Great Lab Results

I just got back lab results from my recent doctor’s visit.  I was thrilled with the results.  And, I believe that some of the results are mostly attributable to the way I have been eating which is aligned with the goals of Weight Watchers’ SmartPoints.  In particular, the fact that I’ve reduced the sugar that I eat and am overall eating a healthier diet.  This is one reason I do like SmartPoints a lot.

Last year, I had some routine blood work done and was unhappy with some of my lab results.  Although my fasting blood glucose was normal and my triglycerides were OK at 104, I was shocked to see my A1C was 5.9% which was in the prediabetic range.  By then I had already lost down to about 159 pounds and was overweight and not obese.  I had worked on limiting bad carbs and during 2014 had eaten about 118g of carbs a day (96g net).

My LDL cholesterol and total cholesterol were a little high, my thyroid function was borderline low, my Vitamin D was shockingly low.

Based upon the results, I really worked on the eating part of it.  I bought a blood glucose meter and spent and tested my blood sugar in the morning and after eating to find out what foods raised my blood sugar.  I learned that I was definitely insulin resistant as some foods really spiked my blood sugar.  And, I really started eating in a way that I now realize aligns really well with SmartPoints.  I often eat a salad like this for one of my meals:

Salad 12-22

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My Eating Going Forward

I wanted to talk a bit about how I’ve been changing how I eat lately. Let me first say that I think the choice of a way of eating is highly personal.  I don’t really advocate my way for anyone other than me, since we are all individual.  Other people may be sensitive to foods that don’t bother me.  On the other hand, I may want to avoid some foods that others can handle just fine. And, I’m mindful that I’m not really an expert in how to eat. On that point, I enjoyed this essay by Dr. David Katz. But, I have tried to figure out what I think makes sense to me, for me, based upon what I’ve read and what my experience has been.

I posted previously about how we ate when I was growing up.  And, then I posted about how my eating evolved over the years after I was out of school. I have made a lot of changes over the years.  For example, I gave up eating beef 14 years ago.  I also have slowly limited the refined grains that I eat and mostly eat whole grains when I eat grains.  And, I’ve increased my intake of vegetables and berries.  But, there are other changes I’ve also been starting to undertake.

1. Probably the most major change is to lessen my intake of highly processed foods and to be far more selective of where I eat out.  I am not giving up all processed foods, but I am giving up (or severely limiting) the ones that have little nutritional value, are highly processed with lots of artificial ingredients, and are more created in lab than really being a food that would be found in nature.  So, I would still buy frozen chopped vegetables, but would not buy Cheetos.

One of the major reasons is that I am focusing on what I think is best for maintaining weight loss.  I’ve been doing a lot of reading about food over the past months.  I’ve looked at various ways to eat and I’ve tried to come to some sort of synthesis of everything I’ve read to something that makes sense for me.  I’ve really come to believe that the industrial food system — which includes processed food manufacturers, fast food companies, many chain restaurants — has become a force that really promotes overeating.  I found The End of Overeating by David Kessler (former FDA commissioner) and Salt Sugar Fat:  How the Food Giants Hooked Us by Michael Moss to be really eye-opening.  They really demonstrated to me how the food industry really tries to use fat, sugar, and salt to make food so appealing and so rewarding that we want to eat more and more of it.  I’m not saying that no one should ever eat fat, sugar, and salt.  But, these books show how this stuff just gets added on beyond a reasonable amount in so much processed food.  To get an idea, here is an article by Moss in the New York Times adapted from Salt Sugar Fat.  Another great book on the industrial food system and why corn seems to be in everything was The Omnivore’s Dilemma by Michael Pollan.  I really loved this book and how it tells us there can be alternatives to the industrial food system.

I also have been very fascinated to read about food reward theory and obesity.  Stephan Guyenet (a neurobiologist) on his blog did a great series talking about food reward: Part I, Part II, Part III, Part IV, Part V, Part VI, Part VII, Part VIII.  I found the entire series very interesting to read.  I hasten to add that I don’t know if he is right on the science, but a lot of what he said resonated with me.

Here I thought he did a good job of explaining the concept of food reward and how it relates to obesity:

Reward is a psychology term with a specific definition: “a process that reinforces behavior”.  Rewarding food is not the same thing as food that tastes good, although they often occur together.

