Blame it on Progesterone

 

The effects of hyperglycemia: flushed cheeks, fatigue, irritability

The effects of hyperglycemia: flushed cheeks, fatigue, irritability

My roommate joked the other day that I blame absolutely everything on my period.  Insomnia, bitchiness, incessant crying, extreme cramps, acne, oily hair, and overheating a week before that time of the month are all things I link to the building and shedding of uterine walls and the hormonal activity that accompanies it.

 

Yes, woman have been complaining of PMS since the dawn of human-kind; however, as only 3% of the world has type 1 diabetes and judging that close to half of those are women, we’ll estimate that about 1.5% of the worlds population deals with controlling their blood sugar during the luteal phase of their menstrual cycle.

 

photo 2To all my male endocrinoligists: Want to know why my A1C is high?  To my boss:  Want to know why I can’t function one week of the month?

Blame it on the Progesterone.

 

For a type 1 diabetic the luteal phase or the weeks leading up to menstruation are the absolute worst.  They are chalk full of hyperglycemia, hypoglycemia, and even diabetic ketoacidosis.  Just as everyone experiences different symptoms of PMS, I would assume the hormonal effect on insulin sensitivity varies from diabetic to diabetic; however, a link has been made between the luteal phase and increased insulin resistance.

In my experience, in the week leading up to my period, my blood sugar becomes uncontrollable, my Dexcom CGM a roller coaster of extreme highs and lows, resulting in extreme fatigue and frustration.

 

Probable Causes

photo 5The little research published on this phenomenon suggests that a decrease in insulin sensitivity during the luteal phase may be a result of increased progesterone levels.

Progesterone is secreted by the corpus luteum and is present in significant amounts only during the luteal phase of the menstrual cycle.  Progesterone levels increase gradually after ovulation peaking at the same time that estrogen peaks around days 21-23 of the 28-day menstrual cycle.  Negative feedback to the anterior pituitary gland and hypothalamus cause gonadotropin levels to fall resulting in decreasing estrogen and progesterone levels.  Menstrual bleeding occurs as a consequence of hormonal withdrawal.

Studies on rats have shown that progesterone impairs glucose uptake in skeletal muscle and adipose tissue.(1)  Progesterone was also shown to augment pancreatic insulin release in animals, theoretically in response to an increase in insulin resistance.  Human trials testing glucose disposal at different phases of the menstrual cycle showed only a 24% decrease in insulin resistance in the luteal phase compared to the follicular phase,(2) not the evidence I would expect from my own personal experience.

Another possible cause of decreasing insulin sensitivity could be low-grade inflammation during this phase.  High sensitivity C-reactive protein change with menstrual cycle phase, which is correlated with physical and mood symptoms associated with menstruation.  This could in turn affect insulin resistance.

Although, it is not completely clear if a rise in progesterone during the luteal phase is entirely responsible for decrease in insulin resistance, it is clear that progesterone plays a part in this phenomenon.

 

Suggested Treatment

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It’s advisable to set alerts and check your CGM or finger prick at least once an hour.  I would also advise greatly decreasing your intake of carbohydrates and increasing your basal rate (if pumping) or lantus dosage.  Upon the start of menstruation it is advisable to lower these to avoid hypoglycemia.

As hormone levels fluctuate uncontrollably there is no estimating the exact times when insulin resistance will rise and fall, resulting in what I like to call the roller coaster effect.  If I had a perfect method of treatment, I wouldn’t experience DKA (Diabetic Ketoacidosis) almost every month.  Right now all I can do is wait for the widely anticipated bionic pancreas estimated to be approved and on the market in 2017.

 

(1) Rushakoff RJ, Kalkhoff RK. Effects of pregnancy and sex steroid administration on skeletal muscle metabolism in the rat. Diabetes. 1981;30:545–550.

(2)Trout KK, Rickels MR, Schutta MH, et al. Menstrual cycle effects on insulin sensitivity in women with type 1 diabetes: A pilot study. Diabetes Technol Ther. 2007;9:176–182.

Coconut Oil: The Good, The Bad, and Everything In-between

There is a great divide between holistic medicine and western medicine, and the same can be said for the study of nutrition.  Disagreements are often made on food groups, and one such example under debate is coconut oil.

Once eschewed for its high saturated fat content, coconut oil is now regaled as being a healthy fat alternative to olive oil.  Where does the truth lie?  Can we suddenly forget that coconut oil is extremely high in saturated fat?

The Truth about Coconut Oil

Pure virgin coconut oil contains about 92% saturated fat, which coincidentally is a lot higher than butter, which rings in at about 64% saturated fat. Like butter, coconut oil also tends to be a solid at room temperature.  What then sets it apart from animal based fats?

