Save your money. Here’s why.

As we’ve talked about previously, metabolism is simply your body’s way of using food to create energy – for physical activity, for your brain, for digestion, breathing, etc. Each person’s metabolism rate is slightly different, based on genetics, ethnicity, health status, physical activity levels, weight and BMI (body mass index), and other factors such as overall food intake. We typically measure metabolism by looking at total calories burned by your body during daily activities (and we measure this based on intricate calculations and/or by measuring gases you inhale and exhale each day).

Now, while your body may experience very small jumps in metabolism rate after eating certain foods, taking supplements, or drinking very cold liquids, for example, these changes are typically very small and/or temporary, and will not serve to boost additional calories (or help you lose weight) in the long term. The best way truly increase the calories you burn is to increase your activity level and/or to increase your overall muscle mass. Muscle requires more energy for your body to maintain, so strength training can be a great way to burn additional calories – as well as improve strength, flexibility, coordination, and bone density. Try 30 minutes 3 times a week. High intensity interval training (HIIT), or short bursts of very intense exercise, has also been shown to provide a metabolic boost, for up to 24 hours post-exercise.

Treat your body right. And it will treat you right!

What to Choose?

Whether or not you choose to buy all organic, some organic, or none at all, is a very personal choice. There is no one single “best” reason to choose organic vs. conventional foods. If you choose to purchase organic, but find your budget can’t fit 100% organic, the “Dirty Dozen” and “Clean 15” lists from the Environmental Working Group (below) can help you choose those fruits and veggies that provide the most benefit in organic form, as well as those you can feel safest buying for your family in non-organic form.

 More Healthy Shopping Ideas: Shop Local & In-Season

If you’re looking to buy the most flavorful, healthiest and sustainable products for your family, consider tailoring your fruit and veggie purchases to the season. Buying fresh-from-the-farm can mean greater variety, better taste and lower cost. And, supporting your local economy is a nice added bonus as well. For a list of fresh produce available by season in Washington State, or to find a farmers market near you, visit http://www.pugetsoundfresh.org or http://www.sustainabletable.org/shop/seasonal. There are also lots of other “buy local” websites for many regions in the US and internationally. Check for them on Google or your favorite search engine.

Happy eating!

The Story “Whole Grain” kids’ cereals are healthier than other cereals.

The Reality: In their advertising, such as http://www.youtube.com/watch?v=KTkfZMsCyHY, General Mills touts these cereals as having plenty of calcium and “more whole grains than any other ingredient,” which is true – whole grain wheat is the first ingredient. However, the second ingredient is SUGAR. And, while whole grains should typically be an excellent source of fiber (of which we typically need 25 grams a day for the healthiest diet), these products are not high in fiber. One serving of Cinnamon Toast Crunch has only 2 grams of fiber (not even 6% of the RDA), but 10 grams of sugar. Similarly, Lucky Charms, with whole grain oats as the first ingredient, also provides just 2 grams of fiber, but 10 grams of sugar per serving. And, Cocoa Puffs is more of the same.

For a good source of fiber (without all that sugar), try instant or old-fashioned oatmeal. Each cooks in under 3 minutes (microwave or by adding hot water) and provides twice as much fiber (4 grams per ½ cup uncooked serving) with no added sugar. For kids that like something sweeter, Quaker low-sugar instant oatmeal has 3 grams of fiber and just 4 grams of sugar per serving.

There’s a debate raging in the media, amongst moms and families, and even within the medical and scientific communities about high fructose corn syrup (HFCS). Some believe that HFCS is approximately “equal” to sugar in terms of chemical structure, sweetening power, and health effects, but others are claiming HFCS is responsible for everything from obesity to diabetes. To better understand the issue, below are some common questions and answers.

What is HFCS?

Simply put, HFCS is a liquid sweetener, made from corn, that is used to sweeten a variety of products, including sodas, juices, prepared foods, ketchup, sauces, salad dressings and hundreds of other items. It was discovered in 1957, industrialized for mass production in the early 1970s, and made widely available in the US in the 1980s. For a fun example of how HFCS is made (along with a dose of humor and political savvy), check out the documentary, “King Corn,” about two recent college graduates who buy a single acre of farmland in Iowa to grow corn and then venture into making HFCS in their kitchen. http://www.kingcorn.net/

What’s the difference between sugar and HFCS?

