Insulin Resistance and Popular Diet Plans

I've been perusing various popular approaches to health and weight loss and have been struck by how little attention is paid to insulin resistance.

Dr. Fuhrman, for example, is all over PBS and has a vegan approach that involves veggie/fruit smoothies. He sweetens them with Medjool dates. I actually bought some dates because everyone seemed to be excited about them. Then I read the label and my jaw dropped to the floor. 29 grams of carbohydrate per serving. They might as well tell me to drop a Snickers bar in the blender and just add in some flax seed to make it healthier and I would do better!

So I said to my husband, "Don't eat more than two of these, they are pure sugar." (In fact, I had a hard time finishing one, they are sweeter than candy.)

My husband said, "I just had seven. Is that bad?"

Short answer, yes!

Now, we can go back and forth about how the fiber in the fruit blunts the insulin spike of consumption, but the reality is, anyone with severe insulin resistance who eats that much sugar, even if it's from 'healthy' fruit, is going to gain weight and travel further down the pre-diabetes highway to diabetes. Which is why I find these popular doctor diets that ignore the nuances of insulin resistance to be irresponsible.

But I don't know how many people are like me. Maybe I'm the only one with severe insulin resistance? I couldn't follow Dr. Fuhrman's plan without significant modification. And let's face it, smoothies that combine vegetables and fruit, need a lot of sweetener to make them palatable.

I can handle a wild blueberry/spinach smoothie, but only if I add in things like Stevia, cocoa powder and cinnamon. The concoction has an unoffensive taste, which is about the most complimentary thing I can say about it. And it's still too carby for me. I make them every so often because Dr. Alternative recommends them and I agree that smoothies enhance the absorption of nutrients. But they don't help me lose weight. In fact, the opposite. They trigger my malfunctioning insulin response. I tend to eat more on smoothie days.

Dr. Fuhrman also likes to use cashews. A lot. Like in every recipe. If you are allergic to nuts, you are SOL on his eating plan. Also, I'm not such a huge fan of pureed cashews in everything I eat.

For me, this is a plan that has significant barriers to entry for the average person. I have the books and a DVD, so I have really looked at it in detail. The changes are so dynamic and the equipment you need to do it is so expensive, well, I'm amazed he's built an audience at all.

If I wasn't insulin resistant, I would probably have a strong tendency toward 'Furhmanization', but that's just me. No one else I know would do it--considering I can't even get the people in my life to go to a whole foods demo, I fail to see where these legions of fans are coming from. Where I live, everyone still thinks McDonald's is a food group.

Then we have Dr. Mercola's diet which is very similar to Dr. Furhman's, but entry is phased. I like phases. I think gradual transitions are really effective, but his are too long and confusing. Plus, anyone with insulin resistance needs to start at the most restrictive phase three, the earlier phases just waste time. Mercola is also into juicing and making smoothies, which, again, is quite expensive.

So Drs. Furhman and Mercola have diets that only people with money can follow. And only if you have natural ascetic leanings (most of us don't) and aren't insulin resistant (which most of us are).

I'm surprised these guys don't hold juicer giveaways as a marketing ploy. Especially Dr. Mercola, who has the distinction of being one of the spamiest physicians I've ever seen online. He wants me to sign up every thirty seconds and pay for access to this and that. His website makes me feel like I'm in a Medical Las Vegas.

Okay, so I've ripped apart the diets, but how do you know if you are insulin resistant? Here's my rule-of-thumb: If you have done Weight Watchers (most of us have at one time or another) and did it perfectly (i.e. you killed yourself trying to lose weight) with little to no results, you are insulin resistant. You can pay to have the blood work done, but inability to lose weight despite serious effort is pretty much text book. If you don't cut the flour and sugar and severely limit fruit, you will never lose weight.

A lot of money and a blender won't change that.

Riddle Me This

So I actually weighed myself after the vacation binge.

Didn't gain an ounce.

I just assumed I had due to all the bloatage, but nope.

Zippo.

Ate pie every day.

Double decker ice cream cones.

Cookies.

Bread, specifically to-die-for grilled cheese with brie, bacon and tomato jam.

I made sure to eat only when I was hungry even if it meant skipping meals. I also walked daily. At least a mile, sometimes two. And I took the equivalent of a cold bath everyday in the Lake, which was cold enough to make limbs approach numbness (which I'm guessing revved up the metabolism a bit).

Here's what I don't understand. I can cut carbs to the bone. Exercise intensely and don't lose weight.

Yet, I can maintain weight in the face of a week long sugar coma despite supposed severe insulin resistance.

It just doesn't compute.

Coincidentally, my last bout of weight loss stopped when I discontinued the ice therapy as described in The Four Hour Body. Do I just need to take a cold bath every day? (I don't think I can hack it though.)

Or, alternate theory, did I have a touch of the adrenals? The cramps in the small muscles of my feet and hands are classic adrenal insufficiency symptoms for me. Along with the flank pain. But that has passed.

