my diet would likely help, going low sodium maybe, but again am worried as to why I am retaining water for so long.

[mgil]

Might not be any one thing but some combination of things.

All I know is that paying attention to both quantity and quality of food has made a huge impact on my health.

[bobmen10000]

To recap, your weight gain started when you realized your diabetes was out of control, started a new drug, increased protein intake, and replaced the sugar in your diet with sugar alcohol? Were there any other simultaneous changes? And is the protein in your urine completely new?
A few thoughts: Cardio causes mild proteinuria.
Creatine supplementation can raise serum creatinine slightly without any change in actual kidney function. We estimate GFR (thus egfr) by assuming your muscle mass and creatine turnover from age, weight, ethnicity, and sex. If those assumptions are incorrect then the number is also incorrect. If you really needed to know, a 24 hour urine creatinine allows you to calculate creatinine clearance based on actual production rather than assumed production, but what are you going to do with that information anyway?

I gained about 10 lbs very rapidly after cutting out 300+ grams of processed carbs from candy, confectionaries and (mostly) soda, this would be between the middle to end of November 2024. I did not replace the sugar 1:1 with sugar alcohols but I am consuming more than I was, never thought to track sugar alcohols before. the new medication, januvia, - per the nurse pract - will not cause water retention. It was supposed to have a moderate impact on my A1C. Since my A1C dropped over 3 points, and furthermore based on past experience, cutting out the sugar likely had the greatest impact. The protein in my urine was also present 3 months ago when I realized my blood sugar was way out of whack; however, the nurse pract then didn't think it was an issue beyond my kidneys then being extra stressed. No other changes during that initial weight gain but I did started back on TRT, lifting and supplementing creatine a month or so after initial weight gain - I added an additional 3-5 lbs almost immediately. The only other lifestyle change, which doesn't sync up to the weight gain, is being weaned off my PPI for GERD. My gastroenterologist wanted to see if it was necessary to continue daily use, I was supposed to be reevaluated in January but she left the office, so I have to wait until the end of February to see my new doctor to determine if I should start back up. I will likely go back on the PPI.

My fear is that the EGFR is a canary in the coal mine. I went back 15 blood tests over 6 or 7 years, my EGF was never below 85 (and then I was passing a 12mm kidney stone and likely dehydrated) and usually was 95 to 100. My EGFR is still 74 and my uneducated guess/hope is that creatine supplementation is likely part of the reason the number is lower, per what you wrote.

[bobmen10000]

Might not be any one thing but some combination of things.

All I know is that paying attention to both quantity and quality of food has made a huge impact on my health.

I am probably worrying about nothing. My health makers are well within my normal baseline outside of the excess weight, egfr and minute traces of protein in my urine. My A1C is the lowest it has been in a couple years and I feel pretty good overall, better than I have since last summer. I am just fixated which is probably dumb.

I will pay closer attention to my food consumption - if nothing else it will improve other aspects of my health. Ranting on here is more therapeutic than anything else. I appreciate all the input.

[mgil]

When I weighed 65lbs more than I do now, my panels looked fine. All of them. A1C included.

They are somewhat diagnostic, but not wholly so.

[cgeorg]

The thing that sticks out to me is that all of these intakes have been estimated. Track everything for 2 weeks, you will be surprised. Don't eyeball stuff, weigh it. You substituted one kind of snack for another that can be equally or more calorie dense - a peanut butter clif bar has more calories than a 4-pack of oreos.

[bobmen10000]

The thing that sticks out to me is that all of these intakes have been estimated. Track everything for 2 weeks, you will be surprised. Don't eyeball stuff, weigh it. You substituted one kind of snack for another that can be equally or more calorie dense - a peanut butter clif bar has more calories than a 4-pack of oreos.

Tracking is a good idea and I am likely off eyeballing the rest of my shitty diet. But the more accurate comparison was before: eating 2 or 3 sleeves (24 to 36 total cookies) of Oreos per "snack" versus now, consuming a single servings of 150 to 400 calories shakes, bars and atkins-fake-ass-fiber-tom-foolery-snacks. I can't eat the equivalent of protein/fake carb junk food to what I easily consume in processed sugar laden goodness. My stomach rebels from too many sugar alcohols and/or whey.

[Philbert]

To recap, your weight gain started when you realized your diabetes was out of control, started a new drug, increased protein intake, and replaced the sugar in your diet with sugar alcohol? Were there any other simultaneous changes? And is the protein in your urine completely new?
A few thoughts: Cardio causes mild proteinuria.
Creatine supplementation can raise serum creatinine slightly without any change in actual kidney function. We estimate GFR (thus egfr) by assuming your muscle mass and creatine turnover from age, weight, ethnicity, and sex. If those assumptions are incorrect then the number is also incorrect. If you really needed to know, a 24 hour urine creatinine allows you to calculate creatinine clearance based on actual production rather than assumed production, but what are you going to do with that information anyway?

