Monday, November 21, 2011

Healthy Living Update & a Few Thoughts on Holiday Eating

As anyone who knows me or has read my last blog post knows, I've been trying low-carb eating as a way to control my blood sugar. I've lost 30 pounds since my surgery. Right now, I'm maintaining that weight loss.

I've discovered that my blood sugar readings get better the longer it's been since the surgery. The illness, the shock to my body of having the operation, and overall stress were all partly behind the super high readings I had back in June. However, I don't have normal blood sugar, so I do need to keep track of my diet, exercise, stress levels, etc. and keep taking the readings to make sure I'm on track. The past few days I've been noticing slightly higher blood glucose numbers, although still below my target number. That tells me I need to back off the total daily carb count a bit. If I want to lose more weight, I need to reduce the carbs significantly.

The holidays are super hard for people with special dietary needs. Holiday food doesn't fit most of the special diets many people are following. it's loaded with carbs, fat, sugar, gluten, nuts-basically everything that often people's health says they shouldn't eat. If you're trying to lose weight and don't have any health issues, you can decide to maintain over the holidays to allow yourself a few indulgences. But, if your overall health is at stake, relaxing your vigilance is not an option.

My body doesn't care if it's Thanksgiving or Christmas or my birthday or a holiday party or whatever. It's going to respond to the food I eat, my exercise level, the stress, etc. exactly the same as it does when it's not Thanksgiving or Christmas or my birthday or a holiday party or whatever. And that's the difference between being on a weight loss diet, as I have for a lot of my life, and working to maintain the best health I can. It's a different attitude. I can't tell myself, "I'll start the diet again on New Year's Day." Or even, "I'll start it again tomorrow." When faced with the temptation to eat more carbs than I should, I have to remind myself why I don't do that anymore.

The other problem is that, for the most part, the recipes I've found for low-carb eating are boring and unappealing. The carb count varies from super low-carb to "this is low carb?". The recipes in cookbooks for diabetics tend to be better in terms of quality, but way too high in carbs. When I ate the recommended diabetic diet, my blood sugar was way too high. This challenged me to find a way to eat well, while keeping my blood sugar within the range that will keep me healthy. I'm discovering that I can eat real food, including some foods that seemed to be automatically "off-limits", as long as I balance the carbs at the meal and throughout the day.

I realized I'd have to develop a new attitude. Moaning about what I "can't" eat anymore just makes me want to eat that food. I'm telling myself that I can eat it, but choose not to right now. Or I plan an appropriate serving size into my meal plan. There are tradeoffs. I can't eat high-carb foods in normal size servings without messing up my blood sugar. No super-size piles of stuffing and mashed potatoes. But I can eat some turkey skin on Thanksgiving, which is one of my favorite things. I can eat a tablespoon or two of the stuffing & mashed potatoes. I can eat a bite or two of dessert. It's a matter of choosing carefully and really enjoying what I eat. Again, it's that positive perspective that makes a difference.

With that attitude in place, I realized I'd have to adapt my recipes to cut the carb count. I'd have to plan my meals around a target amount of carbs and if one course is higher, the rest have to be lower. I know there's a big hype about eating complex carbs instead of refined carbs, but my blood sugar readings don't seem to care much what type of carb I'm eating. I choose mostly complex carbs because I like them better.

People keep talking to me about the glycemic index and glycemic load. They oversimplify it into "don't eat white foods". Ummm...cauliflower is white and it makes a wonderful low-carb puree. Brown sugar is not white and it can easily become a carb nightmare. Some foods that mess up my blood sugar are low on the glycemic index or have a low glycemic load. It's a complicated food plan to follow because what you eat with what affects the glycemic load. It's complicated to follow and there are way more foods they don't have the numbers on than foods on the list. It doesn't make enough of a difference to be worth the time spent working out the glycemic load of everything I eat and sticking to foods on the glycemic index list is super limiting. It's much easier to choose mostly complex carbs and keep track of the carb counts. That is working fine, so I'll stick with doing it that way.

Sometimes cutting the carbs in a recipe is hard. So I cut as many as I can. Then I cut the serving size down until the carb count fits my plan. I fill out the meal with low carb items and it's fine. The American Heart Association says to use meat as a condiment. That advice sends my blood sugar through the roof. So, I've turned it around. I use carbs as a condiment and thinking about it that way really helps keep it in perspective. It also helps me in figuring out how to revise recipes. I was making a pasta and peas dish, both of which have a lot of carbs. I substituted whole wheat pasta, reduced the amount of pasta and peas, and added cut up sausages. Even though the serving size ended up smaller, it was enough.