Chemically, the two are very similar. Each is a combination of two natural sugars (glucose and fructose). Table sugar is approximately 50% fructose and 50% glucose, while the most commonly used version of HFCS is about 55% fructose and 45% glucose. HFCS typically has a longer shelf life than sugar and is easily portable in its liquid form, and thus is a convenient and desirable ingredient for sweetening packaged or processed foods. While it’s often believed that ounce for ounce, HFCS is sweeter than sugar, both have approximately the same level of sweetness and the same calories (4 calories per gram).

Why is HFCS so controversial? 

HFCS strikes a highly political note in terms of its origins and production. Many believe that the US is over-producing corn, due to ongoing government subsidies paid to farmers to grow corn. And, increasingly, much of the corn grown in the US is grown from genetically modified seeds (seeds that have been altered to be pest resistant, drought resistant or otherwise “non-native” seeds).  The science on the effects of genetic modification is still largely in flux: food products grown from modified seeds appear to be safe, but they have not been studied long enough to conclude there are no ill effects on humans, animals, or the environment.  Additionally, the massive production of cheap and often modified corn has created a surplus – more corn than we need to eat or feed animals with – and thus, new ways to use all this extra corn were needed. Because of the subsidies and the surplus of corn, HFCS is a very inexpensive sweetener to produce. And because it is so cheap to produce and use, it is found virtually everywhere, from breads to beverages to everything in between. As of 2008, about half of all sweeteners used in the US was HFCS.

What about health impacts of HFCS?

The increasing usage of HFCS in beverages and other food products parallels the increasing rates of obesity, type 2 diabetes and other related diseases in the US.  Since the 1970’s and 80s, we have seen increased rates of sugar consumption, as well increases in the average calorie intake and the average weight of both children and adults. Because of the similar timing between growing obesity rates and HFCS usage, fructose and HFCS have been at the center of a great deal of research and debate.

Additionally, it is known that fructose is metabolized by the body via a slightly different process as compared to glucose or other natural sugars. This is some of the basis for concern regarding the health impacts of HFCS. Fructose is largely metabolized by the liver, unlike glucose (the latter of which goes straight into your blood stream and waiting organs after being digested by your intestines). Over-consumption of fructose can lead to the storage of excess fructose as fat in the liver, putting individuals at risk for fatty liver disease, cardiovascular disease, liver failure, insulin resistance and other serious health problems. Recent studies have also shown that high concentrations of fructose can decrease satiety (feelings of fullness after eating) and increase hunger levels, leading to over-eating and weight gain. For a highly entertaining (and very opinionated) lecture on more of the potential perils of fructose, check out the UCSF’s Dr. Robert Lustig’s very popular YouTube lecture. He also has a new book out, which I’m looking forward to reading, called Fat Chance

Ultimately, hundreds of scientific studies have been conducted over the last 5-10 years to evaluate the effects of eating or drinking large quantities of fructose, with varying results. Some studies have shown that high amounts of fructose may interfere with or alter the body’s normal metabolic processes, which can lead to insulin resistance, type 2 diabetes, high cholesterol, gout and other related diseases. However, to date, the research cannot 100% conclusively point to HFCS as “worse” (or better!) than regular table sugar when it comes to your health.

What’s the bottom line for my health?

Sugar, in any form and in large quantities, can have adverse impacts on your health and the health of your family. For young children with growing bodies and developing teeth, sugar can cause cavities and lead to the consumption of too many calories, resulting in overweight or obesity. As mentioned above, excess sugar and calories can also lead to metabolic issues, including type 2 diabetes. Americans eat about 80 pounds of sugar each year (which averages out to about 21 sugar cubes per day, or 8,000 sugar cubes each year!). This means that Americans are eating more than 300 calories per day just in sugar. Yuk. Thus, it’s wise to minimize overall consumption of all sweeteners and products that contain them if you can. If you’re looking for something sweet, choose whole fruit, healthy veggies like sweet potatoes and yams, and make sure to eat a balanced diet.