I gained about 10 lbs very rapidly after cutting out 300+ grams of processed carbs from candy, confectionaries and (mostly) soda, this would be between the middle to end of November 2024. I did not replace the sugar 1:1 with sugar alcohols but I am consuming more than I was, never thought to track sugar alcohols before. the new medication, januvia, - per the nurse pract - will not cause water retention. It was supposed to have a moderate impact on my A1C. Since my A1C dropped over 3 points, and furthermore based on past experience, cutting out the sugar likely had the greatest impact. The protein in my urine was also present 3 months ago when I realized my blood sugar was way out of whack; however, the nurse pract then didn't think it was an issue beyond my kidneys then being extra stressed. No other changes during that initial weight gain but I did started back on TRT, lifting and supplementing creatine a month or so after initial weight gain - I added an additional 3-5 lbs almost immediately. The only other lifestyle change, which doesn't sync up to the weight gain, is being weaned off my PPI for GERD. My gastroenterologist wanted to see if it was necessary to continue daily use, I was supposed to be reevaluated in January but she left the office, so I have to wait until the end of February to see my new doctor to determine if I should start back up. I will likely go back on the PPI.

My fear is that the EGFR is a canary in the coal mine. I went back 15 blood tests over 6 or 7 years, my EGF was never below 85 (and then I was passing a 12mm kidney stone and likely dehydrated) and usually was 95 to 100. My EGFR is still 74 and my uneducated guess/hope is that creatine supplementation is likely part of the reason the number is lower, per what you wrote.

Were you supplementing creatine at any time during those prior lab tests?
Another factor, as much as my 46 year old self hates to face it, is that the 40s are when stuff usually starts falling apart, especially with a history of metabolic abuse. Fortunately, it sounds like you have made some of the necessary changes to arrest or at least slow the damage. If you were previously supplementing creatine with egfrs of 90 then we cannot blame it now for the drop to 75.

[bobmen10000]

I was not supplementing creatine regularly during most of those tests - or really ever. I rarely used creatine beyond a month or two here & there, very sporadically, over the years. I would forget to add to my water/gatorade and just go hell with it & stop taking it altogether.

And I do think falling apart is a possibility, I hope not at least, and my blood glucose rebounding so quickly due to cutting out shit tons of sugar- as it has done in the past - gives me some hope.

I may get my Cystatin C tested next time they check my efgr, I guess that is the preferred test for kidney function.

[CheekiBreekiFitness]

The thing that sticks out to me is that all of these intakes have been estimated. Track everything for 2 weeks, you will be surprised. Don't eyeball stuff, weigh it. You substituted one kind of snack for another that can be equally or more calorie dense - a peanut butter clif bar has more calories than a 4-pack of oreos.

Tracking is a good idea and I am likely off eyeballing the rest of my shitty diet. But the more accurate comparison was before: eating 2 or 3 sleeves (24 to 36 total cookies) of Oreos per "snack" versus now, consuming a single servings of 150 to 400 calories shakes, bars and atkins-fake-ass-fiber-tom-foolery-snacks. I can't eat the equivalent of protein/fake carb junk food to what I easily consume in processed sugar laden goodness. My stomach rebels from too many sugar alcohols and/or whey.

You should definitely watch the show "Secret Eaters". It's full of overweight people who "don't understand their weight gain". Meanwhile most of them eat 4000 kcal a day. One of them (my all time favorite) ate a 2500 kcal bowl of special K for breakfast.

I'm pretty convinced you have absolutely no idea how many calories you are consuming, and I don't mean this as a degrading comment.

You gain weight because you eat too many calories, and for the overwhelming majority of us (me included), the only way to control caloric intake is to cut ultra-processed food and alcool and count calories with myfitnesspal or equivalent. It's really not that complicated.

[Hardartery]

@bobmen10000

The Atkins/low calorie/pretend fibre stuff is not helping you. I know plenty of people sing that "Food" the same way you are and getting no useful effect from it. It is useful here to examine what Bodybuilders do on a cut, not that I am saying you need to do that, but it is informative. They don't use any of that stuff, period. Most of them even drop the Walden Farms dressings and sauces because they stall when it is in the diet.

I come from a log line of Type 2 diabetics, I am very familiar with their consumption habits on the wild. Personally, I found going extreme for a few months helped me with a few things. I dropped a ton of water that I was holding, a ton. I can see all of the veins on my feet now and I don't swell up from a flight anymore. I am currently heavier than the plan, but I have managed to remove most of the fat from everywhere on my body except the belly because it is stubborn. I needed to basically go straight keto for a while and then slowly add back in some carbs.

As far as your supplementation. TRT will add weight, there is initial gain and long term gain but there is the offset of metabolism gain over time for some of it. Creatine will absolutely mess up some labs, creatinine and eGFR in particular. Those number become irrelevant outside of results that are WAAAYYYY outside of the ranges. Do not be alarmed by anything even close to the range there and 5 lbs is getting off light with water weight gain from creatine, 10 lbs is not a crazy gain. As far as food goes, I think you have essentially gone from heroin to methadone at the moment. I find it easier to go drastic than to dance with it. Just my 2 cents.