Eating out is much easier on a low-carb diet than it was on a low-fat diet. I love to get cheesesteak sandwiches and a salad. I take the meat, cheese, and vegetables off the bread.  At a Mexican restaurant, fajitas without the tortillas work the same way. It's easy to tell the waiter not to bring the bread, or put it at the other end of the table if I'm with people who want it, because I remind myself of what I will enjoy instead of eating that bread. I can eat a bite or two of dessert, if the people I'm with get some and are willing to share, as long as the rest of my meal is low-carb.

There are days when I don't want to do this anymore. Those are the hardest days. I remind myself what the consequences of not doing it are and remind myself what good things I have to look forward to. And mostly I stay on track. No one is perfect, but somehow, it's easier when the readings remind me every day that what I'm doing is paying off. I noticed that if I take a break from measuring my blood glucose, I tend to restrict my diet too much because I don't have that number to reassure me that I'm doing OK. So, I take the readings and adjust as I need to in order to stay within my target range.

I'm cooking a pretty traditional Thanksgiving meal this week. I think that's why I decided to write this post. I wanted to give myself a pep talk to help me get through it without messing up my health. I'm fine with cooking food for other people that doesn't fit easily into my food plan. I'll figure out the carb counts and figure out my serving sizes and have a great meal. For us food people, Thanksgiving is first about the food because it takes a lot of planning to pull it off. But without other people to eat it with, it's not nearly as much fun. We're having around 10 people and I'm looking forward to enjoying the party.


Tuesday, September 27, 2011

Diets

Although I don't want this blog to become a fitness & nutrition blog, I've been pretty focused on those things since my last post. Right now, fitness is pretty easy for me. Since I broke my arm and had major surgery this year, it consists of walking 2-1/4 miles, Monday-Friday. I can do that. It doesn't strain my still healing upper arm and shoulder the way a lot of other types of exercise would. It's also gradually strengthening my abdominal muscles.

Diet is another issue. It's much more complicated. So, I've been reading and doing research. Here's what I've concluded:

  1. Some people get sick eating a vegan diet. Others get sick eating a low-carb diet. Yet others get sick eating a high-carb diet. Yet others can eat any of those, but specific foods make them sick.
  2. Therefore, everyone should not eat the same diet. 
  3. However, no one should eat highly processed, refined flours, sugars, and junk food. I've not seen any research or indications that anyone is made healthy by eating those foods.
  4. If you're eating the high-carb diet recommended by the major medical associations, you should make it a low-fat diet.
  5. If you're eating the low-carb diet recommended by many diabetes specialists, you should make it a high-fat diet. 
  6. The jury is still out on whether saturated fats cause heart disease, especially since most saturated fats are not totally saturated. It's simply not that simple.
  7. No matter what diet you choose, getting enough protein is important.
  8. If you're eating vegetarian, you can do a low-carb diet. If you're eating vegan, you can't.
When I was in the hospital, drugged out from surgery, they kept sending people in with information about how to manage my diabetes. It kind of went in, but didn't really take hold, thanks to the drugs. When I got out and off the drugs, I read through the information they gave me. I went online and read everything the usual experts recommended. My reaction was, "Huh?"

The thing is that what they were telling me to eat was exactly what I was eating when I got the disease. Plus, since diabetes is a disease where your body doesn't handle carbs well, It didn't make sense to me that eating more of what my body didn't handle well was going to help me. "Well," I figured, "I'm not carb counting and keeping my carb intake even throughout the day." Maybe that's what makes the difference from what I was doing vs. what they're telling me to do. So I did that for a month. My glucose numbers were very stable in the normal to a bit high range. They only went into the diabetic range once-after I ate a very small baked potato. DAMN! Potatoes are one of my favorite foods.

Well, turning my fingers into pincushions wasn't giving me any new information, so I decided to take a break from testing. I'd learned that my sugar was a bit high in the morning. Completely normal after breakfast and lunch. And a bit high at bedtime, as would be expected because we eat a late dinner. I learned that my blood sugar hits its high point a bit faster than average-1-1/2 hours after eating, rather than 2 hours.

I also decided that since my numbers were a bit higher than I wanted them to be, the standard recommendation of high-carb, low-fat diet was not working. I decided to try what many diabetes experts recommend and go low-carb. However, all the research said that I should be monitored by my physician if I followed a low-carb diet. Even though I know it's a CYA, I think that's wise advice. But, I don't have a physician, so I decided not to do a program like Atkins where you immediately drop down to 20 carbs a day and gradually add them back. I decided to use my research and make up my own program.

