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.