The Dolphins Make Me Cry.com - Forums

I've been of somewhat of a diet the last couple of weeks.  For me, when I let myself go, I get weight in my belly and my neck.  My family just gets fat necks as we age, so dieting is only going to help so much.  Mostly, eating healthy consists in eliminating simple carbs and focusing more on proteins.  I also find that by restricting my diet (however it is), I just end up eating less, since I have fewer choices.

What do you guys do to eat healthy, when you do?  Are you doing it now?

I have a craving for bad food that I haven't been able to overcome and it's starting to affect my health  :(

I am absolutely horrible at making healthy eating choices, as I prioritize taste and convenience much higher than I do health. When I do go on a very short-term "eat healthier" kick, it usually means more eating of fish and chicken, rather than beef and bacon, and drinking more water than iced coffee and tea.

My health kicks are so short that they couldn't even qualify as extra points though. Maybe I should just go for two, as in a big juicy double cheeseburger.  Yum! ;D

I started running on the treadmill at the gym to try to lose some weight, but then I found that doing that interfered with my weightlifting.

I recommend this app: MyFitnessPal

I've been using it for almost two months and have lost almost 10 lbs. Stomach is flatter.

All you have to do is put in your measureables, tell it how much weight you want to lose (I recommend 1 lb per week) and count your calories.

I'm experiencing the ugly truth of middle age. I've played sports and lifted weights, etc. all my life and had truly horrible eating habits.  But my eating habits never seemed to adversely affect the way I looked and felt.  Hit my mid 40s........aw crap......where did this gut come from??  I'm still working out and playing sports.  Screw you, aging metabolism.  For me (and everyone is different), I can't eat only healthy food.  So I try to get the proper amount of healthy food mixed in with my usual "guy food" but I have just learned to cut way back on portions. 

Portion control is the key. A couple of tips:

Mashed potatoes are a good food to eat if you're looking to control portions. As long as they aren't loaded with cheese. If you make them from scratch, use skim milk. A serving of mashed potatoes (not loaded) is about 140 calories. A bag of chips is about 220 calories. Mashed potatoes fill you up better.

Whole grains fill you up and keep you full.

I've cut out foods that have just empty calories and don't really give you any nutritional value.  Big case in point, I love to order a hamburger or sandwich when I go out to eat.  Most restaurants serve those things with french fries.  I will always substitute something different, preferably vegetables or a side salad.

I have always traditionally eaten pretty healthy, because I love vegetables and good food.  I really never ate much fast food, never drank sugar sodas, make sure I got proper nutrients, etc.

However, I was always pretty chubby - 200-210 @ 6ft.  I always wanted to lose some weight but don't really have time to work out, and never really wanted to anyways.  I am an avid Redditor and stumbled upon r/keto and after a lot of research decided to give it a shot.  Ketosis is a high-fat, zero-carb diet.  It works on the principle that when deprived of all carbs, your body is able to start burning fat for energy instead of sugar.

I have been doing this diet for 10 months.  I have lost almost 50 pounds with ZERO exercise.  Most of that weight was lost within the first 6 months.  The results are spectacular and speak for themselves.  I feel great across the board.  I used to get bad gas and heartburn all the time; I have had zero of both within one week of starting diet.  Energy levels are through the roof - I have easily double the wind that I used to.  I stopped getting hunger pangs and cravings; because my blood sugar and insulin is not spiking from eating carbs, I can skip a meal or 2 without even thinking about it.  I get to eat delicious things like all the meat, bacon, and cheese I want. 

The only downfalls to the diet are that it's expensive, and can be a pain in the ass to learn and monitor.  Picky eaters will also struggle with the diet.  Carbs are hidden in EVERYTHING and you need to be very diligent monitoring ingredients.  My Fitness Pal is a great app for that.  Also, a lot of people in the healthcare field think that it is bad for you because it goes so against conventional wisdom, but all the new in-depth medical studies coming out say that it's actually great for the body.

So that's my plug for dietary Ketosis.

This is what the original Atkins Diet was based on (they have since modified it to include simple carbs). I did this for a while and am now paying the price for it in my kidneys. It's fine to do as a boost diet for a short period of time but over the longterm, you will build up significant amounts of uric acid in your kidneys that lead to kidney infections, or even worse, kidney stones.

