CGM 6 & 7: The Coup De Grace

This weekend was my final two days on a high carb, ‘celebration food’, diet. For these days I planned several very high carb meals and they didn’t disappoint in their effect on my body.

On Saturday I worked Trinity’s Walk In Clinic at Fort Sanders West. Usually I bring a breakfast treat for the staff consisting of various low-carb yogurts with fruit and some decently low carb granola options. I decided to try out several of the types of yogurt individually to see their effects.

The first attempt was about 8:30am with Fage’s full fat yogurt. As you can see, one of the individual serving containers had no effect on my blood sugar. Listed as 6gm of carbs the actual amount is much less than that as the process of making yogurt utilizes some of the lactose through fermentation. It might be a good choice in the future for me for a low carb, low impact food.

The second attempt was an hour later with a blackberry Carb Master yogurt from Kroger. At 5gms of carbs and plenty of artificial sweeteners I was hopeful for a small impact. Again, there was no rise to my blood glucose but you can see a dip shortly there after. I’ve come to believe that the artificial sweeteners cause a release of insulin or a failure of glucagon which results in a low to often develop. I’ve seen this in several patients too. I will probably be limiting or avoiding these yogurts down the road. I’d rather have the plain full fat Fage.

Finally I got to the day’s glucose master challenge consisting of two apple fritters which I ate before I headed to Home Depot for some errands. I waited until after clinic was done as I knew it would slow my mental capacity and I didn’t want them to affect my clinical skills. No surprise my glucose spiked and I seriously contemplated laying down in the middle of Home Depot to take a nap. Not wanting to be cited for vagrancy I soldiered on and finished up.

After getting home, I spent several hours working outside in vigorous yard work involving moving rock, shoveling, and digging out a new flower bed. Those bouts of activity were associated with spikes in glucose too. I’ll be interested to see how my glucose responds to exercise when I’m fat adapted later this month. I’ve purposely not exercised in a formal way this past week to keep me as insulin resistance as possible. I’m looking forward to getting back to it.

On my final day, I wanted to go out with a bang so asked the family to go to Mimi’s after church. They were pretty surprised as I never want to go eat there as their low carb selection is very limited. This time that was the point. I had hoped for French Toast but since it contains cream cheese and orange marmalade, two things I really don’t like at all, I decided to try the chicken and waffles. Honestly, I’ve never had this before. I’ve eaten plenty of chicken and plenty of waffles but never on the same plate. I can see the appeal especially after pouring 2 ounces of maple syrup on everything.

The impact was amazing. Again, I felt like taking a nap and found it more difficult to think clearly. The carb count on this meal was incredible. The chicken and waffles is listed as 97 gms of carbs on Mimi’s nutrition website. When the syrup is added it totals 183 gms. Essentially the sugar in 2 oz of maple syrup is the same in all of the chicken and waffles! I couldn’t believe it. The effect lasted hours with multiple spikes. The maximum glucose achieved wasn’t especially high but the duration of effect was over several hours. The area under the curve was very large. That’s when the damage is done.

Later that night, I ate another couple burgers with buns similar to the ones earlier in the week. I wanted to see what affect they would have after such a high sugar load for lunch. Interestingly, it was blunted. Whereas they would typically cause an elevation, it was more restrained.

So as the week has progressed, I’ve learned and experienced many interesting things. I feel more sluggish and less mentally sharp in general and specifically after high carb meals. I’ve gained 3.5lbs of weight (in one week!). I’m more swollen and achy during the day. I don’t think I’m sleeping nearly as well as I usually do.

A single meal has a big impact. That impact is in both directions. A single bad meal causes stress for hours. A single good meal can really help you recover back to normal more quickly. Remember that each day is about each meal. Don’t stress too much ahead of time over the upcoming meals. Fight the battle in front of you and move on. Each day has enough trouble of it’s own.

