This is a hard post to write for several reasons.
I'll start by telling you a little bit about what my recent bloodwork showed and then tell you how I've been reacting to this information below. Some of you may recognize yourself in what I'm about to describe, and if so, I encourage you to find a good NATUROPATH to help you with an evaluation. I recommend Dr. Trina Seligman in Bellevue for those of you who are local. (Evergreen Integrative Medicine). Most regular MDs would look at my basic labs and tell me to take a hike as far as more problem solving would go... They'd be thinking I just need to learn to put down a cookie now and then and stop trying to blame some kind of medical problem for my lack of willpower… But here's what I found when Dr. Trina took a deeper look.
My fasting labs before the Glucose Tolerance Test were all superb and normal! Yes, totally, UTTERLY NORMAL. And these labs were all taken before I re-started Phase 1 so they reflect the way I was eating in 'in the wild' while I was struggling to maintain the weight I'd lost.
Fasting Glucose: 82 (Normal: 70-99 mg/dl)
Fasting Insulin: 4 (Normal: 2-27 uIU/ml)
Hemaglobin A1C: 5 (Normal: 4.0-5.6 %)
Total Cholesterol: 207 (Borderline except that my HDL is 66 and my LDL is 122 - good ratios.)
Triglycerides: 97 (Normal: 40-149 mg/dl)
I have some hormone and inflammation marker imbalances consistent with PCOS, per usual for me. Otherwise my labs look fantastic. My only real complaint when I talked to my doctor was about my out-of-control urges to eat sweets and my difficulty sometimes controlling those cravings. Dr. Trina doctor knows me, so she didn't just dismiss my concerns the way regular medical professionals usually do. She knows my history with Ideal Protein, my success with weight loss, the fact that I'm a business owner and very disciplined in many areas of my life… She was open to the possibility there might be a physical cause rather than a failure of will-power, so she set me up to see what was happening to my glucose and insulin levels under the obvious surface.
And thank goodness she did. I am not sure how long I might have gone on pretending I just needed to work harder to manage my relationship with carbohydrates, rather than having the information I needed to understand my actual physical maladaptation.
To illustrate what she found, I'll recreate the graphs she drew for me at the appointment.
This first graph is what happens to a NORMAL person (a.k.a. a Metabolic Type A person) after ingesting a large dose of glucose and then having their blood sugar and insulin levels tested every hour for the next 3 hours.
NORMAL RESULTS / TYPICAL RESPONSE - FOR REFERENCE
The blue line in the above graph represents blood sugar. It usually rises up near 140 - at which level the nutrients in food are able to be converted to energy. Insulin is the hormone that delivers glucose from the bloodstream into the cells. As that happens, blood sugar gradually drops back down to normal - somewhere between 70-99, and the cycle begins again.
This next graph shows what happens when I ingest a large dose of glucose.
ABNORMAL RESULT - MY ACTUAL LAB NUMBERS (**I'm the RED line**)
My blood sugar only rose to 117 before it started to drop. 117 is far short of the range where I'd benefit from an energy boost from metabolizing my food correctly. Once it started to drop, it fell sharply to 54 - well below normal, safe levels. That's because my body released DOUBLE the normal range for insulin - a maladaptation caused by insulin resistance.
Insulin resistant cells have a hard time accepting the energy Insulin is supposed to deliver, so the body produces more and more to compensate. Excess insulin obviously works to lower blood sugar (too far), but when those sugar calories don't get absorbed for energy by the muscles, the body still has to stash them somewhere, so guess what? It stores everything the resistant cells can't burn as FAT!
This means my body, eating the same meal as a metabolic type A person, will store fat rather than burn it for fuel. I'll feel more tired and have less energy, and the blood sugar crash will cause violent, compelling cravings designed to help me survive what my body believes to be a life-threatening famine. Several times a day. Instead of getting high blood sugar associated with Type 2 Diabetes, I get low (hypo) blood sugar, hyper fat storage, and vicious cravings which keep the cycle going. Unfortunately, this cycle eventually leads to Type 2 diabetes, since the pancreas will gradually stop functioning effectively, leaving more and more glucose circulating in the blood.
Note: this test was based on a large dose of pure carbohydrate. Obviously my body does not react well to this. I equate it a bit to our country's dependence on foreign oil as a fuel source. The oil is what we're used to relying on, but it comes with terrible costs and compromises. Like pollution and terrorism. In my body, the costs of relying on carbohydrates for fuel are pollution (insulin resistance and fat accumulation), and terrorism (the vicious hijacking of my mind and physiology by cravings).
So, the obvious solution is to reduce the body's dependence on carbohydrates - and voila! Ideal Protein is the perfect way to lose weight, right? Well, yes and no.