I will admit I did lose significant weight on it and fast, but be careful when you get off it. The weight comes back and then some. You still need carbs, I think a more prudent diet would focus on the types of carbs rather than eliminating carbs altogether. There are significant longterm risks to no-carb diets.

This is the kind of anti-keto conventional wisdom I'm talking about.  The human body does not "need carbs".  It can function fine without carbs.  There are populations of people in parts of the world who have been eating similar diets with no issues.  There are no medical studies that show long-term damage to your kidneys.  Your kidneys DO get stressed while in Ketosis, so those prone to Gout and kidney stones might see increased risk for those.  However, I have had some pretty bad gout in my life, but since eliminating beer and shellfish entirely 3 years ago, I have had no more attacks nor even a twinge in my big toes.  I have been monitoring my uric acid levels while in ketosis and have not seen them increase.  Drinking tons of water is key.

I am going to quit at the 1 year mark (June), and start working out and lifting so that I can start eating carbs again...I miss them too much to give them up forever.

This is not conventional wisdom. This is personal experience. I've done the diet you're on. I've preached it, believed in it, lived it. And then experienced the adverse results years later.

Fiber is a carb, your body needs fiber. Lack of fiber on a high protein, high fat diet can lead to constipation or a slowdown of your digestive system, which leads to the toxins that your body needs to remove staying in your body longer and being absorbed more by your organ. It is not just a matter of needing more water to keep your kidneys clean, it is a matter of ensuring your body removes the toxins to keep the workload of your liver reasonable.

If you want to do a protein/fat diet that keeps your SIMPLE carbs (these are the bad carbs) low, go Paleo. You'll still get the necessary dietary fiber to keep your digestive system functioning and avoid the simple carbs that your body doesn't know how to handle, so it just stores them as fat.

Another thing to consider when dieting is that everyone has a different body type. Some people simply cannot go on high protein diets because they have adverse affects to animal proteins and animal fats. I guess they could just eat Boca Burgers for the rest of the lives, but that just doesn't seem reasonable. Different blood types and digestive systems react differently to different types of food. You mentioned that you experience inflammation from eating certain carbs. This is common with things like dairy, corn, certain legumes and things like nuts. Some people need to do an elimination diet to figure out what inflammatory allergies they have to certain foods. I know people that have had to go vegeterian because meat, even fish or chicken, have adverse affects on them that do not go away while they continue to eat these... one of them even started eating organic grass fed beef and organic cage free vegeterian fed chickens and... same results.

Dieting is not one size fits all.

I've tried keto several times and never really liked it. I always felt run down, had horrible keto breath, and wanted to skip workouts. In my 20 years working out, I find portion control the biggest factor. It's basic calories in vs calories out. It really is that simple. I usually eat most of my carbs for breakfast and taper the rest down over the rest of the day. Unless it's a workout day, then my PWO is 30-40g of protein and 60g of fast acting carbs. My daily macro breakdown is 40% protein/30%carbs/30%fats. As I lean out during the summer months I drop the carbs pretty low for a few days and do a reload a couple times a week. Everyone's different, but that's pretty much what works for me.

When I did the no carb diets, I did go through withdrawals, but once I went into ketosis, my energy levels were pretty good. I didn't get tired at the gym. But like I said before, I paid the price later with kidney issues.

I agree portion control is a more stable and much better longterm option. When you get off the no carb diets, you're at risk of gaining all the weight back and more. With portion control, you actually train yourself to eat less. It is a more consistent approach.

The only thing I would recommend you do differently is to try to have more of your protein in the morning and your carbs for lunch. But, as long as you're under your calorie goal, it doesn't really matter that much. It is just that proteins are more filling and make it easier throughout the rest of the day.

Blasphemer!

I had beers and a Philly cheeseteak for dinner last night. That is my version of eating a healthy diet.

Sign me up for the Phish diet...and let me get an appetizer of bacon-stuffed mushrooms before that cheesysteak, please!

Yum! ;D

Always laughable when I see someone advocating a low carb or keto-nonsense approach. It's been established in literally hundreds of studies that macronutrient content does not affect fat loss, calorie deficit is all that matters. Sachs, et al in particular showed this using over 800 research particiaipants across a two-year time frame.  And this 2006 study from the AJCN not only shows no benefit to keto diets, but flat out advises against their use for health reasons: http://m.ajcn.nutrition.org/content/83/5/1055.full

"Conclusions:KLC and NLC diets were equally effective in reducing body weight and insulin resistance, but the KLC diet was associated with several adverse metabolic and emotional effects. The use of ketogenic diets for weight loss is not warranted."

