Monday, January 26, 2015

Caesar Salad

The recent edible highlights in my life can be summarized as follows: Caesar Salad and Chocolate.

The chocolate came about because of a couple of small celebrations. And both times, Alice Medrich's beautiful cookbook Sinfully Easy Delicious Desserts delivered with great recipes. I'm glad I thought to leaf through the book on my own shelf rather than hitting up the Internet looking for a recipe as I tend to do. 

The first was a birthday celebration at work, and I made a dozen vanilla cupcakes with mocha fudge frosting. This frosting is an excellent option for the buttercream-averse (me!) and it calls for cooking together butter, sugar, cocoa, espresso and cream, then letting the mixture cool into a thick glossy fudge to be spooned onto cupcakes. So easy and oh so good. And given the magical inbuilt portion control of cupcakes, I enjoyed one and the rest were devoured by co-workers. 

Then yesterday we had V's colleagues over for Indian food. Well, everything but the dessert was Indian food. We had the standard oldies but goodies of green bean patties and faux sev puris (faux because of the tortilla chip base and the cranberry chutney instead of the usual tamarind-date one- using what I had in the freezer), egg curry, chana masala, roasted cauliflower, raita and rice.

For the dessert, I broke out the springform pan and tried something new- Medrich's Queen of Sheba Torte version 5.0. It is a dense, creamy, RICH, nearly flourless dark chocolate cake. Easy to make and elegant, at least by my modest standards. V whipped up some raspberry cream to serve with it. I think this will be my go-to company dessert for this year. A tiny sliver is so decadent and satisfying, which is exactly what I'm looking for in a dessert these days.

Sweets apart, I've been gorging on fresh greens. A good salad dressing can make raw greens irresistible. This is my interpretation of a classic Caesar salad dressing. The dressing can be made ahead of time and stored in the fridge but I usually make it as needed in under 60 seconds. This amount of dressing serves 1 or 2.

In a bowl, stir together

  • 2 tbsp. mayonnaise (I like Hellman's)
  • 1 tsp. dijon mustard
  • 2 tsp. capers (drained from a jar)
  • 1/2 clove raw garlic, grated (I use a microplane zester)
  • 2 tsp. fresh lemon juice
  • Salt and pepper to taste

Toss with fresh greens and shredded Parmesan cheese (Sartori from Wisconsin is my favorite and I can find it in the local supermarket). Serve right away.

Have a great week and I'll see you next Monday with a round up of books and TV from this month. 

Monday, January 19, 2015

White Bean Chili

Chilly days call for big pots of chili to warm you from the inside out- and that's just what I cooked this weekend. I was in the mood for something a little different from the usual tomato-based red chili, so I tried a white chili instead, inspired by this recipe from The Kitchn.

White chilis generally have green chiles, white beans like Great Northern or cannellini or navy beans and chicken or turkey- which for a vegetarian version can be simply omitted or subbed with some mock meat. This time I used quorn (mycoprotein) mock chicken tenders- stocked up on sale at the grocery store. Here's my version of the recipe, in brief. It is an easy peasy recipe and it was an instant hit. I'll be making this hearty chili again and again. Canned green chiles and white beans (both the dry and canned versions) are easy to find in any US supermarket. For the corn, I used frozen roasted corn from Trader Joe's- I thawed it before using it in the recipe. But any fresh, canned or frozen corn would work.

White Bean Chili
(Adapted from The Kitchn)
  1. Soak 3/4 cup of dried white beans overnight. Rinse and pressure cook them. Set aside.
  2. Heat 2 tbsp. olive oil in a large pot. 
  3. Saute 1 diced onion, 1 diced green pepper, 1 diced carrot, 1 diced yellow squash and 3 cloves of garlic, minced. 
  4. Add a can of diced green chiles, cumin, oregano, Mexican chili powder, salt and pepper to taste. Saute for a couple of minutes.
  5. Add 1 cup corn, 1 packed mock chicken (I used quorn "chicken" tenders), white beans and 6 cups vegetable stock or water. Bring to a boil and simmer for 20 minutes. 
  6. Meanwhile, in a separate saucepan, melt 3 tbsp. butter. Add 3 tbsp. flour and whisk to make a roux. Add 3/4 cup whole milk and whisk well to make a thick lump-free sauce. 
  7. Add the white sauce into the soup and mix well. Simmer for 10 more minutes. 
  8. Turn off the heat and garnish with juice of 1/2 lemon and a handful of minced cilantro. Taste and adjust salt and seasonings. 
  9. Serve with hot sauce on the side, plus a topping of crushed tortilla chips and shredded cheese, if desired. 
As the original recipe says, the flavor and texture of the soup gets better a few hours after it is made. If you're looking for a hearty stew this winter, I highly recommend this recipe.

