(You’ve been warned: This is a long post! That said I hope you’ll keep reading.)
I’m not really even sure where to start this blog post, as it’s not clear where it all started… I’ve been lucky in that I’ve always been relatively thin and healthy, and I’ve always been athletic and a regular exerciser. But, when I think back on things, I’ve always, ALWAYS had an insane craving for sweets and other carb-y, starchy foods. I’ve been known (since I was a young kid) to eat myself sick on more than one occasion (usually on sweets). And for the last 10-15 years, I can remember always wanting to ensure I had food with me – with the thought of being or getting hungry and not having food available generating significant anxiety (despite the fact I’ve never gone hungry in my life). You should see my purse – filled with snack bars, packages of nuts, granola, dried fruit, etc. I’d like to say it was for my kids, but damn if I didn’t get really pissed when someone ate some of *my* snacks.
Then there’s the stuff that started happening more recently — the rapid and unwelcome weight gain, despite the fact that I was exercising like a madwoman; the increased hunger and near-obsession with thinking about food; the low energy; and what probably sent me over the “edge” (or at least to the sports med doctor) – the continually disappointing, exhausting and almost painful workouts and races I experienced over the past 6 months. At first I thought it was just that starting grad school and managing a family with 3 small kids was taking its toll on me (which is what my regular doc said), but eventually that just wasn’t a good enough answer. No one was going to interfere with my workouts, dammit: They are my sanity! I rely on that “me time” (and the endorphins are a nice boost too).
So off I went this past June to a great sports med doc here in Seattle. She’s a friend of one of my nutrition professors and an article in Huffington Post about her work really sounded like I could learn something. However, going into it, I just thought she’d tell me to tweak my workouts, space my meals out differently, or something else rather obvious that I’d simply overlooked. I did NOT expect her to tell me that I have some really weird metabolic stuff going on. But I’m getting ahead of myself….
During my first visit, I completed a battery of tests to measure/assess my body composition (fat mass vs lean mass), ability to utilize oxygen during exercise (VO2 max), heart rate recovery post-exercise, resting metabolism rate, and completed something called the anaerobic threshold test. For a sporty, data geek like me, this was an awesome experience – running on the treadmill hooked up to all kinds of wires and displays; the whole nine yards. Then, I sat down with Dr. Cooper who looked at me and said, “Well, you’re right, something’s not right here. I just don’t really know what that is.” D’oh!
What we found is that 1) my heart rate drops more than 100 beats in 2 minutes following intense exercise (you typically want to see no more than 50 beat drop) – meaning that my metabolism doesn’t really have any “after-burn” after intense exercise, unlike most people (typically, after high intensity exercise, your metabolism is cranked up for up to 12-24 hours after… not mine!), 2) my VO2 max test showed really strange results indicating inefficiencies in burning carbohydrates and a general trend to just “hit the wall” even though I’m well-trained, 3) I burn fat way more than I burn carbs.
Now #3 sounds like a nice thing if you want to lose fat, but for an athlete, it’s really not good. Carbs are your main source of fuel and a super important staple of rapid energy during exercise, especially endurance exercise like running. Fat is slow burning, inefficient and can cause a host of other issues by having so much free fatty acids coursing through your blood (hello high triglycerides, risk for heart disease, etc.). A typical trained athlete (female) will burn approximately 30-50% fat and the rest carbs during moderate endurance exercise and burn 0% fat (i.e. all carbs!) during high intensity and/or anaerobic exercise. Me? I was burning upwards of 60-70% fat at moderate intensity levels and still burning nearly 30% even at anaerobic/super high intensity. No wonder I felt like crap. There was really not enough “in the tank” to keep me going. So I left the first visit feeling grateful it wasn’t all in my head, but really confused about just what was happening (and why!).
Next up, I went through a battery of blood tests to check levels of hormones like insulin, thyroid hormone, and cortisol; as well as electrolytes and nutrients such as potassium, calcium, zinc, magnesium and more. One of the most interesting tests was a series where I fasted overnight, did a fasting blood draw, then ate a meal (in the lab!) and then had post-meal blood draws every 30 minutes for the next 2 hours. The results of these tests were VERY interesting. As I noted in my last post about the “hormone cocktail” that is your body, when one thing is out of whack, a lot of things can end up out of whack as well. The biggest thing we found is that after I eat, instead of my blood sugar increasing (as a result of glucose from digestion of my food) for the first 1-2 hours and then gradually dropping (as is normal), my blood sugar was instead rapidly plummeting, triggering hypoglycemia. And, my insulin response to my meal was much more aggressive than it needed to be to deal with the glucose that was actually consumed – clearing away too much blood sugar and then leaving my body in a state of (in its view) starvation.
