by gerald bangs
(plant city, fl usa)
Even though my calorie count is below or at a losing weight level, I do not lose weight and gain a little each week.
I watch my carbohydrate intake very carefully and rarely eat sweets. My blood sugar is in the 90s every day.
My intake of fats is very low. I am 5'7", down from 5'9". I weigh in the low 180s at present. I exercise in the pool every morning, with some swimming and some exercises.
Perhaps I am eating the wrong kind of food. Are there some foods that I must avoid? Even those with low carb and fat?
I am male, 85 years old. I have been overweight most of my life, though I was down to 165 a few years ago.
Most of my excess weight is around the abdomen and upper hips, the most dangerous. I take Actos and glipizide.
—Gerald Bangs, Plant City, Florida, USA
Gerald, your weight gain may not be caused by one “wrong” food. Actos, or pioglitazone, can cause fluid retention and weight gain. Glipizide can contribute to weight gain and, at age 85, also increases the risk of low blood sugar.
Arrange a medication review rather than stopping either drug yourself. Report swelling, rapid weight gain, shortness of breath, difficulty breathing when lying down, or unusual fatigue promptly.
Your two-inch height loss also deserves evaluation for osteoporosis, spinal compression fractures, or posture changes.
Answer by Dr. Albana Greca, MD, MMedSc
Hello Gerald,
Aging can reduce muscle mass and energy needs, but it is too simple to say your metabolism works at “low capacity.” At 85, the goal is better health, mobility, waist size, and strength without low glucose, muscle loss, falls, or poor nutrition.
At about 182 pounds and 5'7", your BMI is approximately 28.5. In older adults, waist, strength, function, fluid, and weight trend also matter.
Yes. Actos is pioglitazone. It improves insulin sensitivity but can retain fluid, causing gradual gain, ankle or leg swelling, or a sudden increase over days.
Pioglitazone carries a warning because fluid retention can cause or worsen heart failure. Do not stop it yourself; ask the prescriber to review it in light of age, weight trend, heart and kidney health, swelling, and other medicines.
Our medicine safety guide explains fluid gain versus body fat.
Severe breathing difficulty or chest pain requires emergency care.
Glipizide stimulates insulin release. It can promote weight gain, but the more immediate concern at age 85 is hypoglycemia, especially with low intake, delayed meals, kidney or liver impairment, or prolonged exercise.
Glucose in the 90s may be reasonable, but timing matters. A fasting result differs from one after swimming or missed food. Ask for HbA1c and review the full pattern, including any readings below 70 mg/dL.
Targets should be individualized. HbA1c around 7.0–7.5% may suit a healthy older adult; frailty or multiple illnesses may justify a less stringent goal. Lower is not always safer with hypoglycemia-prone medicine.
Probably not. Very low-fat, low-carbohydrate, and low-calorie eating can reduce protein and enjoyment without solving medication-related gain. Portions and the total pattern matter more than a food label.
Instead, review:
This is not about blame. Even careful records can miss oils, drinks, and serving-size differences. A dietitian can review several typical days.
Our carbohydrate guide explains why portions matter more than banning carbohydrate or fat.
Possibly, but frailty, muscle mass, appetite, falls, and medical conditions matter. In a robust older adult, a 5–7% loss may help mobility and cardiometabolic health—about 9–13 pounds at your weight.
Loss should be slow and protect muscle. Pool exercise helps mobility and fitness but is not weight-bearing. Ask whether supervised resistance work, chair exercises, or light weights are safe.
A decrease from 5'9" to 5'7" should not be dismissed. It may reflect posture changes, disc compression, osteoporosis, or silent vertebral fractures. Men can develop osteoporosis.
Ask the clinician to confirm height, examine spine and posture, review falls and fractures, and decide whether bone-density testing or spinal imaging is appropriate.
Do not change either medicine yourself. Alternatives with less hypoglycemia or weight-gain risk depend on kidney function, heart disease, cost, side effects, and personal goals.
Remember: this may be medication-related fluid or weight gain, not a forbidden food. Review Actos, glipizide, heart symptoms, glucose targets, nutrition, strength, and height loss before stricter dieting.
Safety note: Rapid gain, swelling, or breathing difficulty with pioglitazone requires prompt review.
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