Low Carb Pregnancy

Should you...or shouldn't you?

There is a lot of chit chat on the old world wide web about whether your low carb lifestyle should be abandoned when you get pregnant.  When I was pregnant, I remembered wondering whether my dietary choices would have to change as a result of my growing baby bump.  There was little information out there.  Imagine my surprise when I stumbled on dietary advice on this exact topic from a long-time low carber and registered dietician, certfied diabetes educator, etc., Valerie Berkowitz, M.S., R.D., C.D.N., C.D.E.

Not only does Ms. Berkowitz have the credentials and experience to give this kind of advice, she practiced this advice when she was pregnant with twins, with excellent results.  

So, I won't keep you in suspense.  In her 2002 article, A Mother-to-Be does Atkins, Ms. Berkowitz discussed following the Atkins Lifetime Maintenance Plan during her pregnancy.  She describes her daily dietary intake as about 100-150 grams of protein, 70-90 grams of carbs, and approximately 1,800-2,000 calories per day.  Notably, she gave an example of a typical daily menu during pregnancy,  and it appears that she got most of her carbs from fresh, whole fruit and vegetables, not from starchy stuff and refined sugars.  

Are you in the midst of a low carb pregnancy?  Want to add a few healthy carbs to your diet?  Check out this article about the top 25 healthiest fruits for you to eat, along with a description of their nutritional value and benefits.  

What about a smoothie?  

Combine 1/2 large banana, 1/2 peach, 1/2 cup of fresh strawberries, 1/2 cup of fresh blueberries, and 1 container of Fage full fat plain yogurt, and blend.  Add water and a little Truvia to sweeten if needed.  

You will end up with about 43 grams of net carbs, good protein, probiotics, a ton of dietary fiber, and more micronutrients than I can possible count...

You know what, make that 2 smoothies, and you've hit your daily carb allowance for pregnancy.  Good on you, Mama!

LCHF Creamy Chocolate Coconut Shakes

LCHF.  It stands for Low Carb High Fat.  Historically, I have focused on the "Low Carb" portion of this WOE, because that is the most challenging part for me (and for most of us on LCHF) to comply with, as we typically start off with a serious carb addiction. "High Fat", however, often gets shunted to the wayside, either because it seems effortless, or because we think that we are already eating an acceptable level of healthy fats, or because some of us still have the "fat is evil" mindset lurking about upstairs, especially when it comes to saturated fat..

Dietary fat is not evil.  Regular consumption of varied, healthy and good quality fat is good for the body, and delicious.  Saturated fat, in particular, is important for your health.

So, don't do yourself a disservice and hyperfocus on "Low Carb".  Make it your goal, this week, to make sure you get a little more "High Fat" in your diet.

One delicious way to achieve this goal is to blend up this week-supply of Creamy Chocolate Coconut Shakes and have one serving everyday.  Savvy readers may notice that I have repurposed and adjusted my Coconut Vanilla Custard Ice Cream recipe to make this shake.

Here's the recipe:

LCHF Creamy Chocolate Coconut Shakes (about 6 servings)

Ingredients

3 cans regular unsweetened coconut milk;    
¼ cup high quality unrefined, organic coconut oil
1/3 cup truvia
Pinch salt
5 large egg yolks
4 oz chopped unsweetened chocolate (I use Callebaut)
2 teaspoons good vanilla extract

Directions

1. In a medium saucepan set over medium-low heat, whisk together the coconut milk, coconut oil, truvia, and salt. Bring the mixture just to a boil.
2. While the coconut mixture is heating, whisk the egg yolks until pale and aerated.
3. Once the coconut mixture has come to a slight boil, whisk about 1/3 of the mixture into the yolks.
4. Add another 1/3 of the mixture to the yolks, whisking quickly, then return the combined mixture to the saucepan.
5. Using a wooden spoon, stir the mixture constantly over low heat until it thickens slightly and coats the back of the spoon, about 2-3 minutes. Do not boil or the eggs can coagulate.
6. Place chopped chocolate into a large bowl.  
7. Pour the mixture through a fine mesh strainer into the bowl, and let sit for 2 minutes, until chocolate begins to melt.  Stir to combine.
8. Cover with plastic wrap, and allow to come to room temperature. Stir in the vanilla extract.
9. At this point, I usually put the shake mix into a tupperware container and refrigerate.  It will firm up in the fridge a bit.
10. Then, when I want to make a shake, I will scoop about 6-8 oz of the shake mix into a blender with a couple of ice cubes and blend until frothy.  

This is a very versatile recipe:

I found that the shake base, straight from the refrigerator, has a delicate mousse consistency that is very nice to eat with a spoon for dessert.  

A dollop would also be well-placed on top of my LCHF chocolate cupcakes.  Just make sure to serve right away, as the shake mix will loosen up at room temperature.

As well, you can heat the shake mix until steamy (don't boil) for a very decadent hot chocolate.  

Last but not least, you can always throw the cooled shake mix into your ice cream machine (per manufacturer's instructions) and let it go for 20 minutes, to turn it into frozen custard.  

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!