Hormonal Balance

I look forward to setting a few minutes aside most days to read one of my favorite e-newsletters from Mind Body Green. Have you heard of them? If not, head their way. They have a treasure chest of feel good health articles, covering diet to meditation to movement. Yet, getting to the topic of today’s post, after reading an article on foods to avoid for hormonal imbalance, I want to give feedback on one of the author’s, Alisa Vitti, statements. And to expand on the word “feedback,” I do not intend to suggest she is wrong, I am right, I just want to add more information to educate consumers as we are on the same team here.

The full article is here, but in summary the author suggests striving for hormonal balance by avoiding:

  • raw kale,
  • soy,
  • stevia (and I really appreciated this on the list as so many women are confused what to use as a sweetener, especially when they are pregnant),
  • red meat and
  • “cooling foods.”

Guess which one I want to address? Red meat.

I am not sure I am sold, as I have written an article on Pregnancy Staple Foods and included red meat (grassfed/organic) as a nutrition powerhouse.

After the listing of “red meat” in the hormone article, the author includes, “Many of my clients with PCOS have been told to follow a meat-heavy Paleo diet, but in my experience, this isn’t the best option.”

I agree with that –  a meat heavy diet would not be good for anyone’s long-term health, let alone hormone balance. Carbs are crucial for health. Yes, there are people fitting for a very low carb diet or a ketogenic diet, but carbs should not be the new weight-gaining phobia. In the 80s people learned to fear fat, and in the last decade or more, carbs have become the bad guy. However, carbs are needed for thyroid health, adrenal health, satiety/sleep and weight loss! Protein is needed, in a calculated/intuitive amount, and healthy red meat is a GREAT option.

All in all, I don’t have beef with beef if it’s sourced well, and I don’t want consumers to either. When able, purchase beef that is grassfed and organic (although, did you see the news on organic meat? Either way, it’s best to err on the side of caution and go with organic). So I think this is a great article, yet, I’d change up the wording of red meat, to avoid a heavy meat diet, especially conventionally raised meat.

Cheers to you and good health.

 

 

Just Do It

I honestly can’t think of a better slogan than Nike’s “Just Do It.” It eludes to many things, but simplifies the action for one to get up and go – run, sign up for a race, try something new, enjoy an active lifestyle, etc.

But what if they replaced the word “It” with exercise? Ahh, no bueno. Exercise feels like I am barking an order or a chore. So, how does any of this relate to you and I? Yes, well done Nike, but the point I want to make is when we think about exercise or talk about it, or even put it on our to-do list, we need to keep it positive. And what ticks for one, may not tick for all.

For me – I like to label my exercise as a workout or hobby. And what lies under this changes just as does our mood and the season. I talk about this often with my nutrition clients, so can easily recall what I’ve enjoyed over the last dozen months. I fully embraced tennis as soon as I could postpartum with my first. Man did it make me feel like a teenager again. And the gals I did a weekly class with, made me feel like I was on a team! It was awesome, and indeed I credit my 90 minute tennis lesson per week to my decent shape of running Chicago’s 10 miler in May 2014. Next though, I wanted to move on so I didn’t lose the enjoyment of tennis and fully engaged in pilates and soaked up yoga. Come Fall, I fell pregnant and the strict and intense pilates teacher told me to move onto something else until I had better technique or no bun in the oven. One, I can’t be perfect at everything right?! At least I was trying something new. And, two, I wasn’t going to let this push-back hold me back from being active. Next, I joined aqua aerobics. And guess what, I loved it so much I got my AFAA Group Fitness Certification in March so I can teach it post arrival of baby #2. All things happen for a reason, eh? Nonetheless, you can see I participated in a variety of activities and I believe this is one tactic to be successful in enjoying an active lifestyle. While there is more, keep this in mind.

Making ourselves move is showing up for our health and loving ourselves. The benefits are many, as are the excuses to not do it. But, Just Do It. Find something new and pull along a friend to make you more committed to be active.