This is what I decided to do:
  1. No sugar. 
  2. No refined flour.
  3. No potatoes.
  4. Cut carbs in steps, starting with 90 carbs/day, spread out evenly.
  5. Walk 5 days a week.
Results:

The walking is going well. I got back to 2 miles fairly quickly, then about a week later added another quarter mile. That's about all I can do right now, but I've gotten the speed up to an average of 3 mph.

I'm doing really well with the sugar, refined flour and potatoes. I have eaten a bite of my husband's dessert and a couple of french fries. It's getting easier to "just say no".

I've dropped down to an average of 70 carbs/day. I wasn't trying to drop to a lower level. I just seem to end up there. It's as if my body prefers that level of carbs. I'll reassess the number of carbs I'm aiming for after I start measuring my blood sugar level again.

I'm having an interesting reaction to the low carb diet. When you read about low-carb dieting they always say you don't get hungry. I don't think that's accurate. I think it's more accurate to say that you get full. On the high-carb, low-fat diets I'd finish eating my portion and want more. With the low-carb diet, when I'm finished, I'm full. When I was on the high-carb, low-fat diets I'd want to eat when I wasn't hungry. With the low-carb diet, after I've eaten I don't want food again until I'm physically hungry. I actually know when I'm hungry and when I'm full. It's really, really hard to eat too much. My stomach just says NO to more food. That's a real revelation to me because my biggest complaint my whole adult life is that I don't know when I'm full and when I'm hungry and I thought that was why I overate. Hmmm...maybe not. Maybe I was just eating the wrong foods for my particular body's needs.

I've lost 7 pounds. Weight loss isn't my goal, although I hope it will be a side effect of what I'm aiming for, which is good blood sugar control. However, I don't know what my blood sugar levels are yet. I wanted to give my body a few weeks to adjust to my new way of eating before I measured them so I plan to measure the first week of October.


Wednesday, August 24, 2011

Medical Care--or the lack thereof

I'm so angry and scared I can't find the words to say what I feel right now. I keep wondering whether what happened to me is how the American public really wants people to be treated. We have millions of unemployed people who don't have health care, since most health insurance is through people's employment. We have millions more working people who don't have health care because their employers don't offer it. Somehow we have to fix it, but I don't see how and certainly not in time to help me.

I recently had surgery. They diagnosed me with type 2 diabetes. They said I didn't need medication. I need follow-up medical care to try to keep me off medications. They sent me a referral letter and I called. The registration clerk told me the referral was for the classes I already attended. She offered to make an appointment with a pharmacist. I told her I didn't see why I needed to talk with a pharmacist since I don't need medication at this point. She told me they don't offer ongoing care for people who aren't on medication. I can get medical supplies to test my blood sugars and take all the healthy living and education classes they offer and attend the diabetes support group.

She said that I could get a primary care physician to work with me. I got the number from her and called. The clerk who answered that phone told me some garbage that made no sense about them redoing the clinics so no doctors are taking new patients right now. I wondered if I had insurance or cash if that would have been the case, but I saw no reason to ask because she'd say whatever she'd been told to say. Someone on Yelp posted that they got the same story and the post was over a year ago. The clerk said if I go to outside clinics there's no guarantee that they'd take the program I'm on. I got the message. If you don't have outside insurance or the money to pay, you don't get care unless you need something that specifically requires a doctor. In my case, that would be medications that need to be prescribed.

Right now my disease is barely started. My numbers are not in the "You're not diabetic" range, but they're pretty stable and mostly in the lower range of where you'd be diagnosed as diabetic. If I could get individualized help to tweak what I'm doing to try to keep it under control and improve those numbers, I may not need medication for a long time. But what do I do without that help? 

My research is leading me to the same brick wall. At some point, all the book authors, medical web sites, etc, all say to discuss various aspects of your care with your doctor or health care team because they have to be personalized to how your body is responding to your efforts to treat the disease. How do you personalize it when you have to be your own doctor and you don't have the medical degree and medical experience and access to a lab to test your blood regularly?

And back to my original question-Is leaving people to get sicker to make them need medication so they need to see a doctor to prescribe it, rather than helping people stay healthy and off medication, really what we want to do? Apparently, the answer is yes. When you don't have insurance, people ask why didn't you go to the doctor before it got this bad? Or get angry that you went to the emergency room because what you have isn't life-threatening. What else can you do when no doctor will treat you until you get sick enough to need the emergency room or, if the hospital has it, a clinic for immediate needs that aren't life-threatening?