* * *

Half-way through January, I'm pretty excited about how this month is coming along. The goal for this month was to start cutting down on excess carbohydrates to make my diet more compatible with my body's challenges with managing blood sugars.

The way I am eating now does not feel all that different from the way I ate before. There are only a few tweaks in place to reduce or replace the big carb heavy components. So I have been eating dal and subzi, just with a big pile of koshimbir (shredded raw vegetables) instead of rice. I enjoy Mexican flavors, but in a bowl instead of rolled up in a tortilla. I've been trying out spaghetti squash casseroles and loving them. I've been making a dressing for Caesar salad that is so irresistible that it has me craving big bowls of greens.

And so the emphasis is on satisfying vegetable-heavy meals. This is important because what I'm trying to establish here is not a "diet" in the sense of that short-term unpleasant thing you do to get to some goal. This is the way I will eat for the rest of my life.

As for ingredients like rice, it is not an all or nothing deal. Every now and then, I will eat a small amount. For instance, I made my favorite quick winter meal- khichdi- with 1 cup moong dal and 1/4 cup rice. Usually there's at least as much rice as dal, if not more rice than dal. And I enjoyed my dal-heavy khichdi with a large helping of two different stir-fried vegetables- subzis, making vegetables the star of the meal while also enjoying the warm khichdi.

What about snacks?  Crispy salty snacks are my kryptonite. This month, I've completely stopped buying potato chips, tortilla chips and fried Indian snacks like chaklis. If I am served any of these things somewhere, say at a party or a friend's home, I'll eat a few- no problem. But I just can't have the whole package in my house because I know I simply cannot eat these in moderation- the family size bag will vanish in hours. When V picked up a packet of chaklis at the store, I requested that he keep it in his office for snacking instead of at home. Because I don't need a packet of chaklis in my pantry and also, once I get my hands on it, he has no chance of tasting even half a chakli. I'll polish them off in record time. So you do need family buy-in to help you avoid the foods you're trying to steer clear of.

Instead, this month I'm keeping three snacks on hand, all three are foods that I love: (a) nuts,  (b) hummus and veggie sticks and (c) homemade granola with unsweetened almond milk. If cravings strike between meals, I turn to one of these. Many people use high-protein granola bars and smoothies as snacks, but I really don't like the taste of either granola bars or smoothies, so I'm going with what I personally like to eat.

But here's the funny thing: I rarely feel like snacking any more. All my life, I've been on a roller coaster of high and low blood sugars. I get hunger pangs every couple of hours, and need regular snacks between meals to keep from feeling jittery and moody. Once I removed the thing that my body can't handle- excess carbs- the problem of being constantly hungry is going away too. For the first time in my life, I'm not craving snacks all the time and it is a nice feeling to be satisfied from one meal to the next. Let's see what the rest of this month brings. 

Monday, January 12, 2015

Book review: The End of Diabetes

Image: Goodreads
Every bookstore and library is filled with aisles upon aisles of books on health, diet and self-help. I confess to having very mixed feeling about these books. My approach is to read some of these books to see if they contain anything useful, while being deeply skeptical of embracing any one book or author as the ultimate truth.

Most authors have a central thesis or pet theory. They are often guilty of cherry picking research studies with conclusions that support their pet theory. Don't get me started on how flawed and biased many of the research studies are in the first place. Most books are full of exaggerated claims and promises of a miracle. Authors go to great lengths to explain why everyone who believes anything different is flat out wrong.

But now and then I read these books anyway, because despite everything I just said, I've also come across valuable information, different viewpoints, messages of hope, ideas for changing habits and useful tips and recipes. There is a grain of truth in the hype. I will post a book review every now and then if I come across a book which says something interesting. This is one I read last month.

