Why I test my blood sugar...even though I'm not diabetic

Several years ago, when I was still pretty much a believer in mainstream health advice, I would have my fasting blood glucose checked once a year, along with other basic lab tests. It always came back in the normal range, and I was not overweight, so I didn't think much of it - even though diabetes definitely ran in my extended family.

I also had a brother-in-law with Type 2 diabetes and one day I saw an advertisement for a free glucose meter, so I sent away for it thinking I would give it to him. (Boy was I naive, now I know it's like printers and their ink, or for those who remember, Polaroid cameras and their film - it's not the machine that's expensive, it's the supplies that go with it.)

Anyway, I happened to have it with me, at work one day and thought it would be interesting to check my own glucose after eating a typical lunch, one that I had always thought was healthy.  It was beans, collard greens, and sweet potato. To my surprise it was 190! This is high. Ideally it shouldn't be over 140 one hour after a meal.

Well I ended up keeping the meter for myself and became quite interested in seeing how different foods affected the reading. I went on to read quite a bit about it - finding these two articles particularly interesting: How to Lower Your Blood Sugar and How to Prevent Diabetes and Heart Disease for $16

I now feel that being aware of one's blood glucose, and keeping it in check, is possibly the single most important thing you can do for your longterm health. Even more important than knowing your cholesterol numbers (the significance of which sparks a lot of controversy and the whole statin debate.)  This is because a high blood glucose has been associated with pretty much everything you don't want to have and affects every system in the body...eyes, kidneys, blood pressure, heart disease, liver, blood vessels, brain, depression, nerves/neuropathy, Alzheimer's, gum disease, infections, some even say cancer, etc, etc.

And ironically, had I not tested it for myself, I might not have discovered my propensity for high blood sugar until much later, if at all. Because the fasting glucose - which is traditionally checked -  is much slower to become elevated than the post prandial (after meals) reading.

Though fortunately there has been a shift towards checking the Hemoglobin A1C. This lab test gives you an average of your blood sugars over the past 2 to 3 months.  It is not completely accurate, as factors like anemia, for example, can affect the reading. But overall it gives a better picture of a person's tendency towards diabetes - or if they already have diabetes, how well-controlled it is.

I think everyone should know their A1C number. Because you really can't know if you have glucose issues otherwise. There isn't necessarily a typical diabetes look - you'd be amazed at how many thin people have diabetes. And young people. Although extra belly fat (even on a non-obese person) is often a tip off of glucose dysfunction. And apparently damage can be occurring even if not diagnosed with diabetes. It is more of a continuum effect (the higher the number, the greater the correlation with disease) - than a sharp cut off of either you have it or you don't.

There are still old-fashioned doctors who don't agree with this. When I asked my mother's doctor to check her A1C, he said we only order that test for diabetics (and she wasn't). A friend of mine, who has a strong family history of diabetes, asked her doctor to order a glucose meter and the supplies for her, and was told no, only if you already have diabetes or pre-diabetes. (The test strips can get expensive, but some insurance covers it, or I've heard you can but them at Walmart or on Amazon for less.)

This to me is SO shortsighted. But typical of our American way of dealing with health and disease. We will try to manage the problem once you have it...but let's not give any thought to what might be causing the problem and how we can prevent it. Really stupid.

I think if everyone who wanted one was given a free meter and test strips, we would go far towards having a healthier nation. Of course there are plenty of people who just don't want to be bothered, but there are many who would welcome the chance to possibly improve their chance of avoiding serious illnesses.

I actually find it quite interesting to see how different foods and time of day affect me. I remember years ago a patient telling me that a plate of pasta made her blood sugar spike higher than eating a bunch of candy. At the time, I didn't know much, and found that astonishing. Now I have observed the same to be true for me. Rice too, has a strong elevating effect on my blood sugar. As do oatmeal and potatoes.