Food reward is the process by which eating specific foods reinforces behaviors that favor the acquisition and consumption of the food in question.  You could also call rewarding food “reinforcing” or “habit-forming”, although not necessarily in an addictive sense.  Food reward is a perfectly normal and healthy part of life, although I believe it can be harmful if it exceeds the bounds of what we’re adapted to.  Food reward is essential for survival in a natural environment, because it teaches you what to eat and how to get it through a trial-and-error process.


Here’s the fundamental concept that I think explains a lot of obesity in industrialized nations.  We live in a more or less Darwinian economic framework (capitalism).  Food manufacturers are in constant competition, and any food that sells poorly will rapidly disappear from stores.  How do you get people to buy your product?  You produce something that causes them to come back and buy it again.  In other words, the goal of processed food manufacturers is to create a product that maximally reinforces purchase and consumption behaviors– food reward!  If the product is not extremely rewarding, it won’t sell because it’s competing against other products that are extremely rewarding. Only the most rewarding products survive.

It doesn’t matter whether or not you like the Little Debbie cake once it’s in your mouth.  It doesn’t matter how you feel afterward.  The only thing that matters is whether or not you’ll buy another one tomorrow.  That’s food reward.

 When I look back on when I got to goal weight (actually, I got down to 117 pounds) many years ago, I think the above was a key part of why I regained.  The environment then (early 1990s) wasn’t as obesogenic as today’s environment, but I was a big processed food eater, and I loved fast food and I ate out a lot.  I did for awhile (when I was losing weight) start cooking a lot, but it went by the wayside after I got to goal.  I was very busy at work and it was easier to just cook a frozen meal, or drive through Jack in the Box, or go out to eat.  And, I loved those very rewarding foods.

When I regained 30 pounds ofter we moved 3 years ago, I see that it was because of that kind of thing again.  We were busy finding a new house, then moving, then doing some remodeling to the new house.  And, we ate out a lot.  And, when we didn’t eat out, I was buying packages at the store.  Cookies, chips, ice cream, and frozen (diet) dinners.  We would eat fast food 2 or 3 times a week and then go to a restaurant a few times.  No wonder I regained 30 pounds.

And, to be honest, I’ve resisted for years the idea of giving up or limiting the highly processed foods.  Yes, I’ve modified how much of them that I eat.  I’ve counted calories and Weight Watchers points and when I do that, then I can eat those foods and still lose weight.  But…the rub is that many of those foods are designed by food manufacturers to be foods that I want to eat more of.  So, I now think that if I avoid or limit those foods then the weight loss I have left to do and maintenance will be far easier for me.

Weight loss isn’t the only reason I want to limit my intake of highly processed foods.  I think that doing so will result in overall healthier eating.  I am also being more cognizant of where the food I eat comes from (particularly the animal protein which raised ethical concerns to me).

2. Eliminated soft drinks.  I implemented this a couple of weeks ago.  Since this I have had no soft drinks at all.  I gave up sugared soft drinks many years ago.  But, giving up my Cherry Coke Zero has been difficult.  I tried for awhile to just not have it at home and to only have it restaurants or when out and about.  But, what always happened was that I would maybe buy a 20 oz. Coke Zero at the gas station to drink on the way home…but then I would buy a few more to have at home.  So, I ended up drinking as much as I drank when I was buying 12 packs at the store (and the 20 oz. ones from  a convenience store are really expensive).  I finally realized that I would do better to just not drink them at all.  Since then, at restaurants I have either water or unsweetened tea.  At home, I have iced green tea, water, or sparkling water (the kind with no sweeteners).

3.  Carb limitation and modification – In January, I posted about my blood test results which really suggested my body wasn’t handling carbohydrates very well.  After that, I bought a blood glucose meter and started testing after meals.  Over time, I’ve found that some things do raise my blood sugar high enough that I don’t want to eat those things any more.  I find that refined grains raise my blood sugar a lot.  Of course, something with high sugar will raise my blood sugar (the cinnamon crunch bagel from Panera was, alas, really problematical for me).  On the other hand, I’ve found that limited amounts of whole grains (a small whole wheat tortilla or half a cup of brown rice, for example) are OK for my blood sugar.  I guess most days my carbs are around 90 to 100 grams (net carbs are probably closer to 70 to 80), and that seems to work out well.  I tend to spread them out throughout the day and a lot of them come from berries and vegetables.

So what am I eating?  I’ve gotten some ideas from various sources.  After The Omnivore’s Dilemma, Michael Pollan wrote a great book about what to eat, called In Defense of Food:  An Eater’s Manifesto.  He famously summed up his approach as: “Eat food.  Not too much. Mostly plants.”  That seems simple, but it really succinctly makes some important points.