The End of Diabetes: The Eat To Live Plan to Prevent and Reverse Diabetes by Joel Fuhrman, MD.

The crux of the book is this: Type II diabetes can be prevented and reversed with a nutrient dense diet of plant based foods. Here's what I took away from each of the chapters in this book. Quotes from the book are in italics.

Chapter 1: Understanding diabetes
The actual discussion of the causes of type I and type II diabetes in this chapter was quite garbled, in my opinion. But there is one bit of discussion at the end of the chapter that I really liked. Fuhrman criticizes the system of food exchanges used by the American Diabetic Association (ADA), which is the basis of how most nutritionists teach new diabetics to eat (for example, me when I was diagnosed with gestational diabetes). The ADA tries very hard to work with the standard American diet, recommending small portions of low-nutrient, low-fiber foods. "Cereal is OK, just eat only 1/2 cup of it"- that sort of thing. This leaves patients hungry and struggling to comply with the nutrition plan. Instead of just reducing portions of rice and tortillas when I had GD, I wish I had the sense to add in substantial portions of non-starchy vegetables which would have left me sated. Anyway, I agree with Fuhrman that the standard nutritional advice given to diabetics is very poor and it misses the boat.

Chapter 2: Don't medicate, eradicate
"Clearly our present dependency on drugs to control diabetes without an emphasis on dietary and exercise interventions is promoting diabetic complications and premature death in millions of people all over the world". Fuhrman explains how medications-including oral pills and insulin- give type II diabetics a false sense of security that their diabetes is under control which leads patients to continue living the very same lifestyle that led to the disease in the first place. "The best medicine for diabetics is a high-nutrient, lower-calorie diet and exercise, not drugs. This is the only approach that lowers cholesterol, lowers triglycerides, and lowers blood pressure as it drops weight and blood glucose". 

Chapter 3: Standard American diet versus a nutritarian diet
Fuhrman recommends what he calls a "nutritarian" diet- a diet rich in micronutrients (vitamins, minerals, phytochemicals). The foods it emphasizes are familiar ones- vegetables, especially green leafy vegetables, beans, nuts, seeds and fruits. Animal foods are strongly discouraged. So, he is essentially recommending a vegan diet but minus high-starch foods like white rice, refined grains and bread products. I found this chapter interesting because I eat a vegetarian, predominantly South Asian diet and the recommended foods like vegetables, beans, lentils, nuts and seeds are the very pillars of Indian home cooking.

Chapter 4: Reversing diabetes is all about understanding hunger
"Toxic hunger appears at the lower plateau of the blood sugar curve, drives overeating behavior, and strongly increases the desire to consume more calories than the body requires, leading to weight gain and diabetes. True hunger, however, appears when the body has used up most of the calories from the previous meal...and is ready to be refueled. With a change of diet, toxic hunger gradually lessens and resolves, allowing individuals to be satisfied eating less".

"Wrong food choices lead to withdrawal symptoms that are mistaken for hunger...Initially, these symptoms are relieved after eating, but the cycle simply starts over again with the symptoms returning in a matter of hours. Eating when you experience toxic hunger in not the answer. Changing what you eat to stop toxic hunger is."

"...trying to eat fewer calories is ineffective and almost futile. The secret is to desire fewer calories. The high consumption of low-calorie, high-nutrient foods such as raw vegetables, cooked greens, beans and seeds prepared in delicious combinations makes you feel physically full from all the fiber and satisfied from all the chewing. You lost the addictive cravings and then you simply and naturally desire less food."

Chapter 5: High protein, low carb counterattack
Here Fuhrman spends a great deal of time talking about the dangers of low-carb diets that are based on animal protein. I understand advocacy of vegetarian and vegan diets or meat-heavy diets for that matter but I get uneasy when authors cherry pick scientific studies to support their statements. So this is the part where I just moved on. People have all sorts of reasons for eating what they want to eat. I've made my choices so I just want to know how to maximize them.

This chapter also emphasizes that many plant based foods such as beans, lentils and vegetables have a high protein content.

Chapter 6: The phenomenal fiber in beans
Legumes such as beans, lentils, peas and chickpeas have protein, soluble and insoluble fiber and another type of fiber called resistant starch which has health benefits. "Considering their favorable effects on blood sugar and weight loss, they (legumes) are the preferred carbohydrate source for people who have diabetes or are at risk for diabetes". 

