The Saga, and some recovery

Earlier this year, I noticed I had gained 16 pounds in 8 months. I try to eat healthy food and not to worry about my weight, but obviously I was on a bad trajectory. Luckily I log my weight most mornings, so I could see that it was actually 3 weeks of gaining a pound a week, followed by a week of losing a pound. Travel and holidays tacked on extra weight, but the following week I worked to maintain. Not pretty. Of course the 3+1 pattern is obvious. Two children with bad tummies cause me enough sleepless nights! So oral contraceptives.

Then I thought about why, and I noticed that I had been ignoring nausea. Actually, it was a lot like morning sickness all over again, but milder. Day-long nausea that felt better while I was eating, with heartburn if I ate a full meal. Yeah, I'd rather not have morning sickness again, especially without a bundle of joy to make it worthwhile, and to know it will end. So I was eating too much to mask the nausea. Another confounding symptom was that exercise made me feel worn out, worn down, and just plain tired. Usually I expect exercise to wear me out, but with a side effect of feeling powerful and strong, just let me catch my breath.

Next I did my research to link nausea with ocp. Yes, it's a common side effect, so I made an appointment with my doctor and kept digging. I finally found an explanation that gave me an attack vector. Since nausea as a side effect is an androgenic effect, I could switch to an ocp with less androgenic activity (but also low estrogen since Cale still likes to nurse). Armed with what to reduce, I found what I needed to take to my doctor. As a side note, another reference pointed out that androgenic weight gain was caused by interference with carbohydrate metabolism. As someone with diabetes in the family, I don't want to take any medication that damages my carbohydrate metabolism!

That month (the ninth), I noticed that my biggest day-to-day weight gain was after a spaghetti dinner, a high carbohydrate meal. So I resisted carbs, but it was ever so tough!

First month on the new stuff ... first week or two! ... I noticed that resisting carbs was suddenly easy. The change was sudden and dramatic. I realized that I used to be able to resist temptation, but since I don't usually worry about my weight, I hadn't noticed. Realizing my own blindness made me empathize with people with addictive behaviors. It's hard to do what you know you should when there's that compulsion. I'm glad my bout was from an external cause I can control (once I noticed). Much less nausea, less heartburn, better control of what I ate, in one month. Compared to the previous month, when I knew but I had to fight the androgenic demon inside ... on the right track!

Last night's dinner was another example: I was still hungry after dinner of salad and meatloaf. On the previous regime, I would have been craving sweet carbs, probably chocolate too. A chocolate cake craving, in short. Instead, as I tried to figure out what I wanted to eat after dinner last night, I knew I didn't want sweets, and I wasn't in the mood for carbs or chocolate. I didn't want more meat(loaf). I was so sure I didn't want sweets that I didn't even want fruit! If it's not sweets or carbs, not fruits, and not proteins, that just leaves vegetables. Yes, I was in the mood for more veggies! I ate apple with the rest of my family instead of making another salad just for myself, but I would have been just as happy with a salad. There's a huge difference between the food craving that I used to have, and the milder food wanting I sometimes have now. I've been using the verb 'to crave' incorrectly most of my life. At least I'm more sympathetic to people who do have cravings now, because those are brutal.

The weight loss, not trying too hard, is about a pound a month. Exercise is no longer a chore, but back to being empowering and exhilarating. But the best part: I had spaghetti for dinner a couple nights ago, and it didn't spike my weight! So in 3 months, my damaged carbohydrate metabolism appears to be repaired! I was worried, what with my diabetic family history, that I might not be able to reverse the damage. But I could, I did, and I think I'm on the right track!

My main androgenic complaint (nausea) is gone, along with a host of other possibly-related problems like utter exhaustion from exercise, food cravings, and a damaged carbohydrate metabolism. Still unanswered is if my hair experienced androgenic alopecia or something else, but hair growth takes at least six months to see any changes, so it's too soon to tell. I'm unsure about the heartburn, since I think my heartburn correlates more to my weight (so it goes away as my weight drops back to healthy levels) than to any actual androgenic effect. On the flip side, I am experiencing more headaches, many at the migraine level. I need to be sure I'm well-hydrated (I haven't been as good about drinking lots of water lately for stupid reasons like 'busy') before I know if this is a new side effect. It's certainly easier to tolerate the occasional headache than continuous nausea, so I'm not complaining. I'm curious to know if my cholesterol and my blood pressure have also improved.

Insulin Resistance Quiz

I found an insulin resistance quiz from Sensible-Alternative Naturopathic Clinic that I like, for the most part. The good part is that the different questions have different weights (makes sense), the bad part is that I think it's too easy to get a score of insulin resistance on this quiz. As long as the next step is to talk to your doctor, as I did yesterday, that's fine. I will have a fasting glucose test done Thursday morning (advance notice of crankiness!), and we'll see how it compares to the previous one done a few weeks before I got pregnant with Cale.

Calorie (In)equality

I used to believe the old saw that the only thing that matters for weight issues is to watch calories in (food) and calories out (exercise). Up to a point, that's even true. This is The Physics Diet, and it works if you're strict. I'll cut to the end game: clearly the source of the calories matters, at least in some cases. Don't believe me? Diabetes. Check mate in one word!

To work on the "calories in" side, I developed all sorts of low-fat cooking techniques years ago. I'm pretty good at it now. The reason why I learned low-fat is that you get 9 calories from a gram of fat, while just 4 calories from a gram of protein or a gram of carbohydrate. Obviously knocking out fat is a bigger calorie drop than protein or carbs. [The building blocks of protein are amino acids; the building blocks of carbohydrates are sugars.]