Another surprise was how much fruit can increase my blood glucose.  I used to think fruit was healthy no matter what, but I now know that fruits can cause a significant rise in glucose. Especially bananas. I still eat them, but usually only a half at a time and without too many other carbs. I can usually tolerate one or two servings of a carb food per meal. Beyond that, the additive effect is too great.  Berries, such as blueberries or strawberries, are the least likely of any fruit to raise my blood sugar, so I try to eat more of those.

I have also noticed that I can eat way more carbs in the morning than at night, in terms of not sending my sugar too high.  But I had a diabetic patient (who was type 1, in which the pancreas does not make insulin vs type 2, which is more common as one gets older, and the cells become insulin resistant) who told me her experience is exactly the opposite.

So, I believe, testing for yourself is the way to go. And you don't have to test all the time. Once you learn how various foods affect you, it's not necessary to keep testing unless you introduce new foods.

The Japanese Are My Inspiration When It Comes To Food

One of the biggest surprises of all when I visited Japan (a fabulous two week trip to Tokyo and Kyoto last year) was to discover that 7-Eleven convenience stores - which were everywhere - had the most delicious and economical food! Yes you heard me right. That was not a misprint. 7-Eleven!! Of all places.

They had all kinds of amazing and tasty fish dishes, as well as vegetables and other things that I'm not really certain of what they were, and of course, sushi. I marveled that their convenience foods could be so healthy. How disappointed they must be when they come to the U.S. only to discover Slurpees and hot dogs.

I noticed this too when we walked along the local tourist-oriented shops in Ohara (a lovely rural spot an hour's bus ride away from Kyoto.) The tourists seemed to be mostly Japanese (I guess kind of how we might make a weekend trip to Santa Barbara from Los Angeles) or from other nearby Asian countries. I did not see many Western faces.

There were many food shops - apparently it is particularly common in Japan to bring home local food delicacies for friends and family to try after a trip. I was surprised how so many of these shops featured huge varieties of fermented vegetables and pickles, ginger, matcha/green tea, seaweed and fish variants. All beautifully packaged and displayed. There were sweets too, but much less and in smaller portions than we are used to seeing.

The Nishiki Market in Kyoto is an immense and completely overwhelming food hall.  As was the basement food court at Takashimiya department store in Tokyo. Do not miss either if you are ever in the area! And again I was struck by the amazing variety and preponderance of healthful food items displayed.  We tried many things, though far from everything and I found there were many new things that I liked but some that I just didn't care for, even though they were considered delicacies by the Japanese. I wonder if I kept at it, would I develop a taste for it or is it a taste that has to be inculcated from childhood?

Picking out candied ginger at  Nishiki Market.

Traditional Japanese breakfast we enjoyed in Ohara.

And even back in Los Angeles, shopping at my local Japanese Market, Mitsuwa, I notice that the produce and fish sections are huge and filled with variety, whereas the dairy and bread/cake sections are almost nonexistent. Although sadly I have noticed a trend over the years to more sweets and frozen and convenience foods, just like their Western counterparts. But their portion sizes tend to be much smaller, so even the junk food doesn't seem as bad.

So I guess it is not terribly surprising that Japan has the highest life expectancy in the world and that our obesity rate in the U.S. is 10 times that of Japan. 30% vs 3%. Or that their heart disease deaths are 30 per 100,000 people compared to our 106 per 100,000 people. They do have more smokers than we do - 30% vs 17% - which actually makes the heart disease rates even more impressive. Imagine if they didn't smoke! They also have significantly lower rates of breast cancer and Alzheimer's disease than the U.S. Interestingly, we also spend three times more on health spending per capita than they do. Which tends to confirm my belief that the food one eats is the single most important factor in health and longevity. Health care, exercise, genetics and environment are important, but it seems to me that diet trumps all.