Chapter 7: The truth about fat
Fuhrman emphasizes that whole plant-based high fat foods such as nuts, seeds and avocados are an important part of the diet. "I have encountered many individuals who have not thrived on vegan or flexitarian diets...Often they do not realize their real problem. They go back to eating large amounts of animal products, not knowing that they were fat deficient on their low-fat vegan diet. For most of these individuals, eating more healthy fats from nuts and seeds, taking a DHA supplement, and eating fewer starchy carbohydrates clears up the problem". 

Chapter 8: The nutritarian diet in action
In this chapter, Fuhrman outlines his recommendations: The unlimited foods to be eaten liberally are all raw vegetables, all cooked green vegetables and other non starchy vegetables like tomatoes, peppers, eggplant, mushrooms, onions and cauliflower. Some fruit can be eaten. 2 cups a day of beans are allowed along with some nuts and seeds. "The salad is the main dish". Fuhrman recommends starting every main meal with a big salad.

My take on his advice from this chapter: Fuhrman's diet does not endorse oil, not even for sauteing vegetables. His recommended diet is restrictive and unappetizing with almost no salt. I understand that Fuhrman's patients are often very sick and I don't know what their particular needs might be. For myself, I know that spices and seasonings and sauces are all wonderful things that will support me in eating better.

There is a whole spectrum between eating to live (food strictly as fuel, which is right there in the title of this book) and living to eat (food as entertainment and indulgence). But there is plenty of space to thrive in a middle zone where many of the pleasurable and emotional connections of food are retained while eating food that nourishes the body and is right for one's own metabolism.

Chapter 9: The six steps to achieving our health goals
These involve making the commitment, drawing up a plan, tracking progress, making it public, making your kitchen healthy and the exercise prescription. "In place of dependency-inducing drugs, the proper medical intervention for this disease is to focus on the aggressive use of diet and exercise".

Chapter 10: For doctors and patients
This chapter is a pep talk for physicians to recommend diet and exercise changes and not just prescribe medication.

Chapter 11: FAQ

Chapter 12: Menus and recipes
Breakfast recipes typically contain oats, fruits and nuts. Other recipes are a variety of dips and dressings, lentil and bean soups, bean burgers, vegetable curries and stir-fries.

In summary, this book has two interesting take-home messages. The first is that people diagnosed with diabetes or at high risk for becoming diabetic have very good reason to be optimistic that at any time and any stage, they can change their lifestyle and reverse the disease to a remarkable extent, even reducing or eliminating the need for medication.

The second message is that a plant based diet is compatible with preventing and reversing diabetes. This is reassuring to anyone who has chosen to eat a vegetarian or vegan diet (or mostly vegetarian or vegan) for whatever reason and who feels a bit defeated by the prevailing climate of meat-based low-carb diets. 

Tuesday, January 06, 2015

"Noodle" Stir Fry

Sowmya requested the recipe for the "noodle" stir fry I mentioned in my last post- so here it is as promised. I swapped out noodles for broccoli slaw to lower the carb content of this meal while making it vegetable-heavy.

This does not have to be an all or nothing swap, by the way. Even if some cooked wheat/rice/other noodles were added to this dish, it would still have a lot more vegetables than standard vegetables noodles which tend to be heavy on noodles with only a few bits of vegetables here and there. Do what works for you!

Broccoli Tofu Stir-Fry

Broccoli slaw is a shredded mixture of broccoli stalks, sometimes with some carrots and red cabbage included. It is sold in packages in the produce section of American supermarkets.

  1. Heat 1 tbsp. oil in a wide pan on medium heat.
  2. Drain and pat dry 1 package of extra-firm tofu. Cut into bite-sized cubes. Pan fry the tofu until lightly browned. When the tofu is almost ready, sprinkle it with 2 tbsp. nutritional yeast and a bit of soy sauce. Stir fry for a minute more, then remove tofu into a plate and set aside.
  3. In the same pan, heat 1/2 tbsp. oil. Pour in a 10 oz package of broccoli slaw. Stir fry for a couple of minutes.
  4. Add 2 tsp. ginger garlic paste, soy sauce, hoisin sauce, sriracha sauce, a drizzle of maple syrup, all to taste.
  5. Add a handful of crushed peanuts or a couple of tablespoons of peanut butter.
  6. Stir fry for a couple more minutes.
  7. Garnish with minced cilantro or green onions.
  8. Toss with the tofu and serve. 

