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Wednesday, March 16, 2016

Why I follow a low-carbohydrate meal plan

I would like to start off this post by explicitly stating that a low-carbohydrate diet has worked extremely well to help *me manage my blood sugar. However, this does not mean that I am going to try to convince *you to do anything. I am after all a libertarian – freedom of choice to do whatever you want is important to me, and I am not here to preach or to convince you to do one way or the other – simply relaying my experiences with different food choices. Nor am I going to partake in the stupid divide I have witnessed in the #doc when people have different opinions and can’t seem to accept that “to each their own” ;)

Now that I have gotten that out of the way, I must also point out that the dietary guidelines recommended for the general population as well as for PWDs are unfortunately not the best. Better than the food pyramid? Sure. However, still way outdated and not supported by research (saturated fat, anyone?) As a scientist I read primary literature. All. The. Time. Be it developmental biology (my current area of expertise), immunology and cancer (my graduate work), or simply for fun (read: nutrition). As a result of my background and constant need to read papers, I have realized that a low carbohydrate diet can be both “safe” and very sustainable. If you have specific questions, please feel free to contact me :)

Now, I realized many years ago that eating less carbs per meal helped me avoid post-prandial blood glucose spikes. However, at the time, I was not well-educated about fat consumption, and as a result of adhering to the low-fat advice, couldn’t maintain my weight, and thought to myself – hmm, I guess this is unsustainable and I need to eat more carbs. Fast forward to today, and I have learned a lot more about both metabolism, and also the terrible studies that produced the low-fat guidelines/craze (luckily, things are slowly starting to change – even the 2015 dietary guidelines have finally removed dietary cholesterol and saturated fats from the “nutrients of concern” list.) In any case, once I realized that fat (good fat!) is not the enemy, and also that there is absolutely no evidence that eating more protein causes kidney damage, I once again began my journey of diet experimentation in an effort to normalize my blood sugar. 

Here’s the caveat  - a majority of health professionals are not up-to-date on their continuing education and as a result are prone to continuing to misinform the public. Don’t get me wrong – I think the vast majority of physicians have the patient’s best interests in mind (after all, why wouldn’t they?) However, about 50% of what doctors learn in medical school is unfortunately wrong (we just don’t know which half). I whole-heartedly applaud those doctors (such as my paleo-eating endocrinologist, who holds both a D.O and a M.D., and has actually conducted research) who stay up-to-date and don’t just spend decades regurgitating information they memorized years ago. One of the reasons I never became a medical doctor was because I really didn’t want to deal with the ridiculous hours (residency and beyond), and also because I don’t really want to deal with the stress of getting sued. But – if you are a doctor reading this – I applaud you – and I hope that you are finding time in your busy schedule to attend conferences and read studies yourself. (My endocrinologist is appalled at how many docs are getting their CE from pharmaceutical reps. He is also appalled at how new drugs are pushed out today with pretty much no safety profile). But, I digress – that will have to be another post.

Anyway, back to my low-carb (moderate fat/ unlimited protein) diet. PROS: Amazing BGs. Fewer lows. More stability. As a result – improved mood. CONS: Learning to bolus for protein (this was the hardest for me), and spending a lot of time in my kitchen (some may consider this a con, but I personally do not :).  As an example, I am posting some CGM graphs from my “standard diet” days vs. today’s low-carb. The first set of graphs illustrate the difference (for me anyway) between eating a bagel vs. low-carb waffle + egg. The 24-hr. ones are representative of overall stability throughout the day (I am still working out all the kinks). Importantly, these graphs are not representative of effort (I tried really hard to have stable blood sugars on a “regular” diet just as much as I try to do it now), these graphs are reflective of diet. 

Now, I personally eat a lot more carbs than most people adhering to a low carbohydrate diet (e.g. Bernstein plan). I eat about 60g per day (on average), and I don’t actually have any foods that are “off limits”. If I feel like eating it, I will eat it. However, most of the time, I tend to prefer feeling good instead of “indulging”. What does indulging look like to me? These days, this would be a serving of popcorn and an ice-cream (together, at once). I had some last week, spiked to 150 mg/dL. Did I regret it? Not necessarily, but looking back, I wish that I had split up these “treats” into two occasions. What does a typical day look like? For breakfast, I have a two egg/ cheese (sometimes meat too) “sandwich” on a low-carb wrap. An alternate breakfast is a low-carb waffle (made with almond flour, plain yogurt, a bit of milk, and eggs, with Stevia) with a teaspoon of jam and 1 fried egg with a sprinkling of cheese. Another alternative is plain yogurt with berries. And coffee. ALWAYS coffee :) My favorite lunch is hands down a loaded Greek salad – lettuce, tomato, cucumber, olives, feta, green onion, with added avocado, or chicken, or tuna. I make my own dressing (1:1 EVOO/red wine vinegar with s/p, oregano, and garlic powder – so good). Alternately, I bring my leftovers from yesterday’s dinner – usually this is a protein source and lots of vegetables. For instance, last night I had cheeseburger casserole and bacon-fried French green beans. It is also my lunch today. This particular meal is quite high in protein and fat (and illustrates one of my lowest-carb meals), but not all my dinners are. I also enjoy blackened tilapia, ramen using shirataki noodles, Parmesan-crusted chicken (with a tiny bit of bread crumbs) with steamed spinach or broccoli, etc. I could go on and on and on (I will have to make a separate recipes-only post ;) And I am not afraid to throw some refined carb in there – be it about 1/3 – 1/2 serving or rice or French fries or whatever if I feel like it. My favorite “carby” thing to eat remains the occasional small serving of multi-grain bread from Costco with artichoke spread or smoked salmon and cream cheese. Alternately, I really like crackers and cheese J Oh and I loooove Kind+ bars as an on-the-go snack. I also love berry/plain yogurt smoothies.

