The Case for Low-Carb Diets

Sticking this here mostly so I won’t forget to read it:

http://www.nutritionandmetabolism.com/content/2/1/16

One More Thing

I forgot to add this to my list of good effects of the diet.

My feet don’t hurt when I get out of bed!

For the past several months, when I eased my (formerly) 160+ pound body out of bed onto a pair of feet that are designed to bear 120 pounds, my feet protested.  Of course, as long as I wear proper shoes, my feet are pretty stoic – they would get over themselves pretty quickly and support me, without (much) pain, throughout the day.  But first thing in the morning, you could almost hear them shout, “An extra forty pounds again?”

It’s impossible for me to be believe that a 6-pound weight loss really helped with that.  There must’ve been some carb-induced inflammatory response going on, one’s that’s cleared up in 2 weeks of carb restriction.

2 Weeks

OK, it’s been two weeks on the low-carb diet, and here are the results:

• I’ve lost 6 pounds.
• Those jeans that Land’s End sent that were a little too small fit now.
• Those jeans that Land’s End sent that fit just right are a little loose now.
• Those jeans that Land’s End sent that were a little loose are even looser now.  (Yes, all three pairs were the same style and supposedly the same size.  I credit the fine Malaysian craftsmanship.)
• No cravings for sugar, bread, pasta, potatoes, etc.
• Caffeine now makes me nuts, so I quit cold turkey with no bad effects.
• I’ve gone for a walk just about every day at lunch, plus my 2 25-minute walks to get to and from work.
• The neuropathy in my hands is better, though not totally gone.
• My energy level is more consistent – I can walk for roughly an hour a day and still have energy for chores, gardening, and unpacking (current task – hundreds of books).
• I’m sleeping better, and probably as a consequence, needing less sleep.
• My concentration has improved slightly.

It’s too soon, of course, to know whether this is having any effect on PCOS, but as I continue to read more and more about PCOS, the link between insulin resistance and PCOS becomes stronger and stronger in my mind.

 Your mileage, of course, may vary.  But I’m still kicking myself for ever getting off the low-carb diet in the first place.

Finally, Not Hungry

Finally, the low-carb diet’s appetite regulating effects have kicked in.  It’s been over a week.

Usually I notice this effect after two or three days.  I must’ve had a huge amount of stored glycogen or something.

Today I ate 2 eggs for breakfast, a chicken kabob salad from the chicken lady for lunch, and a couple of ounces of cheese for a snack.  Half the time I’m jonesin’ for some kind of sugar fix around this time of day, but not now.  I can’t even believe that I ate some of that stuff.

I’m making some sort of sole recipe for my husband (and of course, myself) tonight.  I’ll cook a few potatoes for him, some green or yellow squash with cherry tomatoes for us both.

I won’t say my mood has improved much since last week - woke up crabby and took it out on everyone around me.  But I do feel better this afternoon than I did this morning, and maybe I just need a good night’s sleep.

Why Women Have More Migraine Than Men

Check out this post on The Daily Headache, and make sure you follow the links to all the articles that Kerrie references there.

Very interesting.  I wonder if the cortical spreading depression explains why inderal – which supposedly makes the adrenalin receptors in the brain less excitable – prevents migraine.

By the way, I’ve been on inderal for 77 days now, and no migraine.  It’s supposed to be hot and muggy this weekend, though – not looking forward to the washed-out inderal feeling.  At least I know enough to stay away from booze now, or at least limit myself to one drink, and my husband and I have plans for a movie with a friend, so there’s a couple of hours of air-conditioned bliss in our weekend.

In any case, if the choice is between feeling a little slow and tired for a few days during the summer (it’s seldom unbearable in Boston) and skipping alcohol, or losing at least half a day twice a week to migraine, it’s pretty much a no-brainer, isn’t it?

A Little Bit Hurts – A Lot!

I decided today to take a simple Miss Manners approach when offered foods I don’t eat anymore:  a simple “No, thank you.”

If I say the foods have been banned by my doctor, or that I’m avoiding them for my health, I frequently get some variant of “A little bit won’t hurt.”  A friend just e-mailed me and the hostess of a small dinner party we are both attending tonight, offering to bring a pie.  This does not bother me; let other people eat dessert if they want.  But what does bother me is that the friend tacked on the comment, “Perhaps you’re feeling up to a bit, Migraineur?”

Makes it sound like I have some acute illness, like food poisoning, instead of a chronic health condition.

No, I’m not feeling up to a bit.  I will never feel up to a bit.  A little bit will hurt.  It will send my blood sugar way up, and then way down; I’ll start craving more sugar, and it will make it really difficult for me tomorrow when I have to try to get back to my healthy diet.