Saturday, January 03, 2015

The Plan for Jan

Happy New Year! I'm glad 2015 is here with a blank slate, and I hope it will be sprinkled liberally with joyful and meaningful moments for you and for me.

I've read of people who, instead of making resolutions, adopt a word or an overarching theme for the new year. It is a great way to help steer one's life in the direction you want to go. I thought about it a little bit and chose the theme Nupur 2.0 for this year. One of my favorite quotes from Dr. Seuss goes like this: “Today you are You, that is truer than true. There is no one alive who is Youer than You.” So the goal is to listen to what my body needs and revise my habits to be more true to myself.

In more concrete terms, I'm going to be working on one major goal every month. Based on my family's medical history and my personal medical history that I've talked about before which points to insulin resistance, the most urgent change for me is to stop eating excess carbs. Other factors are important too- getting enough sleep, managing stress, exercising regularly- but this is the critical one. Without making this change, the rest won't matter much.

As far as cutting out excess carbs goes, I'm aiming for the low hanging fruit, so to speak. The stuff that is mostly empty carbs and that I tend to eat too much of- rice, bread, parathas, tortillas, noodles and pasta. These will be replaced by vegetables and more vegetables, both raw and cooked. I happen to love vegetables so this is no hardship. Beans and lentils, nuts and seeds are all in. Beans, legumes and some veggies like carrots and sweet potatoes have an abundance of nutrition even if they are carb-heavy, and if I'm cutting down on the other starches, then I have room in my "budget" for these. The idea is not to cut out carbs altogether but to bring them down to a level that my body can handle.

I'll continue to eat eggs and some dairy- mostly homemade yogurt and some butter, ghee and cheese which I use mostly as flavoring. And I occasionally eat tofu and meat substitutes as well.

Here are some examples of swaps I've been making in December, replacing carb-heavy staples with vegetables.

Our lunch consists of leftovers from the previous night's dinner. Often, my lunchbox would have rice, dal with pickle on the side. Here's version 2.0: garlickly moong dal with a large helping of roasted broccoli and squash and the requisite dollop of pickle. I was pleasantly surprised that I did not miss the rice at all.

Rajma (kidney bean curry) and tortillas are a popular dinner option at my home. On that day, a friend left on a long vacation and stopped by with a big bag of produce that he'd cleaned out from his fridge- could I please use it up so it would not be wasted? The bag contained lettuce, cucumbers and peppers among other things. So I skipped the tortillas and spooned the rajma on a giant salad, dressed simply with lemon juice, salt and pepper. This I expected would taste really weird. It was surprisingly tasty- the hot rajma wilted the lettuce a bit, and everything was juicy and delicious. I thought I would eat seconds but could barely finish this bowl.

Fried egg is one of my favorite breakfasts. Instead of eating it with a couple slices of toast or a whole grain tortilla, I took half an avocado, mashed it with a fork and stirred in a pinch of salt and some hot sauce. I had some salad left over (this was the morning after the rajma dinner) and ate that on the side. This was a great way to start the day.

Another favorite meal at my place is noodle stir fry with vegetables and tofu. For version 2.0, I skipped the noodles, and used broccoli slaw instead. Broccoli slaw is sold in packages in the produce section of US supermarkets- it is basically shredded broccoli stems, sometimes with carrots and red cabbage. I was pleased at how much the sautéed slaw resembled the texture of noodles. The whole meal was a snap to put together and very satisfying.

All this month, I will continue these swaps and pay attention to my mood and energy levels, my hunger and cravings, and to my weight and waist size. I've taken some "before" measurements so I have something to compare to. The idea is to make the changes, see if they work and adjust as necessary.

How did you ring in the new year? What are your hopes and dreams for 2015? 

Tuesday, December 23, 2014

What I'm Reading in the Winter Break

I want to thank everyone who wrote me messages of encouragement and shared their own stories on my last post. I am so touched and grateful that you joined in the conversation. In talking about my fears of diabetes openly, I feel like a great weight has been lifted off my shoulders. Clearly, a lot of us are in this together. I do believe that 2015 is going to be a big year of small changes for the better. 