Tuesday, August 16, 2011

Changes

This year has been about change. Life is always changing, but this year things have been turned on their head more drastically than any other time except for the other real biggies-getting married and having my children. This year I broke my arm-alerting me to the osteoporosis that I didn't know had started to develop. Several months later, I needed surgery and they discovered I've begun developing type 2 diabetes. That's a total life-changer. While still getting my head around that, we moved in with friends. I'm feeling a need to sort through it all in my head and I do that best by writing about it.

I've been researching the subject and finding that they don't, in fact, really know what to do. The literature seems to assume people won't do the diet, exercise and weight loss that's needed to perhaps avoid needing medication, at least for a long time, and to avoid the nasty complications of the disease. It's a progressive disease and, like every other physical process, your body's ability to produce/use insulin gets worse as you age. it's likely that even if you manage it for a long time without medication, eventually you may need it. But some doctors say they always prescribe medication, just in case you don't do what you're supposed to do. They figure they can always stop the medication.

But it seems to me that sets you up to fail. Plus, using the medication alters your numbers, so you really don't know what they would be if you didn't take the medication. Everyone is a bit different, so you have to tweak their advice based on your own body's reaction to what you eat and how much you exercise. When I was in the hospital, the doctors said I'd just begun to develop it, so they recommended I start with diet and exercise and losing weight.

To that end, I'm monitoring my blood sugars to start to figure out my body's pattern. I'm following the carb counting diet recommended by the dietician. I'm using Weight Watchers to keep track of appropriate portion sizes. And I'm walking the track every morning. I can do a mile. I could walk farther, but my post-surgery abdominal muscles aren't up to it yet. I'm hoping to build back up to walking an hour and aiming for at least 3 miles. None of that is especially difficult. It's doing all that stuff every day, all the time, that can burn you out.  Keeping accurate records is hard for me because it's tedious and time-consuming and I get bored and don't want to do it. But without the records, I'd have no idea what's working and what isn't.

The hardest part is the feeling that I'm pretty much on my own due to our broken health care system. I haven't yet seen a doctor about the diabetes, although I'm in the middle of the diabetes education classes. In order to see a doctor, I had to get the business/insurance stuff dealt with first and that took much longer than it should have. That's finally done and I'm calling this morning to make an appointment.

The blessing is that the woman we moved in with has had type 2 diabetes for years and she's been super helpful as I've started to learn how to live with this disease. She knows so much, but she waits for me to ask her for help because she knows I need to be ready to hear what she's learned. It's not just a physical disease. It affects you mentally and emotionally, too.

I think the hardest thing for me mentally and emotionally is that I knew it was in my family history, so I've always tried to exercise regularly and eat healthy food. I've not been able to sustain weight loss because of the emotional eating, but I can't just give up and quit  because of past failures. I've learned a lot from those failures and hope putting what I've learned to good use will help.

However, in the long run, the weight and the genes won out. I'd like to think I managed to stay healthy until I was almost 60 because of my attention to my health, but who knows? My grandfather's family has a lot of people with diabetes in it, including him. My aunt also had it. She died of kidney failure. She seemed to do less of what she needed to do as time went on, which was probably burnout. That's the lesson I'm taking. I'm not going to pretend it's going to go away or that it's a mistake or that I can ignore it and be OK, somehow. I'd rather be like my grandfather who lived well into his 80s and he was diagnosed much earlier in his life than I have been.

Thursday, August 11, 2011

Need a Techie Guru's Help

We've set up three computers in our recent move. I almost hesitate to say that the SJCO Mac, my work computer, is the only one that works properly when connected via the wireless network to the internet because I don't want unhelpful comments like, "Just replace your PCs with Macs" because that's not a viable solution for our situation. Neither do I want a PC vs. Mac war. So, please limit your comments to suggestions I might actually be able to use to fix the problem. Thanks. On to describing the problem:

Paul set up his computer and checked his email. When he tried to go to any site not connected with Google, the sites wouldn't load. He did get Craigslist to load, once, but after he shut the computer down and rebooted it would no longer load. It doesn't matter what browser he's using.

I set up the office Mac and, once the first page loaded, which took longer than normal, everything worked perfectly.

When Paul set up my desktop computer, I experienced the same problem he's having with his laptop. My computer will not load any pages except gmail, etc.

Here's where it really gets weird. Paul hooked up his laptop using a LAN cable and it worked perfectly. When he unhooked it and tried it wirelessly again, the problem returned.

Anyone ever heard of this? Anyone have any suggestions?

Thank you all for taking the time to read and consider our problem.