At 33 weeks pregnant, riding on some strong insulin resistance (type 1 diabetes for 2 decades plus) in my third trimester, I am still pumping iron, attending spin classes, restorative yoga and core courses. Are there challenges to being active, especially with moving blood sugars and kicking baby? Yes, but pushing ourselves out of our comfort zone brings numerous benefits and happiness.

With diabetes, even pregnancy, I am taking extra measure in what I am eating, how well I am hydrated and monitoring blood sugars, but I am still out there. Are you? Everyone has different things that maybe challenging their physical fitness, but let’s engage, move, set goals and motivate one another.

If you fall into the pregnancy or diabetes camp, I have some tips to offer, yet I am not a pro. As well, I have included motivators for anyone looking to move their body:

TRYING A NEW ACTIVITY – STAYING MOTIVATED TO MOVE – BEING YOUR FITTEST

  • Variety. As eluded select a number of things that sound interesting to you and sprinkle sessions of such over your calendar for the next month. These activities do not have to be in a gym setting either. One thing I always try to plant on our weekend agenda is a bike ride. Beyond something that looks like exercise, broaden your brainstorm to dance lessons, putt putt with a date and more. A great trend here in Chicago is something call ClassPass. Heard of it? It’s growing into numerous other cities, but instead having to have a membership to one type of studio like Core Power or Bikram yoga, it gives you access to a diverse offering for one flat rate. It’s quite genius I think.

PinterestInterval PinterestWorkout

  • Budget. Memberships and personal training can definitely stack up and if this expense isn’t a priority, seek low cost or free things. Since I have been modifying so much in my classes, I have created some of my own workouts and have used Pinterest to help me with a plan. It’s too easy to do the same. One practice I do, is find a workout I like and take a picture of it on my phone, as shown below, and pull it up when I am ready to break a sweat.
  • Efficacy. Being our fittest doesn’t mean the more the better. It’s easy to overdo exercise, just know your limits and when you start to show signs of too much ie. fatigue, poor recovery, soreness, amenorrhea in extreme cases, etc.

DIABETES + ACTIVITY

  • Move – start small and measure. When I had my son Declan, it took a great deal to feel the edge to want to engage in anything more than walking. So I started small; like real small. Instead of giving myself a deadline to get to the gym, I told myself I had to do 5 pushups a day. Not only was this goal small enough for me to easily engage in the objective, but I often did more than 5 pushups. Over the following weeks, I started doing more weight bearing movements and then went to a class. An easy class too. With each enhancement I also kept an eye on my blood sugar. I test before and after activity, and if I sign up for a class, I also avoid large boluses of insulin before the engagement. This helps prevent hypoglycemia and I am better able to predict what my blood sugar is going to do. Also, in a perfect world, I try to place activity before a meal, so if I didn’t use a large enough temporary basal on my pump, I’d already have a plan to eat after. Depending on the activity and the duration I will take my pump off or at a minimum use a temp basal of 80%. What I decide to do, also varies with the time of day. In the AM I need a smaller temp basal or none at all, verse the evening, I am more insulin sensitive. Everyone is different so be sure to test, measure and not guess for yourself.
  • Food – As mentioned, I try to have a meal planned post activity, but this isn’t always the case. Pre-activity if I need something, I will have a handful of nuts any maybe some berries. Overall something lower in carbohydrate to keep active insulin low. Depending on the intensity and what my starting blood sugar is, this can all change. If I was about to do some low stress cardio (running, swimming, non-sprint biking) I’d maybe grab a Raw bar mini. (And I have no ties w/ this product, they just work with my blood sugar really well).
  • Test, don’t guess. I test preworkout every time and post. Even when I know I am low, I will still test to know exactly how much I should treat to put me back at a good level. I have learned the hard way of consuming too many carbs then putting myself of a roll-coaster cycle. What works for me will vary with anyone else. Some of my go-tos include fruit leathers and Kind bars. I will first have the leather and then followup with carbohydrate that is combined with protein and fat. What do you use?

PREGNANCY + ACTIVITY

  • Boundaries. Know your boundaries and trust your intuition. You don’t want to engage in a new activity once you are pregnant, and a positive pregnancy test doesn’t meant to freeze the gym membership. While walking is wonderful pre and postnatal, and all around, so is weights and breaking a sweat. This is a good article to understand more advice on being active while brewing a baby.

