Pull out your stress reliever tea cause I have some FEELINGS TO THROW ATCHA! (Followed by hopefully stress-reducing cute pictures)
(The tea pictured above is delicious and I recommend buying it.)
So a lot of this might be oversharing but I actually feel like writing about the current state of affairs will be cathartic. SO IF YOU DON’T KNOW ME VERY WELL OR DON’T LIKE ME THAT MUCH JUST DON’T READ IT.
Longtime readers/people who actually know me in IRL know I have PCOS. You can read about this fun syndrome that affects up to 10% of women here. There are not particularly good explanations for its etiology because it is woefully underresearched (because it only affects women, amirite?) but it is quite the serious beast.
It’s not clear what comes first or what initiates what but its nasty symptoms include problems ovulating (instead of releasing mature eggs your ovaries accumulate big lumps of little not-all-the-way mature eggs that don’t properly detach from the follicles of the ovaries), excess androgens (too much testosterone, not enough estrogen; which is probably what jacks up ovulation), and screwy metabolism. The official diagnostic criteria for PCOS does not discuss insulin resistance. However, insulin resistance is commonly seen in women with PCOS and is bad news.
I got diagnosed with PCOS when I was 16. My mom dragged me to her gynecologist around the time I went “Er, by the way, I haven’t gotten my period in six months”. In retrospect, I was also displaying some of the other typical symptoms (excessive hairiness and weight gain. But I was also in the throes of puberty so what did I know?) The gynecologist diagnosed me with PCOS and spent about 30 seconds telling me about my ovaries, then put me on the pill and sent me off.
For more than ten years I had gone trundling ahead with my birth control pills thinking my ovaries were regulated and all was well… and then wham! I learned I could have higher risks of diabetes, heart disease, and other nasty things, due to other janky hormone action in my body that wasn’t directly involved with whether or not I was getting my period.
This year was the year I tried to get really serious about being my own best physician and advocate in dealing with PCOS (in part due to inspiration from a lecture by an expert in the field, Angela Grassi, founder of the PCOS Nutrition Center).
So I marched into a doctor’s appointment I’d made to get blood work and announced that I thought I should get my HbA1c checked. Hemoglobin A1c (HbA1c) measures your glycosylated hemoglobin, and indirectly tells you your average blood glucose over the prior three months or so. Your body always has hemoglobin circulating around on your red blood cells. Your body also always has glucose circulating around in your bloodstream. Some of the hemoglobin molecules get glycosylated- get a little molecule of glucose attached to them. The more glucose in your blood, the more little glucose molecules get attached to the hemoglobin swimming around with them. A normal HbA1c is between 4.7 and 5.6 (corresponding to an average blood glucose of 88 to 114 mg/dL). An HbA1c level higher than that indicates prediabetes, and anything 6.5 or above means you’re a full blown diabetic.
And now, sports fans, as you’ve probably inferred from this long prelude, my HbA1c was out of whack. 5.8. Corresponding to an average blood glucose of 120 over the previous three months. Not horrific, but worrisome. WORRISOME. Yes, irony of ironies, this masters level nutrition student is in that nasty scary prediabetes category at the ripe old age of 27. (Ew, typing that made me physically wince).
My kind nurse practitioner did a nice job of talking me down. She reminded me I’m at a healthy weight and I’m active, so this isn’t about me being “bad”, it’s part of the PCOS thing (sigh). She also said there were a few possibilities going forward:
- She could put me on Metformin. Metformin is a Type II diabetes drug that improves insulin signaling in the body, thus helping alleviate problems with insulin resistance. (I actually learned the biochemical mechanism by which Metformin works this semester, whoo). The NP was reluctant to do this because Metformin can have nasty GI symptoms.
- I could revamp my diet. As she pointed out, as a master’s level nutrition student, I am better equipped than most to do so.
So that was the plan, Stan. Obviously, there is nothing so fantastic as getting orders to consume a low glycemic index, low sugar diet two weeks before Christmas.
Here are some thoughts I’ve had in the subsequent two weeks or so since my diagnosis, in no particular order:
- Feeling like your body is malfunctioning is scary as hell. Eating a meal and then imagining all the sugar swirling around in my capillaries is an uncomfortable visual. (And this is one of those things where my education has taught me TOO MUCH about the horrifying symptoms that develop with uncontrolled high blood sugar. Amputations anyone? Blindness?) And just thinking about my increased risk of heart disease. I can no longer just blissfully push away thoughts of my future health and go, “I’ll be like the fabulous Greek women in my family who grow old and healthy and eat whatever they want”.