Eat food – My first thought when I read this quote (long before reading the book) was to wonder why he was saying that?  I mean, what else would I be eating?  But, that is his point.  Not everything we eat is really food.  Some (a lot) of what we eat isn’t food, but is more like food like substances.  His point is to eat actual real food, not something that is really a science experiment created in a lab.  S0, he suggests that we not eat anything that our great grandmother wouldn’t recognize as food.  And, to avoid food products that have ingredients that are unpronounceable or are unfamiliar or that have more then 5 ingredients, or that contain high fructose corn syrup.  I don’t totally follow this.  For example, I buy stuff with more than 5 ingredients if I can read and understand what they are.  And sometimes, I buy things with uunpronounceable or unfamiliar ingredients (but I do look them up first).  But, the general rule holds.  Buy real food and cook it at home when possible.

Not too much – Well, yes.  I still am losing weight and then will need to maintain my weight loss.  Calories still matter.  Now that I am cooking more at home, though, I find that I get to eat a lot more volume of food for less calories than I was eating when I would eat out or buy processed foods.

Mostly plants – I think the point here is that Pollan says to eat mostly plants, yet he doesn’t say to eat only plants.  I was a vegetarian for a couple of years (lacto-ovo, not vegan), but I feel comfortable now with having some animal protein.  But,  I m eating a lot more vegetables now than I used to eat.  And, more berries.  I find that on some days, without setting out to do so, I end up not eating any chicken or fish.

Another book that I found helpful in translating this into actual eating was 100 Days of Real Food where a family transformed their eating inspired by In Defense of Food.

So, what am I doing?  More cooking.  I truly don’t like to spend a lot of time cooking, so I looked for recipes that were easy to do.  I make a large salad several days a week with a lot of veggies in it.  I make a simple balsamic vinaigrette (really simple – olive oil and balsamic vinegar).  I add a little cooked chicken to it or maybe a pouch of wild salmon or even a couple of tablespoons of hummus.  Maybe a little cheese or a few almonds or not.  I make some simple recipes that don’t take a long time to make such as a vegetable frittata that I modified from Food Matters.  I buy frozen fish and cook it.

I do sometimes eat some processed foods.  I buy frozen vegetables (but look carefully at the ingredients).   I look carefully at ingredient labels and decide whether I feel comfortable with the food.  I am avoiding the really ultra processed foods.  I am avoiding fast food restaurants.  I could certainly envision eating at one such as when traveling, but not for everyday eating.  We do still eat out a couple of times a week, but I’m much more careful about where we eat and what we eat.  I really make an effort to eat simpler foods where I know what is in them. Some of my favorite places currently: The Counter (burger place where you can build your own burger — I have mine in a bowl with no bread), Panera (I don’t buy the pastries, basically I eat some of the salads and a couple of the soups), Chipotle (I have a bowl, not a burrito).

This is very much still a work in progress, but I’m definitely feeling better and feel that this will help me sustain my weight loss for the long term.

Blood Sugar Testing and Me

As I posted previously, I  had recent blood test results. I was surprised by an A1C of 5.9% given that my fasting blood glucose was 84 and my triglycerides were 104. I also eat lowish carb usually in the 100 to 120g a day range, occasionally higher or lower.

An A1C at that level supposedly maps out to an average blood glucose of around 123. I know this can vary and be misleading if you have long-lived red blood cells.

From research, I know that results like I received could be valid if I was spiking really high blood sugars which took a long time to come down. I wanted to know so I bought a meter and have been testing my blood glucose. My fasting blood glucose in the mornings have been around 87 to 94. I had one outlier at 110, but I retested 20 minutes later (without having eaten) and got a reading of 87. So I think the 84 fasting result at the end of December seems reasonably accurate. (I’m using a Relion Prime meter).

I have also been testing after meals, usually 1 and 2 hours after. Some of the results have been surprising. It is clear to me that some foods do raise my blood sugar to a higher level than I would like. Others are a bit more equivocal. And, some carbs do nothing bad at all.

I read Jenny Ruhl’s book on how to do this. She gives varying potential targets to shoot for. One is to be at 120 after an hour, 100 after 2 hours, which is what she says truly normal people end up at. Another option (which I gather is more for people not truly normal but which she seems to think is sufficient) is 140 after 1 hour and 120 after 2 hours. She says is up the individual which target to shoot for.