This could not be further from the truth.  I never watched caloric intake, didn't exercise, yet shredded pounds.  By making your body burn fat instead of sugar you burn the fat on your body instead off he sugar you eat.  It's simple metabolic science.  If two overweight twins ate the same caloric count but one ate ketogenically,  he would lose the weight faster and with less effort.  There's a reason doctors are starting to prescribe ketosis to morbidly obese patients.  It also can cure diabetics. 

All recent studies show ketosis to be extremely effective at successful weight loss.  Combined with the new science regarding the reversal of decades of "cholesterol=bad", we are realizing pretty much everything we have known about the human diet was wrong.   We have been cutting fat and cholesterol from our diets, yet obesity, heart disease, diabetes, and countless other diet related problems are only getting worse.   The common denominator?  Sugar and processed carbs. 

Low carb and keto diets ABSOLUTELY lead to fat loss. And rapid weight loss. And you can eat as many calories as you want.

The big problem is the long term effects from this kind of dieting.

LMAO. Somebody needs to go back to basic Pathology 101. You can't "cure" diabetes. It's treatable, but not curable. Remission is the closest thing.

Rich, despite your belief that with low-carb (or any diet) you can eat as many calories as you want, you can't circumvent thermodynamics. If your BMR is 2500 calories and you eat 3000- even if NONE are carbs- you WILL gain weight. Thermodynamics. Consistent as gravity.

As for the results of cutting sugar and/or carbs? Sure you'll burn fat- but not any quicker than similar calorie, moderate carb diets. But sure, what do I know? I've only been a nutritionist for nearly two decades. Don't believe me. But DO believe years of clinical research. This isn't a football discussion. You guys are out of your league on this one.

Have a read.

From “Diet-Induced Weight Loss Is Associated with Decreases in Plasma Serum Amyloid A and C-Reactive Protein Independent of Dietary Macronutrient Composition in Obese Subjects” in the April 2005 Journal of Clinical Endocrinology & Metabolism: "Thus, in otherwise healthy, obese women, weight loss was associated with significant decreases in both SAA and CRP. These effects were proportional to the amount of weight lost but independent of dietary macronutrient composition."

From the Journal of the American Mecical Association Meta anaylsis:
“A review of studies on low-carbohydrate diets published in the May 2004 issue of the American Journal of Clinical Nutrition found no advantage to these diets compared to equal calorie diets that include carbohydrates. Conducted by researchers at the University of Wisconsin at Madison, this review concluded that calories, not the composition of the diet, was responsible for weight loss and there are no differences in satiety (the feeling of fullness) between the two dietary approaches.

A classic study published in the Journal of Clinical Investigation found that any short-term differences in weight loss between those on either a low-carbohydrate or a balanced diet of equal calories is entirely due to water loss, which cannot be sustained over time. This study demonstrated that fat loss is entirely driven by a reduction in calories and was the first to describe “weight snap back”— the rapid regain that occurs on low-carb diets when carbohydrates are reintroduced.

An analysis of the diets of 2,681 people who are listed in the National Weight Control Registry found that fewer than 1 percent who had maintained at least a 30-pound weight loss for a year or more followed a diet with less than 24 percent of the daily calories from carbohydrates.

Despite all the hype, research confirms that low-carb diets do not perform better in the long term than diets that incorporate essential carbohydrates. Moreover, leading nutrition and medical groups caution against the use of low-carb diets because of the increased risk for such serious health problems as kidney and liver disorders, gout, coronary heart disease, diabetes, stroke and several types of cancer.

New England Journal of Medicine, Sacks et al. studied the controlled diets of 811 adults assigned four different macronutrient ratios for two full years. Carb % ranged from 65% down to 35%. Their findings? “Low-carbohydrate diets, whether extreme or moderate, do not consistently result in more weight loss than other approaches. Moreover, our findings confirm that despite best efforts, studies that compare diets for weight loss have not shown large differences in dietary macronutrient composition.”