- In spite of the previous statement, I am SO SO LUCKY and I realize this. My God, I could have cystic fibrosis or some awful incurable genetic disease that would affect me my entire life and ultimately be fatal. Yes, PCOS sucks and I’m sad I have the crappy genes on which it is written but that’s life. It’s just the way it is. Some people have things wrong with their bodies. Duh.
- I think the thing that gets me about this is that it’s about food. Directly about food, unlike other health problems which are about, say, thyroid hormone or red blood cells or crappy joints. So so much of my life has been about food drama.
- With that being said, prior to this crappy news I was in this fairly blissful period where I felt that I’d attained detente in my war with food. I ate relatively intuitively, didn’t deprive myself, didn’t binge eat, and didn’t feel like a crazy person when confronted with food. I had joyful eating occasions with friends. I ate foods that made me happy and was at peace with the shape and size of my body. I was a healthy weight and on a new fitness regimen that made me feel physically and mentally healthy. And now whomp whomp. That thing that felt so right wasn’t working.
- Then I thought back to that earlier, crazier, deprivier time when I’d make little tallies in the margins of my notebooks in class, counting out the calories in each individual half teaspoon of olive oil I’d allowed myself to put in my lunch. I’d said goodbye to that time. I’d sought help and decided that I could either be thin or sane, not both, and I’d chosen sanity. But oh, irony of ironies, that time when my brain was a scary, sad little place, my body was doing fine. In fact, calorie restriction is one of the mechanisms that VASTLY improves insulin signaling and in fact likely increases longevity.
- It feels inherently icky to me to monitor and count things when I eat. I’ve been tracking my macros and calorie intake on My Fitness Pal. I did this in the past, when I was in a real bad place. I’d be oh-so-virtuous and track everything and nod approval at my appropriately low calorie intake… and then have a mindless binge explosion. And even if I wanted to, I wouldn’t be able to log how many calories had gone down while burying my face in cereal and chocolate and whatever. And of course that was probably why I’d done it. Maybe other people can dispassionately track everything they eat and look tranquilly at the numbers. Maybe I’ll achieve that. I’m not there! As you’ll see from the schizophrenic nature of this post, it’s hard to both think and talk about food like a dietitian and think and talk about food like someone who actually enjoys cooking and eating.
- I hafta say, this has made me realize how much I rely on food for pleasure. Which makes me sound like quite the pathetic single girl, eh? The truth is that I have a lot of wonderful people in my life with whom I have a lot of wonderful experiences (and examples are listed below). However, as a fundamental introvert, when I’m alone, I like to read and I like to eat. I constantly desire sweets, which is a very typical PCOS thing, I’ve learned. And I want to be able to grab my chocolate and bliss out. Sigh.
- Final, perfunctory note: I am entering the nutrition profession. If (when?) I come out successful on the other side of this with better managed blood sugar, I can help my clients with this. IT ALL MEANS SOMETHING, GUYS. Sigh.
So I have been in an ongoing process of creating a plan of attack to get my diet together, lower my HbA1c and prevent heart disease and diabetes and all the horrible other possibilities hanging in the back of my mind. This is all a raw work in process. Since the diagnosis, this is the order in which the plan was created/continues to be created
- I continued to exercise like a boss. That felt good. And exercise gets the sugar out of your blood even when insulin isn’t signaling properly (this is scientific and I can explain it to anyone who cares to listen).
- I gave away all the food in my apartment that wasn’t cool for an insulin resistant girl. White bread, chips, sweets, etc.
- I set a goal of 20 grams of protein at each meal (snacks I didn’t track as closely but I wanted them to include protein to prevent blood sugar spikes). I was largely successful in this endeavor. However, I am not a big meat eater and opt out for a decent chunk of the year for religious reasons. Therefore, a lot of my diet consisted of refined soy products. No bueno. Here’s an example of a semi-typical day after setting the protein goal.