Low-carbing is an obvious solution to Reactive Hypoglycemia. In fact, research shows that carefully timed feedings of low carb meals (with 5-6 hours in between to allow insulin levels to return to normal), and long-term keto-adaptation is the best strategy for reducing symptoms and managing blood sugar and insulin levels. However, for some of us, me included, just low-carbing in the classic sense isn't enough.
Some of us produce insulin based solely on the sensation of sweetness, or even just a vivid thought of sweetness. An insulin surge where there isn't actual glucose present is capable of dropping blood sugar to dangerous levels. I know I'm in this category after reflecting on a couple of incidents that happened to me last summer.
Trav and I stopped at a Mexican restaurant after going a little too long before eating. Of course they brought chips, which smelled great, and I ordered an Iced Tea - to which I added powdered Splenda. I felt hungry but fine when I sat down. I was in the food peace of Ketosis so I wasn't tempted to order anything off protocol. I was very thirsty so I quickly downed about 3/4 of my splenda sweetened drink. I remember it tasting *FANTASTIC.* (Now, that should've been a warning because the only things usually I find that tasty are carbs.)
Drinking the tea gave me a big surge of happiness. I remember it clearly. It felt like I'd had sugar. But then very quickly I started feeling strange. My head started pounding, I felt so tired I wanted to lay my head on the table. I felt dizzy, sweaty, nauseous… I grew up with a severely diabetic father, so I recognized the signs of low blood sugar and decided I'd better eat a few chips while I waited for my meal. I started to feel a little better. My meal of carne asada and mushrooms came, and I ate it, but it took a long time to feel better because there were no carbs in the meal to restore my poor crashed blood sugar level.
There were no carbs in the iced tea. But my body, based on my mind and my taste buds' interpretation of what I drank, acted as if I'd consumed something very sweet and released a surge of insulin designed to reduce the expected blood sugar. But there was no extra sugar to remove, so it crashed my already reduced level drastically.
Another time, we were walking through a mall and I was in food peace, having recently eaten. We walked by a cinnamon roll shop which was obviously pumping the scent of the freshly baked rolls into the nearby area. The smell made my body sing… My mind swam with extremely vivid images and memories of eating sweet rolls - in the way only scent can provoke. Within a minute or two, my stomach was growling and I was starting to feel ravenously hungry, shaky and my mind grew fuzzy. I had to eat the IP bar I had with me a couple of hours earlier than I had planned just to get through the experience. I know now what it was… My body released insulin at the THOUGHT of carbohydrates. My blood sugar which was already low because I was in ketosis plummeted through the floor and gave me a hypoglycemic episode. Thankfully I had a bar with me and was able to eat a solid meal shortly thereafter…
After thinking it through, I'm having to come to terms with the fact that my maintenance can't contain the exciting sweet alternatives that most people take for granted in Maintenance. Things like sugar-free syrup, candies, baked goods, drinks, fat bombs, and other treats that use alternative sweeteners will keep my insulin levels spiking and dropping - even if my blood sugar looks normal on lab tests. If I never even out my insulin levels, I'll still be on the road to Type 2 diabetes, even if I've done low-carbing *technically* right.
So I have two levels of reality to face. First, I'm Metabolism Type B and "normal" "balanced" dietary guidelines (designed by and for Met Type As) don't apply to me. On top of that, I'm in a further subset of Type Bs who can't even tolerate the artificial sweeteners that most Type B's can use to make low-carbing more enjoyable.
One of the things I used to tell my Phase 1 dieters was that Maintenance, if they took time to learn a few basic recipes, could be almost as delicious as their old way of eating. They could make sugar-free cheesecake that tasted almost like the real deal! They could have desserts using whipped cream, cocoa powder and splenda that contained virtually no carbs but tasted like chocolate mousse! Peanut butter can be made into amazing cookies using just granulated splenda and an egg - with less than 2 carbs each! I spun these examples to encourage them, and myself. Because the thing I miss most when low-carbing is the taste of sweetness.
Now I know that even the taste will keep my body spinning in metabolic imbalance, and keep me teetering on the edge of diabetes and health disaster.
For the last 2 weeks I've been going in and out of a rough emotional place about this. Essentially when I look at it, I've been experiencing the stages of grief.
Denial: at times my mind just wanted to reject what I knew this diagnosis meant for my future. I just didn't want to (couldn't?) really acknowledge the reality and found myself thinking I'd rather not have had the test done. I also found myself imagining I hadn't gotten it and that I'd just lived my life without knowing it -- and in my mind it all turned out fine. (Which I know it wouldn't).