The saturated fat in coconut oil is made up of medium chain triglycerides, which could have a different effect than other types of saturated fat.  Coconut oil is a blend of fatty acids and is made up primarily of lauric and myristic fatty acids, which have a high number of carbon atoms (12). Medium chain triglycerides require more energy to break down than short chain.  Although it is extremely high in saturated fat, it contains no cholesterol, which puts it a leap ahead of animal fats such as lard and butter.

What’s unique about coconut oil is that it not only raises LDL cholesterol levels (it has to with all that saturated fat), but it also raises HDL cholesterol or “good” cholesterol. This differs from butter and ghee, which mainly raise LDL cholesterol. That being said, coconut oil is still extremely caloric and high in saturated fat, meaning moderation is the key. Furthermore, There have been no comprehensive studies on the effect of coconut oil on heart disease.  All in all, coconut oil ranks higher than butter, but I wouldn’t trade it for olive oil just yet.

Summer Berry Crumble

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Summer Berry Crumble

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Crust Ingredients

1/3 cup honey (or 1/2 cup brown sugar)

1/3 cup coconut oilIMG_4565

3/4 cup oats

1 cup oat flour

1/3 cup sliced almonds

Bottom layer:

1 cup strawberries

1 cup blueberries

5 sliced nectarines

Directions:

Preheat oven to 375 F

Mix all crust ingredients in a bowl.  You may need need to melt the coconut oil first.  Make sure your crust forms a crumbly dough.

Fill a glass pan with fruit and top with about an inch layer of your crumble crust.  Press down to form a solid top to your fruit. Sprinkle sliced almonds on top.

Bake in oven for 35-45 minutes or until your crumble top is golden-brown and the fruit is cooked.

Shrimp Tomatillo Cotija Enchiladas

Shrimp Tomatillo Cotija Enchiladas

IMG_4887 If any of you are wondering why I’ve been MIA for a few weeks, I have recently moved to Berkeley and am exploring and enjoying myself too much to sit still and write a blog post.  Although I have had many blog worthy experiences, none have come together as simply as my recent kitchen exploration with tomatillos. On one of my Berkeley explorations I discovered the market to school all markets.  Cheaper than Whole Foods, but with all the local organic and bizarre mumbo jumbo, Berkeley Bowl is my grocery jam.  In particular I am a fan of the discount produce, a big mixed bag of whatever needs to be gotten rid of for the price of a dollar.  A couple of days ago, I discovered a bag of tomatillos. Born from my find, came the memory of a shrimp tomatillo dish I copied from my aunt for a dinner party.  My dinner guests and fellow gourmands were extremely impressed, but had the suggestion of adding white wine to the tomatillo sauce to balance out the flavor, something I did this time. What started as a shrimp in sauce morphed into enchiladas with the discovery of cotija and corn tortillas in my magic fridge. IMG_4885

Shrimp Tomatillo Cotija Enchiladas

Ingredients:IMG_4898 1 onion (I use vidalia) 3 tbsp olive oil 2 tsp salt 10-12 tomatillos 1/3 cup white wine 24-30 shrimp 1/3 cup lime juice (juice of 8 limes) and zest 1 bunch fresh chopped cilantro 1 package of about 10 corn tortillas 1/2 package cotija 1 avocado Directions: Preheat oven to 400 F Chop onion  and saute in a sauce pan with a pinch of salt in a little bit oil until onion is soft and golden in color.  Add peeled and quartered tomatillo pieces and lime zest and simmer until tomatillos are olive green in color and soft, adding white wine as is necessary when tomatillos begin to stick to pan.  Add lime juice and blend in a food processor.  Return to pan and heat.  Add shrimp and cook until shrimp are pink in color and no longer transparent about 10 minutes depending on the size of your shrimp.  Turn off heat and top with fresh cilantro. Prepare your tortillas by either heating them on the stove of frying them in oil (the less healthy option).  Roll crumbled cotija and 3-4 tomatillo shrimp in each tortilla placing the enchilada in a glass pan.  Once all the shrimp have been used up, pour the rest of the tomatillo sauce over your enchiladas and toss with some crumbled cotija. Bake in oven until cheese has melted.  Top enchiladas with avocados and serve with greek yogurt or sour cream. IMG_4883

The Great Gluten Debate

As I was sitting at dinner with my parents the other night, I wondered at the strange texture of the pasta we were eating.  I asked my father, the chef of our household, what kind of pasta it was, and he responded quinoa.  Much as I approve of all the strange new pasta inventions, I was confused why he elected to cook quinoa pasta, when no one in our family has celiacs or a gluten intolerance.

