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Posts from the ‘Diet and Food’ Category

Guest Post: Diabetes and Our Relationship with Food.

Georgie is a twenty two year old university student and future French teacher living in Melbourne, Australia. She’s had type 1 diabetes since 2010 and has become very talented at hiding her pump in various dance costumes.  She hates her pancreas but loves the DOC, and is in the very slow process of creating an organisation Down Under to help those with type 1 diabetes and eating disorders. 

I feel lucky that I’ve had the opportunity to spend time with Georgie (she is my favorite holiday card buddy), and today I’m very lucky to have Georgie guest posting about disordered eating, diabetes, and the way we view food.

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Sometimes I read things while procrastinating on the Internet that strike a chord with me. Usually they are quotes that revolve around cats and wine, but occasionally there is one gem that sticks with me. I read a quote recently while scrolling through Tumblr that read:

“We are prescribing for fat people what we diagnose as disordered eating in thin people.” – Deb Burgard, keynote at the 2011 NAAFA conference.

At first this quote didn’t surprise me – it seemed quite obvious really, I muttered a ‘duh’ and kept scrolling until I hit the funny cat pictures instead. It wasn’t until I was sitting down to my dinner that night, slowly adding up my carbs, and berating myself about my 16.8 (288 mg/dL) that I realised that there was a reason for that. I was identifying with that quote so strongly not because I am morbidly obese and have had doctors make me count my calories, but because I have type 1 diabetes and “disordered eating” is basically my normal.  We are asked to weigh our food, count our food, know everything there is to know about our food, and yet somehow keep a healthy attitude towards what we put in our mouth every day. Some people manage this – but I know a lot of us don’t!

People with type 1 diabetes are set up for a weird relationship with food, no one seems to mind, and it’s driving me crazy.

“You have to see what’s on your plate as numbers!”

“Don’t eat that, that’s bad!”

“What do you mean, you’re not weighing your food?”

We are doubly lucky though – not only do we have healthcare professionals telling us what to eat, we also have the Food Police!

We all know the Food Police. They can be sneaky – they come disguised as your work colleague, your neighbour, or your aunt at a family dinner. They usually come armed with “lots of knowledge” about diabetes, because their third cousin’s grandma had diabetes, and she “DIED because she ate too much cake!!!” It hides under the guise of concern, but mostly it’s a nosy way to exert control over you while claiming that it’s for your own good. At one point I had a member of the Food Police say, “What if I hadn’t been there to tell stop you eating that? Haha!” Oh, I don’t know, I would have eaten this muffin anyway, but without the omnipresent feeling of shame?

The only other group of people that I know whose food choices seem to be up for public comment are obese people – which is why I think the quote above stuck in my head. We are both told to live a life that revolves around counting our food, and people in our life feel the right to comment on whatever is on our plate. Is it any wonder that some of us start to see food as the enemy? The most ridiculous thing about this is that we CAN eat what we want – we are just like anyone else, except our pancreas comes in syringe/pump form. Would you ever look at the food on a twelve year old’s plate and say “There’s way too many carbs on that plate – remember, you’re trying to lose weight”? No? Then why do you feel obliged to say it to a child who happens to have type 1 diabetes?

Food shouldn’t just be a number; food is there to be enjoyed! I look at a piece of bread and I see “15 grams,” but I should also see “I am full of delicious grains to get you through the afternoon” and “Damn, I taste delicious with some avocado.”

Food is not inherently bad or good. Did your donut creep up on you during the night and rip out your pump site while letting out an evil cackle? The only labels food should have is a Post-It saying, “Eat me, I’m delicious.”

Food is food – what you eat does not define your worth as a person, and leading on from that, what you eat, how much you weigh, and what your hba1c is does not define how “good” of a diabetic you are. We HAVE to stop looking at our A1Cs, our weight, our food choices, and our insulin dosage as something that we can measure and evaluate ourselves against.

How is that healthy? Disordered eating doesn’t necessarily mean an eating disorder, it means eating in a way that could or does harm you physically or psychologically,  and I’m pretty damn sure that some of the practices that healthcare professionals are advocating do not create healthy and balanced attitudes towards food.

