"Your message is in the system."

So... (this is how most of my blog entries start).
The traditional health system in this country sucks. I mean, royally blows. It's pathetically broken.

I've been having a fun time with high blood sugars. And by high, I mean 120-200, which is by no means crazy high. Ever since I started my anti-diet (I had bacon fried in oil, topped with guacamole for breakfast), I have had really good control, and very few highs over 150.

Starting two days ago, my blood sugar started getting really stubborn and would not be nudged down with insulin. I took far higher doses than normal, but still no dice. I corrected for a BG of 180 with 3 units (each unit brings it down 35 points), so it should go down to 75.

Didn't happen. Only got down to 160.

No matter what I tried (short of crazy dosing with 10 units--I didn't try this as it would likely kill me), the BG stayed high, or came down temporarily and bounced back up.

Like a good diabetic, I called my endo yesterday morning. I explained it to the nurse (remember, a nurse in the clinic once told me that I could ease up on testing now that my A1c was 6.1).

"My blood sugars are not responding to insulin," I explained. "I've taken twice as much insulin as would normally be needed, plus a max dose of symlin. I haven't eaten anything carby, and still the BG is not budging. I don't know what it could be -- my insulin, my pump, perhaps I'm getting sick, maybe it's my time of the month... I am concerned that I might be in ketoacidosis. Here's what I've done: I've increased my basal rate by 35% and am drinking lots of water."

She said someone would get back to me.

NOBODY GOT BACK TO ME.

I called back in the afternoon.
"Oh yeah," I was told. "Your message is in the system."

Oh crap. Now I know I'm doomed.

NOBODY GOT BACK TO ME.

Here I am, potentially stewing in my own toxic acidic blood, and "my message is in the system."

Taking matters into my own hands (and after polling the myglu.org community), I went and did some yoga flows and strength training to get my blood flowing. By the time I was done, my levels were below 60.

OK. I can deal with lows. I turned my pump off for an hour, and it came back up slowly. The night was OK, never went above 125. Woke up this morning, went to work out, blood sugars are looking good.

Then, after eating breakfast (bacon and guac) and sitting down to work for an hour, the stubborn BGs are BACK! My blood glucose was 180. I took a total of 8.8 units (6.8 through the pump, and an additional 2 injected just to make sure it was getting in, plus 60mcg Symlin), and it only came down to 140! WTF, as my husband put it.

I called the clinic back. She said, alright, she'll make sure the doctor gets the message and will get back to me. I told her to note that I understand that they do not approve of my diet, but they will never convince me to go off it.

A few hours later, here is the call I receive from a nurse in the clinic:

Starts out with a disclaimer: "We do not recommend the zero carb diet, but if patient wants assurances that she is not in DKA, she can come in and take a ketone test. I recommend increasing her basal rate by 0.1 units and setting an alarm for 3:30am to wake up and test to make sure she isn't low.
I recommend the patient see if she is eligible for the continuous glucose monitor."

How does one describe the biggest pile of stinking, unhelpful dogcrap ever known to pass as "patient care?"

There are so many things wrong with this. It should be obvious, but I'll still take the time to outline why there are so many problems with this chain of events.

1. If the doctor is too busy to deal with patients, he should not have any patients.
2. This is the very doctor who prescribed me the CGM, so his advice to get one is just pure laziness on his part. 
3. Really, doc? You thought I was calling to ask what my basal rate should be set at? Do people still do that? Did you not get the part of the message that I had to relay through 3 different nurses that I already upped my basal by 35%
4. Lastly, and I say this with the utmost patience, it is not a ZERO carb diet. That is next to impossible to achieve. It's a 30-50g carb diet. But thanks for your accuracy and your malpractice concern.

I said thank you to the nurse, who clearly didn't know what the hell she was talking about and at several points in the conversation, actually said, "that's what the note says."

I also expressed some of the points outlined above and said, as I'll say again, THIS IS NOT CARE.