What’s next? This week will be short as I’m headed out on vacation Saturday but I’ll be turning my attention to a good low carb, whole food recovery plan for the remaining days. I’ll be interested to see how quickly the weight will come off and I start to feel better. After vacation, I’ll use another sensor and document my progression into nutritional ketosis. I’ll be showing my ketone meter readings too.

I’d love to hear feedback from anyone about how this blog series has impacted your decision making process on food or your experiences with blood sugars. Please feel free to email me directly or post a comment publicly as you deem appropriate.

CGM Day 5: Recovery may be boring but boring may be good.

Recovery can be boring but good for you.

Yesterday was day 5 of my CGM experiment with my FreeStyle Libre. It was pretty boring which was a little by design and a little by accident. Interestingly, this blog series has prompted about a dozen of my patients to contact me and acquire a CGM for themselves. I have heard feed back that the lowest price seems to be about $35 per sensor using a GoodRx coupon. Several folks have found that price at Wal-Mart and Walgreens.

I started out the morning still feeling very full and, as you can see from the graph, my glucose numbers were still bouncing around until about 3 am from all the food on July 4th. So, I fasted for breakfast to try and recover. I had planned to have a very low carb lunch of left over plain hamburgers but walked out of the house with them still sitting on the counter. Doh!

I wasn’t able to leave the office at lunch so only ate a small snack and a protein powder shake. In total, it was about 20gms of carbs. That accounts for the small spike and quick recovery. I didn’t end up getting home until 9pm and decided to have leftovers from the July 4th party. That was a pretty high carb meal. As I’ve come to expect, I spiked and dropped after going to sleep. The roller coaster of numbers continued until this morning. One lesson I’m learning is just how detrimental late night eating is. Next week I’m going to eat some moderate to large size dinners of very low carb food and see how much effect that has while I’m asleep. I’m also going to focus on skipping more late night dinner meals if they aren’t a sit down meal with my family.

Overall, the first part of the day was a recovery period which went well. If I had stuck with that process, you can see how a day of appropriate celebration can be accommodated better when surrounded with a few days of self-control and proper eating. We are built for cycles of fasting and feeding. Celebration with rich food can be very appropriate. We just need to limit our celebrations to those days which are in fact a celebration.

CGM Day 4: Did I say cake? I meant cakes.

Celebrating Independence Day, like almost every other American holiday, involves lots of food. Yesterday’s rumor of cake was not unfounded and today was a day marked not by one big meal but by multiple opportunities to eat richly.

Breakfast began with my first cake, four of them to be exact. Paleo Pancakes found at Costco are a lower carb (but not low carb) grain free version of traditional pancakes. They are surprisingly filling for their size and generally you don’t want very many.

Interestingly, these pancakes produced in me a phenomenon I see in many other people and regularly talk about. It’s a clear sign of insulin hypersecretion and dysregulation of the body’s glucose balance mechanism. I developed reactive hypoglycemia after my breakfast meal of four 3 inch diameter pancakes with honey and butter, two fried eggs, and blueberries.

When my CGM read low I double checked it with a finger stick. You can see they correlate well. As my glucose rose, so did my insulin level. It effectively moved my blood stream glucose into the cells of the body and brought the level back down to normal. However, when it hit normal, about 85 mg/dL, the body’s compensatory hormones that help balance the effect of insulin likely failed to appropriately be released. Glucagon is the chief counter-regulatory hormone and signals the body to release its stored glucose from the liver. This slow dripping stream of glucose raises the blood glucose levels just as insulin lowers them. The delicate balance between the two allows for a stable number. Failure of glucagon to release allows insulin to work unchecked thereby continuing to move glucose into body cells and lowering the blood level. Many people feel this occur and Snickers has based an entire ad campaign on this phenomenon. “You’re not yourself when your hungry.” Anyone ever been called h-angry?

Many people try to correct these symptoms by having a carb rich snack or drink. If you must, have a small amount of complex carbs possibly with some protein or fat to slow digestion. Something like a couple ounces of nuts or half an apple and avocado. Ultimately the best fix for this scenario is retrain your body to release hormones appropriately by converting to a low carb, moderate protein, quality fat diet as we’ve been discussing. When done correctly this always corrects the issue as a thoroughly fat adapted individual cannot suffer hypoglycemia.