We also found that my cortisol (the stress hormone) levels were excessively high (hello rapid weight gain) and my leptin levels (the “satiety hormone”) were low (oh how I hate you, Constant Hunger). The net package is that my body thinks it is nearly always hungry, even though it’s getting healthy balanced meals, and the plummeting blood sugar is its way of signaling me to feed it – which just sets off the whole cycle again. And, I also have some of the other issues associated with hypoglycemia – fatigue, lack of ability to concentrate, anxiety, etc. Dr. Cooper calls this whole picture: “reactive hypoglycemia.”
As one might expect of a nutrition graduate student, I promptly went home and read about 30 scientific research studies on this topic, which were somewhat ridiculously hard to come by. This over-production of insulin in an otherwise healthy person (e.g. I have a BMI of 22, my blood pressure is ridiculously low, my fasting blood sugar is 94 and my triglycerides and cholesterol are also low) is not common, and is downright atypical from what I could find. Oh Great. And, some of the possible causes are pancreatic tumor and/or being in a very early, early stage of type 2 diabetes. Double Great. Other causes can be simple genetics, which I’m hoping is the case. Still, I’m frustrated, confused and a little scared. How can someone as healthy as me be, well, perhaps not so healthy?
So where am I now? Well, we’re currently in the midst of some slightly random (to me, anyway) “experiments” to see if we can get my blood sugar and insulin levels to correspond a bit better. I’m currently taking a couple different medications that are targeted at slowing carbohydrate digestion and gastric emptying, to see if we can moderate the levels going in as well as the insulin response to them. I’m also eating slightly smaller and more frequent meals, and making sure I have a mixture of complex carbs (low-glycemic), fat and protein at each meal, to avoid any major “spikes.” And, in a really weird twist of sports nutrition, I’m eating immediately before I exercise (like 5 minutes before), rather than a few hours ahead, so that the food I consume is able to provide rapid blood sugar and energy for my exercise rather than being cleared away leaving me high and dry and/or being stored as fat. (During moderate to high intensity exercise, insulin is suppressed, as you’d want it to be, so that your blood sugar and glycogen stores are readily available and able to fuel up your muscles and cardiovascular and respiratory systems).
I’d like to say that after 8 weeks of this I feel awesome and am ready to add a few more races to my calendar this summer/fall, but I’d be a big fat liar. Frankly, I feel like crap still. And I’m really frustrated with that. But, I see small glimpses of light here and there – an awesome feeling run a couple days ago (about 2 minutes/mile faster than what I’d been doing lately, even) and a few more days without desperately needing a nap. Add to that, 10 pounds gone. Even better, however, is the lack of insane hunger and constant worrying about my next meal. That may sound weird to anyone with normal metabolism, but it really only just occurred to me in the midst of all this, how anxious about food I’d become.
Through all of this, I have a newfound (and profound) understanding of just how hard weight loss can be for some people. While the accepted wisdom is that “calories in (food) vs calories out (exercise)” explain our body weight, it’s really not that simple. Genetics, hormones, stress, and so many other things can really influence this. I was absolutely killing it at the gym the past 6 months and yet gained 13 pounds. And I wasn’t eating Cheetos and Big Macs either. While I do love my occasional cupcake or ice cream, my diet is largely lean meats, veggies, low-fat dairy, fruit and nuts. It just didn’t feel “fair”!
Metabolism is an extremely complex thing and we need to respect this. And, as a society, we need to not over-simplify the “weight thing” – nor judge others. We really can’t know what someone’s world is like unless we’ve walked a mile in their shoes. And yes, even “skinny girls” can wind up with metabolic issues. Future dietitians too.
I’ll keep you all posted as this plays out, but wanted to share. If you feel like your body has “gone off the rails” in any way, listen to that voice in your head. Take charge and find out what’s happening. It’s important. And so are YOU!