Anger: I've felt a general "F*ck It!* attitude for the last couple of weeks, especially related to food. Rebellion is the word I'd use. I have totally abandoned Phase 1 and eaten loads of the very foods I know are absolutely slowly killing me and making my condition worse. My mind says, "Well, if I'm going to have to give this stuff up completely, I'm going to pretend for now that I didn't have the test or know the results. I'm going to eat like I don’t know anything is wrong." I've binged on sugar. I've gone overboard on artificial sweeteners. I've been existing in a toxic bubble of self-destruction and self-pity.
Bargaining: Before this diagnosis, I used to fantasize that if I were good enough, long enough at low carbing, maybe my body would switch to being "normal," (which I now know means Type A in my mind), and I'd be able to eat like Normies. With this next level diagnosis, now I'm fantasizing that someday my body might heal to the point where I can at least eat like other low-carbers! Suddenly I'm seeing that the sweet taste of artificial sweeteners is as sticky and addicting as sugar! I've always had it in my mind that it'd be ok to give up sugar because of all of the delicious sweet low-carb goodies I'll be able to have once I'm in maintenance. I didn't realize until I had to contemplate giving it up how much I rely on the sweeter IP foods in Phase 1, and my sweetened low-carb treats in Maintenance. I should be able to use those if I just… so many ways I may be able to wriggle out of this fate…
Depression: My house is a mess. I have wanted to sleep more. I'm not clinically depressed because I'm already medicated for that, but my energy is low. I want to focus on anything but work. I haven't wanted to talk (or blog) about any of it. I've been embarrassed at my acting out with food and with irritability…
Acceptance: I've been waking up at 3 a.m. (probably because I've been eating so badly) and googling RH to learn more about it. I've found some good articles and blogs from others who are managing it successfully. Maybe it won't be as bad as I think. Maybe this is part of my path and purpose -- there are SO MANY of us who suffer with this issue. If I don't know much about it, I'm sure many laypeople are even more in the dark. Maybe my personal journey with this will help someone else someday. Just like my own process with pre-diabetes, insulin resistance, PCOS and all of my other personal conditions have enabled me to spot and help my clients with similar issues… I'm becoming willing to be the guinea pig and pioneer to discover how to LIVE in a world that is different than most people's. I'm actually pretty used to that and getting kinda good at it. Maybe this will turn out ok…
My psychology background reminds me that this process of grief is not linear. I'll probably cycle back through each of those stages a few times as I come to terms with my new reality. But at least I've had glimpses of acceptance and know there is blue sky above the clouds of my emotional storm.
I've been sideways for about 2 weeks now but I'm working my way back to peace. It's simply reality. Simply science. Graphs and charts of cause and effect. It's not negotiable. Denying it or saying F*ck It and pretending I didn't just find all of this out doesn't change anything. I can't pretend anymore. I can't put the genie back in the bottle and dream of a day when I can have sugar free cheesecake for breakfast and it'll be just fine. My maintenance plan will be veggies, lean protein, healthy fats and occasional nuts, legumes and very low-glycemic fruit in small quantities. No diet soda. No xylitol gum. No stevia-sweetened iced tea. No intense sweetness.
Eleanor only semi-jokingly calls this a joy-free diet. She knows what she's talking about since she had to give up ALL dairy for awhile (which I think may have been harder than what I'm going to need to do). Dang, writing that just made me feel sorry for myself again. I think I may be popping in and out of grief for a little while here.
I'm fighting the voice in my head that says I should just forget all of this dieting stuff, I'll never win anyway, I may as well quit, close my clinic, disappear from 'life,' just hole up to play video games and eat what I want and deal with it all later. Except I know EXACTLY and in vivid detail what misery that leads to. I watched my Dad die from the consequences of that line of thinking. And I've promised myself I won't EVER give up like that. EVER! I will never, never, never, NEVER give up!
I'm getting my mind around restarting Phase 1 again. Ceasing my childish acting out and getting my self-pity under control. I have tried for a few days to make a beginning, only to fail mid-day or in the evening. But blogging this and telling you all the truth about what's happening makes me face the ironic ridiculousness of my reaction. I am starting over again this morning, with the wind of accountability once again in my sails.
I'm standing up to embrace all the wonderful, beautiful happiness and health in my life, and letting go of my false belief that I deserve to be like other people... No one EVER said this life was fair. Besides, I have so much joy in my life in so many ways! Avoiding carb-laden and sweet foods is such a small price to pay to enjoy and protect it. After all, I love myself. I love myself enough to treat myself well and make healthful choices for my future. I can do it kindly and with self-compassion. I can do it creatively and by filling my life with sweetness of other varieties. I can do it whether or not I prefer to… because that's what you do for someone you love.