No matter how much I explain this, people still want me to eat things I know I shouldn’t.  I wonder, if I had full-blown diabetes instead of a condition that indicates a pre-diabetic state, would people who knew this offer me “a little bit” of pie?  I hope not, but I suspect they would.

So I’ve decided to quit explaining, quit arguing, and quit justifying what I choose or do not choose to put in my mouth.  Miss Manners is right – a simple “No, thank you” is all that is required.  If I have to repeat it 12 times, so be it.

What really hurts is when the person urging me to just have one bite is a close friend or family member.  Strangers, coworkers, and casual friends are more easily forgiven, but people who are close to me – what’s up with that?  They have heard the stories, over and over, of how low-carb worked well for me, how I never felt better than when I was on a low-carb diet, and they are well aware of the diabetes that is rampant in my family.  I have to wonder — are they trying to kill me?  And why?

The Death of an Excuse

I have been telling myself that one of the reasons I’ve lapsed so much from low-carb is that the food choices near my office are so abominable.  There’s a Souper Salad across the street with a big salad bar, but the only two meat choices are that dreadful processed chemically treated “smoked” turkey, which I wouldn’t touch with a pitchfork, gloves, and a biohazard suit, and salami, which I like, but not every day.  There’s an Au Bon Pain, which serves a number of salads topped with chicken breast, but the chicken isn’t much better than deli smoked turkey – I’m pretty sure it’s injected with a “marinade” that is mostly chemicals.  There’s Davios, in the lobby of our building, but they mostly sell pasta, sandwiches, carby soups, and salads with little or no protein.  I’m aiming for 14 to 21 grams per meal. and the teensy sprinkling of hard-boiled egg and bacon bits on their chopped salad isn’t nearly enough.  (Davios, by the way, is the lunch place that is most likely to trip me up.  Their pasta, especially their mac-n-cheese, is wonderful, as are most of their sandwiches.  Alas, this is a love affair I have to end.)

Then there are a number of sit down places, and I’m sure I could get a salad topped with a real chicken breast or some sliced steak, or a hamburger without the bun, or some such thing.  But who can afford to do that every day?

I could bring my lunch from home, but buying lunch is a hard habit to break, since I’ve been doing it since 1992.

Today I realized – wait a G-D minute.  I get an hour for lunch.  Newbury Street is only a little further away than some of these other places.  Surely there’s somewhere on Newbury Street to get a decent takeout lunch …

So off I set.  And let me tell you, Newbury Street is not, in fact, a hub for takeout.  It’s mostly sit down restaurants, though I did find a sushi place that has a kind of pricey sashimi platter for takeout – maybe I’ll do that some day for a treat.  Finally, I ended up at Deluca’s Market, where I got a small salad at the salad bar, and bought a little over half a pound of sliced roast beef from the deli, and bought some plain unsweetened Greek yogurt and an avocado for snacks.

The round trip took me forty minutes of my lunch hour, but that was nearly all walking, which is a good thing.

Maybe tomorrow I’ll go over to Downtown Crossing, also a 20 minute walk, and order lunch from the Chicken Lady, this wonderful Armenian woman who makes chicken kabobs that are to die for.

So, yes, there aren’t very many good choices with a five-minute walk from my office, but I can expand my reach, can’t I?  I should be getting more exercise anyway.

Slowly Killing Myself

I had my appointment with Dr. Fellow and Dr. Ovary a few days ago.

Dr. Fellow seemed to be a bit younger than me (I’m 38), but not young enough to make me nervous.  Still, knowing that she was a fellow, and therefore still in training, one part of my strategy for getting the most out of the visit was to make extensive notes about everything I wanted to discuss - how the recent migraine relapse led me to look for a connection to my menstrual period; how that, in turn, led me to realize that my periods, once like clockwork, had become very irregular and further apart; my bizarre family history, including my grandmother’s menopause when she was around my age; the weird little beard I used to spend all my time plucking, until I finally gave up and started shaving … everything I could think of.  I used my subway ride that day to make the list; it covered a full page in my smallish handwriting.

I needn’t have worried; Dr. Fellow is nothing if not thorough.  She and Dr. Ovary are at Mass General, as is my primary care physician, so Dr. F. had already read my PCP’s case notes about my migraines.  She asked a ton of questions, listened carefully to the answers, and even took some time to get the details of my adoption – important for understanding family history – straight.  (In theory, it’s quite simple – my birth mother died when I was a baby; her sister adopted me; I knew my biological father but didn’t know his family all that well.  But in practice, this really complicates filling out family history questionnaires – my adoptive mother had Type 1 diabetes, but she’s really an aunt.  My sister has a thyroid condition, but she’s really a cousin … and, sadly, I couldn’t tell you my paternal grandmother’s name, much less what illnesses she suffered from or when she died.)