How My Current Way of Eating Has Evolved

At the moment, I am pretty content with the way of eating* I have settled upon.  Of course, that could change at any time. It already has gone through several iterations, as I learn and tweak and adapt and tweak some more. But fortunately, I find this process interesting, rather than onerous. Kind of like solving a puzzle. And the outcome, feeling good and staying healthy (at least I hope so - thus far so good) seems worth it to me.

At 62 years of age, I am pretty much at my college weight. I know what my college weight was because my old college boyfriend used to joke "Nankie, 2 pounds per inch".  Meaning I was 5'2" and weighed 124 pounds. I am now 126 pounds. I have never been really heavy, but I was definitely starting to head in that direction the past decade or so. My weight was creeping up, 134 at its peak.

Of course, it's no longer distributed exactly the way it was 40 years ago, but still for my age I feel I am doing pretty well. I wear a hand-me-down two piece bathing suit from my daughter (who has a great figure) and it's passable. I was pleasantly surprised to find that I could even get into it. (And Mr. Nankie said it looked nice!)

But worse, my blood sugar was becoming elevated, to the point of pre-diabetes. I have a strong family history of diabetes, hypothyroidism, hypertension, heart disease, and thin people in youth becoming heavy people as they aged (the last is true of many, many people). Really shocking was incidentally finding out I had a fatty liver when I went in for an ultrasound for another reason. It was mild, but still.

Anyway, to show how my eating has evolved, I will start with my childhood. My mother did her best to serve us healthy food and was ahead of her time in insisting on fresh vegetables vs. the canned that were so common in that era. She had it easier though, because of "Jack, the fruit man" who came from his farm in upstate NY to the suburbs of Queens NY, in his truck filled with fresh fruits and vegetables. She would stand at the back opening of his truck where everything was displayed and choose what she wanted. Sometimes she would just leave a list on our door and in the afternoon a bountiful bag would be sitting there. I guess he trusted her to pay up later.

It wasn't exactly like this, because we were on a much more urban street - but Jack's truck was similar.

My mother also did not believe in junk food. To my dismay, we almost never had soda, candy, chips, etc in our house. I envied my friends who always had these things. An occasional box of Mallomars was about it for us.

                                  

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So of course, as soon as I moved out on my own, to the Nurses Residence at Bellevue Hospital in New York City, I pretty much ate primarily junk food. I was thrilled to discover a vending machine room in the building where I could purchase Hershey bars 24/7.  I also recall making a lot of English muffin pizzas in the community kitchen. Beyond that, I can't recall (which is why I have so little faith in the findings of the Nurse's Health Study, which asks you to remember, in detail, what you ate decades ago, even though I am a participant in it.)

This pattern continued as I moved into my first apartment in Manhattan and became a full time working nurse. I honestly do not recall thinking much about food or the right way to eat. Taste was my main criteria. I don't think at this point I thought much about if it was healthy or not. Of course, neither did most of the rest of the world yet. Nutrition labeling was still far off in the future. The term obesity epidemic was yet to be coined. I also smoked cigarettes for a few of those years. So clearly health was not a major concern of mine.

Then in a few more years I followed my boyfriend (the present Mr Nankie!) to California where he had taken a job - the land of the wacky health nuts that we New Yorkers always ridiculed.  But still my eating habits remained the same until we married and had a child and by now I paid a bit more attention to the "proper" way to eat.

Which from what I could glean from pop culture magazines and media, was more carbohydrates and less meat. (Although I took a Nutrition course in college for my nursing major, I don't remember learning any useful information there except for post surgery patients needed extra protein and Vitamin C to heal.)  I remember serving lots of pasta meals and feeling virtuous when we chose pretzels as snacks instead of nuts. Wheat Thins were another big favorite of mine that I felt was a good snack and I would eat them by the boxful. I also served a fair share of frozen dinners (Stouffers Lean Cuisine) just because I was often too tired to cook. A half gallon of orange juice, a loaf of whole wheat bread, and a box of breakfast cereal were always on my weekly shopping list.