When I was volunteering on a kids’ diabetes camp last year, a twelve year old girl was sitting next to me at supper and wouldn’t eat her cookie.

“Why honey? The dieticians told you the carbs, right?”

“Yeah … but Mum won’t let me eat stuff like this at home, she says it’s bad.”

“Food isn’t bad or good, food keeps us going and it’s delicious – don’t you like it?”

“Yeah I do, but … Mum would be so angry – is there an apple or something instead? I can’t eat bad foods.”

My heart nearly broke – this girl, already under pressure from society to look a certain way, can’t bring herself to eat a cookie because her Mum, and no doubt her healthcare team, has told her that foods are ‘bad’ and ‘good.’

I appreciate that it’s a very fine line for carers and healthcare professionals, between keeping their patient healthy and not causing them to hate everything they put in their mouth – but food is not the enemy.  Food is not something we should judge ourselves by – we have to stand up for ourselves. Don’t let the fact that we’re acutely aware of what we’re putting in our mouths affect our enjoyment and love of food.

Food is not the enemy, our pancreases are!

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Not Guten for My Gut.

Skipping gluten was once classified as a preference, but the last few weeks have shown me – beyond a shadow of a doubt – that gluten is not “guten” for my gut.  It feels good, figuring out what was causing so much chaos, and I feel more human, and much healthier.

So all that “oooh, so healthy!!” stuff aside, going gluten-free while traveling is a pain in the ass.

Choosing gluten-free options isn’t unfamiliar territory for me, as we did skipped gluten entirely for Birdy for the first 15 months of her life.  I’m accustomed to carefully reading food labels while shopping, and I’m no stranger to reshaping recipes to fit nutritional needs.  But on the road, it’s hard to tell what foods contain what.

Last week, my family and I were in Vienna, Austria and it was my first experience with “needing” to be gluten-free and being away from home at the same time.  At home, I can read labels.  In Vienna, I couldn’t even read the menu unless it had English subtitles.  The language barrier, plus the dessert constants, made this trip a challenge.

“Let’s stop at that cafe and get strudel!”

“How about some chocolate cake?”

“The schnitzel looks delicious!!”

Everything in Vienna looked delicious, and covered in a layer of gluten.

Being gluten-free is a double-edged sword, but one “for good,” as my daughter would say, because rethinking carb consumption is (sigh) good for my blood sugars.  Avoiding the cream-filled desserts and opting for coffee instead gave me some really steady post-prandial blood sugars.  Not piling on the carbs made for awesome Dexcom graphs, but it was frustrating to have yet another food rule in place.

“I’m pissed off because it’s not a matter of choice.  I like choosing healthier foods, but I really don’t like being forced to because of all this gluten crap,” I said to Chris over yet another boiled-chicken-over-greens lunch.

“I know,” he said, diving compassionately headfirst into a plate of schnitzel.

And sometimes things just got all screwy.  Like on the plane ride home to Boston, where I avoided the roll of bread and opted for the chicken-and-rice meal choice, only to find out from the flight attendant that the sauce on the chicken contained flour (the presence of which was confirmed by my belly about 45 minutes later).  Or when I ate a bag of plane pretzels, forgetting that I needed to care about gluten.  My brain isn’t rewired yet and I need to constantly remind myself (see also:  grabbing a bite of Birdy’s breakfast cereal, only to remember that it contains gluten, and then spitting it into the garbage).

Because it’s not all in my head.  Removing the fog and bloating from my body’s repertoire is such a relief, and I have no desire to go back to the way I’ve been feeling over the last year.  The few times I made the mistake of eating something with gluten in it, I regretted it.  The return of bloating, headaches, abdominal discomfort, and exhaustion were a reminder that my body does not respond well to gluten.  Even if the tests for celiac and gluten sensitivity came back negative, there are clear and present markers that I feel better going gluten-free.

This is an adjustment, but in time, I’ll have a plan.  I’ll have this figured out.  My health is worth the investment.  Besides, Riesling is gluten-free, so I’ll be just fine.

Belly Ache.