Too bad I'm sensitive to refined sugar! Not that it's bad to be a low-fat cook, but it's not all I need to watch. What I've learned from observing myself is that eating refined sugar (certain types more so than others; haven't figured out what those have in common yet though) triggers munchies. I'm sure I'm still hungry. I mean, I feel quite hungry. I can tell it's a hungry feeling, and not boredom or any of those other wrong reasons to eat. Luckily, I've learned the "reset" button for the refined sugar munchies, and that's to fight back with unrefined sugar. The sweetness of fruit is appealing, and it (generally) turns off my desire to eat more. Apples are great! So it's not that the calories in sugar are bad, but my reaction to them (wanting to eat more) is. Complex carbohydrates are good (especially the ones high in fiber), but refined carbs and especially refined sugars are not good for how I respond to them.

I've still got more to learn here, but I'll start by acknowledging that not all calories are equal; some calorie sources have undesirable consequences.

Sleep Deficiency and Women's Health

Here I was, thinking I was doing well to reduce my insomnia to half an hour (or less!), but this study says I should keep working on it.

First,

they found that poor sleep is associated with greater psychological distress and higher levels of biomarkers associated with increased risk of type 2 diabetes and heart disease. They also found that these associations are stronger in women than in men.

Since I do have some issues with blood sugar, the mention of diabetes caught my eye.

"Interestingly, it appears that it's not so much the overall poor sleep quality that was associated with greater risk, but rather the length of time it takes a person to fall asleep that takes the highest toll. Women who reported taking a half hour or more to fall asleep showed the worst risk profile.

OK, I'll stay in sleep school a while longer!

Eating Before Exercise

In high school, on the cross country team, I was the one eating food right before running. Everyone else thought I was asking to barf. On the other hand, I was one of two who gained weight (7 pounds, in fact), so I maintained that I didn't have any weight to lose back then.

I just ran across this article, What to Eat Before You Work Out, and identified with this quote.

Some people do have a hard time exercising without eating first, especially if it’s been a long time since their last meal or snack. These individuals often are more sensitive to changes in their blood sugar levels, which fall during the first 15-20 minutes of workout.

Yep, that sounds like me! If I go too long between meals, I get all hypoglycemic with low blood pressure and need a nap to bounce back. Food good, exercise good, no need to separate them too far. Eating before a hard run never upset my stomach!

Greater Trochanter Bursitis

My right hip (aka "greater trochanter") bursitis has been waking me up at night, hardly what I need while pregnant. I've had this bursitis pain constantly for the past 7 years. Around the one-year mark, I went to a doctor who knows me well, and had four corticosteroid injections. The injections hurt, the swelling from the injections lasted about two weeks and hurt the whole time, and then the regular bursitis pain came back. So we tried again, tweaking the injection formula for me, and it never helped. We also tried large doses of NSAIDs with the same lack of luck. I figure I must be doing something regularly, for seven years, to keep it so irritated. *sigh*

So it's time to look for other ideas.

Here's an overview of trochanteric bursitis treatment. The good information here is to stretch tight iliotibial bands (ITB) as well as tensor fascia lata (TFL). I've had the corticosteroid injections and I wear my orthotics. I haven't used deep heating, but it feels a lot better when it's warm/hot than when it's cold! So maybe I should try ITB and TFL stretches, and use a heating pad.

The most helpful "cure" for me tends to be physical therapy. Previous research turned up that hip bursitis is often a tight piriformis muscle, and sure enough, my right piriformis is significantly tighter than the left. I was surprised because I'm used to my benign hypermobility, and here I am with a very tight piriformis. So not only does PT work on me in general, I've got the lack of range of motion to back up this specific case too. Here's a description of, with link to pictures of, trochanteric bursitis rehabilitation exercises. It targets piriformis and iliotibial, the main culprits. (However, when my ITB is tight, I get a characteristic pain in my knee that feels like I twisted my kneecap. The pain is on the edge of my patella, from the bottom to the outer side. I haven't had that in a while. ITB stretches are good, but I think piriformis stretching is best for my right hip bursitis.)

Heading to the fringe, there's also a list of herbs for bursitis and tendinitis (the number of leaves represents the confidence level). Willow is just aspirin, and I've tried that route, so I'm not interested. Ginger might have promise, and possibly magnesium (Mg also helps glucose tolerance / insulin resistance).

So I think I'll stretch my right piriformis muscle right now, and maybe put a heating pad on it tonight.

Weight Loss and Refined Carbs

If you dig behind this HealthDay article, the bottom line is that insulin-resistant people lose more weight on a diet that's low in refined carbohydrates (no white flour and sugar!) than on a diet that's low in fat. It's not just about calories in and calories burned, but about eating the right food! Complex carbohydrates (whole grains) are still important. During the weight loss phase, complex carbohydrates provide fiber for that full feeling, and afterwards healthy carbohydrates are a major part of long-term weight maintenance (not regaining weight after loss).

This points to a low glycemic diet (not sure between glycemic index and glycemic load), but I suspect it really boils down to the usual answer to use common sense.

Caffeine

I read this article on caffeine and I'm glad that I stopped drinking tea several years ago. I don't need a stress amplifier that raises blood pressure and increases insulin resistance! I was at the worldwide Spectrum users conference in New Hampshire September 2003, and they didn't have my then-favorite drink of iced tea at the breaks, but they did have water bottles. Hot tea takes too long to drink (have to wait for it to cool before sipping!), cola is too sweet and causes burps, and I just don't like to drink milk. So that leaves water, and I started to enjoy it. Since water's good for you, I decided to stick with it. I sometimes drink green tea now, but it's decaf ...