By the time Dr. Fellow was done, she’d already covered everything on my notes page (and several things I hadn’t thought about), except the one burning question – my fear of early onset perimenopause.  She cleared that one up pretty quickly by looking at the results of some tests my PCP had ordered back in June.  My FSH level was normal for that point in my menstrual cycle, and FSH, apparently, is the test for perimenopause.  FSH is one of the hormones that signals to the ovary that it’s time to ovulate; when ovulation occurs, the ovary also produces estrogen, and estrogen tells the pituitary, “OK, I ovulated, you can stop making FSH now.”  If ovulation does not occur, the pituitary keeps making more and more FSH, so FSH levels are elevated.

At this point I thought of insulin resistance as an analogy - when the insulin receptors wear out, blood sugar continues to be elevated in spite of the presence of insulin, and the pancreas keeps pumping out more insulin, because blood sugar levels haven’t dropped, so there’s no signal for the pancreas to stop …. The endocrine system seems weird and wonderful and very finely tuned, doesn’t it? 

Dr. Fellow acknowledged that this meant that I had ovulated in June but didn’t mean that I had ovulated in every cycle.  So she ordered another FSH test, as well as the usual alphabet soup of endocrine tests.

Then came the dreaded question about my weight.  Like most overweight people, I hate discussing my weight with my doctor.  With me, the discussion is complicated by the fact that the only weight management strategy that ever worked for me was Atkins, but most doctors seem to be convinced that Atkins is a slow form of suicide.  And it’s even more complicated lately because psychologically I haven’t been able to get my mind around Atkins.  I know I should limit my carbs; I know I should not have pasta for lunch every day; I know that, when the Red-Haired Boy made cookies last week, it would’ve been best if I hadn’t eaten any, and if I had to sample them, I should’ve had just one.  Why, then, did I eat four before dinner the night he was at guitar class?

So, when Dr. Fellow asked about my weight, I told her, reluctantly, that I’d lost and gained back the same 20 pounds twice in the last 5 years; that the only thing that ever worked was “carbohydrate restriction” (see how cleverly I tried to avoid the loaded terms “Atkins” or even “low carb”?), and that it really wasn’t as bad as it sounded.  I was about to say all it meant was that I ate meat and vegetables and a little fruit, when she said, “Oh, yeah, Atkins is great.  It really works, and if it has any effect at all on blood lipids, it’s a positive one.”

Well, shut my mouth.  A doctor who not only doesn’t think that Atkins is going to kill you, but thinks it’s a good thing.

Later I thought, “Of course she likes Atkins.  She may be in training to be a reproductive endocrinologist, but first she had to become a plain old garden variety endocrinologist.  So of course she understands the insulin-glucose-glucagon system, better than I do, in fact.”  And I do know a lot about the insulin-glucose-glucagon system, because when I was on Atkins, I decided the best thing I could do in the face of all the negative press was arm myself with information.  And here was a doctor, an actual medical professional, hinting that I needed to lose weight and telling me outright that the Atkins diet, the one that every other doctor, including my PCP, thought was going to kill me, was a good thing.  A great thing, actually.

I am now Dr. Fellow’s devoted slave.

She went off to present my case to Dr. Ovary.  She was gone quite some time, during which I occupied myself with an extremely sad article in an old issue of Harper’s written by an oncology nurse.  Every time I shed a tear over some patient who was too young to die (isn’t everyone?), I worried that the doctors would return and think I was crying for myself.  Fortunately, by the time they returned, I had moved on to the book reviews, which are generally nothing to cry over (unless you are the author being reviewed).

Dr. Ovary delivered the diagnosis – polycystic ovary syndrome.  She hastened to add that I should not be alarmed by the long scary name; that all it meant that I was having irregular periods and some signs of excessive male hormone production – in my case, that annoying beard that keeps getting thicker.  (It wasn’t until later that I realized that this isn’t really a diagnosis, it’s just a description of my symptoms.  PCOS – The Diagnosis That Isn’t.  Kind of like chronic fatigue syndrome or fibromyalgia.) 

She went on to add that about 10% of women have PCOS; that it doesn’t necessarily mean that I have cysts on my ovaries; and that it can be treated with metformin, which is also a drug for type 2 diabetes.  She said that PCOS is common in women with a family history of obesity (bingo! at 5′3″ and 161 pounds, I am the thinnest woman on my mom’s side of the family) and diabetes (bingo! it’s faster to list my family members who are not diabetic than those who are).  She reiterated that there are no signs that I am in perimenopause, and she said that PCOS’s only effect on my fertility is that longer cycles mean fewer ovulations per year.  She suggested that, if I am not trying to get pregnant – I’m not – that we might hold off on metformin, and that I might try to lose 10 to 15 pounds; even a modest weight loss sometimes helps women with PCOS regulate their cycles.  If I did want to try to conceive, we could try metformin later, if I had been unable to lose weight, or if weight loss didn’t regulate my periods.