Read More:

• American Medical Association, The Health Effects of High Fructose Corn Syrup, http://www.ama-assn.org/resources/doc/csaph/csaph3a08-summary.pdf
• Dietary Guidelines for Americans 2010, http://health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf
• Sugar: The Bitter Truth, http://www.youtube.com/watch?v=dBnniua6-oM
• Harvard Health Publications/Harvard Heart Newsletter: Abundance of fructose not good for the liver, heart, http://www.health.harvard.edu/newsletters/Harvard_Heart_Letter/2011/September/abundance-of-fructose-not-good-for-the-liver-heart
• The Truth about High Fructose Corn Syrup: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=486
• Straight Talk About High Fructose Corn Syrup: What it is and what it ain’t, http://ajcn.nutrition.org/content/88/6/1716S.full
• King Corn, the movie, http://www.kingcorn.net/

Back in November, during a lovely family vacation in Mexico, I enjoyed a gorgeous sunrise run on the beach. Toward the end of the run, my left foot began aching mightily, so I stopped to walk. I assumed that I’d just overdone it, running 4 miles barefoot when I normally run in shoes. I limped back to my hotel room and then eventually back home in Seattle, and tried to put it out of my mind. But after 2 weeks of ongoing pain and swelling, and harassment by several well-meaning (and smarter than me) friends, I finally went to the doctor to have him take a look. Umm, an acute fracture?! You mean I broke my food just running? Gulp.

So off to the orthopedic surgeon I went, and days later, under the knife. I now am “bionic,” as one friend deemed me, with a metal plate and 4 small screws holding my second metatarsal together (and a nice “zipper” where all the stitches used to be). This was a ridiculously painful process, that somehow really surprised me. I know, I know, we need our feet for walking, running, chasing after small kids, life…. But really, this just absolutely and completely sucked. And following surgery, I had to maintain a couch- or bed-bound position for nearly 3 weeks, which didn’t exactly make for a super exciting holiday season. I’m now 3 weeks into being able to walk (or hobble) around on a walking cast, and hopefully just 1 week shy of getting to wear 2 real shoes for a change (insert one-footed happy dance here).  So, now, I’m both cautiously optimistic, and frankly, going utterly and completely insane. I really miss my workouts, my time outdoors, time getting sweaty, time running with friends and family, and the highs of of endorphins. And I miss the freedom that uninhibited motion can bring. Never again will I complain about a workout, being too tired, or moan about being sore after a run. I will be GRATEFUL that my body is capable of physical activity. And I will treat it with kindness and respect.

And I will never, ever, ever again run barefoot.

Happy trails!

First, some of the statistics. This may help illustrate why people are concerned (though perhaps, overly so in some cases).

• Some 4% of the US population have food allergies, and it appears to be more common in children
• Peanut allergies TRIPLED among children from 1997-2008
• Food allergies in general (among children) have increased 18% between 1997-2007
• Approximately 12% of US adults self-identify as being lactose intolerant

The theories around these increases in allergies include a general greater awareness of food allergens (due to the aforementioned media coverage), concerns around genetic modification of foods, over-use of antibiotics (including soaps) and the excessive “cleaning” of our home environments, and even deficiencies in sunlight and/or vitamin D. Net net, we don’t really know why this increased prevalence of food allergies has occurred, but it has.

Food Allergies:

These are immune-system responses to food, whereby your body thinks a particular food (usually a protein contained by that food) is an “invader” and tries to attack it. In this case, your immune system releases a variety of histamines and other chemicals that ultimately lead to the signs of an allergy or allergic attack (congestion, swelling, rash, GI issues, problems breathing, inflammation, and even death). Allergies are diagnosed by an MD or allergist using skin prick tests and/or specific blood tests, with other tools, such as oral food challenges (where an individual eats a little of the suspected food and is monitored for reactions) also used. The most common food allergens are milk, egg, wheat, soy, peanuts and tree nuts, fish and shellfish, and for some, specific fruits (especially in toddlers and young children). There are limited treatments for food allergies (other than avoiding the foods in question 100%), but there is some promising research around oral immunotherapy and even Chinese herbal treatments. And thankfully, some kids (but not all) “outgrow” these allergies over time, as their immune system develops and adapts.