His response of, “I am thinking of going gluten-free,” shocked me even more.  My father, the health nut, is also a regular at the whole foods sandwich bar, and sandwiches, which are generally made with bread, tend to be chalk full of gluten (I realize I’m ignoring the option of gluten-free bread).  Inspired by the recent video phenomenon where Jimmy Kimmel asks a group of people who follow a gluten-free lifestyle, “What is gluten.”  I posed the question to both my father and mother.  Their responses were less than shocking.

My father responded with a hint of sarcasm, “You know what Julie, I don’t know.  I guess it’s in bread and pasta.”  My mother piped up trying to be helpful, “It’s wheat!”  Well, kind of, but what is gluten really?  It’s in wheat, but it is not wheat.  It’s in bread, but bread is not in itself gluten.  I was more shocked by my mother, the public health expert’s, next response, “It’s a starch!”  Well, that’s getting closer, but is not quite right either.

Gluten is not a starch, but is actually a composite of two proteins gliadin and glutenin which tends to be conjoined with starch in a few grass plants including wheat.  It constitutes close to 80% of the protein found in wheat.

Gliadin, a component of gluten

Gliadin, a component of gluten

“A protein! How can protein be bad?”

Gluten in itself is not “bad”.  It has just gotten a bad rep for the recent upsurge in incidence of gluten intolerance, and the related gluten-free fad.

Celiacs Versus Gluten Sensitivity

First, let  us distinguish between celiacs and gluten sensitivity known as NCGS.  Celiac disease is an autoimmune disorder that tends to occur in those with the genetic predisposition.  The enzyme transglutanimase modifies the protein gliadin causing the immune system to react with the small bowel tissue.  This can damage the villi lining the small intestine, which are responsible for nutrient absorption, which is why the symptoms include severe anemia and weight loss.

NCGS is harder to test for.  Symptoms can be similar to that of celiacs or less extreme including: gastrointestinal discomfort or IBS.  Many approach by eliminating common allergens to discover intolerance.  The elimination of food sources that contain gluten often relieves symptoms.

Photo by Amanda Minoff

Photo by Amanda Minoff

Is gluten even the culprit?

Recent studies have indicated that reduction of FODMAPs can be attributed to the decrease in gastrointestinal problems in people with NCGS (note, not in those with celiacs).  FODMAPs are fermentable short chain carbohydrates, including lactose, galactans (found in legumes), and polyols (sugar alcohols). As FODMAPs are commonly found in things with gluten, people find their symptoms are relieved when they eliminate gluten and thus FODMAPs from their diet.

FODMAPs are not well-absorbed in the small intestines, and when they hit the large intestines they are fermented by bacteria.  This causes gas and discomfort.  While we are all susceptible to the effects of FODMAPs, people with IBS are particularly sensitive; therefore, reduction of foods that contain FODMAPs can be beneficial.

There are of course many that argue with this theory.  For a good overview of the study on FODMAPs versus gluten read this.

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Should You Eliminate Gluten from your Diet?

If you’re eliminating gluten in an effort to lose weight (hem hem manorexics in my family), I would not suggest it.  If you are already a healthy eater, choosing complex over simple carbs, have good cholesterol, and few gastrointestinal issues, then I can’t see how cutting gluten out of your diet will benefit you.  Yes cutting gluten will force you to skip out on restaurant bread and pasta to your benefit, but I would advise against many certified gluten-free foods which can be over processed and even less nutritious than your glutenous options.  Corn flour is a common substitution, and proves less fibrous or nutritious than many of its glutenous alternatives.

If you are experiencing the symptoms of celiacs or NCGS, I would suggest getting tested for celiacs and then eliminating gluten or FODMAPs from your diet for a couple of weeks.

The point I’ll try to drive home is that before you choose to eliminate whatever food according to current fad, make an effort to understand what it is, and why it is thought to be the root of all digestive problems.

A Little Sicily Feast

IMG_3085If you know me or read my blog, you probably know that I am obsessed with Sicily, and consider myself a Sicilian at heart.

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When considering my Sunday plans, I jumped on the opportunity to attend the 21st annual Sicilian Festival in downtown San Diego’s Little Italy.  I prepared myself for the inevitable feasting and sugar highs with a light breakfast and a high intensity morning workout.

Boy was there feasting!  Calamari, pizza cannoli, gelato…  the best from Sicily transported me to the beautiful volcanic island as well as transporting my blood sugar into the high zone.