Of note, I think my hemoglobin and hematocrit are low as a result of the retained fluid from my excessive carb intake this week. Hyperinsulinemia results in retained salt and water which dilutes a stable red blood cell mass. I suspect my blood pressure is running higher than normal too although I haven’t checked it. I have noticed more lower leg and ankle swelling at the end of each day.

After breakfast we began getting ready for our family to come over to cook out. As I started the fire and prepared the outdoor space, my wife made an All-American Angel Food Cake. Her offer of the mostly empty frosting bowl and a spoon was not refused and that promptly spiked my glucose around noon.

Lunch was burgers and hot dogs cooked over the open fire using this awesome campfire grill set up from Wimpy’s. Burgers cooked over a real wood fire really are the best you’ll ever have. They were so good I had the leftovers for dinner. Both lunch and dinner were finished with a piece of cake. You’ll note a small peak between those two meals on the CGM graph. I honestly don’t know what to attribute that to. I don’t think it was food related.

Lastly, what’s Independence Day without a little bowl of ice cream? I think I remember from history class that General Washington celebrated each victory with vanilla bean, or maybe that was Captain America. Either way, it’s definitely American.

So like many holidays, at the end of the day I’d swear I’ll never need to eat again but without fail I do. I think this is a challenge for many of us. Our celebrations are defined by food. We celebrate holidays and get togethers and times with friends and families. I’ve celebrated many an afternoon just making it through the work day. We celebrate Saturday mornings and Sunday lunches. We should celebrate all of these times as life is a celebration of God’s grace and love to us. However, we don’t always have to celebrate with massive meals of carb rich food. Remember the 1/2 lb of brisket I ate the other day? It was delicious and never moved by glucose. I truly believe we can celebrate wonderfully without developing insulin resistance or diabetes. Just think of all the extra celebrations we could have if we lived this out well. Too many lives are cut short by diseases resulting from high insulin levels. We can be a generation that adopts a new normal and changes our own destiny.

I don’t know what tomorrow’s going to be like. It’ll be hard to top today but I’m sure there will be something I can try.

CGM Day 3: double spikes all day

Here on my 3rd day of wearing my Freestyle Libre, I moderated my food intake a little and didn’t go overboard on anything in particular.

Cracker Barrel Double Meat with Biscuits, Jelly, Gravy, and Grits

For breakfast, I ate at Cracker Barrel with my Bible study group and I ordered the Double Meat. Typically I skip the biscuits and gravy before heading to work but have been known to partake on other occasions. This time I chose to eat both biscuits with butter and one strawberry jelly. This was about 70 gms of carbs as calculated through LoseIt.com. Remember that the toast and jam I had on Day 1 was 72 gms. Interesting that I ate more carbs at home than at Cracker Barrel. I admit, I didn’t see that coming.

CGM Day 3

Breakfast developed a double peak glucose spike again. Pizza showed a similar response last night but you can see that it continued to cause spikes well into the night. It caused 5 spikes all together and then still displayed lots of variability in the normal range until I got up only to disturb it again with breakfast. All told, having eaten the pizza at about 6pm last night my glucose wasn’t stable until about 6am this morning.

After breakfast, my numbers leveled out until lunchtime when I ate a low carb meal of eggs and cheese with a medium sized apple listed at 22 gms of net carbs. It barely got my glucose over 100 mg/dL and then it leveled again.

When I got home from work I ate a small snack of 7 dates at 28 gms of net carbs. They are often one of my whole food snacks when carb count isn’t as critical. As you can see, their effect is not very high and is a smoother curve than breakfast breads have been. Foods in their whole form often are much slower in digestion and absorption than you might expect for the amount of carbs in them. This will show up as lower peaks and a more rounded shape on the monitor.