Food Intolerances:

This is a very gray area, as it’s not one that can be cleanly diagnosed via blood test or skin prick test. An intolerance is typically a gastro-intestinal response stemming from an individual lacking an enzyme necessary to digest a particular food – e.g. lactose, wheat/gluten, etc. While the symptoms of a food intolerance can often mirror some of those of food allergies, these are typically much more minor (and not life-threatening) — centering on GI distress such as bloating, diarrhea, constipation, and general discomfort. Other symptoms, such as depression, migraine/headaches, hyperactivity, aggression, ear infections and more can also occur. And, ongoing consumption of foods that trigger these responses can also lead to inflammation of the gut and GI tract, causing longer term health issues. This is where things like gluten intolerance come into play. It may not be a full-blown allergy, but constant ingestion of the food in question can lead to destruction of key components of the GI tract (intestinal villi) which can lead to food malabsorption issues and malnutrition. Thus, it’s important to be aware of your own body’s reactions to eating specific foods. Treatment for food intolerance is varied, but typically the most important thing for diagnosis is the “elimination diet,” where one eliminates a specific food from their diet for a period of time (1-2 weeks typically) and self-monitors for (lack of) symptoms. Then, a period of reintroduction of the food takes place, and again, monitoring takes place. If symptoms go away while the food is gone from the diet, but return when the food is reintroduced, it’s wise to stay away from it!  This can be done on your own, in conjunction with a registered dietitian or naturopath, or using a variety of online resources. For each food that is suspected, a separate elimination and reintroduction period should be established, so that you’re not confusing one food with another in terms of symptoms.

SO WHAT?

Clearly, either situation (allergy or intolerance) can create health concerns or adverse health problems. However, the elimination of specific foods from the diet without a strong case for allergy or severe intolerance can be problematic from a dietary/nutrition perspective. Cutting out foods that are good for you can leave you with an unbalanced diet and leave you open to nutrient deficiency and/or disease. This is especially true for children and adolescents (and pregnant women) who have significant nutrition needs for growth and development. Always make sure that your diet is complete with a wide variety of fruits, veggies, whole grains, lean meats (or meat alternatives), and low-fat dairy (or dairy substitutes with calcium). While missing one particular food group may not make a big difference in the short-term, it can certainly cause problems for a person whose diet is already not “top notch” as time goes by. So, Eat healthy! Live healthy!

Some resources:

• http://www.nlm.nih.gov/medlineplus/foodallergy.html
• http://www.faiusa.org/page.aspx?pid=374
• http://www.fda.gov/Food/FoodSafety/FoodAllergens/default.htm
• http://www.celiac.org/
• http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/
• http://www.gluten.net/
• http://online.wsj.com/article/SB10001424052748704893604576200393522456636.html
• http://en.wikipedia.org/wiki/Gluten_sensitivity

But what if that’s not actually true? What if it’s just that we’re eating too much of the wrong thing(s)?! How can we change the discussion and give people the freedom and permission to eat MORE sometimes (and still stay healthy)? That seems like a much happier solution, and one people are more likely to follow and/or stick with.

