January 2, 2012

It's That Time Again . . .

The rows of candy in the Seasonal Aisle will be replaced with Diet Food, mostly toxic. The media will be full of diet advice, mostly wrong. The bookstores (what few are left, but that's another story) will move the newest Miracle Diet books to the front of the store, each one promising to reveal a simple secret that will make the pounds drop off like magic. The gym will be packed.

It only lasts a month. Then the shelf at the grocery store will be full of chips and dips for SuperBowl parties, at least in the USA, you won't have to wait in line for a treadmill at the gym. The Miracle Diet Books will be shelved with all the other, failed, diet books, as it becomes clear that this year's magical secret is no better than last year's.

People with diabetes, of course, don't have the luxury of dieting only for 2 weeks in January. We have to watch what we eat year-round because we can't afford to let high blood sugars ravage our bodies. But as I've explained elsewhere, people with diabetes are also normal human beings, and that means that a certain amount of the time we are going to eat things that aren't good for us, overdo it, and pack on a few pounds over holidays.

The critical thing for us to master is not that we never eat anything that is off plan, but that, when we do, we learn how to get back on track as soon as we realize things are getting out of control.

A few hours over 200 mg/dl (11.1 mmol/L) won't make you go blind, give you a heart attack, or take out your kidneys. Neither will a few weeks. Most people who develop the classic diabetic complications do so after years of exposure to blood sugars way over 140 mg/dl (7.7 mmol/L)--the level that appears to be the upward limit of safety. Details HERE.)

But as many of us have learned the hard way,those harmless hours of high blood sugars have a way of turning into weeks and months, sometimes without our noticing it, and when that happens, those damaging years aren't far behind.

So it's good practice to clean up our act every now, and this January period right after the holidays is a great time to do it.

As always, our primary focus should be first on bringing our blood sugars back to where we know they should be. Most people at this time of year diet for weight loss, but weight loss is not what preserves the health of people with diabetes, no matter how many times you may have heard this said.

What preserves our health is keeping our blood sugars as close to the normal range as possible. That means staying under 140 mg/dl (7.7 mmol/L) and, if possible, ended up under 120 mg/dl a few hours after we finish a meal. Lower is better if we can do it without experiencing hypos (defined, technically, as blood sugars under 70 mg/dl (3.9 mmol/L)).

After you've gotten your sugars into control, you might also decide to drop some weight which may happen on its own if you're new to cutting back on carbs, but which will likely require some calorie restriction if you are an old hand at it.

Modest weight goals work better than ambitious ones. Set a goal you can achieve in a month, which may be anywhere from three to ten pounds depending on your size, and then set a new goal at the end of the month rather than setting a grandiose goal ("I'm going to lose 80 lbs!") which is much harder to attain and much easier to depress you after the first enthusiasm wears off.

If your blood sugar has been running a bit high lately or your occasional snacking has turned into round the clock eating, you will run into some known problems when you cut back. For starters, you're likely to be very hungry. Fortunately, the physiological component of your hunger is entirely due to the change you are making in your blood sugar and should be gone within a day or two once you get back on track. Remind yourself that if you can get through two days of eating the way you want to eat it will become a lot easier.

The other problem you'll run into is temptation. There is something about seeing some food we have decided not to eat that makes us immediately crave it. If that food is always in our field of vision, it can become very hard to withstand the urge to eat it. Diets that rely on willpower can be very short diets. So plan ahead to eliminate as much temptation as possible. Here are some suggestions I've found helpful. Please post your own in the comments section.

1. If it's not there, you can't eat it. Rid your home of any food that you find hard to resist. A common diet disaster pattern is eating perfectly all day, only to come home and blow it all by snacking on junk as the evening progresses. So throw out, or give away the items you end up pigging out on. If they aren't there, you might think about eating them, but you won't be able to eat them. This sounds idiotically simple, but the world is still full of people who try to diet with fridges full of ice cream.

This may require taking a hard line with family members. Demand their support. If they argue that just because you are on a diet they shouldn't have to be, ask that they keep their junk food somewhere out of your sight. Even just putting snack foods in a cupboard instead of leaving them out on a counter where you see them every time you walk through the kitchen can make a big difference. Just remember, Monkey See, Monkey Eat.

2. Don't Watch TV Commercials. One major cause of diet stress turns out to be the ads on TV. Seeing food makes people hungry, and TV is full of closeups of pizzas and burgers and "endless" shrimp. One strategy that has worked for our family is to use the commercial breaks for mini exercise sessions. During the commercial breaks turn off the sound and do some pushups. Lift hand weights. Run a few laps around the house. I have a nice long, steep driveway which is just the right size for a few laps of brisk walking during my beloved Patriots games. You'll feel a bit silly, but you may be amazed at how much better you feel if you do this. Even better, turn off the TV entirely and read or do things online that don't expose you to food porn.

