The quest for 40 percent

It's no secret that I hate my body. I've been at war with my body for most of my life, hating just about everything about it. Early-onset arthritis, spinal stenosis, and SI joint dysfunction have been making me miserable for years and they're getting worse. Those conditions have been getting significantly worse for me for the past few years. I'm bitter about that because, historically, I have taken good care of myself. My body has not returned the favor.

My husband thinks I should stop complaining and go to the doctor, specifically, for my knees. Fourteen months ago, I fell knees-first onto a granite cobblestone crosswalk in Mexico. I twisted my ankle in the process, and ended up with some of the worst swelling and bruising I've ever seen on my body. I could only wear flip-flops for a week. When I got home, my doctor ordered an x-ray and was visibly surprised to learn I had not broken my patella. She did point out that, unrelated to the injury, my knee joint was rapidly deteriorating. I have done nothing about it since, and 13 months on, my knee is still painful and swollen. I didn't know swelling could last that long.

My bruised and swollen ankle in Mexico.

My leg, eight days after I fell.

 Back in November, the hamstring on my "good" leg started to tighten up and hurt. I stretched, I massaged, I stretched some more. Despite this, while pulling on a pair of yoga pants, I landed off-kilter, heard a frightening popping sound, felt white-hot pain shoot through my knee, lost my balance, crashed into the wall, broke out in a sweat, became instantly nauseated and almost fainted. I couldn't put weight on my knee for a week, having torn its medial collateral ligament. They don't do surgery on that one--it's just three or four months of rest and healing. In my case, there were ice packs, large doses of ibuprofen combined with Tylenol, and a small fortune spent on lidocaine patches. I wouldn't say it's healed (since it hurts a lot), but it's functionally better.

I'm still in significant pain, but I refuse to go to the doctor. Here's why. I know that my weight is an issue and I will be scolded for being fat. This will color any evaluation the doctor makes. Fat aggravates arthritis--I know that. I don't need to be told that. My goal is to be not so overweight the next time I ask for a doctor's help, so toward that end (and ending my pain), I'm dieting.

Yes, I'm dieting once again. My goal is to drop 40 percent of my body weight, or approximately 80 pounds. This will put me at such an indisputably healthy weight that not even the most egregiously fat-shaming doctor will be able to give me a hard time. Until then, I limp. And eat bacon.

Enter keto

I've lost 18 pounds since Thanksgiving. That's a blazing one-pound-a-week weight loss, I know. It's what I've typically done on diets in the past, but this time, I'm not so bitter about it and here's why: Keto.

If you're unfamiliar, keto is a high-fat, moderate-protein, minuscule carbohydrate diet.  I get 75-80 percent of my daily calories from healthy fats and, most days, I consume fewer than 20 grams of carbohydrates. No sugar, no flour, no grains, no fruit, no root vegetables, no pasta, no bread, no low-fat dairy. What I do eat: Lots of avocados. Eggs. Cheese (cheese!!!). Bacon. Fish. Cauliflower. Nuts. Cacao butter. Hemp seeds. Chicken. Turkey. Broccoli. Green beans. Spinach. Heavy cream. Sour cream. Butter. Gobs of coconut oil. Vodka.

I am never hungry. Sometimes, I go 24 hours without eating. It's not painful because I'm not hungry. I'm not resentful about dieting because, although it's painfully slow, I'm losing weight--and I'm never hungry.

Bonus: A high-fat diet is supposed to be good for the brain. It turns out that most of what we've been told about nutrition is flat-out wrong. If you take carbohydrates out of your diet, you need to replace it with something. If that something is just lots of protein, your body will store whatever it can't immediately process as fat. Your cholesterol level is largely determined by genetics and, to a smaller extent, exercise.

The ketogenic diet has been around for about 100 years. It was developed specifically to help epileptics, and it's still used that way therapeutically. It also stabilizes blood sugar and there are legions of diabetics who have been prescribed this diet. Once you get the hang of it, there's really no downside to keto. I do have to take a daily fiber supplement, high-potency magnesium, and I drink an electrolyte solution as part of my everyday two-liter water intake. I check my blood ketones every few days. My body refuses to go into a highly ketogenic state, preferring instead, apparently, to lollygag at the low end of the ketosis spectrum, down in the light-green zone. That's OK--I'm still burning fat and losing weight. Slowly.

I'm not celebrating my 18-pound weight loss. I've been here before. I have a long way to go. I went pants shopping yesterday and haven't even dropped a size yet (because my body despises me). It was a bracing reminder that I have a lot more work to do before I have any right to feel good about myself.

So, we'll see. If I lose a pound a week, that's 52 pounds in a year. Add another 15 weeks/pounds to get us to this time next year, and I'll be within a few pounds of my goal then. I hope my knees are still functioning enough so I can still walk by then, and if I can, I will walk into the doctor's office and maybe be lectured about waiting too long to seek help, but I will not be lectured or admonished for being fat.