Sunday, April 21, 2013

Hack Your Metabolism, Part I: Mindful Eating

Note: this post is part of a three part series I wrote. If you like these, consider contributing to fundraiser called the Tour de Cure. If this helps you or someone you love, please consider clicking here to see more donate to support my campaign on behalf of the American Diabetes Association. Thank you!

How to Eat?
This is some information, and some advice, about mindful eating. I briefly considered calling this post "How to Eat" because when I left my doctor's office on December 15th, 2006 an hour before lunch time with a diagnosis of Type II Diabetes (T2DM), it occurred to me that I needed to re-learn what to do about eating.

I did not think that I'd eaten my way into the disease - and I have some things to say about that, but not in this post - but I did know that eating differently would be part of managing the risk factors that the doctor had ticked off for me that accompanied T2DM: high blood pressure, good cholesterol low, bad cholesterol high, and of course chronic high blood glucose (BG) levels. These are chronic symptoms with deadly impact if left untreated. In the immediate term, I knew I had to eat in such a way as to control my BG levels. That was the key to preventing immediate vascular damage and, managing those levels over the longer term would bring my cardiac risk factors in line as well.

But how in the heck do you eat to manage blood glucose? Even as a well-educated person, I didn't know. Now I do know some things about it, and I think I can offer others some advice. I'll tell you how I learned and what I learned. And I'll share with you a theory or two about how you can use this information to get to or maintain a healthy weight, which is also a very effective way to manage cardiac and BG-related risk factors.

A disclaimer: this is not medical advice. It is just plain ol' advice. I am not a medical doctor. I'm a bio-hacker. I am a Ph.D. who has studied the research literature carefully and I actively manage risk factors related to T2DM in my daily life. You should always talk about your health and any plans to improve it with your primary care doctor. If you find that hard to do for any reason, seek out a new doctor. For those confronting a new diagnosis of T2DM, you may also find it helpful to see a certified diabetes educator. The American Diabetes Association has a finding tool that may help. If you are covered by insurance, your doctor may be able to prescribe an education program that your insurance will cover. These programs are clinically proven to improve outcomes in patients. They are good medicine.

Step 1: Pay Attention
By far, the most important thing you can do to make a change in your health related to eating is to pay more attention to what you eat and drink. And by this I mean that you should be able to account for everything that goes in on a given day. Every. Thing.

This is a challenge at first, so I recommend writing it all down: items, amounts, and time of day. You might have heard of a food diary? This is what we are talking about. The U.S. National Institutes of Health has a good format you can get for free. So does And there are lots of smartphone apps, etc. you can find too.

Eventually, you'll want to track carbohydrates as well if you are managing BG. To do that carefully, you'll need to read some nutrition labels. Those of us doing diabetes (rather than "having diabetes") count carbs 15 grams at a time, and we call each 15g one unit. This lets you figure out a "budget" for your meals and snacks that keeps your BG levels where they should be. More on that below, but first a bit about carbohydrates.

Q: What Raises Your Blood Sugar? (and what doesn't)
A: Carbohydrates are the only thing that directly raise your blood sugar.  Almost everything else you eat does not. (Fat is a bit more complicated, because it has a systemic effect that can mess with the signals your liver gets about the need for more glucose in the blood. And so eating a high-fat meal may well contribute to longer-term rises in blood glucose levels. But it is not a direct cause.)

Step 2: Get Data (You can't hack code you can't read)
Blood glucose meters
Used by permission of Flickr user DeathbyBokeh
Before my T2DM days, I had no idea how BG levels worked - what is normal? what foods raise them? does exercise lower them? And, like a growing number of adults in the U.S., I was walking around with dangerously high levels of BG without being aware of it. That began to change when I got a glucometer. A glucometer is a device that measures the amount of glucose in your blood at any given time and gives you a simple number back: N milligrams of glucose per 100 milliliters of blood.

Now the reading you get from a glucometer doesn't tell you how well you are doing over the long term at managing your BG or those nasty risk factors I mentioned. It can only tell you what's going on in the moment. And the levels it reads are subject to all of the metabolic things going on right then and immediately before you test. So if you just ate a high-carb meal, your BG will be elevated no matter who you are. After a couple of hours, the body should adjust BG levels provided that that person's insulin response is normal. For those with DM (of any sort), it may take more time and more direct intervention to make that adjustment.

Get a glucometer and learn to use it. Test yourself a lot and write down the results. Chart them too if you know how to do that (see example below). When you first start, test more often. This will be expensive because the test strips are a huge racket. That's yet another post... But your doctor may be able to up your Rx for these as you first learn to manage your symptoms - ask for more - ask for lots of free samples too. The more data you can get the better in the early going.

Q: What is "Normal" BG?
A: Not to be evasive, but that's a difficult question if you read the stuff above. Why? Because it depends on when you test and what happened before that. Did you eat? Did you run a mile at a brisk pace? Your body dynamically and rapidly adjusts levels of BG to respond to the need for energy (or the lack of it). This "insulin response" is complex and involves multiple systems: nervous, digestive, endocrine, circulatory, musculo-skeletal. So normal is different for different people. What doctors agree on, though, is that after an 8 hour fast, normal adult BG should be below 125 g/ml.

Step 3:  Work the Trends
Once you can account for what you eat and test your BG, you can start to see trends. These trends can tell you how what you are eating affects your BG. Over the long term, they can also tell you if you are doing what you need to do to manage risk factors. There is another very important test for that called an HbA1C that is the gold standard for diagnosing DM, including T2DM. These are done every three months and they give you an extremely accurate measure of your blood glucose levels over that period of time. If you haven't had an A1C and your doctor is prescribing diabetes-related medications, go ask for one. It is essential information for managing your risk-factors.