After eating, I headed outside to keep working on cutting up the fallen and hung up trees from last week’s windstorm. It was strenuous work especially given the heat and humidity. Exercise can mobilize glucose for immediate use which I believe accounts for the second spike after that from the dates.

Lessons learned from today, I think, are real food is better than fake food, the effects of poor choices can last a long time, and more than food can cause glucose to rise and you can’t always control those factors.

Tomorrow I’ll have a couple opportunities at my family’s get together to really test my glucose response. Rumor has it there will be cake!

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Promising.

Pizza’s sucker punch

Tonight I enjoyed my favorite pizza, Little Joe’s ham and mushroom. Having grown up with the owners, I spent many a Saturday night there with my family. The breadsticks are fantastic.

As you can see pizza has a hidden surprise. It’s not just one peak of glucose dumping into the blood stream, it’s two. This delayed phase can be especially tricky for diabetics who live by insulin (type 1).

I decided to follow it up with two mashmallowless S’mores. I calculated the pizza at about 102 grams of carbs and the S’mores at 72gms. That’s a huge sugar load right here before I go to bed. Wonder how I’ll sleep and how long it will take me to recover once I get back to eating well.

Tomorrow I have my weekly Bible study breakfast meeting. Our usual place is closed so we’re headed over to Cracker Barrel. I’m going to see what a couple biscuits and jelly do relative to my toast experiment from earlier this week.

I’m honestly anxious to finish up this process. The data makes it so clear what I should eat and it’s hard not to clean it up. I know that anytime by blood sugar is much above the green area my body is being injured. I can feel my brain not working well. Things are dull and I know I’m slower than I should be. But the experiment must continue.

All in the name of science!

Day 2 of CGM

Here’s the majority of today’s readings.

You can see small impact of breakfast which was the same 3 eggs and 1/2 cup blueberries as yesterday but no toast or jam. What a difference that made. Note too the dip in my glucose right before awakening and the rise as I got up. The normal stress of standing upright and waking in the morning will raise your glucose some. Notice the good glucose control overnight when the body isn’t trying to metabolize a Star Crunch but is essentially fasted? Powerful.

Lunch was a 1/2 pound of delicious beef brisket. There was no impact or elevation on my glucose. Dry rub BBQ is one of the best options to limit sugar intake as almost all BBQ sauces have added sugar.

The blue arrow indicates an elevated glucose associated with a stressful situation. We should be cognizant that our body responds to stress with elevated glucose. This is why the fourth pillar of good health is peace, or stress management.

Tonight’s dinner is going to be one of my all time favorite meals, Little Joe’s pizza and breadsticks. There’s no doubt what’s going to happen but it will be interesting to see the impact it has. Stay tuned for a full report later on.

Day one in the books

Here’s the final picture for day one.

I think it’s pretty self explanatory. I kept my utilization of excess glucose high by eating a very lite snack of 2oz of cheese and 3 oz of macadamia nuts.

If any of my patients feel inspired to get a CGM for themselves and try their own experiment (no social media posting necessary), then send me an email and we’ll work out the details.

Breakfast of champions? Doubtful

Breakfast is often touted as the most important meal of the day, but is it really? What you eat in the morning certainly has an impact for the rest of the day. So, one could say that breakfast is the foundation of your daytime health. Choose wisely, the foundation you build upon.

Breakfast of champions?

On this first real day of my CGM experiment, I ate a modest breakfast consisting of my usual three eggs, blueberries (1/2 cup to be exact), and black coffee. This time I added two pieces of toast with butter and ‘Natural’ blackberry jam.

As you know from my previous post, I didn’t feel well getting up this morning. I struggled with poor sleep from my late night snack. I believe that prompted more insulin resistance than typical with high cortisol levels. I wish now I had drawn some labs this morning to see. In that context, I added this 72gm net carb meal.

