Fasting Glucose is Down!

My fasting glucose was 103 at 6:30 a.m. today!
Hooray!  I tested at 2 a.m. (when I woke to use the bathroom), and it was 105.

What did I do differently?  How can I duplicate these results!  I am wracking my brain to figure it out!!

Acupuncture on Monday and Chinese herbs (Rehmannia 6) twice daily.  Check.

Metformin 500 mg in the morning.  Check.

Last night we ate an early dinner (5 - 5:30).  Nutritionally, dinner was mostly fat (salty organic butter; homemade pesto) and protein (about 10 oz of shrimp, sauteed in the butter).  I also had a serving of sauteed broccoli mixed with the pesto and a few bites of pasta (just a few. don't shoot me.)  It was probably about 5 grams of carbs.  Check.

I took the Rehmannia 6 at about 8.  Check.

I had a late night snack at 9.  Nutritionally, the snack was basically all protein and fat: about 3-4 ounces of leftover steak cooked in homemade tomato sauce, with a tiny dollop of mayo, all mixed together and eaten cold.  (Sounds gross, but totally delicious).  Check.

Metformin at 9:30.  Check.

Also: I am drinking water at night.  No alcohol.

Will keep you all posted!!

Tongue Chronicles: Are We All Yin Deficient?

Yin.  I didn't even know what that was until a week ago.  Now, it's got me thinking.  Here's the story.

As many of my dear friends and readers know, I have had endocrine issues for years, starting with obesity at age 9, transforming into gestational diabetes during my first pregnancy in 2007.  The saga continued in March 2010, when I was diagnosed as "pre-diabetic" by my MD, following an oral glucose tolerance test and HbA1c.  I was put on metformin and monitored, but with no healthy diet changes yet made, my numbers did not change much.  

Fast forward to January 2011.  I started LCHF, and noticed dramatic improvements to my health and well-being.  Among those improvements was a change in my HbA1c and daily blood glucose readings for the better.  

Fast forward to the present day, and labs from my last two PCP and endocrinologist appointments have come back with a "normal" HbA1c.  I give all of the credit to LCHF.  Carb restriction is the way to go, without a doubt.  There is no better diet to help control your blood glucose.

However, for many of us who have a history of metabolic and endocrine disorders (Diabetes, Obesity, PCOS, anyone!?), diet is not enough to get your glucose down to where it needs to be.  This has certainly been true for me.

I take blood glucose readings pretty regularly with my glucometer, at home.  While adherence to a LCHF diet has improved my glucose readings tremendously throughout the day, I am still getting high glucose readings in the morning.  This is frustrating and confusing, because I fast during the night when I sleep, and so why in the heck would my fasting glucose at 7 a.m. be the highest of the day??!!  

I tinkered around with the timing of dinner, and found that earlier dining and no snacks aftert 7 p.m. helped to get my fasting glucose down from 139 to 117, on average.  That's still too high for me.  I am a young woman who is interested in having more children, and the American College of Obstetrics recommends that fasting glucose be below 100.  

There are a lot of theories, including the Dawn phenomenon and the Somogyi effect, to help explain why fasting blood glucose is so high in some people.  The Dawn phenomenon essentially posits that counterregulatory hormones (growth hormone, cortisol and catecholamines) cause the glucose level to rise overnight. For people with diabetes who do not have enough circulating insulin to keep this increase of glucose under control, the end result is a high glucose reading in the morning.  The Somogyi effect can be called "rebound hyperglycemia", and essentially posits that diabetics become hypoglycemic during the overnight period, and the body seeks to protect itself by releasing hormones that create glucose, in response to dangerously low levels of blood glucose.  One way to determine if either of these things are happening to you is to test your blood glucose at 2 a.m.!  That sound great!  Not.

So, I drew this conclusion: fixing my diet is not enough to get my blood glucose completely in control.  There is more going on than meets the eye, and it has everything to do with unresolved hormonal issues. 