It is cold and dreary here and I've spent most evenings this month reading or quilting. I took up a rather challenging (for me) quilt this year, making a couple of squares each month of 2014 and shocked myself by finishing it before year end!

As for reading, my three favorite books this month were all about questions and answers. 

What If?: Serious Scientific Answers to Absurd Hypothetical Questions by Randall Munroe (of xkcd comics fame) is the most delightful book I've read all year. Munroe is a physicist. Readers of his website posed absurd questions to him and he answered them as thoroughly and seriously as he could, using principles of science, math and logic.

If you have a curious nature, if you've ever wondered, "How much physical space does the Internet take up?", or "What would happen if you made a periodic table out of cube-shaped bricks, where each brick was made of the corresponding element?" or "How many unique English tweets are possible?", you'll find this book hilarious, entertaining, illuminating and very very clever.

I disagreed with a couple of his answers to biological questions. I would have answered them a completely different way. But that is the point of absurd hypothetical questions- they make you think and there is rarely one right answer, just a range of plausible ones. If science was taught this way, more kids would find themselves in STEM fields.

Big Questions from Little People: And Simple Answers from Great Minds compiled by Gemma Elwin Harris. Kids ask the most baffling questions from morning to night, and this book collects some such questions posed by kids ages 4-12 and gets experts to actually answer them. The questions range from "Why is space so sparkly?" to "Why do wars happen?" to "What should you do when you can't think what to draw or paint?" to "Who is God?". The resulting collection is a delightful collection of quirky wisdom and some very profound thoughts. I think any grown-up would enjoy leafing through this book, and if you have a child ages 5-12 (or so), it would be really fun to read some of the questions and answers with them. 

Tiny Beautiful Things by Cheryl Strayed. This is an unusual sort of book. Strayed used to be an anonymous advice columnist on a website. Readers would submit questions on love and life and the answers are compiled in this book. Reading a bunch of advice to strangers seems like a weird thing but this book is a powerful compilation of authentic and raw human emotion. This book made me "feel all the feelings and think all the things"- my litmus test for a worthwhile book. I'm very glad I read this masterpiece of heartache and hope. 

On to some fiction...

Quartet in Autumn by Barbara Pym. I have to thank Arpita for introducing me to this author. Pym has a knack for commenting on the tiny details of everyday life with wit and humor. This is a book about two men and two women who share an office and who are all approaching retirement age. This is not a plot-driven novel but a character-driven one. It is a quiet book, sad and funny in its way, as it comments on human nature. 

The Unlikely Pilgrimage of Harold Fry by Rachel Joyce is a gentle, sad yet ultimately uplifting story. This is a story both literal and metaphorical about the journey that we humans undertake. Harold Fry is recently retired, living with his wife in a tense and bitter marriage in their home at the Southern-most tip of England. He gets a good-bye letter from an old colleague who is dying in a hospice at the Northern tip of England. Harold sets out to the corner mailbox to post a reply, then somehow, without planning or preparation, keeps walking for weeks (!) to see her in the hospice. “The world was made up of people putting one foot in front of the other; and a life might appear ordinary simply because the person living it had been doing so for a long time.” 

The Mistress of Spices by Chitra Banerjee Divakaruni was on my to-read list for a long time. When I finally picked it up this month, I did not "get" the story at all. It was tedious, not fun and I returned it without finishing the book. Oh well.

Meanwhile, here's what we have been reading with Miss Lila...

Otis by Loren Long. Lila borrowed this book from her school library and she can't get enough of it. It is the sweet story about friendship between a calf and an old tractor. Lila loves to say "putt putt puddety chuff" and those sort of tractor noises from the book.

The Grouchy Ladybug by Eric Carle is so hilarious and endearing. The ill-tempered ladybug doesn't want to share a breakfast of aphids with the friendly ladybug and looks to pick a fight. When the friendly ladybug agrees to the fight, the grouchy ladybug says "Oh you're not big enough" and goes off to find progressively bigger animals to fight with.

If You Give a Moose a Muffin by Laura Joffe Numeroff and Felicia Bond. Boy, we've read this one so many times that Lila and I both know the words by heart. This is completely ridiculous story about a young boy who offers a muffin to a visiting moose. One thing leads to another as the easily distracted moose jumps from activity to activity making a complete mess in the process.