Here's my unsolicited advice. Get a doctor you like and who works with you, even if they are out of network or not covered. Honestly. I called my new doc, he called back right away. He took a moment to tell me sorry for the frustration I was experiencing, and brainstormed a series of events to try to make sure I was dealing with the problem (switch to long-acting to make sure it's not the pump's fault), and insisted that I check back in with him later in the day.

I'm having a really bad day but you would never know

While most days I feel relatively normal, today I really feel like a person with a disability.

What you would see on the outside is a seemingly able-bodied person, going about her day doing seemingly normal things. She goes to the gym in the morning she drives to work she eats her lunch and she does her work. 

But here's what you don't see: you don't see her getting dry mouth from having elevated blood sugars. You don't see her trying not to step too hard on her right leg because she put her continuous glucose monitor there this morning and it twitches a nerve every time she steps. You don't see her stress levels rising because no matter what she does, they don't seem to come down, which is only making the situation worse. You don't see her vision getting blurry from having elevated blood sugars. You don't see her feeling shitty about herself because she can't seem to keep things in control. You don't see the sticky marks all over her body where she placed her various devices. You don't see her hunger when she wants to eat like a normal person but can't, knowing that if she eats too many carbs she'll really be in trouble. You don't see her trying to ignore her high blood sugars and do her work well she patiently wait for them to come down with little success, but eventually caving in and having to go straight to the gym to run until they come down. 

All you see is that lazy girl next-door leaving work early again. 

Breaking up with conventional thinking on nutrition

I'm not trying to be all negative here, but I'm starting to get the feeling that we have got it all wrong.

My husband and I watched Cosmos last night, hosted by Neil deGrasse Tyson. I loved how he emphasized how dedicated science is to follow where the evidence leads. Except when it comes to nutrition, I guess.

Here are some revelations I have discovered in my nutrition awakening, relevant only to what I previously believed:

1. You have to limit fat if you want to lose fat.
FALSE. Limiting dietary fat is no fun and is largely unsustainable. Instead, try limiting carbs, which will subsequently lower insulin production (the hormone responsible for triggering fat storage). Of course, you shouldn't outeat your true energy needs no matter your macronutrient ratios. Fat is amazing. It tastes great. And if you can change your metabolic pathways to better utilize fat for energy, fat can be so beneficial in curbing hunger, providing sustained energy, and burning fat.

2. Every meal should be a balanced meal.
NOT REALLY. It kind of depends on what your body needs. If you need some quick energy (as an efficient fat burner), you should go for some medium-chain triglycerides or saturated fat, such as coconut butter, butter, coconut oil, and palm oil. If you need micronutrients, you should go for chia seeds, avocados, asparagus, spinach... Carbohydrates are the only non-essential macronutrient. We would die without dietary fat. Same for protein. We would function just fine without carbohydrates. The body has other mechanisms for creating glucose, which is essential for a small portion of the brain.

3. It's best to eat small meals throughout the day.
NOT IF YOU CAN BREAK YOUR CARB ADDICTION. While this may be true for the majority of the population that depends on the quicker burning (non-essential) carbohydrate diet, this is good advice. If you are working with mostly fats, then your meals will naturally be small (fat packs in a lot of calories), but you can (and should) go for at least 5 hours in between meals. Some people even try intermittent fasting (IF) and do just fine.

4. Breakfast is the most important meal of the day. 
AGAIN, TRUE FOR CARBERS. NOT TRUE FOR EFFICIENT FAT BURNERS. The reason that carbers should never skip breakfast is because their body is at the whims of the blood glucose cycle. Your body needs to replenish the glucose stores it went through during the night. If you don't replenish these supplies, you can land yourself in big trouble (read: famished by lunch, craving carby foods and further exacerbating the cycle). However, if you train your body to use fat for fuel, you will efficiently burn stored fat throughout this morning period without getting super hungry and without losing energy. This is freeing.