And finally, from the American Journal of Clinical Nutrition, 2009, “Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo”: “This study showed that the isocaloric LC and LF diets resulted in similar weight loss and reductions in blood pressure, glucose, insulin, insulin resistance, and CRP after 12 mo. However, the diets resulted in differential effects on blood lipids, with greater increases in total cholesterol, LDL cholesterol, and HDL cholesterol and reductions in triglycerides with the LC diet than with the LF diet, independent of differences in energy intake and weight loss.”


From “Diet-Induced Weight Loss Is Associated with Decreases in Plasma Serum Amyloid A and C-Reactive Protein Independent of Dietary Macronutrient Composition in Obese Subjects” in the April 2005 Journal of Clinical Endocrinology & Metabolism: "Thus, in otherwise healthy, obese women, weight loss was associated with significant decreases in both SAA and CRP. These effects were proportional to the amount of weight lost but independent of dietary macronutrient composition."

http://redirect.hp.com/svs/rdr?TYPE=4&tp=iefavs&s=downloads&pf=cnnb&locale=en_us&bd=all&c=104

“Comparison of a Low-Fat Diet to a Low-Carbohydrate Diet on Weight Loss, Body Composition, and Risk Factors for Diabetes and Cardiovascular Disease in Free-Living, Overweight Men and Women” in The Journal of Clinical Endocrinology & Metabolism June 1, 2004: “These data suggest that energy restriction achieved by a very low carb diet is equally effective as a low fat diet strategy for weight loss and decreasing body fat in overweight and obese adults.”

http://jcem.endojournals.org/content/89/6/2717.abstract


From the Journal of the American Mecical Association Meta anaylsis:
“A review of studies on low-carbohydrate diets published in the May 2004 issue of the American Journal of Clinical Nutrition found no advantage to these diets compared to equal calorie diets that include carbohydrates. Conducted by researchers at the University of Wisconsin at Madison, this review concluded that calories, not the composition of the diet, was responsible for weight loss and there are no differences in satiety (the feeling of fullness) between the two dietary approaches.

A classic study published in the Journal of Clinical Investigation found that any short-term differences in weight loss between those on either a low-carbohydrate or a balanced diet of equal calories is entirely due to water loss, which cannot be sustained over time. This study demonstrated that fat loss is entirely driven by a reduction in calories and was the first to describe “weight snap back”— the rapid regain that occurs on low-carb diets when carbohydrates are reintroduced.
An analysis of the diets of 2,681 people who are listed in the National Weight Control Registry found that fewer than 1 percent who had maintained at least a 30-pound weight loss for a year or more followed a diet with less than 24 percent of the daily calories from carbohydrates.

http://www.atkinsexposed.org/atkins/117/partnership_for_essential_nutrition.htm

So...apparently no better going lower carb than lower calories....

Finally, a little real world application. I present to you item 1: Chris Voigt. Voigt ate nothing but potatoes between Oct. 1 and Dec. 1. He had them for breakfast, lunch and dinner — about 20 potatoes per day prepared in a variety of ways. His weight dropped from 197 pounds to 176 pounds and his cholesterol level fell 67 points. Lots of carbs, all the time.

http://today.msnbc.msn.com/id/40424707/ns/today-today_health/t/days-nothing-spuds-leaves-advocate-lbs-lighter/

And item 2: Mark Haub, a professor of human nutrition at Kansas State University. Haub lost "27 pounds in 10 weeks subsisting almost exclusively on Twinkies, Doritos, Oreos and other treats by ensuring that he consumed fewer calories than he burned."

http://articles.latimes.com/2010/dec/06/health/la-he-fitness-twinkie-diet-20101206

In my 20s, I did the Atkins diet for 8 months. All I did was Atkins and weight lift. And I am not talking about the pussified version of the Atkins that exists today. I am talking about eggs, bacon, chicken, meat, fish, cheese. High fat, high protein. And foods like cheese are high calorie. I was eating roughly 3000-3500 calories a day and doing 45 minutes of weights 4-5 times a week. Mostly push/pull.

I was at 17% body fat when I started, weighing 225 lbs. I lost 20 lbs the first two months. I started lifting heavier and heavier. By the time I was done I gained half of the weigh back but I was at 7% body fat and 215 lbs. So what I gained back was muscle. I also drank whey protein after my workouts, which helped quite a bit. I didn't do any cardio.