3. I would’ve said no sweets at all, but this was not a good idea. (For the record, my doctor told me I was welcome to take December off from worrying this stuff and enjoy the holidays, but I didn’t have that in me). What I decided was that I wanted to be able to enjoy social occasions with friends or I wouldn’t be living. Furthermore, if I were to have a single lapse and ate a sweet when I had told myself they were totally forbidden, that’d be a great prelude to a binge. So, I said twice a week, tops.Also tried to avoid white food, which is similarly no bueno for the blood sugar. That sort of worked when I was still in NC. .
4. Then, I went home. Home is GREAT! But, let’s talk about how home for the holidays is different from real life: unfamiliar kitchen not stocked by me (check), spontaneous trips to enjoy delicious ethnic cuisines unavailable in NC (check), Christmas treats all over the house both to prep for our annual party and coming in as gifts (check), no formal schedule with ample time to hang out in the kitchen (check), overarching tone of relaxation that causes one to lounge about in bed rereading Harry Potter instead of working out (check), other people cooking for me (check), spending time in a house where I lived out a lot of unhealthy eating habits (check). So then you get this:
You’ll want to focus on that snack section, what with all the bread and dry cereal and ooh also let’s not forget all the cookies as a nice blood sugar spiking pre-lunch snack!
This, dear friends, is what I crave. This is what I need to take down if I want to stay on top of this.
Now I’m looking for a way to be healthy and sane moving forward. So here’s where I am, today, right now:
- I am going to continue to aim for 20 grams of protein per meal. Three things currently in my fridge that will deliver that are cod, bean soup, and eggs. I will also aim for protein in my snacks.
- I am not going to stress about carbohydrates as a whole, because that is too overwhelming to me at the moment. (It also may not be necessary as long as I properly balance my meals). Instead, I am going to
– eschew desserts (except for a twice a week mulligan; and I am planning out those occasions in advance!)
– eat only whole grains (I’ll allow myself a twice a week exception for white bread on that too, to stay realistic).
– eat my grains mindfully. Sitting at the table for a nice oatmeal breakfast, yes. Handfuls of Life cereal mindlessly eaten while reading blogs, no.
- I am going to exercise regularly. I will aim, as I have been since I kicked up my physical activity level in the fall, for five days a week. At least three, please, but five is best. Today I did a little kickboxing and a lot of walking and felt good.
Three guiding principles seems about right. After all that verbal diarrhea, let’s take some space now…
That was a lot of words. This is all raw and jumbly and messy in my head. As I said, I am writing to process this and to inform you, dear audience, that I am working on this stuff and I am figuring it out. Now I will share some of the day to day existence I’ve had in the past few weeks. If you read the blog for fun glimpses into my everyday life, here you go! If you want further thoughts on the nutritional components of the following events, they are italicized for your reading pleasure.
I took my biochem final. I got Chinese food with my sister and we watched Bridesmaids. It was amazing.
Good, soul satisfying low glycemic index meal: shrimp, broccoli, and just a bit of brown rice.
Then I went to my friends’ for a bit and we had ourselves a lovely campfire. Their dog sat in a camping chair and stared contemplatively into the flames and it was the cutest.
I could’ve theoretically headed up to Virginia the following day, since I was all done with class, but I opted to stay in NC for a few days. I could finish up my Christmas shopping at all the local crunchy shops I love, work a few more hours at my on-campus job and thus achieve my ability to do the aforementioned Christmas shopping, and hang out with some friends I didn’t get to see enough during the height of the semester craziness.
The next day I walked (exercise, see, see?) to see the Chapel Hill Carrboro Christmas parade! I brought my favorite baby and her parents!
The floats were super adorable. I feel so happy and lucky to live in a real town, where people know each other and there are adorable community events.
Latin Club at the high school. Pretty great, right?!
There were many many Boy Scout troops represented. The guys below were the coolest.
My all time favorite float was from the Botanical Garden. The guy with the red arm flaps is a Venus fly trap!
The next day was legit like 70 degrees so outdoor brunch seemed important. We went to always reliable Milltown. I got the veggie burger, salad on the side.
The veggie burger came on brioche bun and I thought I’d be so clever and ask for it instead with whole wheat toast (which was listed elsewhere on the menu). As you can see, what arrived was suuuuuuuuper white bread. Shrug. I ate it bunless and felt like an Atkins tool.