I'm back to low carbing and interval running (which is going amazing because of the pylometrics I've been doing. FYI if you want to run, do squat jumps first, then run, it'll give you a head start).

Now the scale is being a bitch even though I'm doing all the right things.

So should I be eating pizza, fries and ice cream now?

Why is my metabolism such a strange brand of screwed up? Why can't I just do Weight Watchers like everyone else?

Blame Hitler for Obesity

I hate listening to radio interviews because they are so slow compared to how fast I can read. It's better if something is on television so I can see and hear (although I often read with the TV on, because even TV is too slow) but radio really sucks for me. Like life at sloth speed. It makes me twitch.

That being said, I'm glad I sucked it up and plowed through these two radio interviews with Gary Taubes.

The first, explains why obesity is Hitler's fault. The second, explains why I shouldn't eat after a workout. I'd previously been advised to eat a sweet potato after the metabolic conditioning workouts, I think I'm going to pass based on this interview as it seems to defeat the goal.

Insulin Poisoning or Why You Really Don't Want Diabetes

No weight loss.

After three weeks of serious focus and effort.

(Barring the ice cream, but even then we split the pint three ways, not a big enough sin to destroy weight loss.)

Excuse me while I take a moment to swear, kick puppies and smash expensive crystal into a fireplace.

I've toned the hell out of what I can tone, but that is worthless. When I taper at the end of the month, exercise will be difficult if not impossible and I'll flab out again.

Toning is not weight loss. Sorry, but it ain't. What I needed was weight loss.

I'll keep it up until I taper and what I do next will depend on the taper.

Dr. Atkins used to recommend a fat fast for seriously resistant patients. I am willing to try it, but not sure how that interacts with the adrenal stuff.

This is when I really wish I could tolerate Metformin or that there was a good pharmaceutical alternative to it that could impact the insulin resistance in my favor. I looked into this last year and while there was a doc willing to prescribe things like Byetta, Wellbutrin and Januvia (sp?) to aid weight loss, I was unimpressed with their efficacy and concerned about their side effects.

(Especially coming off an anaphylactic reaction to Cipro which will forever make me think twice before taking new-to-me medication.)

One of the theories the low carb community has been discussing is the idea that being bathed in so much insulin all the time causes permanent metabolic damage. The evidence supporting this layperson theory is diabetics who develop lipohypertrophy.

Insulin makes fat and if you spend all day, every day jabbing straight insulin into specific sites on your body this is what happens ...

Yeah, think about that the next time you eat a carton of ice cream in one sitting after eating a super-sized fast food meal. Diabetes can be treated, but you pay a price. Gonna be hard to find a pair of pants to hide those lumps.

So in essence, by (formerly) eating low fat, high carb food just like mainstream science exhorts us to do, I have been 'injecting' my entire body with boatloads of insulin for years.

Regaining the weight via carb inhalation while pregnant didn't help. (FYI the doctors told me low carbing could hurt the baby and advised me to eat carbs. I was too afraid of doing anything wrong after such a hard won pregnancy to risk screwing it up so I did exactly as I was told.)

On the upside, I got fat all over, no lumps for me,unless I become insulin dependent. But the question is, how does this impact weight loss? Is tissue forever metabolically altered past a certain point?

I don't know, but I can see how the damage could be permanent.

Resisting the Plateau

I have not lost any weight since before Christmas.

For a while, I was blaming the week I spent making french-kissing, from my lips to my hips, butter toffee, drenched in chocolate and dusted it with crushed pecans.

It was supposed to be a gift for the neighbors, but uh...I ate it all. So I would make it again and then eat it again etc...

I really really really like butter toffee. A lot lot lot.

I gave up on the toffee ever leaving my house and thus, stopped making it and promptly returned to low carb, but the weight just wouldn't move.

It wasn't that much toffee, okay?

Plateaus and stalls are common in weight loss and, it seems, particularly in low carb. I think half the reason people abandon low carb is due to the unavoidable plateau somewhere between week 3 and 6.

"It's not working," they cry and then they quit in a huff. I see it all the time on the diet forums.

I know better, but this has been one heck of a long weight loss stall. Especially considering I've been exercising pretty consistently on top of all the low carb goodness. Two months with nothing? Not even half a pound? Really?

So I've been reviewing my options for busting through this stall.

1. Go ultra low carb. As in meat and egss and nothing else until a)I puke or b) lose weight, whichever comes first.

Not such an appetizing option in my opinion. Also, it's hard to be perfect with a family that doesn't low carb. Plus, adrenals = low blood sugar so I have to watch that too.

Perhaps I could do ultra low carb on alternate days or just on the weekends as a kickstart. Something to consider.

However, I have been cleaning up my diet a bit. Focusing more on low carb and less on low carb 'legal' stuff which always has more carb content. That and no snacking after dinner, which always seems to help.