All by Myself by Aliki. Nothing exceptional about this book except that since the title is Lila's all-time favorite phrase, I could not resist picking it up at the library. The book goes through a busy day in a child's life, highlighting the everyday actions he learns to do by themselves, such as buttoning his shirt and brushing his teeth. 

What are you reading these days? 

Saturday, December 13, 2014

Towards a Healthier 2015

In the blink of an eye, we're counting down to the end of 2014. At this time of year, I always find myself reflecting on the year that was. As with most years, Twenty Fourteen had highs and lows for our family. We had many wonderful and memorable moments with our loved ones. The lowest low was V's father passing away. Indeed, all the sad and bad moments this year had to do with serious illness and deteriorating health among some of our close friends and family. Health is wealth, the old cliche says, but how often we take it for granted.

And that's what this post is- a long and rambling contemplation on food and wellness and where my life is headed. There's no recipe in this post but there is some food for thought- for myself and perhaps for some of you reading it. I guess I've been writing this post in my head for over 3 years and this week, I finally decided to type it and hit the publish button.

In the summer of 2011 in St. Louis, I was about two thirds of the way through a fairly uneventful pregnancy. We were happy and excited to welcome our baby daughter. My OB ordered a routine glucose tolerance test- and I failed it. I had gestational diabetes. I was surprised and not surprised at the same time. Surprised because I had the hallmarks of being healthy and low-risk with a normal BMI. Not surprised because I have a woefully strong history of diabetes on one side of my family and I knew very well how the genetic dice was loaded.

Things happened rapidly after I was flagged as having gestational diabetes. The very next day I saw a diabetes counsellor who taught me to finger-prick and test my blood glucose 4 times a day- upon waking (the fasting number) and an hour after breakfast, lunch and dinner. This was torture enough for me- I hate hate hate needles. It was all too much- I burst into tears in the counsellor's office but she was as kind and reassuring as can be. I also met with a nutritionist who taught me the basics of carb counting. The strategy was this: make sure I restrict carbs to 200 grams a day (budgeted over meals and snacks), do some brisk walking for exercise, test blood glucose, record my numbers and make sure they stayed within the acceptable range. If I could manage to control my blood sugar with diet and exercise, fine. If not, they'd dose me with insulin.

My baby's health was at stake. There was nothing I would not do for her. I pulled my act together and I was meticulous. I did everything I was told- counted carbs and walked for 10 minutes after every single meal. Working full time and trying to get stuff done before I went on maternity leave, I set alarms and did finger pricks at my desk. The numbers were always within range. My OB remarked that if all her patients were so compliant, she would see many fewer complications.

I had nine(!) friends and acquaintances who were pregnant at the same time as me. Everyone else was indulging in their favorite foods, eating for two, giving in to cravings. My life looked quite different. But at the end of my pregnancy, at a time when most women are feeling distinctly heavy and encumbered, I was feeling lighter and fitter than I'd ever felt. This whole torture of finger pricks, carb counting and brisk walks in the St. Louis August heat- it was working. Lila's birth was uneventful- although she was a smaller-than-expected baby and my OB and I realized that in my zeal, I had probably been stricter with my diet than I should have been. Two weeks after giving birth, I was back at my pre-pregnancy weight.

Gestational diabetes is situational; it resolves when the baby is born. Or more precisely, when you deliver the placenta, which is what produces the hormones that lead to insulin resistance. But a graduate of gestational diabetes learns some important things about her body's ability (or the lack thereof) to process carbohydrates and sees a big red flag that there is type II diabetes in her future if she's not careful. So in getting that warning sign, I will say that gestational diabetes was the best bad thing that has happened to me.

You'd think this episode would have changed my life immediately and forever. It did not. Humans can be exceedingly resistant to change. There's always an excuse and usually a laundry list of excuses not to change our habits. There was a new baby to care for and the next year went by in a blur. There was no mental space or physical energy to make any lifestyle changes. The year after that we moved to a new state and life just went on as usual.