The veggie burger was exemplary. Gruyere and sauteed shiitakes on the top. There are a lot of veggie burgers that nail the taste portion of the burger equation, but this rocked that and also nailed the texture portion- it was satisfyingly fatty and crumbly, like the real deal burger.
I spent the later part of the day again hanging out with Baby Friend and Parents Friends and making cookies. It was really nice enjoying the craft of baking (particularly when the little one participated!) and I didn’t feel terribly deprived not eating dough/cookies (and as you’ll see I did include some of our finished product in my twice a week rule).
I mean seriously how cute is this child?! She was so enthusiastic about helping. She has also started calling me Nana (which is also what my little sister called me when she couldn’t yet say my name <3)
I grabbed a bag of the freshly made cookies and then headed to dinner with some of my best girlfriends in my program. We’ve all helped each other get through some stuff this semester and it was so nice to celebrate together.
My contribution: both vegan and very healthy and appropriate for my health goals. This is a recipe I learned from a very sweet lady at church and it’s as simple as can be: black eyed peas, spinach, and caramelized onions.
My plate- a healthy chunk of roasted chicken (yeah I know I said I wasn’t eating much meat but my friend cooked for us and I don’t turn down hospitality), a healthy chunk of spinach and black eyed peas, smaller portions of the trouble things (beets, which have a super high glycemic index; gluten free roll; and sweet potatoes) and some broccoli slaw. I feel good about how I filled this plate- got to try the things my friends made but also slowed down my blood sugar spike.
And yes, then I did have dessert (this was my first time doing so since the diagnosis earlier that week): a wee little scoop of (light) vanilla ice cream, and cookies from my friends’ place- one little Buckeye and a piece of a whole grain gingerbread cookie.
There are tricky things I’m still navigating- like the catered lunch at a work event. There wasn’t a lot of protein in this meal. I’m hoping I had fiber and portion control going for me? Lots of eggplant curry, chickpea curry, lots of salad-y stuff (that did have white rice puffs in it :/), small portions of bread and samosa.
(The kind of analysis I just did is what makes me really sad about this health stuff. I want to revel in the thrill of free food from my boss, not stress about protein grams and blood sugar)
I did get to do something that did bring me pure joy the following day: time at the cat refuge! I still go there all the time, don’t worry.
It was a gorgeous sunny day. Sunny day= shadows to chase for Genevieve. She’s the cutest.
I also had a great roomie date with Alli. We had this amazing mind meld where I texted her to see if she was interested in sushi at our neighborhood spot and she said it was fate and she was about to wait in the Harris Teeter line with takeout sushi but she’d way rather eat with me.
I got my usual favorite, the Bento Box.
I didn’t eat the white rice (easy way to avoid glycemic index drama). I ate all of the sashimi and most of the (yummy!) crunch roll and all of the salad. This meal was a protein superstar. I had recently fallen in love with sashimi prior to this diagnosis so that ended up being fortuitous. I did not feel deprived at all whilst eating this meal, though I confess I did think how good it would be to eat ice cream after it.
So by Wednesday I really didn’t have any excuses for still being in NC as I’d gotten everything I’d done that I planned. But in the morning, I got to meet my classmate’s baby! And in the evening, I got to watch me some STAR WARS!
No, I didn’t see the new one (and I haven’t yet; no spoilers!) Rather, I went to the Baxter, the hipster bar/arcade that was screening all three films of the original trilogy! OMGSOFUN!
I went with a few friends and wore Leia buns, natch. This nicest guy was sitting by us and we were chatting (exclusively about Star Wars) and he was clearly like, “OH MY GOD GIRLS”.
I got a cider, which was the first alcohol I’ve had since the diagnosis. I am not a big drinker, which is almost a shame as if I had been I could go from being a big drinker to a small drinker and that’d be an easy way to look after my blood sugar. But my drinking was low and only on social occasions and remains low and only on social occasions. I feel like if my heart disease risk is high, I should go for the protective effects of moderate alcohol consumption.
Then Thursday I really, really, I swear, really was going to drive back to Virginia. But it rained all day, so I didn’t leave right away. So after packing and procrastinating I was going to leave around four pm. But THEN I got a text from my friend Steph telling me there was something I needed to see at her place… and then there was THIS!
If you are feeling sad about anything EVER, might I recommend baby chicks?
I came home the next day. More winter break updates to come!