Which brings me back to Ellie Krieger and Barbara Rolls. Their session was creative and enlightening, and did not put the onus for how much we eat solely on individuals. It’s also an environmental thing; consumption norms have crept and leapt upwards. We don’t always know what a “normal” or healthy size portion is anymore thanks to Super Size this and Vente that. So, we should work on building that awareness and/or changing those norms. But, in the mean time, let’s look at how we can be healthy by EATING MORE. Crazy, huh?!  Here Rolls and Krieger presented some great ideas about how to still eat a lot, but keep calories and fat low. Some of the strategies they outlined were:

• Increase the water content of your foods. This naturally lowers calories. Examples include soups, broths, fruits and veggies. You can get a lot of food for few calories by increasing overall water content (and a lot of great nutrients too!).
• Add vegetables into a cooked dish. This can replace other fatty or high-calorie ingredients, or simply increase the water and nutrient content, so again, you’re getting a dish that has few calories, but you can still eat a lot.
• Variety. We get bored easily with our food. Including a wide variety of fruits and veggies at every meal can lead you to eat more of those (and less of the “other stuff”). Bright colors and interesting textures help too.
• For kids (and adults!), try including some “stealth veggies” too – add veggie purees (squash, carrots, sweet potatoes, etc.) to soups, stews, sauces, baked goods. Or, create a healthy syrup for pancakes with fresh or frozen fruit puree. Ellie Krieger has a great cookbook that talks about how to add purees to foods to lower the calorie content, while adding flavor and increasing nutrient content. I just ordered it and can’t wait to dig in! (Now this doesn’t mean you stop trying to get your kids to try “naked” broccoli, carrots, beans, etc. – you definitely want to do both!)
• Don’t scrimp on taste. If you like to saute your veggies in (a little) butter or olive oil, and that gives them enough flavor that you’ll want to eat 2 cups instead of 1/2, go for it. Satiety and flavor are key to building a dietary pattern and habits you can actually stick to. Find low-fat, flavorful sauces you like and use those for stir fry or dipping. You don’t need to suffer to eat healthy!

If you follow some of these strategies, you can still eat a LOT of food. But you’ll probably be a lot healthier. Win-win?

My usual “method” for constructing breakfast is to ensure my kids and I have some of each of the following:

- Complex carb (starchy vegetable or whole grain)

- Healthy fat

- Protein

- Fruit

Now, this may sound way too hard, but really, you can do it. Here are a few ideas for you, divided into 5 minutes or less and 5-10 minutes of prep (and some ideas for make-ahead meals). Some of these you can even get started while you’re still getting ready (who doesn’t brush their teeth in the kitchen? I sometimes do….).

5 minutes or less:

• Smoothie with: 1/2 cup milk or water, 1/2 cup greek yogurt, 1 cup fruit of your choice, 1 cup raw spinach or kale, 5-6 ice cubes. Add extra protein powder or chia or hemp seeds for an added boost.
• Hard-boiled egg (boil a batch on Sunday night so you have them at the ready), 1 piece string cheese, 1 piece fruit, 1 piece whole grain toast.
• Whole wheat waffles with 1-2 tablespoons peanut or almond butter + one piece of fruit (I like to make waffles in advance and/or use toaster waffles and make a “sandwich” out of them)
• Oatmeal (get the old-fashioned kind), cooked for 3 minutes in the microwave, topped with 2-3 T greek yogurt, dried fruit and 1 T toasted nuts. To add some additional protein, you can cook the oatmeal with 1-2 egg whites (you won’t even notice the flavor).
• Homemade trail mix with almonds, walnuts, dried fruit, plain unsweetened coconut, and seeds of your choice (chia, flax, hemp, pepita).
• Cottage cheese with greek yogurt and fresh or frozen fruit (add some nuts or seeds for extra healthy fat and antioxidants).
• Don’t be afraid to have lunch or dinner for breakfast! A turkey sandwich on whole wheat with tomato, harvarti and some spinach is a great way to start the day. Add a piece of fruit and you’ve got a great meal. Leftover rice and beans topped with a fried or poached egg is also awesome!