She talks on her website about what a truly normal blood sugar is. My thought is to be close to the 120/100 most of the time, with it rarely going over and to work really hard to never go above the 140/120.  I recognize that some people may develop diabetes regardless of what they eat and some may never develop it.  For me, I wanted to see if I was sensitive to any carbs and whether they would raise my blood sugar above 140g.  If so, then my plan would be to eliminate or reduce my consumption of those carbs.

My results so far have been interesting. I’ve tried during this time to eat as normally as possible so I can get a feel for my usual diet. I did eat a few things that, in actuality, I eat only a few times a year but I wanted to see what they would do. I put things with carbs in 3 categories: OK, Problem, Borderline/Mixed. (Things that aren’t carbs are all OK for me in terms of blood sugar).

Since I’ve been testing my total daily carbs have ranged from 46 to 129. Average daily carbs is 99.

Some of the things that have been OK for me:

Pistachios (this is good since I eat an ounce of pistachios on most days)

Quest bars.  I mostly eat the ones without artificial sweeteners, but I also tried one of those.  They were all fine.

Dark chocolate square, at least 70% cocoa.  In the tests I did I was eating one square, about 60 calories worth (which is the serving size I usually eat).  Basically, of the ones I tried the ones with most carbs only had 7g of carbs and didn’t raise my blood sugar to any problematical level.

Whole wheat tortilla with high fiber, with hummus, and half cup blackberries (25g carbs, 13g fiber) – I had this a few times and it did not do anything problematical.  Note that this was with only one small tortilla.

Whole wheat tortilla with high fiber, with scrambled egg, lowfat cheese, bell pepper (13g carbs, 8g fiber).  Again, this was a small serving with one small tortilla.

Tuna Salad Sandwich – this was on 2 pieces of 45 calorie whole wheat bread (19g carbs, 5g fiber) – I had thought this might be much higher than it ended up being.  I don’t actually often eat sandwiches like this.  Usually it my husband that eats the bread we buy and I maybe eat a couple of pieces once or twice a month.  Anyway, this was much better than I expected. My blood sugar was 118 at 1 hour, 106 at 2 hours, and 100 at 3 hours.

Things that were bad:

Note that many of these things are foods that I rarely eat.  I tried some of these out to get an idea of whether they affected my blood sugar.  Some of this was really eye-opening to me.

Salad with chicken, greens, bell peppers, cucumbers, cherry tomatoes, 3 T. friend wonton strips, 2 T. Lite honey mustard dressing – My blood sugar was 140 at 1 hour, although it was down to 99 at 2 hours. While not totally horrible, it was higher than I would like for a salad. Next time I will do this without the wonton strips.

Mexican food – Tortilla chips (about 18), chicken fajitas with 2 whole wheat tortillas, about 3/4 serving Mexican rice, few bites of charro beans. This is a meal I rarely have, but wanted to see the result. – 160 at 1 hour, 135, at 2 hours, 116 at 3 hours, 90 at hours. Definitely not having this again. I think at least the chips and rice have to go. I might be able to have 1 of the tortillas, but not sure.

Panera – Thai Chicken Salad, Mediterranean Flatbread, chips – 158 at 1 hour, 136 at 2 hours, 108 at 3.5 hours. I was surprised by this as it was so much worse than another meal I had there of a BBQ chicken salad, turkey chili, and chips. However, this meal has more refined carbs and slightly more carbs and a little less fiber that that meal.  Specifically, this had fried wontons on the salad (the BBQ chicken has corn and beans instead) and the flatbread itself (the other meal has turkey chili with beans instead). Both meals have 1 oz. potato chips. I don’t actually usually eat this meal, but wanted to test it out.  What this really tells me is that I probably need to stick to salads and maybe soups at Panera which is what I usually do anyway.

Panera – Cinnamon Crunch bagel. I had this for breakfast.  I fully expected this to be bad. I don’t often have this, but was curious. My blood glucose was 87 right before starting to eat it. An hour after eating it, my blood sugar had risen to 179. Holy cow! At 3 hours (I was not able to test at 2 hours) it was back to 100. No more of these for me.

Potato chips, 1.87 oz – 121 at 1 hour, 131 at 2 hours, 102 at 3 hours. This is a larger serving than I usually eat (1 oz). 1 oz. might work out occasionally OK for me, perhaps with a meal on an occasional basis.