Since my appointment, I’ve done a little research on PCOS.  The connection between diabetes, insulin resistance, obesity, and PCOS seems very strong.  The first three conditions run in my family; I don’t know enough about my family’s reproductive health to say if PCOS does, too.

I feel like I’m falling apart.

In the last 11 months, my migraines – gone for 18 years – have returned; my peripheral neuropathy – gone for 5 years – has returned; my ankles and hips occasionally hurt a little; my knees frequently hurt more than a little; my acne has gotten worse; my periods have gotten irregular; I’ve gained about 15 pounds; and I have occasional acid reflux.  And now I have a diagnosis that isn’t really a diagnosis, of a syndrome that correlates closely with diabetes and insulin resistance and is actually treated with a diabetes drug.  (She might as well have said, “You are in a pre-diabetic state.  It’s time to change your ways, right now.”)  How did I come to this pass?  What else happened in the last 11 months?

Well, I completely gave up on the Atkins diet for the first time since I tried it in 2002.

So you tell me – what is it that’s killing me?  Atkins?  Or giving it up?

I have allowed myself to be seduced by the conventional wisdom (maybe saturated fat IS bad), by the Fat Rights movement (maybe I have a RIGHT to be fat), by bogus studies that suggest that some people, genetically, are just going to be fat no matter what they do (maybe it’s all USELESS anyway), and even, ironically, by my husband’s complete acceptance of me as I am (maybe there’s no point getting thin, since he thinks I’m sexy just as I am).

And yet, note all those maybes.  I have had lingering doubts about all my excuses.  I spent nearly a year reading everything I could about carbohydrate and fat metabolism, so I know that saturated fat is the best kind, monounsaturated is second, certain polyunsaturates (the essential fatty acids) are required in small amounts and the rest are bad, and trans fat is the worst of all.  I know that you can not only live, but live healthily and vigorously, without consuming a single gram of carb, but if you fail to eat protein or fat you will die in short order.

And maybe the Fat Rights people have a point – I certainly have the right to choose to be fat, just as I have the right to choose to smoke cigarettes.  And certainly, people who have not found a weight-loss strategy that works for them should not be treated like moral failures, pariahs, or lazy good-for-nothing slobs.  But I have found the key to my own personal weight loss; and just because I have the right to keep getting fatter and unhealthier doesn’t mean it’s smart or a good way to live.

Maybe it is all useless, maybe we’re genetically programmed to be fat – but then why did Atkins work for me?  For me to say Maybe it’s useless was just an excuse.

And maybe my husband does find me sexy as I am, but will he think that if I become a full-blown type 2 diabetic?  If my fingers and toes, or even feet and legs, start dying off one by one?  If heart disease interferes with my daily activities, including sex?  If I lose my vision or my kidney function?  Besides, he also thought I was sexy when I was nearly 20 pounds lighter.

Neither of the endocrinologists said, “If you don’t go back on a low-carb diet, you’ll die young.”  And yet, I feel that this is exactly what’s happening.  And I’m disgusted with myself, because I brought it on myself.

My husband, who is the least judgmental of men, said, “Why?  Because you ate food you like?”

No, dear, it’s because I ate food I knew – not just from some magazine article, but from personal experience – was bad for me.  Over and over.  There was a time in my life where I’d completely gotten out of the habit of eating bread, potatoes, pasta, and sweets.  I didn’t even want them.  How did I let myself get back to the point where I not only wanted them, I craved them?

Do addicts feel this way, when they go clean, then relapse?

After my visit with Dr. Fellow and Dr. Ovary, on my way back to the office, I stopped at the Whole Foods salad bar and made myself a huge green salad topped with steak and feta cheese.  I also bought some green beans, some guacamole, and some peanut butter for office snacks.  For dinner, I made mahi-mahi with lemon and dill, green beans with a few slivers of carrots and more dill, and some potatoes for my husband, which I did not touch.

Atkins, I’m back!  Did you miss me?

(Weight on Thursday:  161, on an empty stomach.  Weight today:  158, after breakfast.  It’s working!  I knew it would.)

All Quiet Here

Well, actually things are not quiet, exactly – we bought a house and moved all our stuff over the course of 36 hours, then I headed off to god-forsaken Orlando (yes, in August) for a conference that is a total waste of my company’s time and money to send me too.  Now it’s budget time at work, which is a huge pain in the ass, and I’m trying to paint, and … and … and …

But it’s quiet in the sense of, no migraines.  Hooray!  More than 60 days on inderal, and it still seems to be working.  I’m a little tired and weak in the heat, but hey, this is Boston – it was actually chilly this morning when I woke up.

I’m seeing the endocrinologist on Thursday; maybe I’ll have news to report then.