5-10 minutes of Prep/Cook Time:

• Omelet with 2-3 eggs (don’t skip the yolks, they have lots of good fats) with spinach, your favorite chopped or canned veggies (I like mushrooms and peppers), and a pinch of cheese.
• Steel cut oats – Soak them for a bit before cooking to reduce cook time. (I like to make a big batch on Sunday and/or do it overnight in the crock pot too) topped with fruit, greek yogurt and nuts.
• Sweet potato pancakes (cook the sweet potato in the microwave or the night before to speed prep, and increase the eggs from 2-3 for more protein). These are really more of a 15 minute thing, but they are GOOD.
• Breakfast burrito with scrambled eggs, whole wheat tortilla, salsa, avocado, cheese and plain greek yogurt topping + 1 piece of fruit. You can also use tofu instead of eggs.
• Egg sandwich with 1 egg however you like it + whole wheat english muffin (add hot sauce and avocado for a kick, and maybe a slice of bacon or sausage for extra protein).

Make Ahead Meals (or meal items) – you can get several meals out of a limited amount of prep work on a Sunday night!

• Grilled flank steak – grill and slice up a large piece of flank steak to have alongside eggs cooked your way. (Here’s my favorite recipe for grilled steak. Goes great in a salad for lunch too!)
• Hard-boiled eggs – I usually cook up 6+ each week for breakfast, lunch and/or snacks
• Breakfast casserole – this one sounds really tasty and I’m going to try it out next week!
• Crockpot oatmeal (steel cut or old-fashioned).
• Homemade energy or granola bars. Also, check out these great recipes for homemade Lara bars (they are amazing).
• Whole grain muffins (pair with some fruit, a piece of cheese and/or an egg for a full meal).

The best thing you can do is plan meals ahead if at all possible; make sure you have ingredients on hand, in convenient packages and portions, and always, double the recipe if you can to have leftovers for the next day!

Got other great ideas? Please share!

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!

Blood sugar: What’s the Big Deal?

Your body needs to closely regulate its supply of glucose, as it is one of the most important fuels to support major body functions – your brain, your muscles, your various biological systems, etc. Glucose comes from digestion of the food you eat – primarily carbohydrates, but also fats (and to some degree, protein) — and your liver can also make glucose when your food supplies have run low (e.g you haven’t eaten in a while, such as overnight).  “Enough” glucose (which your body closely monitors) is important to maintain energy for daily activity, physical activity, and the aforementioned biological processes, but too much (hyperglycemia) is also problematic. In this case, the sugars in your blood can cause imbalances in all kinds of hormonal systems (see below) and can cause kidney damage, neurological damage, poor wound healing, damage to blood vessels, blindness and much more. These issues usually take place over a relatively long period of time, but many of them are irreversible, so clearly, you want to avoid them!

Hypoglycemia is the opposite of this scenario, and this is where your blood (and thus, many of your cells and systems) doesn’t have enough glucose to do the jobs necessary to keep the body functioning well. This can lead to fatigue, sluggishness, inability to concentrate, low athletic performance, weight gain, and again, a host of metabolic or hormonal issues. Thus, maintaining your blood glucose (“sugar”) levels in an optimal range is really important for your health. A typical healthy range for blood glucose is between 80-100 mg/dl (fasting). After about age 40, you should check your blood glucose levels annually. If you have a family history of diabetes or other related issues, talk to your doctor and begin annual checks earlier as appropriate.

Insulin: Under-appreciated and VERY Important!

Insulin is a hormone produced by the pancreas in response to the arrival of new glucose (“yay, food!”).  This means that as you start eating, the pancreas begins to release insulin, whose job is to take any excess glucose above and beyond immediate needs  (maintaining that optimal blood sugar range I mentioned above) and shuttle it to liver, muscles and fat cells for storage (as something called glycogen). Thus, insulin is heavily involved in dealing with the products of fat and carbohydrate foods you consume, but also, to a lesser degree to proteins and their amino acids. Problems can occur with insulin levels or the pancreas when constant high levels of carbs or fats are eaten – making the pancreas work over-time to produce insulin to “clear” all that glucose from the bloodstream. Or, other hormonal imbalances can also send the pancreas wrong signal and keep it working when it shouldn’t be (sometimes resulting in hypoglycemia – where too much insulin is produced and it begins to clear away way too much blood sugar). Either situation is problematic – for the obvious reasons of either high or low blood sugar and the problems they cause. But, an overworked pancreas is also a serious concern on its own, because the cells in the pancreas that produce insulin can “burn out” (and they don’t regenerate often or well, if at all). Once your pancreas gets “tired,” it may slow down in producing insulin, or stop altogether. Then, your blood sugar cannot be carefully maintained, and the problems mentioned above can begin to creep in. Type 2 diabetes can result, which is a serious disease with numerous complications (and is linked to other chronic diseases such as heart disease and stroke). As an aside, Type 1 diabetes is usually a genetic condition that results from no insulin (or insufficient amounts) being produced by the pancreas and is treated with insulin injections to maintain blood sugar levels.