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With the exception of the phenomenal food tents set up by various Italian restaurants, the Sicilian festival wasn’t so Sicilian, but rather just like pretty much every other fair or festival in San Diego, with various organizations handing out fliers about every club or organization imaginable.  The only thing missing were the hari krishnas.

It makes sense then, that me and my three friends ignored most of the tents and made the day about feasting.

Antipasto

We began with fried calamari provided by Caffe Zucchero.  It may have been the hunger we had built up walking around, but it turned out to rival even the calamari I ate in Sicily.  In fact, I am inclined to bestow upon it the title of best calamari I’ve ever had, high praise from a seafood connoisseur.

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Pizza

IMG_3086Our second course was pizza from Napizza.  Now, although everyone else was a huge fan, I was hardly impressed.  As I’ve mentioned before, Italy ruined food for me in the sense that I am now the biggest food snob you will ever meet.  There are few restaurants I can stand, and you can forget taking me to an Italian restaurant.  That being said, there is one thing that turned me off about the pizza.  The dough was average, the veggies were fresh and locally sourced, the cheese was gooey.  Why then am I being so harsh on this pizza?  The easiest answer would have to be it wasn’t authentic.  I ordered parmigiana, a basic tomato sauce topped pizza with eggplant and cheese.  It looked normal in the window, however when it arrived there was something green on it.  The something green was not fresh basil, but rather a green sauce, pesto.  Now, I love some good pesto, particularly with pasta.  Pesto on pizza, pesto on pizza with tomato sauce is a crime.  I noshed on some of my friends pizzas, and there was nothing fundamentally wrong with the veggie pizza or the porcini mushroom pizza, however mine was a disappointment.

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Dolci

No Sicilian  meal is complete without i dolci.  Sicily is famous for its sweets and desserts, and after my brief disappointment with the pizza, I knew I wouldn’t be disappointed by Pappalecco.  I can say that Pappalecco is the best gelato in San Diego.  I judge gelaterias initially on the color of their gelato (natural muted color is always better) and then on the taste of their pistacchio gelato.  Pappalecco passes with high marks for their pistachio.  It’s color is a light green brown and the taste is creamy but not too heavy or sweet.  It’s a little taste of Italy in a cup.  Another flavor to try is the pappalecco flavor which is a heavenly toffee color and tastes like tiramisu.

 

Having eaten our way around the Sicilian festival, we left with exploding tummies and food comaed minds.  Left with the taste of Sicily on my tongue, nostalgia for the authentic thing hit me hard.

Recipe for Wellness: Mugwort Soba Miso Stew

 

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I know I haven’t posted a recipe in a while and this blog is way overdue.  It’s not that I haven’t been cooking, I just haven’t been cooking anything blog worthy.  Nursing a cold this weekend and craving hot spicy soup, I remade this stew this weekend.

Upon seeing these photos you may be somewhat confused.  Soba noodles aren’t usually green!  Those of you who are well-versed in Asian cuisine may assume that these are cha soba noodles, or green tea soba noodles.  Although green tea soba sounds delicious and nutritious, these green noodles get their color from mugwort rather than Camellia sinensis (the plant green tea comes from).

Mugwort is a plant that is used medicinally in Japanese, Chinese, and Korean culture.  It is typically taken to relieve stomach and digestive issues.  It is also taken to boost energy and relieve anxiety.  In general mugwort seems to benefit both the physical and mental being, although it is not suggested for pregnant woman.

I chose to use mugwort soba, as I was interested in the flavor this bitter herb could add to my stew.  I was unaware of the benefits, and find now that mugwort soba is well-suited to a recipe for wellness post.

You should be able to find mugwort soba at your local supermarket or health food store, but if not regular old soba works just as well.  It just doesn’t look as cool.

 

Mugwort Soba Miso Stew

IngredientsIMG_4459

1 onion diced

2 cups oyster mushrooms

1 cup carrots

1 red bell pepper

1 cup okra

3 cups vegetable broth

1 package mugwort soba noodles

4 tbsp miso

1 package medium to firm tofu

2 limes

1 bunch cilantro chopped

2 green onions chopped

Directions:

Throw onions in a large pot with a tbsp of oil and cook over medium heat until golden and no-longer crunchy.  Add mushrooms, carrots, okra and chopped bell pepper.  Stir and cook for 10-15 minutes.  Add vegetable broth.  Cover and let simmer for about 1/2 hour or until carrots and other veggies are soft.  Add soba noodles, tofu and miso and let simmer for 10-15 minutes or until both noodles and tofu are cooked.  Add lime juice to taste.  Serve topped with green onions and cilantro.

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