On another occassion, I did the Atkins with no exercise, same foods, and lost 10 lbs in 2 months, reducing my waistline two sizes. I also know other people who completely changed their bodies doing Atkins-like diets. Phase 1 Atkins which is the ketosis phase.

You can throw all the credentials and articles you want at me, it has worked for me and I have seen it work for others, including my wife who lost 5 lbs in a month doing it.

The problem is her cholesterol shot up after spending her entire life with cholesterol in the 150s, it went over 220. I also dealt with cholesterol issues until I significantly increased my soluble fiber intake. I could have eaten more fish but I like red meat, not a big fan of fish. I also got kidney stones one time. This while drinking copious amounts of water. You know that when you are in the gym you start craving water.

But ketosis works from a fat elimination perspective. It is just not worth all of the risks.

I'm doing MFP now and consistently staying under my calorie goal. I have lost 12 lbs in 2 months. Also started lifting again for toning purposes, but will eventually up the weight. I did have to start taking glucosamine chondroitin, the joints aren't what they used to be.

This morning I had three chocolate chip cookies and two pieces of cake for breakfast

Ugh. 

I'm not saying it won't work. I'm saying it's not optimal. It's not any BETTER. And it doesn't matter what you want to believe, you can NOT eat above your BMR, even with zero carbs and lose fat. Excess calories- irrespective of where they come from- are stored as fat, because the body will eventually break them down into glucose via gluconeogenesis. Your claim that you can eat as many calories as you want and lose fat is scientifically impossible. Again, you can not circumvent the laws of thermodynamics. That's why they are scientific laws. Period.

MFP is a great app. I use it as well. FWIW, though, you can not "tone" a muscle. A muscle can either atrophy or hypertrophy. Tonicity refers to the constant and residual tension on a muscle that is there at all times and isn't something you can change through weight training.

Rich, from reading your posts here you see like a smart and reasonable guy. Don't take my word on it. I challenge you to go to any fitness forum on the web- BB.com; Simplyshredded.com; MuscleandStrength.com- or any other, and make the claim that you can eat as many calories as you want as long as they don't come from carbs and you'll lose weight. See what kind of responses you get.

I just stopped drinking alcohol for the most part and lost 20lbs in 2 months...

Well then I guess me and the circle of people I know that did this are defying the laws of science. It worked for me and I ate a lot while on it. Maybe you get fuller faster and stay fuller longer eating higher protein.

I didn't argue that it was any better, obviously I am trying a new method that is more balanced and still getting good results. And not pissing out rocks in the process is a plus. :)

I started at 226 lbs, weighed in at 208.8 lbs this morning and I had pork fried rice for dinner... so there ya go.

As far as "toning", all I know is I started lifting again and the results have been immediate.

By the way, I'll take 140 calories of mashed potatoes over 220 calories of potato chips any day. Mashed potatoes fill you up more.

I can assure you that you were not. When you cut out carbohydrates- which make up between 50-60% of the average American's total caloric intake- you're cutting out around half of your total caloric consumption. Because carbs are so easy to eat in so many forms, replacing all of those calories with fat and protein and then going above and beyond that is not easy. You lost weight because you had fewer calories, and for no other reason.

You understand what your BMR is right? The amount of calories you need to maintain your current weight. If you eat more than that, it doesn't matter where they come from, you can't lose weight. You have to understand the math at play there, don't you? 2+2 can never and will never =3 when it comes to this. It just can't happen. I'm not shitting you here. Go post that claim on ANY reputable diet or fitness board and prepare for the shit storm you'll receive.

And of course your results (congrats on that, by the way) have been immediate- you're shedding subcutaneous fat to reveal lean body mass. But you're certainly not "toning" muscle.

Food for thought, from one of Dr. Layne Norton (PhD, nutritional science)'s clients:

https://twitter.com/DustinMRhoads/status/574762742302670849

You cut out carbs but you replace it with something else. Mostly cheese, which unless you're eating skim cheese, you're getting a lot of calories for a small quantity of food.

That being said, I will say I found myself less hungry when on a no carb diet. Conversely, I did have cravings and it was easier to crash.

Doing it the way I am doing now, I don't crave anything because I eat whatever I want, I just control the portions with the appropriate information.

You're missing the point. I'm not sure if you're doing it purposefully or not.