3. Set modest goals. I don't tell myself I'm going to eat perfectly for the rest of my life. Instead I say, "I'm going to eat perfectly for the next two weeks. Then I'll see where things are at and decide what to do next." What I usually do next is continue to eat reasonably, because two weeks of keeping things clean makes it much easier for me to continue. But for me, it's very important to maintain my feeling that I am in control, not the diabetes.

4. Eat Dull Food. Stephan Guyenet over at The Whole Health Source Blog has posted some interesting research over this past year about how the palatability of food tends to push us towards weight gain. I've found that it is often easier for me to diet when I eat the same predictable dull low carb foods for breakfast and lunch every day for a few weeks. When they become intolerable, replace them with other dull foods. Eggs and meat or cheese for breakfast, Fage yogurt and nuts for lunch, a big green salad with meat for dinner, are good examples. All too often when people start dieting they spend their time reading diet cookbooks and recipe web sites looking for ideas. This dwelling on food is the last thing you need to do. If you need to come up with recipe ideas for a new diet, do it before your diet starts. Then think about other things.

5. Do A Different Diet. If you're trying to lose weight, especially if your previous attempt hasn't worked out as well as you had hoped, rather than just reflexively reach for the newest diet doctor book with its promise of Miracle Weight Loss Secrets, take some time analyze what it was about your last diet that made it fail.

Was it that you didn't like the foods you ended up eating? If so, don't go back to eating those foods, but find other foods that you might like better to diet on. Did the diet make you hungry, even after the first week was over? If so, maybe you are past the point where diet alone can flatten your blood sugars to where you aren't hungry. Maybe it's time for metformin, or perhaps insulin.

If you haven't had your thyroid checked in a while, do, and make sure your doctor does more than a TSH test to determine if you are having thyroid problems. Diet alone is not enough to solve many metabolic problems. Hunger is a SYMPTOM. If cutting back on sugar and starch do not resolve nagging physiological hunger, it may be time to get help from an intelligent doctor.

Your issues with failed diets of the past may be different, so you need to figure out what it was that derailed you. Doing the same thing over and over again expecting a different result is the definition of futility. So figure out what didn't work for you and solve the problem it posed.

6. Hold Yourself Accountable. Post your weight or blood sugar goal and daily progress in the appropriate section of an online diet or diabetes support forum. If that is too exposed, log them into tracking software, like Fitday.com for diet or one of the diet and blood sugar tracking apps available for your smart phone.

Average your results every week and see if the trend is up or down. Weekly averaging of individual values for things like weight and post-meal sugars will give you a much better idea of how you are doing than just looking at the individual values that can be all over the place.

7.Investigate What You're Eating. One of the biggest reasons for diet failure turns out to be eating a lot more than you think you are eating. If you are trying to cut carbs, you need to learn about how much carbohydrate there is in every food you eat. Look it up online. Download diet software. Use an app.

And remember that the nutrition counts you read are always pegged to a specific weight or volume. Weigh and measure your food for a few days to see what you are really eating. If you are like most people you may find that you are eating between two and three times as much carbohydrate each day as you think you are and far more calories, too.

What are your tips? Add them in the comments section.

 

14 comments:

Sandra said...

I use GlucoseBuddy on my iPhone to track blood sugar, weight, and food log. There is a tie-in app, also free, that will figure carbs for you. The basic app is free but I paid for an upgrade for the weight and blood pressure tracker.

Lona said...

A post full of common sense. Thanks, Jenny! For the first time in three years, I maintained my diet plan over the holidays and not one drop of junk went in my mouth. The results? My fasting number this morning was 86 and I've lost about 5 pounds over the holidays. It seems to have finally clicked in my head - keep the bg numbers as low as possible and the weight starts to take care of itself! Down about 15 pounds since the beginning of August.

I send all new diabetics that I run into to your site. You and Dr. B make more sense to me than any doctor I have run into in my every day life. Thank you for the work you do, it means a lot to many people.

Lona Brown, in snowy Ohio.

Deidrel said...

Thanks, Jenny! I was disheartened after gaining 13lb through a combination of holiday excess (in the form of citrus fruit, but hey -- some people gain weight from eating fruit!) as well as two weeks with the flu. So this is encouraging.

Question: Do you have a link for a fuller discussion of how my doctor and I can figure out what's up beyond the TSH tests?

For months I have had a lot of symptoms that suggest to me that my already hefty thyroid prescription may need to be increased, but my TSH tests have remained normal (though inching towards hypo a little more every year) for many years. I do worry that low-carbing may be slowing down my thyroid, but LC is the primary way that I'm managing PCOS (I'm one of your "pre-diabetic" (i.e., non-diabetic) readers).

Sooz said...

I find it funny that you describe meat, salad, yoghurt and nuts as dull foods. These are my favourites. Meat, depending on how cooked can have 'umami', which is a most desirable flavour. I think we need to get back to the fantastic flavours of fresh meat, seafood and vegetables that grow above the ground.