My celiac tests came back negative.  So did my IgA or IgG AGAs (these could be exactly the same as a celiac test but I do not know all the lingo and thus, I remain clueless).  The basic gist is that my body seems to have no trouble at all with gluten.

Except that it totally does.

I don’t know exactly when it started, but I’d say about eight months ago.  That’s when the first nondescript symptoms came into play.  My weight went up a little bit, despite the same amount of exercise and generally eating the same mostly-healthy foods.  My stomach wasn’t upset so much as a little uneasy, and my abdomen felt slightly tender after some meals … and other times without any known catalyst at all.

But I’m not good at keeping track of when things “start to change.”  The only way I knew that my weight was changing was because my clothes fit a little bit differently.  My blood sugars were fine, and my overall health seemed fine.  The decline into “not so fine” wasn’t fast, but really slow and subtle until all of a sudden, I was like, “WAIT.  Just a frigging second.  Why do I feel sick all the time?”

In the last three months, I’ve been acutely aware of not feeling well, and the list of noticeable symptoms grew week by week.  I was exhausted – falling asleep on the couch and having trouble maintaining my normal vampire hours.  I was moody and grouchy, especially later in the day.  (And I’ll just offer this up because I know you’re thinking it:  I’m not pregnant.)  My hands, on some mornings, were tingly and pins-and-needlesish.  And my stomach was angry, but in a really passive-aggressive way.  I had sharp pains in my stomach, but not all the time.  I had wicked bloating, but not intensely all the time.  I just had a permanent belly ache, and it was becoming the norm.

And I was permanently belly aching about it.  The only thing that alleviated symptoms was to cut out gluten, but I didn’t do it consistently enough or in a dedicated enough fashion to really assess if going gluten-free helped.  (Sadly lazy, but true.)  On the whole, our family is about 80% gluten-free, but apparently the 20% was enough to leave a trail of blargh.

Thankfully, my endocrinologist is thorough, so when I saw her a few weeks ago, she ran all the appropriate tests to rule out different this’s and that’s and to help establish certain baselines and other fancy doctor/patient discussion things.  My thyroid function is fine.  My A1C is fine.  My blood pressure is fine.   Nothing came back flagged as an issue.  (Except the whole diabetes thing.)  Which made me feel weird, because the absence of a concrete YES YOU HAVE A GLUTEN SENSITIVITY made me feel a little powerless, like I was just grasping at straws.

In efforts to take some definitive steps towards actually doing something, I talked with Sara(aah) about this issue, and she and I compared symptoms until I felt confident that, even if the tests didn’t flag an issue, there still could be some kind of correlation.  Whether gluten is the root cause or just a trigger, its absence makes me feel much better.  I can’t dispute that fast-becoming-a-fact.

So for the last week, I’ve been running my own gluten-free tests.  And fortunately for my body, it seems to help.  (Unfortunately for my preferences, though, because I love Italian bread and all that jazz.)  It’s been almost a full week now without a whisper of a symptom.  It’s been months since I’ve gone more than a few hours without a sore belly, so this is a step in the right direction.

My plan is to continue to go with my gut and do what makes my body feel better.  If I go against the grain, I’ll feel better.  It’s a diet omnivorous about sticking to, but I know it’s best in the long run. 

… more gluten-free puns once I cook them up.  For now, you’ll have to wheat.

 

Free Foods!

…  “You can have pickles?  Or gelatin?  Or cucumber slices!”

My mom tried to make these options sound appealing and delicious, but when I was a kid and my blood sugar was super high, pickles weren’t what I craved.  My body wanted to chug water and cheeseburgers simultaneously in efforts to cleanse the ketones and sate the high hunger.

“Can I have something else?”

“Not right now.  Those are the free foods you can have, until your blood sugar comes down.” she’d reply.

The phrase ‘free foods’ was a real one, twenty years ago in our household.”

more about free foods at Animas.

Pre-Bolusing for Snacks.

“Do you pre-bolus for your meals?”

“I do.”  (I was happy to answer this question because I actually do pre-bolus.  Pre-bolusing is my A1C’s saving grace.)

“Okay, that’s great.”  She made a few notes in my chart.  “How about for snacks?  Do you pre-bolus for those?”