Here is the fun part – since I now bolus for protein, I don’t have to wait 15-30 minutes after bolusing to eat my meal to achieve flat lines. So I bolus for my carbs and 30% of the protein up front and eat! 

And this is why I choose to eat low-carb. Here is this morning :)

Tuesday, March 8, 2016

A Discourse on Diabetes Technology

Hi there! Still here, still have diabetes :)

Today I am talking about diabetes technology. In today’s diabetes world this can mean many things – blood glucose meters, insulin pumps which can deliver very tiny and precise amounts of insulin (some of which are integrated with continuous glucose monitors, automatic insulin suspension and other safety features, etc.), continuous glucose monitors (CGMs), which deliver (*almost) real-time blood glucose results to a receiver or even your cell phone (by measuring interstitial glucose and correlating that to BG values via calibration with a meter), a multitude of sharing features that allows PWDs and their loved ones to have more peace of mind, and of course, the several ongoing AP (“artificial pancreas”) projects (definitely a misnomer), which aim to integrate CGMs with pumps (either insulin-only or a combination of insulin and glucagon), with the end goal of automatic delivery based on the individual inputs in order to keep BG as close to normal as possible at all times (Whew! Hopefully I covered most of that without too many mistakes or omissions :)

I catch myself often thinking about the “Diabetes Dark Ages” – check out Kelly Kunik’s blog for example - - to learn more about the “Diabetes Dark Ages" – the times of testing your urine (qualitatively) – a very drawn out process, guillotine-type lancets, enormous (and slow) blood glucose meters requiring a “hanging drop of blood”, backpack-sized insulin pumps, and needle sterilization via boiling, etc. Wow – what a pain in the ass! That’s when I remind myself how lucky I am to be living in the 21st century, and currently have a job with health insurance that will cover 80% of all my supplies with a minimum deductible and a max out-of-pocket of only $2k annually. I am thankful to have a good plan through the university I work at this time; over the last couple of years of graduate school, I was much more broke, had crappier health insurance, and although I did manage (with my mom’s help – thanks mom!) to get my hands on the original Dexcom 7+ CGM system, I couldn’t really afford the sensors on a regular basis (shout-out to the #doc folks who sent me their expired ones!)

Although I never tried one, I never felt like an insulin pump would be a good choice for me, personally (that is not to say I would never try one). The reason I feel this way is a combination of the troubleshooting that comes with kinked pump cannulas, occlusion sites, scar tissue, delivery failures (for various reasons, which unfortunately can be very dangerous, as all insulin delivery – basal and bolus occurs via the site, so if anything fails, the threat of DKA becomes very real very fast), battery issues, and a cohort of other potential problems that I have read about on many pumpers’ blogs. Couple those potential issues with my vanity  let’s call it self-consciousness (I don’t really want to have a device attached to me at all times – tubing or not - on the beach, during sex, etc.), along with the high financial cost of pumping insulin, and that  pretty much explains why I am not a pumper. Don’t get me wrong – it works out fantastically for so many people, and I can totally see the benefits of pumping, especially for those who have needle phobias, or are very active and benefit from the easiness of basal dose adjustment/ suspension. 

Moving on to CGMs. As I mentioned, I had the original Dexcom 7+ system a few years ago). It was the most profound piece of technology as far as improving my diabetes management. It allowed me to assess my overnight control, providing a safety net (via low BG alarms) to allow me to run tighter BG control, especially overnight, gave me great insight into postprandial BG values, allowing me to better time my meal-time insulin to avoid post-meal BG spikes, and it also acted as a constant accountability buddy, which was very useful to me. This is why I am super-thrilled to be getting hooked up with the Dexcom G4 system this week!!! I am excited for the slim transmitter (at least slimmer than the original G4 transmitter as of 2014), the sleek (not egg-shaped, eye roll emoji) receiver, the increased range of signal, and hopefully better accuracy and sensor life. I should mention there is a G5 on the market as well – I personally chose the G4 for a couple of reasons, such as the slightly smaller transmitter and the longer transmitter life. I can’t wait, and will have to post some pics and graphs once I get everything delivered (hopefully later today)! Here are some pics of the original Dexcom 7+ system (along with its giant egg-shaped receiver – like really – who thought of that!?) from a few years back. But even this original system changed profoundly my approach to diabetes technology and management alike. 

And even though I don’t like a device attached to me – as Kerri Sparling of points out “healthy is sexy” – thanks Kerri ;) That, and (as with an insulin pump or any other kind of Diabetes technology) we have a choice! We are lucky to have a choice to remove it whenever we want, go back to the more old-school ways of management – we can chose to do what works for us and when and that is awesome! I dream of a world where every PWD across the globe has easy access to insulin and BG monitoring supplies, and I recognize just how fortunate I am. 

Now, I promise not to be a stranger as much as I have been. I miss this place, because it’s like a break from work (while I am at work currently, hehe). Also, because I really benefit from writing about diabetes from a mental-health standpoint, and by connecting with all of you! In addition to writing about diabetes and technology, I soon hope to write more about my low-carbohydrate diet approach, as well as more about travel, stress, and many other things ;) (I am posting it, so I will have to come back soon and write more!)

Peace out. 

<3 MM