I have made an appointment with my endocrinologist, and will see him tomorrow.  He will undoubtedly prescribe me some form of long-acting insulin to take before bed, to keep me low for the morning.  I can do this.  I have done it before.  I will do it now, if need be.

I ALSO started seeing an acupuncturist (is that the right word?), for the first time, last Monday.  He took one look at my tongue and diagnosed me with a chronic yin deficiency.  Apparently, I have a cracked tongue (not a split tongue, thank you very much), and TCM (Traditional Chinese Medicine) dictates that a cracked tongue indicates yin deficiency, you know.  Here are some creepy photos of yin-deficient tongues for your enjoyment.  

Here are some of the apparent symptoms of yin deficiency:

• Afternoon mild fever
• Night sweating
• Five Centers Heat
• Scanty, dark urine
• Dry stools, no pain
• Thirsty, with no desire to drink, or just in small sips
• Dry mouth and throat at night
• Mentally restless but tired, vague anxiety, fidgety
• Defensive
• Frequent waking during night
• Red line inside eyelid
• Mild red, painless spots
• Overextended
• Red cheeks;
• Tongue is red with little coating, peeled, and possibly cracked
• Rapid pulse.

I have several of these symptoms.  Interestingly enough, I happen to have mild, red, painless spots - my dermatologist calls them guttate psoriasis.  

This is Rehmannia.
Pretty, but unpalatable.

So, the acupuncturist is treating my yin deficiency with acupuncture (which doesn't hurt) and vile Chinese herbs.  "Herbs" is a very benign word, and cannot begin to conjure up how disgusting the prescription really is.  Called "Rehmannia 6", though they typically carry this in capsule form, the office was out this week, and I had to take the powdered version, ten tiny spoonfuls each day.  It is like eating lemon-scented sand.  Just as gross as you can imagine. There is literally no way to prevent myself from gagging.  Ugh.  

But, how do I feel?  

The answer: Pretty good.  

This Chinese medical treatment is definitely having a diuretic effect on me, which is good because I was feeling kind of bloated.  I feel less thirsty, and my water output is up.    My fasting glucose readings haven't changed much, though I did just have a 114 reading on Wednesday, which is the lowest I've seen in a while.  

Here's the skinny on TCM: for those of us who are used to Western medicine, TCM sounds a little crazy.  Yin is substance, yang is energy.  Yin is damp, yang is hot.  I need more yin-derived dampness to tamp down my normal levels of hot yang...  Odd, and a little dirty?  Just me?  Okay.

Sound a little wacky to you?  Think again.  

Check out this 2003 article from the journal Endocrinology (link is to the full free .pdf version).  On page 3752, there is a diagram which depicts leptin and ghrelin as yin and yang, respectively.  When in balance, yin/leptin and yang/ghrelin "maintain an appropriate and tight regulation of body weight and food intake".  When out of balance, obesity, anorexia and cachexia result.  

I'm giving TCM a chance.  What about you?

I'm pretty sure that I'm not going to post pictures of my tongue.  Let's keep it classy, world wide web!

Fat People Only Gyms? Not for me.

Check out this recent article in Time about a gym that has banned skinny people from exercising there. I read about this phenomenon in a Fitday article, where the question was asked, would such a thing be helpful or harmful.  I "weighed" in.

Here's my gut reaction:

It is a stupid idea.  What happens when that woman who is 50 pounds overweight loses her 50 pounds?  Will she be kicked out on her now-slender keister?  

No gym can sustain its existing clientele if the clientele's achievement of their health and fitness goals will mean that they are no longer welcome at the gym, either expressly or impliedly.  

It is a gimmick.  I suspect that these gyms are banking on the presumption that these overweight women will never reach their weight goals.  Now, that's a gym you can trust.  That's a promise of success you can believe in.  Not.