“I … um, nope.  I am horrible at pre-bolusing for snacks.”

Unfortunately, hat is completely and utterly true.

Meals are easier to pre-bolus for because there’s time involved in making them.  If I know I’m cooking chicken and green beans for dinner, I have 25 – 30 minutes to let that bolus sink in before the meal is even ready.  Going out to eat at restaurants is easy, too, because I usually have an idea of what I’d like to eat, so I’ll bolus for the meal once we are seated at the table.  (Pre-bolusing backfires at times, too, but as long as I’m not in the middle of the woods, I’ll take the risk.)  A meal feels like an event, and therefore easier to accommodate.

Snacks feel like an accident.  An unplanned moment.  I don’t take an apple out of the basket and bite into it in a premeditated fashion, but more like a fluid movement without any thought involved.  (A run-by fruiting by any other name …)  It’s not until I’m done with a snack – apple, yogurt, nuts, protein bar … cupcake? – that I realize I haven’t taken any insulin to cover the carbs.  My post-snackial blood sugars aren’t grateful for the misstep.

This would not be a big deal if I wasn’t such a grazer, but when 50% of my caloric intake throughout the day is on a whim, pre-bolusing for snacks matters.  My A1C is currently in my range (under 7%) but I know if I can remember even half the time to pre-bolus for snacks, I bet my standard deviation will tighten up and blah blah blah other numbers as well.

Little, conscious changes will hopefully become habit.

 

BOLUS: Beware Of Loose, Unsupervised Snacks.

I graze.  I’m a grazer.  Visually speaking, my food choices are spread out over a gigantic field and I run through, grabbing bites here and there and never properly taking amounts or serving sizes into account.

“How many grapes did I just eat,” is a common, whispered question.  “Did I bolus for that protein bar?” is another one.  “Hey, I only had eggs and not toast – how many carbs did I bolus for, and what needs to be consumed now so I don’t hit the deck?”

I am good at going through the motions of diabetes management, but I have been slacking on minding the minutiae of late.  I don’t sit down to formal meals throughout the day (schedules are nonexistent at the moment), so keeping track of the food I’m eating has been a challenge.  Grazing makes for dodgy carb counting.

I need to mind my B.O.L.U.S:

Must Beware of Loose, Unsupervised Snacks!  When carbs are roaming around unsupervised and unbolused-for (terrible grammar, worse when spellcheck changes it to “unbloused-for”), blood sugars go high and stay there because I’m chasing my insulin-tail or I go low because I’m over-estimating.  Insulin is potent stuff, and SWAG’ing it makes for Ms and Ws on my Dexcom graph.  If I can just pay-the-fuck-attention to what I’m eating, I’ll have fewer frustrating results.  Right? RIGHT??

The more I mind what I’m eating, the more even my blood sugars will be.

Now let’s see how that theory shakes out, as I attempt it for the 10,000th time since diagnosis.

Gluten-Free Pizza Crust for the Epically Lazy.

[Insert whole paragraph about how I hate to cook/am bad at cooking/have no interest in cooking/would rather paint the deck.]

I don’t normally do anything resembling a “food review” because that’s not my bag (baby).  But I’m lazy when it comes to preparing food, so if I stumble across something that makes being a lazy chef even easier, well then hot diggity damn I am going to post about it.

BEHOLD!!  It’s a generic, “Acme Pizza” looking box, but the contents are wonderful.  This is gluten-free pizza crust and it’s legitimately delicious.  Kinnikinnick, your tagline is accurate.

I can’t say the name of it out loud without feeling like I’m casting a spell, but this pizza crust is worth writing about because it crisps up nicely, is thick enough to hold a pile of toppings, and when you bite into it, you don’t wish it was something else.  Birdy and I have experimented with several gluten-free dough options (not because of celiac, but due to preference) and this Kinnikinnick pre-made pizza crust has been the best one we’ve found so far.

“This pizza is good, Mom!”

I agreed.

[This is not an advertisement, or a sponsored post.  This post is the result of going to Whole Foods, spending eight billion dollars, and for once not regretting it.  Again, friends share.  So I'm sharing.  :) ]

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