French Fries – I ate grilled fish/shrimp which I don’t imagine would be much of a problem.  There were limited sides available (rice or French Fries) and I decided to try the French Fries even though I rarely eat them.  At a little over an hour after eating, my blood sugar was 159 and was 129 at around 2 hours which is higher than I would like.  So, I will be crossing French Fries off the list.

Things that were kind of borderline/mixed

Panera – BBQ chicken salad (half), cup turkey chili, 1 oz. Panera potato chips  – Somewhat to my pleasant surprise this was 118 at 1 hour. I wasn’t able to test at 2 hours, but it was at 112 at 3 hours and was 79 at 4 hours (between hours 3 and 4 I spent 40 minutes on a treadmill). I was reasonably happy with it and think it would be fine if I dropped the chips. I’m going to try this meal again and test at 1 and 2 hours.

Luvo Breakfast Burrito  – Was 95 at one hour, 111 at 2 hours, 124 at 3.5 hours and 107 at 4.5 hours.  This was a little higher than I would like.  I want to check this one again.

Grilled fish with a Green Giant vegetable medley that had potatoes as one of the vegetables. – Even with some potatoes in the medley, I was kind of surprised that it was at 126 at 1 hour, but was 95 at 2 hours. I want to test this one again.

Skillet crisp fish with green beans and almonds. (This is Gorton’s Skillet Crisp Fish which has a light flour coating. This was baked in the oven) – 122 at 1 hr, 20 minutes. 116 at 2 hours 20 minutes and still at 109 at 3 hours. This didn’t come down as quickly as I would like. Again, I probably just won’t buy this fish again.

Mediterranean buffet – Hummus, Falafel, tabouli, small amount of pasta salad (oil dressing), chicken shwarma, fattoush salad, 1 small piece of baklava – Was not able to test at 1 hour. Was 111 at 2 hours, which was actually not that bad for what I ate. Will try this again and not include any baklava. I think without the baklava, it will probably be OK for me. We’ll see.

Conclusions – I don’t really see anything that would equate to an A1C of 5.9%. Most of the food that I ate during these several days didn’t create any issue at all and isn’t mentioned. There were only a few times that my blood sugar ever got above 140. I looked back at what I was eating before the A1C. It was a little higher carb (my test was on 12/30 right after holidays). So I could see my average blood glucose being a little higher then than it is now, but looking at what I was eating then I can’t see it actually being that high. I wonder if I’m just one of those people with long-lived red blood cells.

That said, it is clear that I do react negatively to some carbs so I want to modify my diet so I don’t have it going as high as it did with some of those meals.

Going forward, pretty much any meal below 25g carbs seems OK. Meals between 25g carbs and 65g carbs may be OK depending on what it is. The more refined carbs the less OK it is, even if the total carbs are still relatively low. The few things that I ate above 65g carbs (the Mexican food meal, the bagel and the salad/flatbread Panera meal) all raised my blood sugar a lot compared to anything else and what is notable are the refined carbs in them.

On the other hand, I don’t see a need for me to 100% avoid all grains. A single whole wheat tortilla with hummus or with a scrambled egg in it did fine. I ate 3 or 4 triscuits as part of a meal a couple of times with no problems.  However, refined grains seem to be more problematical.  Awhile back I went without grains for a couple of weeks (I’ve done this a few times) and I also went gluten free for a month.  I didn’t find that I had personally had any negative reaction to grains, so I think limited whole grains are fine for me personally.  The key there are the words “limited whole” since I think it is those grains that I can sometimes have without it bothering me.  (I do recognize this may not be the case for everyone).

I also found that a square of dark chocolate was fine, so I don’t see a reason to avoid eating that which I do a few times a week.  Of course, I’m sure this is a food where the portion is important.  I eat a very small portion.

My sense from this is that I can fairly easily tweak my diet to avoid refined carbs that raise my blood sugar. I already don’t eat them a lot (I ate more during this period so I could test what was problematical). Some of the problem or borderline meals could be easily modified (no baklava, no chips, etc.). My 100g or so a day of carbs doesn’t seem to be a problem, if spread out over the course of the day. Even my higher carb days (in the 120s) weren’t problematical as a whole, unless individual meals created a problem.

I don’t see a reason from this to drastically lower my total carb intake specifically, but this does suggest to watch how many total carbs I eat at a meal and to avoid even relatively small amounts of refined carbs. Those don’t seem very difficult changes for me to make.