72gms of net carbs

So what was the effect on my system? As you can see my glucose spiked up to nearly 150 mg/dL and then returned to normal-ish range (~100mg/dL) within about 1-2 hours. After that, it has bounced around and stayed elevated only to drop consistently below 100 mg/dL nearly 8 hours after that meal. Of note, at 12:30 I ate a very small meal consisting of several ounces of sirloin and cheese totaling 3 gms of net carbs. I’ve also tried to mitigate the excess glucose by increasing my water intake and will be spending a couple hours in outdoor yard work tonight.

Overall, what’s the take away here? First, it takes 30 hours to metabolically process your last meal. When you have a poor foundation from yesterday’s choices what you choose for breakfast can have a real impact either positive or negative. Second, small choices matter. About half the carbs at breakfast were from the toast and the other half from the jam. Third, the term ‘natural’ is confusing and misleading. Natural doesn’t mean something is healthy nor is it good for you. Arsenic is natural too but you shouldn’t eat it. Finally, I’d say that seemingly small indulgences can take many hours of diligence to overcome. Just think what would have happened if I had had a high carb meal at lunch too.

Tonight, I’m going to take a respite from food and either fast completely or eat a small protein/fat meal to allow my body to recover from the last 24 hours. Tomorrow, I’ll pick out a couple other items to document. The show must go on!

Star Crunch and skyrocketing insulin

My CGM experiment started last night when I placed the Free Style Libre CGM at about 7pm. It takes an hour to ‘warm up’ before showing any readings.

As I previously wrote, I’ll be eating foods that I call ‘celebration’ foods during the first week. Generally these are foods I reserve for treats and times of celebration. They are foods that have a clearly powerful impact on hyperinsulinemia (think jet fuel on a bonfire). Being mostly simple sugar and nearly nothing else they drive the blood sugar up extremely fast which drives the insulin up. As insulin goes up all the things you don’t want to happen do.

Star Crunch, Little Debbie’s best treat

So for the prequel to my one week celebration food experiment I decided to document the effect of one of my all time favorite packaged treats, Little Debbie’s Star Crunch. Perhaps, it’s more of an emotional attachment for me as I used to have this food as my 2am reward when I was on call at LeBonheur Children’s Hospital in Memphis. When you’re 20 hours into a 36 hour shift and it’s a struggle to fight off fatigue to answer your pager one more time, sometimes you need little rewards to encourage you through. Ironically for me, but great for the kids, LeBonheur decided they needed to offer healthier food in their cafeteria for the kids and removed all the Little Debbie snacks about halfway through my last rotation there.

Back to my prequel experiment…I had spent the weekend camping with my family and some friends and, perhaps, had started my ‘celebration’ food experiment a few days early without my CGM. However, after returning home Sunday afternoon, I spent a considerable time working outside in the yard including chainsawing some trees that were toppled in Friday’s isolated freak windstorm. I had worked hard. It was time for my reward.

I decided to eat the Star Crunch about 30 minutes prior to going to bed. Studies show that most American’s eat about 15 hours a day consuming something within the hour prior to getting into bed. I thought it would be interesting to see just how bad this habit would be for me.

Here’s the nutritional information for a Star Crunch.

Star Crunch Nutritional Data

The carb calculation for a Star Crunch is 42gms of net carbs. Forty-three grams of total carbs minus 1 gram of fiber. So what was the effect on my blood sugar?

This is disturbing.

As you can see, the Star Crunch eaten before bed caused my body to be hyperglycemic all night. My morning glucose was 103 mg/dL. Incidentally, I didn’t feel well either when I got up. I felt like I hadn’t rested well.

So what’s the take away? Did I learn that a Star Crunch is not healthy? Was I surprised that it made my blood glucose go up? Not at all, I already knew those things. What I learned was to associate the feeling of being unwell with the knowledge of why I felt unwell. Honestly, it made it hard to eat breakfast. I’ve come to enjoy fasting as a corrective measure so much that I naturally wanted to skip breakfast to correct this issue. Yet, I soldiered on and ate anyway. I’ll document that in a post later today. Stay tuned.