I am a woman who is carrying 50 extra pounds.  I go to a gym that is very inclusive.  I started going about 30 pounds ago.  Fat, thin, old, young, male, female - it doesn't matter.  Am I intimidated sometimes because I am not as athletic as some of the other people in my gym?  Certainly.  I am the kind of person who trips walking up the stairs.  But that's my issue, and I have to deal with it.  I am fat, and I am working on it, as evidenced by the fact that I am at the gym in the first place, sweating and panting.  I am not ashamed to be there.  

When I started, I would go to the gym first thing in the morning, to get the hang of working out before the gym got too busy.  I go now whenever I want to.

If you are big, and you want to go to a gym, enroll in one that you can afford and that will provide you with the resources that you need.  Meet the people who run the gym before you sign up, and if they treat you poorly, don't sign up.  Hold your head up and be proud, because you are trying.  That is half the battle.  If you try long enough, you just might be surprised at the results.  Just do it.

What do you think?  

I am not trying to be harsh, here.  I'm guessing that there are a significant number of obese people out there who would be comforted by a segregated gym.  It's just that segregation rubs me the wrong way.  

If you are an obese person, you are probably a very tough and strong person, because you have dealt with years of discrimination due to the extra weight you carry.  We both know that it is not easy being fat.  In our culture, FAT = LAZY and UNDISCIPLINED.  I've been there.  It is heart-breaking.  

Guess what?  It is not true.  If you are reading this blog, it means that you care enough to want to make a change in your health.  Exercising, no matter whether inside or outside of a gym, means that you are not lazy and undisciplined.  Watching what you eat means that you are not lazy and undisciplined.  Be proud of yourself for giving good health a try.  Remember that those thin people have probably never had to walk a day in shoes like yours.  

Face the world with your head held high.  You belong no matter where you go.  Most of the thin or athletic people you would see in the gym aren't even thinking about you.  If they knew you, they would be proud of you for trying.  They may not care whether you succeed, but they don't want you to fail.

Don't let fear motivate you.  Don't let it become just one more excuse for why you shouldn't help yourself.  

Do go and see your doctor before you begin a new fitness or diet regimen, and get their input.  You may need some extra help or oversight at first, and they can advise you of that.  

LCHF Recipe: Philly Cheese Steak Lettuce Wraps

I am enamored of lettuce wraps.  They completely rock.  I had my first one at California Pizza Kitchen - thai chicken and shrimp.  Yum.  Since then, I've been completely hooked.

Here's the basic technique: you saute finely chopped veggies, meat and then add some kind of sauce to bind the mixture into a not-too-drippy filling.  You then scoop the filling into an iceberg lettuce leaf.  Hold it like a wrap sandwich, and eat it.  I've done this with a bunch of flavors, including my own take on Asian chicken (very close to CPK's version), and traditional taco meat with toppings.  

Last night, we used the lettuce wrap technique to help us finish about 8 oz of left over rib eye steak from Monday's dinner.  It was so good, I took a picture (it tasted better than it looked, but you could pretty this up with some chopped scallions or something).  

Now, I'm sharing it with you.  

Here's how the recipe goes.  It will serve 2-4 people, depending on how hungry they are.  It would also be a phenomenal filling for stuffed mushrooms, if you are having people over.

Ingredients:

• 2 tbsp butter
• 1/2 yellow onion, diced
• 1/2 red pepper, diced
• 1/2 cup mushrooms, diced
• salt and pepper to taste
• 2 garlic cloves, finely minced
• 8 oz left over rib eye steak, chopped
• 1 tbsp mayonnaise
• 1 tbsp sour cream
• 1/2 cup shredded cheddar cheese
• 1 head of iceberg lettuce, lettuce cups carefully removed

Directions: 

1. In a large skillet, melt butter over medium-high heat.  Add veggies, sprinkle with salt and cook, without browning too much, until veggies are soft and aromatic.
2. Add chopped steak to the skillet, and stir to combine.  Continue to cook until the beef is heated up.  
3. Turn off the heat.  Add the mayonnaise, sour cream, and shredded cheese, and stir until thoroughly combined and cheese is melted and well incorporated into mixture.
4. Serve immediately in lettuce cups.  Delicious!