 

Type 1 DM and 26 Weeks Pregnant

The insulin resistance is full on – but for once in my pregnancy, I feel pretty good and on-top of things.  I’ve increased my insulin pump basals and now every-time I eat, I dose with plenty of time in advance (30 minutes – 50 minutes depending on the time of the day) and usually use a dual bolus. If you are reading this post for insight on your own situation, I of course advise talking with your health care team before making any changes. The dual works well for me as my meals are moderate carb and protein and high fat. A sample of my meals lately below.

Breakfast – 3 pasture-raised eggs, cooked over easy (yes, this is a pregnancy no-no, but I trust where I source my eggs), 2 pieces of breakfast meat, usually Applegate chicken sausage and vegetables (mushrooms maybe something fermented). All paired with a black coffee and organic cream.

Yup – I also drink coffee. I didn’t with my first pregnancy but have a cup in the morning with baby #2.

Lunch – Vegetable meat muffins – I have been making mini meatloafs and having 2-3 depending on their size and pairing with a green apple or salad.

Snack – nuts or organic cheese and maybe some melon or gluten free pretsels.

Dinner – bunless, lettuce wrap burger – homemade with grassfed beef paired with either green beans cooked in bacon, onion, garlic or a side of warm organic berries.

This is pretty much the backbone of my meals but there are typically some lows that I have to treat as I continue to tweak my basals.

Type 1 and 24 Weeks Pregnant

Where has the time gone? I am sure many of us are asking this same question, pregnant or not.

My first pregnancy, Dex was born August 6, 2013, and I could pretty much recite the weeks, day and perhaps the hour of time I was pregnant, and this go-around I am finding I have to track it in my calendar or the ask the nurse at my monthly appointment. Perhaps this is due to the fact, I have been a little behind the 8 ball with baby Schmidt #2’s arrival from the get go. I didn’t know I was pregnant until about 8/9 weeks; and yes, this can be a dangerous thing being type 1 diabetic. Thankfully I had a decent A1C at the time, it was about a 6.2% and now I am riding in the 5’s.

So what is the blog post all about? Well, the title is a little obvious, but I have been wanting to write out and publicly share my experience with pregnancy and type 1 diabetes because the last 24 plus weeks haven’t been easy, and perhaps my experiences can help another. I also hope to continue writing quick posts, in a style of writing in a personal journal, and if this is something that is beneficial for you, please share your feedback. To start, maybe I’ll explain my journey thus far…

Early October (24ish weeks ago) I was packing my suitcase for a trip to Los Angeles to present at a conference on blood sugar control, diet and diabetes for DiabetesSisters.org. As I was in my bedroom loading my things, my 14 month old son was being “busy” exploring all my accessories in all my draws in the bathroom. A few items he kept pulling out and showing off to me included a pregnancy test. Geesh, I haven’t used one of those in quite some time; 14 months actually. And for some reason I thought, I should take it. In the last few days leading up to this moment I had an appetite like a triathlete and while I didn’t think I was pregnant, my cycle hadn’t arrived, which wasn’t too off due to it still balancing out from breastfeeding. So I took it. What do you know, it was positive. I immediately told me husband. His response? Take another one. I took another one. His response? Are they accurate???

So there I was. Focusing on a trip, 2 presentations and now having a minor freak out if my blood sugars were good enough, as well as, having a moment because my pump hadn’t been working out for the summer and I was currently on MDIs (in diabetic jargon this is multiple daily injections). Oh snap, I should call my mom, I should call my nurse, I should breath. Wait, is this really happening? Yes.

(Tangent, mom and dad, if you are reading this, sorry my news of expecting is never lovey dovey. It’s usually an immediate phone call of worries and tears and your support has been beyond appreciated. Maybe if I have a third, I will be a little more traditional. Oye.)