But back to those should be able to produce a picture that looks something like the one below. Have a look and then we'll talk about why this picture is valuable for losing weight (yep, I said it)...

First, let me say that these are made up numbers. But they are reasonable and not uncommon for me today. They track BG every waking hour of two fictional days. The red line represents a day when I eat in a way that manages BG well. I stay in a zone between 90 and 130 BG. This level, by the way, corresponds with an HbA1C in the normal range over three months (below 6).

Here's another fascinating fact...the red line also stays inside the green zone, which is a "sweet spot" in my own metabolism when I lose weight (if I am trying to do that) or maintain a healthy weight (if I am trying to do that). To maintain weight, I need about 75 minutes of moderate exercise per week with one or two short intervals (15 minutes) of intense activity thrown in now that I am very fit. To lose weight, I would double that to 150 & 30 minutes. Do that, and the lbs. come off at a rate of about 1.5/wk unless I eat differently or exercise less.

So what is the blue line? That's a strategy I see lots of people trying when they are "on a diet." Follow goes like this: wake up a bit low, but not overly so, and have only coffee for breakfast maybe with a touch of cream. BG stays below 90. Stomach grumbling, you eat one little thing from the candy bowl at work at 10 (17g carbs, one unit). Ridden with guilt, you eat only a salad and an unsweetened ice tea for lunch. BG continues to slide through the afternoon until you are starving at dinner. You've been "good" all day though, so you eat a low-fat meal of pasta primavera with garlic & olive oil only, some garlic bread, and a glass of wine. You also have two thin mint cookies for dessert. BG goes up after dinner and as you watch TV you can't resist a couple more cookies before you turn in. All in all, it's been a successful diet day. Or has it...

How much time do you spend in the zone on that kind of day? Not much. Compare that to the red line which goes something like this: Breakfast 2-3 carb units. Lunch 4 carb units. Dinner 4-5 carb units. After dinner snack 2 carb units. With that "carb budget," I'm in the zone all day.

I'll offer some more thoughts about what this zone is and why being at that level is likely good not just for folks with T2DM but for anyone trying to lose or maintain their weight in Part II when we talk about exercise.

Like what you read? Feel free to share, make comments or ask questions below. Also check out my Tour de Cure fundraiser here and consider a donation! Thanks!

Tuesday, April 16, 2013

Fight Cancer & Diabetes at the Same Time!!

Hey, you hate cancer, right? Me too!!! I'm ambivalent about the Diabetes, as you might have read. It's not that I think everyone should have it, or even that it is a good thing to have to deal with it. But for me personally, doing diabetes (not having it) has helped me to become a much more healthy person.

But cancer, well, with cancer there is no such equivocation. There are unbelievable things about cancer as a disease, but none of them are good. And so when I come across ways to fight cancer AND fight diabetes (or help others do those things), well I simply can't pass those up.

So there's this guy who calls himself The Fat Cyclist, or Fatty for short. His real name is Elden, and he is a great human. He and I have a lot of things in common (see what I did there?). He used to be a tech writer. I teach tech writing. He works in the software industry, so did I (and do still, even though I'm also a professor). He's hilarious. And I'm hilarious! Also, both of us are good with a joke.

But the thing that is perhaps not so obvious: we both have before and after shots that look something like this:
Yep, that picture on the left is me as a fat cyclist, small "f," small "c". About 70lbs heavier, to be precise, than the me on the right. More importantly, that picture on the left is me as a cyclist with all the Type II diabetes risk factors over the limit in the red zone. Blood pressure, lipids, blood name it. Today, I manage all those risk factors with my bike as the most important arrow in the quiver. Ok, who are we kidding: bikes. There are, uh, lots of bikes. But no prescription meds. No metformin. No ACE inhibitors. No statins. No beta blockers. Just me and bike and reasonable restraint on the eating side (mostly).

Change Your Life or Someone Else's
So me and Fatty, well, I like to think we understand one another. Fatty lost his wife Susan to cancer. My wife and I lost her Father and a dear friend of ours to cancer in the same year. That friend, Vic, also had T1 diabetes. My Father is fighting cancer now. When you love somebody fighting cancer, you are by turns grateful for and furious with the available weapons - clinicians call them "interventions" - for the battle. There are, on the one hand, many. But never enough. They've come a long way. But not far enough or fast enough. See cancer, as a disease, is especially insidious because it is a problem with the very way our bodies heal: by growing new cells. Cancer grows, changes, and adapts. And for any one person, it does this faster than we can develop new interventions to throw at it.

Not so, diabetes. Diabetes is also a disease concerned with the very fundamentals of our existence: how we process food into energy that our cells can use. But for most patients - T1 and T2 and other variants - there are things we can do to manage symptoms and, especially, to manage the other risk factors that are life-threatening. We can fight. And for some of us who get diagnosed early enough with T2, we can do a lot to fight back.

I took the whole thing very personally. I did not see a way to NOT fight my T2 after watching people I love die of a disease they had very few options to fight. And I'm still fighting. But not just for myself.

Fun(d) Raising
Since 2007, I've been raising money for Diabetes research. And I'm doing it again this year. I do it by...surprise!...riding my bike. In a ride called the Tour de Cure. You can donate to my campaign for the June 2013 ride here. Last year, we raised over $3,000! All told, I've raised a bit more than $10,000 for the American Diabetes Association.

To boost that effort, I've also been doing a crazy ride that Fatty dreamed up that supports a cancer charity called the 100 Miles of Nowhere. Here's what I did last year: 3000 laps of my circle driveway (almost...see the link). That little stunt got me on Fatty's blog and in the list of crazy people doing crazy things. And I'm fixin' to do that again.

You can help me pick the route! Go here to vote. And drop back by here to find out the winning route!