Earlier this year, we went to visit our families in India for a month. Seeing older relatives is a form of time travel because you can see your future self reflected in them. I was seeing my extended family after 5 long years. Almost everyone I know has diabetes and its painful complications. I'm not just talking about those who are affluent and have unlimited access to food. The nice lady who cleans my aunt's house and who struggles to make a living as a maid also has diabetes. Everyone is on medication and many take insulin shots. Almost no one seems to have received any rigorous counseling about nutrition and exercise. Many have had perilous cardiac surgeries. I saw people with vibrant minds who are trapped in a body that is too heavy, with joints that are literally unable to take the weight. One close relative is losing her eyesight because of diabetic complications. In a nutshell- I was scared straight.

It is not like I haven't been trying to do better all along. I read books and try to nudge my eating habits in the right direction. I've been struggling for years to get into an exercise habit. Part of my resistance to real change has been the feeling that things are not so bad the way they are- after all, I'm not overweight, and I have tons of energy and no debilitating symptoms per se.

But the logical part of my brain knows the evidence is mounting. My energy is more mental than physical and frequently a mind-over-matter thing. Climbing a couple of flights of stairs leaves me panting- this is pitiful for my age. When my toddler wanted me to jump with her, my sister overheard and commented that she hasn't seen me jump since the 1980s. I've been labeled a bookworm and a couch potato since the days of primary school and I fully embraced that label. My BMI may fall within the normal range, but I have no muscle tone. I participated in a research study last year (it was to study the effect of walking on body composition) and the scan showed that I have a very high proportion of body fat. This is called being "skinny fat", where even a person of normal weight has fat deposits coating their organs- a very high-risk situation for a variety of diseases.

Disease is a complicated thing, a subtle interplay of genes, environment and lifestyle factors. But you have to do what's in your hands even if there are no guarantees of dodging major illness. A friend of mine was athletic and robust and healthy as the proverbial horse, that is, until she was diagnosed with lymphoma. She told me that her underlying strong health helped her survive the harrowing treatment and now she's thriving again.

All these things have been running in my head for the last few months, and I sat down and identified two goals. My experience with gestational diabetes was hard at the time, but in reality, it showed that a modest increase in exercise (just brisk walks!) and a modest decrease in carb intake gave me good results in a matter of weeks. So those are my two goals at this time.

Already, I've been exercising more this year than I did before- walking and swimming. I'm gingerly getting into the exercise habit and will talk more about this in a future post if anyone is interested.

As for eating, what constitutes a "healthy" diet is a very loaded question. I'm interested in answering the question for myself, for my own body and its challenges. I don't know or care what the universally best diet is. Humans being omnivores, I highly doubt there is one ideal diet. There are likely many different ways to get to the goal of having a favorable body composition with good blood sugar control.

I eat a mainly plant based diet along with eggs and dairy and that's what I intend to keep eating. What will change is the proportions of foods in my everyday meals. In my case, I've identified the problem as eating excess carbs and for the last couple of weeks, I've started to replace some of the carbs with lots of vegetables. My goal is not to eliminate carbs or even to drastically cut them but just not to eat more than my body capable of handling. Beans, sweet potatoes, lentils are very nutritious and will be a big part of my diet. But I will find ways on cutting down on rice, tortillas, pasta and noodles at least for my everyday meals, while replacing them with a lot more cooked and raw vegetables. There's reason for me to be optimistic because I have several things going for me- I already cook in a "veggie-centric" style and know how to prep vegetables- I just have to ramp it up. I don't have a sweet tooth and rarely eat desserts anyway.

To change my habits, I have to know myself and work with myself, and not fight against my basic nature. I don't like drastic changes. However, subtle nudges in the right direction quickly become habits and stick with me for life. I am a moderator rather than an abstainer.

Publicly stating nutrition goals often attracts criticism. There will be people who think I'm going too far ("Just eat less and you will be OK, why vilify carbs?") and others who will think I'm not going far enough ("You won't be in the fat burning zone unless you cut out all beans and starchy vegetables"). But the reason I'm putting it out there is because making a public commitment is a strong motivator for changing habits. Because I was so sad to see diabetes and other metabolic disorders eroding the people I care about, and would like to talk about it. Because this discussion might strike a chord with someone else who is thinking about these issues.

Happy Holidays and Merry Christmas to all, and I will see you in the new year! We'll continue to eat well on this blog, I promise you.