Next, I got on the flight the following morning, put my ducks in a row, and drew back on my memories of my last pregnancy. Well, this pregnancy and my first haven’t been a lick alike. The first pregnancy I was low in the beginning all the time. I had to cut my insulin basals and with this current pregnancy I was running high and actually had to increase my daily insulin needs. Secondly, while MDIs can do the job, I wanted back on the pump. I needed to make it work and I wanted that security knowing I could have the insane tight control of an average of 5.4% A1C I had with Dex. It also didn’t help I was puking like it was fashionable this go around. Are girls always tougher??

Long story short, I did the conference, I was in bed by 8 every night! And returned back to Chicago and put myself back on my Minimed pump as soon as possible. Ahhhh, the Quickset infusion set hurttttttttttttttttttttttttttt. But hey, I thought, I’ll do WHATEVER I need to do, regardless of pain. I stuck it out, but oh crap, absorption sucks, sugars ran high, ketones!!! Ketones, not ketones! I call my doc and she recommends I use the steel needle infusion set called the Sure-T. I get some from Minimed and gave it a whirl. Yes it worked. Oh, but only for about 24 hours. I changed my site sometimes 3 at a time. And this happened for days. Every few it would work, and then I’d have moments where I had to change it again and again. Meanwhile, and in retrospect, I was having absorption problems with my infusion sets, but I also was banking on the fact my first pregnancy I was bloody low all the time in the first trimester, and that wasn’t happening this time. I no doubt was jumping the gun with changing my site and not being patient with my insulin, but I was worried. Every high blood sugar could honestly mean birth defects, or worse. It was hard to calm down. Until my first appointment I was constantly holding my breath. Side note – I am thankful for how advance insulin is these days, but it surely has room for improvement, esp with my impatience at the time in pregnancy.

Next up, I finally get to my first appointment to learn if I was 11 weeks or more; I was 12, and thank the heavens for my CDE. I think I have the best one in Chicago, she encouraged me to do what is best for me in the moment and if need be, we would figure out how to do MDIs and have optimal blood sugar numbers. I switched back to MDIs – I needed a break, and I needed to sleep, and we worked it out.

Since then, I got a Dexcom or a CGM (continuous glucose meter) and the data is magical. Well, when it works. Another twist with pregnancy is that a CGM is less accurate and there isn’t research done on using a CGM in pregnancy. I had a similar experience in fighting to find a spot on my body for a CGM to accurately read, but over time I have found my upper stomach is my only accurate site. Post pregnancy perhaps, I can use my backside, arms and thighs. Not now, and that’s okay, as long as it works.

So I am on the Dexcom, on MDIs and by about week 23 I am finding that with creeping insulin resistance, as it happens around this window, I was taking anywhere from 10-16 shots a day. I felt like my quality of life was dwindling and my CGM, shots, blood sugar pricks and being married to exact meal time for every meal was affecting my personality. I was surely declining social events because dinner dates did not line-up with my dinner time, or if I did attend, I’d fight blood sugars all night. I talked to my CDE and we switched back to the pump….and it was not easy, but I was and am persistent and was on top of it.

So far in this pregnancy I have been on MDIs, to MDis with a Dexcom (quick learning curve there obviously as I have never used one), to various Minimed infusion sets, and I will add the silhouette manually inserted is doing me the best, back to MDIs and then back to the pump. I’ve continued to assess and analyze what daily changes I need t make, including the number of carbs to eat at each meal, when to have snacks or not to, to how long dependong on the time of day I need to take insulin before eating. Right now I wait about 30 minutes for bfast, lunch, 40 for an afternoon snack and about 50 minutes for dinner. I’ve moved my diet from a low low carb eating plan to a daily intake that is still considered low carb, but higher to meet pregnancy needs of 100 grams a day. I have also tried to drop my protein down, closer to 80 grams per day. My fat intake is somewhat the same. I do not restrict and indeed during this pregnancy butter, eggs, and nuts are my main cravings.

It has not been easy, but this entire journey has really made me appreciate every tool I have to control my blood sugar and to be able to grow a baby. A century ago my life expectancy would have been a week and these days, I can not only grow up and be what I want to be (the best dietitian!!!), but a mom and to have a family. For this I am forever grateful, and while there are challenges, sleepless nights (already) and worries (who doesn’t worry while they are pregnant), it makes the end result that much more special.