2. Revisit my exercise program and look more at metabolic resistance training (a.k.a. strength cardio, high intensity interval training and interval training).

However, the adrenals don't like intense anything. I go too hard and I risk crashing (based on past experience and not wanting to risk any recovery gains I've made thus far). Heck, if I go easy I can crash so...eek.

Consider though that interval training's guiding principal is rest for twice as long as you work. That sounds right up the adrenals' alley. So I could crank out a hard minute on the elliptical and then coast for 2. Sounds doable.

On the strength cardio aspect of the concept, I would have to craft my own workout. I am not ready for P90X (I actually have no desire to ever do P90X but the principles it uses are the same as what I'm looking to do) or kettlebells and I don't have access to a gym with weights. I'm not sure I'm doing it exactly right but the routine I've come up with is something like:

SET 1

-10 plie squats

-10 plie squats with jump

-Hold squat for 10-20 seconds



Rest


SET 2

10 Burpees

Rest

etc...

Supposedly the science says if I do it like this, fast and hard with rest in between sets, that I will improve my insulin sensitivity for up to 36 hours after. Additionally, science seems to show that some kind of aerobic resistance is the best work out for insulin resistance. "Steady state cardio" (as trainers call it) is worthless for fat loss.

I kind of agree with the trainers after all these weeks of walking and ellipsing and low carbing and not losing weight.

Just can't make it too hard or else I will poop out. That will be the trick, to balance it all against what my body will actually tolerate.

Shape Up

I am getting bored with working out. I don't feel like it's helping me lose weight anymore.

Which I know, for me, exercise is not really the answer. But I had toned so much and had such great success in changing my body shape, I thought if I just did more and did it harder, I could continue to have dramatic positive results.

Also, I do like being physically active, but it is a time suck and a logistical challenge. I'm hitting the wall of 'do I really want to kill myself and move heaven and earth to find even more time to devote to squats?'  I mean, how many squats do I need to do?

The fact is, I have insulin resistance, a parting gift from prednisone. And if I am not eating a strict low carb diet, I am not going to lose weight. That's just the way it is.There aren't enough squats in the world to make me skinny.

I am low carbing, but not strictly. As in, I ate a plum yesterday and I will probably have corn-on-the-cob tonight. The other day, I had a small piece of french toast. I won't gain weight, but I won't lose weight. Little stuff matters even if every other thing I put in my mouth has zero carbs.

So I need to refocus on what I'm eating and stop thinking if I just work out more that will solve the problem. The carbs have got to go.

By the way, one of the workouts I've been doing is a 20 minute Shape 'body makeover' dvd. It's fast, hits hard, and never seems to get easy. The extra segments kind of suck--too much channeling of yoga, pilates, and Cirque du Soleil contortionist for me, but the main 20 minute workout is fantastic. Highly recommend.

Sometimes I Am Prescient

When I was a kid, don't ask me why, but I once said "Man, it would really suck to have asthma and be diabetic, wouldn't it?"

I was 16 at the time. I have no recollection of what prompted the statement, but it stands out in my memory for some reason.

Probably because now look at me... here I am flirting with diabetes and total destruction of my thyroid (you know, just in case asthma + diabetes is easy peasy).

Hahahahaha. Irony. You blood sucking heartless bitch.

Ahem. I digress. The point is...

This afternoon I was on hold with a doctor's office for an eternity so I was googling to pass the time and found this little study abstract. (The toddler is napping by the way.)

The title alone makes me happy. "Insulin resistance is a poor predictor of type 2 diabetes in individuals with no family history of disease."

Then this: "...insulin resistance per se is not sufficient for the development of diabetes in individuals without family history of disease..."

I have no family history of diabetes. I might have a shot here. I'm trying not to get too excited because it's a snippet, one from the internet no less. Who knows where it lays (lies?*) within the broader context of science, so I'm not truly qualified to interpret it.

But it made me feel warm and fuzzy inside when I read it. Good enough for me!

Oh as for the hold thing...I'm trying to see if I can go back to my RE. Regular endos are too rigid. I need Doctor Cowboy not Doctor By-the-Book. Reproductive Endocrinologists are much more flexible, creative and interested in what the patients have to say in my experience.

Also, I would like to not bleed to death. Which is, unfortunately, still a concern. I am taking the pills that are supposed to stop it. They aren't working. I think I need someone who knows their way around not just the hormones, but the girly bits too and regular endos, well, they don't keep speculums in their offices now do they? Or transvaginal ultrasound equipment.

All the regular endos are totally missing out.

I didn't make an appointment yet, just called to see if I could and turns out I can! I think I will wait to see what happens with the OB, the lump and my blood pressure and decide from there whether I need to drag the RE into this mess or not.


*Yeah, yeah, yeah. I can use the word 'prescient' but can't figure out lay and lie. Sue me.