Glucagon: Insulin’s Alter Ego

Glucagon is a hormone also produced by the pancreas (different cells than insulin) and its job is *increase* blood sugar levels as appropriate. The typical scenario is several hours after eating or after an overnight fast, where your body no longer has any immediate or short-term source of glucose “lying around” and thus needs your liver to release or make some to keep you on the straight and narrow. Glucagon turns insulin off, thereby providing a nice counter-balance. In biochemical terms, this is called homeostasis – or a nice pretty system with plenty of checks and balances.

Cortisol: Quick Energy in Times of Need (and Your Worst Enemy in Over-Stressed Times)

Another hormone, this time produced by your adrenal glands, cortisol’s role is to help your body free up energy when you urgently need it. It’s one of those “fight or flight” helpers, and tells your body, “Hey, there’s an emergency here, we need energy!” In times of stress, cortisol helps your body release short-term stores of glucose (stored as glycogen), tells your liver to produce more glucose (via something called gluconeogenesis) and sends a signal to break down fat cells to provide energy. This may happen in response to your nerves about an upcoming presentation, ferrying your small child out of the middle of the street from the path of an oncoming car, or any other sort of stressful scenario. In the short-term, this is a good and positive thing. However, in today’s modern world, many of us are constantly in a state of stress, and thus, levels of cortisol are high and sending some of our body’s processes well into over-drive. In this case, cortisol starts to over-ride some of our normal regulatory processes with blood glucose and insulin levels (it counteracts insulin), and may even serve to increase fat storage over time (as your body tries to hold on to fuel to use in stressful situations). This is not a good thing.

Leptin: Your Fat Cells Are Talking to You

Leptin is a hormone produced by fat cells and is often called the “satiety hormone,” because it is released when your body (in theory) has enough fuel stored and doesn’t need more. Thus, as you’re eating, and your body decides it’s got what it needs, leptin is released to tell you, “Hey, slow down, we’re done. We’re full here.” Conversely, in the case of low blood sugar/hypoglycemia (or just when you are hungry), your leptin levels will be low, signaling your body, “We need fuel! We’re hungry!”  You might expect that obese individuals would have very high levels of leptin – given its origination in the fat cells – but something seems to go haywire with leptin in various individuals, and leptin levels are actually lower (triggering more eating and additional weight gain).  It may be a case of too much leptin being produced initially and the body becomes “resistant” to its signals over time, so it’s just not released anymore, or it may be a result of a variety of hormones interfering with one another and lack of homeostasis. Net net, this can be an important issue in regulating weight and/or obesity.
Ghrelin: Feed Me Now, Dammit!

Ghrelin is leptin’s counterpart, where your body tells you, “Wow, I’m low on fuel, please feed me!” Ghrelin is released when fuel stores are low and serves to control your “feeding behavior” as we say in science-speak. Ghrelin levels are high before meals and decrease as you eat. Unfortunately, ghrelin levels can also be impacted by stress and/or other issues, such as lack of sleep. How many of you feel insanely hungry after a bad night’s (or several nights!) sleep? Ghrelin is often increased as a result of other hormonal activities that occur in under-slept individuals. (And, leptin can also be decreased in these cases, a double whammy making you super hungry and not always able to easily control your cravings or food intake). Been There, Eaten That.

There’s a lot of other stuff going on in that metabolic system of yours, but this at least offers some general insight – and perhaps give you an idea how complicated and complex it all can be. Throw just one piece of this overall system off and you can have some serious issues. More on that next time.