As people with diabetes, we have to watch what we eat as much as treat properly what we eat, especially with insulin, exercise and whatever else is at one's disposal. Yes, the insulin can stack on the weight, but in this growing (pun intended), food-obsessed society, I think it's very easy to feel deprived and get angry at having diabetes. It's easy to feel like a leper at social occasions, and to be a difficult customer at a restaurant when trying to order within carb limits. Fitting in is impossible for many people and we're never given enough counselling to cope, so some of us can, and some can't.

Despite eating well under 100gr of carbs a day most of the time, I don't deny myself the ice cream, or good dark chocolate or a piece of cake, but have them now and then, and in small doses. And that doesn't mean every day or even every other day. It's really a very now and then thing, with enough insulin to cover it and maybe add a walk afterwards. For people who aren't on insulin, that can be a bit more difficult. With lower carbs, I rarely get hungry. If I do, I will never let myself get ravenously hungry - that'll be my downfall. Have a few nuts like almonds, or some cheese - a relatively small amount should satisfy the hunger and make little difference to your blood glucose.

Another tip... don't socialise around your kitchen.

Jenny said...

Deidrel,

I'm not very knowledgeable about thyroid issues, but quite a few people suggest getting free T3 and free T4 tested, along with TSH. Sometimes TSH will be normal but these other measures of available thyroid hormone will be low.

Jenny said...

Sooz,

Great advice!

Howard said...

Good post, as usual, Jenny. That's why you are on my reader and my blogroll.

January's a good time to avoid the gym. Fortunately, fitness is more dependent on the kitchen than on the gym. As I mentioned on GuestDietBlog a few days ago, I don't bother with New Year's Resolutions myself.

I usually keep track of the date for the Super Bowl, but only because it's a GREAT day to get out & do some shopping. That's a general pattern for me dating back to my Navy days -- I didn't even bother to leave the base on the weekend after payday. The off-payday weekends were much more fun; less competition for the girls! I was constantly amazed at how few of my fellow sailors ever got that.

About your advice to "try a different diet" -- last week, I went on a Christmas cruise. Ate like a KING. Never a hungry minute, with 4 or 5 meals a day consisting of all the lobster, steak, prime rib, pork, dozens of types of fish, etc that I could possibly stuff down. I made a point of consuming at least 5 or 6 pats of real butter every day (got some funny looks for adding it to my coffee :) ). When I got back, I stepped on the scales, and was almost disappointed to see that I had lost only one pound. ;) I think I've found pretty much the perfect diet for me. That's the "different diet" I started in 1999, and have followed ever since.

Karen said...

Thanks Jenny for the reminders! Took the grandaughters nuts to her room and putting other stuff away! Karen

Susanne said...

I gained a lot this holiday season drinking carbs...eggnogs and hot buttered drinks served with love got me started, and once that fire was lit I was out of control. So.....back to sparkling water and iced teas. Reconnected with an old friend who is taking Actos and has weight gain in her legs and eye problems so I'm ordering your book to send her. I look toward to a better healthier year for us all.

Susannah Allen said...

Thanks Jenny. I have morphed away from where I should be and I made a goal to restart, slowly, comfortable and find support.I agree with all your posts, thank you for the confirmation.

ShottleBop said...

@: In December's teleseminar, Dr. Bernstein gave this link about checking out thyroid issues:

http://nahypothyroidism.org/deiodinases/

The linked-to article is titled "Understanding Local Control of Thyroid Hormones: (Deiodinases Function and Activity)"

Thanks for the post, Jenny! Of course, just a few days after this post, "Diabetes in Control", for gawdsake, came out with an issue replete with articles such as one discussing USN&WR's report rating 25 diets, putting paleo at the bottom overall and Ornish and vegan tied for second as diabetes diets, and one discussing a JAMA study that, based on a controlled in-ward study of diets with varying amounts of protein, concluded (at least, per Diabetes in Control), that calories alone matter in determining weight gain from what you eat.

Jenny said...

I have yet to hear from anyone who has been able to stick to a vegan diabetes diet and who saw it improve their health. There may be one or two out there, but they are remarkably silent. I have heard from quite a few people who tried one and found they were starving on it all the time.

And of course, the high soy content of vegan diets explains why vegans end up with gluten intolerance and other autoimmune conditions, including thyroid ones. The soy causes "leaky gut syndrome", large protein molecules get into the blood stream where they don't belong, and antibodies are formed.

Jim S. said...

Thanks Jenny. If I had not found your website,(Blood Sugar 101), when I was first diagnosed as type II 8 months ago I would still be confused about what constitutes a proper diet for diabetics - and how to normalize my blood glucose. Thanks for this sane article and all the hard work you have done on your website (and in your book) to inform the diabetic community. The ADA informs people, too, but their information is less than sane, IMO.

Luana said...

Deidrel, Your TSH, though normal, may be at the too high end of normal. Some only eliminate their hypothyroid symptoms when at the low end of normal. It may be a good idea to see an endocrinologist rather than a family doc to manage your thyroid. Sometimes adding T3 can help much with energy level, even if your T3 levels are normal. Mine was on the low end of normal; endocrinologist prescribed 5mcg Cytomel, and it's made a huge difference.