5. If you skip meals, your body will go into "starvation mode."
KIND OF TRUE, BUT MISREPRESENTED. Starvation mode is the amazing mechanism of our bodies turning to stored fat for fuel. But your brain needs some glucose, so it will use some stored glucose for that ~20% brain function that relies on glucose (the rest can use a byproduct of fat breakdown called ketones). If need be, your body can bust into lean muscles and tissues for protein, and create glucose from it, called gluconeogenesis. If you are already an efficient fat burner, "starvation mode" makes little difference. See the previous point about skipping breakfast. You should eat. Your body needs fuel eventually, and you do NOT want to start metabolizing muscle and tissue.

Until recently, I was participating with a group of health coaches promoting the low-fat, high-carb, restricted calorie lifestyle. I think this approach is one that will work for many people who lack the discipline to stay away from carbs and realize that they "like" carbs because carbs stimulate pleasure in the brain--let's think of other ways to do this! But if we are going to really educate people, we should be screaming from the mountaintops: There is no one size fits all approach! And if there were, it would certainly not be a high-carb, low-fat approach. Calorie restriction and low-fat, high-carb usually does not work long-term, and it certainly isn't working as a societal recommendation.

It can work short-term, and it can work for people with the right kind of genes to handle all those carbs, but I am convinced that our dietary guidelines should be steered to a lower carb approach. Maybe 60% of calories from fat, 15% from carbs, and 25% from protein.

For your entertainment, here are a few gems of the "fuzzy math" of nutrition being promoted by self-titled health coaches:

• Your body turns protein and fat into glucose. Huh? Since when? Your body turns carbs into glucose at very high rates, turns 30-50% of protein into glucose (which is why you shouldn't overdo protein), and, in rare circumstances, can turn as much as 10% of fat into glucose (like, if you have been running for 40 hours and have run out of glucose stores and you broken down a significant amount of muscle and tissue--not a common scenario).
• Complex carbohydrates are called as such because they have protein in them. Yeah, that's not really how the naming convention works in science. It's based on the structure of the carbohydrate molecule, and how complex it is compared to a simple sugar. Nothing to do with protein. 
• You should eat 1.5 g of protein per pound of body weight. OK, all you are doing here is providing an excess of protein to be turned into glucose. Good job. The recommendation on this one is pretty sound, actually (about 54 g of protein for a 150-lb adult; not at least 54, but 54). It's mostly comes from the performance oriented goals of sports nutrition science. As a caveat, if you are truly building muscle, then your protein needs will be a bit greater. Also--a good benefit of protein is that is slows digestion and hence, makes you feel full. An overage of protein can stop up the works. The best approach to calculating your protein needs is to start with your bodyweight, and from there, account for any significant muscle-building you are consistently doing.

And while we are on the subject of protein, all of these protein-pushers may be making a quick buck on the trend now, but some new research even suggests that a surplus of protein might have detrimental health effects.

Unfortunately, I don't think there's as much money to be made from promoting a high-fat, low-carb, moderate protein lifestyle. Protein is expensive and has many allies (meat and soy industry, nutrition companies that are on the protein bandwagon), carbs are a cash cow for the food industry (cheap to make and you can rely on people's cravings for them), and are especially lucrative when you throw a "low-fat" banner on the label.

Where's the money to be made in promoting whole foods that naturally promote less consumption, like olive oil, butter, green vegetables, coconut milk, etc... ? In this approach, you would need to eat a lesser amount of food, as your energy is mostly coming from fats, which pack more that 2 times the amount of energy per gram than protein or carbohydrates. Instead of a huge, $15 salad with fat free dressing and chicken, you could have what I had today: 2 eggs cooked in coconut oil plus 1/2 an avocado. Last night I fasted from 4pm to 11am this morning and felt totally sustained. Not to mention my blood sugar stayed on a straight path between 75 and 110 all day. Pretty good for someone with a dysfunctional pancreas. And for someone living in a country with dysfunctional thinking on nutrition.