Gamifying My Diet for Blood Sugar Management

 Brain tumors and Brain surgery do crazy things to people! To be honest, we don't actually know if my current challenges were caused by either of these, the 12 weeks of intense IV antibiotics I had to take, or something else entirely (hey there, perimenopause! I see you!). So what are the things I'm dealing with? Blood sugar and cholesterol levels. Prior to my brain surgeries, these were completely normal. The only indications I'd had of something potentially being off was during each of my three pregnancies when I consistently tested positive with the initial glucose test and had to return for the four hour test for gestational diabetes, which always came back negative. Apart from these, I've never had a problem with my A1c or my cholesterol levels. 

 My doctor's theory is that either the trauma inflicted on my brain during my surgeries and healing or the tumor itself has caused my body to go wonky. Regardless of the cause, though, I am not faced with the reality. My A1c has consistently been over 6% since surgery, putting me solidly in the Pre-Diabetic range (5.7%-6.4%). Last year we tried Metformin to see if it would help level things out. After being on it for six months, my A1c went from 6.0% to 6.3%. My digestive system also spiraled and despite trying different formulations (regular vs extended release) and different doses, it was eventually determined that I was allergic to it and Metformin wasn't going to be a good fit for me. Interestingly, six weeks after going off of it, I realize it wasn't fully out of my system yet, my A1c was down to 6.1%.

 There are other medications out there that work well for a lot of people. Ozempic is one of the most common ones, but one of Ozempic's side effects can be gastroparesis. It is a rare side effect (which basically mean sign me up!), but because people like me with Ehlers-Danlos Syndrome are already predisposed to gastroparesis, Ozempic and the other GLP-1 agonists were off the table. So what does that leave?

 Well, the primary effectors of your blood sugar are food and exercise. So, I am now on a quest to manage my blood sugar with those tools! I call it a quest because that sounds so much more fun than a diet. I've had some diet trauma in my past, including having to do multiple seriously restrictive diets, so I'm not a big fan of them. It's so much more interesting to gamify the system. Give me a point score to target and have me strategize to reach it. The hard part is getting a health professional to nail down any number. They don't like giving me numbers for some reason 😜. The nutritionist I'm seeing did challenge me to consume 100g of protein every day though. She said it like it was a lofty goal that I might achieve over time. That day I got 93g, I saw her late in the afternoon so I didn't have as much time to get the food in. The next day I ate 143g! From there I settled out and I've been eating between 100-115 per day typically.

 My doctor did mention that in order for me to meet my goal of weight loss (I've put on 50lbs since the surgeries) I could track my calories for a week and then consider targeting a number about 400 per day less. So I started tracking my calories. Turns out my average calorie intake was 1412 per day. My doctor had stated that my goal should be between 2000 and 3000 calories per day, so I'm guessing I shouldn't subtract 400 after all.

 At first I asked my doctor if she wanted me to go keto to manage my blood sugar. She adamantly rejected that as it does not fit well with some of my other health issues, and my nutritionist concurred. What she suggested instead was something I hadn't heard of, a low glycemic diet. Glycemic, according to this dictionary (evidently they didn't use the word glycemic in 1828 when my favorite dictionary was written), means, "The presence of glucose in the blood." This diet uses both the Glycemic Index and the concept of Glycemic Load. Really, this diet is something I'm making up as there isn't any good, decisive information out there. This chart lists numbers for common foods for both index and load. Glycemic index (GI) is a relative ranking of carbohydrate foods based on their effect on blood glucose levels (1). They determined the numbers for these foods by giving servings that contained 50g of carbs of each of them to 10-15 people and then measuring their blood sugar every 15 minutes for two hours to test the effect of the food on their blood sugar. For comparison, glucose has a GI index of 100. Low glycemic foods are those with a GI of 55 or less and High glycemic foods have a GI of 70 or more. So this seems simple enough, just stick to low glycemic foods and you're fine, right? Wrong. Nothing in my life is this simple! The challenges are that each person reacts to different foods differently so while the GI is measured based on an average of 10-15 people, I may react very differently. Each of them may have reacted very differently for that matter. In addition, the GI was measured based on a serving with 50g of carbs. Many, if not most, of the foods I eat do not have 50g of carbs per serving. So, the GI doesn't take standard serving size into account. What are the alternatives?

 In addition to the Glycemic index, there is also a concept called Glycemic Load (GL). While the GI measures how quickly a food is converted into glucose, Glycemic Load takes this information and adds in how many carbohydrates there are in a standard serving. I'm a math nerd, so I loved how this site showed the formula used to determine GL:

To calculate GL, the following formula is used: GL = (GI x amount of available carbohydrates per serving) divided by 100.

The result of this calculation is then expressed in terms of grams of carbohydrates per serving.

An example of this in action would be a slice of white bread, which has a GI of 70 and contains 15 grams of carbohydrates per slice. Using the formula, GL = (70 x 15) / 100 = 10.5 grams. (2)

 This seems rather straightforward, right? Now we can see that low GL foods have a rating of 0-10 and high foods are rated 20+. Again, it's not really that simple. You see, foods have a different GI if they are raw or cooked, whole or peeled, canned or fresh. And you've still got the base problem that GI is not a standard rate for everyone, but an average of a lot of people. Each person who eats the same type and size of apple may have a different rise in their blood sugar levels. Oh, and this can be affected by what you eat the food with. So do you eat the apple by itself or do you eat a couple of tablespoons of peanut butter with it? That peanut butter will decrease the rise in blood sugar. AND it is affected by your level of activity. Do you go for a brisk 15 minute walk after you eat or do you lay down and take a nap? Guess what, that affects your blood sugar too!

 

 You can see why I said this is a diet I'm making up and there isn't any great information out there. Most of the websites recommend that you stick to low GI foods, and I can see how they're trying to do their best, but it's just not good enough for me. So, with my doctor's support, I've started using a constant glucose monitor to track exactly how different foods affect me. Let's just say I'm in the data gathering stage. At this point very little of it is making sense to me. I'm eating exactly the same thing three or four days a week under exactly the same circumstances (starting w/ a similar fasting glucose, no exercise within an hour afterward) and get completely different readings. All I can figure is it's got something to do with how I slept? The phase of the moon? What I'm wearing?!?!?!?! Hopefully with more data, patterns will emerge. 

 I didn't get any firm numbers from my doctor or nutritionist yet, but I think I should be targeting a rise that keeps my blood sugar under 140 after a meal. I'm definitely not there yet, but I'm much, much closer than I was before I started being intentional about what I ate.

 Also, I am adding more movement/exercise into my routine. I'm trying to spend about 15 minutes in moderate movement (a walk, vacuuming, etc) after each meal and I'm returning to gentle yoga at the Y a few times a week. Now, I would not necessarily recommend yoga for someone with EDS, but I am a trained yoga instructor and have learned a great deal about my body over the last ten years so I feel more comfortable knowing my limits and how to keep myself safe and avoid injury. YMMV

Here's the Thing: I obviously don't have all the answers here. I'm not even sure I have some of them, but I'm working on it! I'm trying, and that's all I can do at the moment. Trying is better than not, I think. I'll update you here on the blog if and when I get somewhere with all of this!

(1) Complete Glycemic Index & Load Chart - Glycemic Index Guide

(2) Glycemic Load Explained: Definition, Formula, Benefits, and Examples