It wasn't until many years later that I discovered low carb eating. I decided it was time to start eating more healthily and try to lose a few pounds, and I added in lots of quinoa, other whole grains and fruit, thinking that was healthy. Two weeks later I had GAINED 5 pounds! Clearly this was not the right path. A friend who was smarter than I said "well carbs are still carbs, even healthy ones" and that started me doing research into what exactly was the best way to eat. Fortunately, by now the internet had made its appearance, so it was a lot easier to look things up and figure things out (and also to get distracted and waste time)!

I was in love with low carb because suddenly I could eat all the cheese I wanted and was still losing weight! But alas, after awhile, this effect started to wane and I started looking for what I could change. I was particularly surprised when I trained for a hike down and up the Grand Canyon, and while doing more exercise than ever before, I ended up gaining five pounds! And it wasn't muscle.

That is when I realized that what I always thought was just an excuse "my hormones are off, that's why I'm fat" - actually had some basis in reality. I think the increase in exercise without a corresponding increase in carbs shifted me towards a more hypothyroid functioning. I've since read this has been observed in many Crossfit followers, particularly women.

I came across The Perfect Health Diet by Paul and Shou-Ching Jaminet and this has been essentially my guide. Although I never weigh or measure anything, I do try to stick with their overall recommended and forbidden foods. I make plenty of exceptions, but in general these are the guidelines I follow. It is essentially a paleo low carb type diet, but with the addition of some carbs (mainly rice, not grains). Although I don't agree with everything they say, they do strike me as intelligent, thoughtful people who read the scientific studies. And know a lot more about nutritional science than your average doctor. 

So this is where I have been at for the past few years, because it  has been working for me. I have also introduced intermittent fasting. And lest you think I am someone with crazy strong will power and self-discipline, I am not! By any means. I never believed people who would say "you will lose your cravings" or "you don't get as hungry" but I have in fact found these to be true. Not to say, I never grab a chocolate when there is a box of See's candy sitting on the desk at work. I do. But I am much more able to eat healthily without it feeling like a tremendous sacrifice.

*I do not call it a diet because I have never followed a specific "diet" and allow myself to eat anything I want, if I really want it. However, I do try and follow certain guidelines, most of the time. The 80/20 rule works pretty well for me. If I stick to my guidelines 80% of the time, I am happy with that.

I just don't think I could do this!

I am always in favor of trying new things and being open to new flavors and foods of other cultures. "Dishversity Day" was one of my favorite parent participation days when my daughter was in elementary school! I think it's silly to think that the limited vegetables and fruits we eat over and over and over in the U.S. are the only ones in the whole wide world that are tasty and health giving. Whenever I travel I am impressed by the variety of produce I see, things that I am not familiar with. I love shopping in ethnic food markets. And I think the more variety, the better for us.

However....this is something I am hearing about more often recently, and while it makes perfect intellectual sense, I JUST DON'T THINK I COULD DO IT! Eating insects! Apparently they are quite nutritious and lord knows there is no scarcity of them. But I just don't think I could do it. Cultural conditioning is just too strong in this case. Perhaps if they were pulverized and disguised. But even then, just knowing they were in there would probably freak me out.

Once, many moons ago when I had just moved to California from NY and I had a friend and his father stay with me for a few days, they sent me as a thank you gift a case of U-Bet Chocolate Syrup. This was my holy grail of chocolate syrups (obviously before, way before, my days of health conscious eating). And at the time it was only available in NY. And they knew I missed it so. So this was the most amazing gift they could have sent me and I was ecstatic.

Except that shortly thereafter I read an article in Consumer Reports reviewing of all things, chocolate syrups. And U-Bet was the ONLY one rated UNACCEPTABLE!  Why, you ask. Because it was found to have "insect parts and feather barbules" in it. Sadly, I never touched them again and the whole case went to waste.

So as much as I like to try new things, I'm just not sure about this one.