 

What I’ve Eaten So Far Today – 7/22/13 – 36 wks Pregnant

One thing about logging my food during pregnancy is that I need to plan a bit more on what I am going to eat. Just with the slightest increase in hunger, I find myself more likely to reach and crave foods that I don’t usually snack on, or build in my meals. Indeed, I have added an AM snack on many days since being pregnant. Having a plan of what to eat is one of the things that has helped me gain (thus far!!) a healthy amount of weight. And tracking a food log has helped me to ensure I am getting plenty of variety, color and flavor in my meals.

7:30AM – Breakfast – Blood Sugar 81 mg/dl

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2 over easy eggs, cooked in Kerrygold butter, 1 slice of back bacon and grilled zucchini and onion

Water

Supplements: probiotics, fish oil, catalyn GF, vitamin D (I source these from Standard Process)

Disclaimer: some people may shy away from undercooked eggs when pregnant. This is a choice I knowingly make, having confidence in the high quality eggs used. 

10:30AM – Snack – Blood Sugar 79 mg/dl

1 mini kind bar, 32 ounces of filtered water

By this time, heading into lunch, I had walked about 3 miles.

Lunch – 12:30PM – Blood Sugar 89mg/dl

Romaine (organic) lettuce sandwich

– Columbus brand Herb Roasted Turkey

cheddar cheese and mustard.

Carrots and 1 spoonful of nut butter (not shown)

Soaked chia seeds (overnight in almond milk) with 2 sliced large organic strawberries

Herbal passion tea, chilled

Photo1 (1)3PM – Blood Sugar – 112 mg/dl – corrected to be in the 80s.

3:30PM – SnackGo Raw Chocolate square (raw cacao contains the highest level of anti-oxidants, including magnesium and chromium, of any whole food)

5:30PM – Dinner – 110mg/dl

Homemade Chicken Salad

– organic, free range chicken

– Greek yogurt

– honey

– apple cider vinegar

– almond slivers

– organic raisins

– salt/pepper

1 small orange

Butter lettuce

Extra virgin olive oil

Photo1

Overall, it’s a little hard to eat what I want in the latter part of the day this late in pregnancy. I am very insulin resistant and have to choose my carbs wisely. The resistance is starting to tapper down, and I likely over did it on carbs at dinner. At my 7:30PM check I was 141 mg/dl and I will eat something again before bed.

 

What I’ve Eaten So Far Today

It’s been too long since I have captured what I have eaten on my blog, and when asked by a client today, I thought I’d share with all. Thirty-three weeks pregnant, with few to no cravings, yet, anything too flavorful or sweet upsets my stomach.

8AM – Breakfast – (Blood sugar 86 mg/dl)

Beet Protein Smoothie

– 1 large cooked beet (picked up some from Costco)

– 5 large celery stalks

– 1 tablespoon of soaked chia seeds

– 1/2 tsp of maca powder

– 4 ounces of almond milk

– 4 ounces of water

– 1 scoop raw protein powder

While making smoothie I had a spoonful of almond butter (I was starving)

 

10:30 – AM Snack – (Blood sugar 96 mg/dl)

Kind mini bar

1 oz of Kerrygold grass-fed cheese

 

12:15 – Lunch – (Blood sugar 111 mg/dl)

Romaine lettuce sandwich

– 2 large romaine lettuce leaves

– 3 ounces of Chicken Columbus brand deli meat

– 2 large green garlic stuffed olives, sliced for “sandwich”

– Yellow mustard

5-8 baby carrots w/ tahini dip

1/2 large organic apple

1 square of dark chocolate

 

3:30 – PM Snack – (Blood sugar 81 mg/dl)

Second half of organic large apple

1 hard boiled egg

2 strawberries

 

Overall, I have found that having set meal and snack times is important to control my blood sugar, portions and hunger. Overall, I am eating more carbohydrates during pregnancy, and focusing heavily on eating intuitively. One thing is for sure, I can’t eat spicy food like I used to!