You can not eat more calories than you burn and lose fat. Macronutrient content is immaterial to that.

This is also not correct. Over the past few decades the research shows that obesity levels increasing has nothing to do with diet (calorie consumption and macro content hasn't changed much since 1988- in fact, eating habits have actually improved), and the common denominator is actually decreased activity. Nice try.

http://www.ncbi.nlm.nih.gov/pubmed/24631411

"Average daily caloric intake did not change significantly. BMI and waist circumference trends were associated with physical activity level but not caloric intake. "

I didn't miss your point. I don't think you're listening to mine.

Im absolutely hearing your point. It's just not correct. You CAN'T eat above your maintenance level BMR and lose weight simply because you're not eating carbohydrates.

As a desk jockey, I know it all too well.

However, when I was at 215 with 7% body fat, the BMI index told me I was obese, so I don't put that much stock in BMI. It tells me that at my height (6'1") I should weigh something like 175 lbs. I wouldn't need x-rays if that were the case.

Did I say that in my last post?

No, I stopped arguing that point.

That was my only point of contention with your posts. Until now you have not withdrawn that point. I think we agree on pretty much everything else.

I am also 6'1" and when I was at my optimal weight (235, cut, six pack abs, etc.) BMI said I was obese as well.  Now that I'm a desk jockey, I ballooned up to 275.  I'm around 255 now and decreasing.

I'm not going to withdraw it. We're not going to get anywhere so it is not worth continuing to discuss. The point of my post was to point out that it is better to do it the way I am doing it now anyway because I am avoiding the cravings that come with eliminating carbs. Let's leave it there.

^^^This is correct. To lose weight you have to be in a calorie deficit. The macros matter, but not as much as you think they do. A good percentage of "weight" lost on keto is water weight and glycogen depletion. That's why it "appears" to lean you out quicker. I won't dig through it right now, but the majority of the research that I've read indicates that Keto and a low/moderate carb diet are on par with each other as far as "fat" loss. My personal experience with both indicates the same, keto just had worse effect on me personally.

^^ give up. People think because they have driven a car, they know how to do all the maintenance, and even when presented with an overwhelming bulk of clinical research, hold true to their scientifically unfounded beliefs.

That's fine. When they stall and plateau and no longer can make gains, they often end up coming to trainers and nutritionists and that keeps me in business.

Never had to do this. I get by just fine. Good luck!

Fixed that for ya. ;) You also didn't keep the weight off and admitted to compromising your health. And still didn't circumvent thermodynamics. But at least you're on the right track now, so props for that!

I didn't keep the weight off because that's what longterm relationships do.  ;D

But when you start seeing your numbers go up, you realize it's now or never as far as eating right to live better. I've also noticed that since I started portion control, not only is my weight getting where it needs to be, my energy levels and my digestive system are as well.

So yea, there is no yet necessary. I think I have educated myself enough about nutrition and I was always a gym rate in my younger days.

QFT

Nope, el wrongo. Long term relationships don't make you gain weight. What you put in your body is a choice. How much you exercise is a choice. Statements like that are nothing more than a weak excuse for not being in better shape. If you're over weight, fat, obese, or just plain out of shape. That's fine, just be man enough to admit that you have no will power. Denial of the reasons why you are over weight, fat, or out of shape is worse than just being over weight, fat, or out of shape and saying that it's your choice to be like that.

Do any of you notice that when you try to add cardio to your lifting routine, it affects how much you can lift?  I have noticed that.

I would assume because it makes you tired due to the energy you've expended. Less energy = less weights to be lifted? Dunno.

When I lifted, I did weights first, then ended my workout with cardio

I try to combine the two. I load up my fork (or spoon) with extra weight, and then I eat really fast, with very little cool-down time between bite sets. ;)

My understanding of how weight lifting works is as follows:

1) When you lift weights, you break your muscles down.

2) When you eat protein, it rebuilds them stronger.

Are you a personal trainer?  If you are is my previous post correct? 

Personal trainer, sports nutritionist, and PTA. And more or less, yes that's what happens. If you really care about the biology involved I can expand, but that's the Cliff's Notes version.

proud moment for me yesterday at the doctors.  They tried to take my blood pressure and they could not because the cuff wouldn't fit  on my arm.  They had to use a bigger sized cuff.