Photo from medium.com

Photo from medium.com

Intermittent fasting is a big time buzz-phrase these days. I see people posting about it on Facebook and Instagram, some of my fitness-savvy friends advocate for it, and I read an article about it in Women’s Health magazine. I’ve seen a teensy bit of research floating around but I’m ready to dig in and really see what it’s all about and whether or not it’s something I might incorporate into my practice.

Today I started my own intermittent fasting experiment. I will be trialing an intermittent fasting lifestyle for the next 3 weeks to practice it, research it, and teach you about it! Along the way, you’ll get all the details of how I’m feeling, whether or not my weight, measurements, blood pressure, or heart rate change, and how cranky I am (I’ll let my husband score that one – for objectivity’s sake). For today, let’s go over some basics of intermittent fasting:

What is intermittent fasting?

Boiled down, intermittent fasting basically means alternating between eating normally and restricting your food intake on a regular schedule. This manifests in many different styles. Some of the more popular protocols are detailed here:

  • 16:8 or 20:4 – This is a daily goal to limit time spent eating during the day, making the nighttime fast longer. In a 16:8 schedule, people fast for 16 hours each day and limit their eating to an 8-hour window each day. This is the protocol I will be using. In a 20:4 schedule, people fast for 20 hours per day and limit the eating window to four hours.
  • Alternate-day Fasting – I’ve read about a few different schedules under this name, but the most common is a 5:2 schedule. In a 5:2, you would eat normally 5 days of the week, and 2 days during the week (you can split them up) you fast entirely or restrict intakes to 500 calories per day.
  • Extended Fasting – In extended fasting, folks avoid eating or restrict the types of foods they eat for longer periods of time, anywhere from 2 days to several weeks or months.

 

Can you eat anything during the fasting period?

That depends on the type of protocol you’re following, but best I can tell, most protocols recommend only calorie-free beverages like black coffee, tea, or water during the fasting period. Anything with calories breaks the fast.

 

Are there limits to what you can eat during your eating window?

Generally, no. Most websites and researchers recommend eating healthful foods, of course, but there are not too many limits. Some protocols advocate for tracking what you eat to make sure that you meet your macronutrient (carbohydrate, protein, and fat) needs during the eating window. Other plans allow intermittent fasters to eat however much they choose. The end goal is to eat as much food as you need, just in a shorter period of time.

 

What are the benefits of intermittent fasting?

There have been many claims about the purported benefits of intermittent fasting. I’m working through the research on a bunch of them and I will let you know what I find out in a future post! In what I’ve read so far, supporters of intermittent fasting report improvements in:

  • Focus, productivity, and mental performance
  • Stress resistance
  • Longevity
  • Resistance to chronic diseases like diabetes, cancers, and Alzheimer’s
  • Fat loss, especially belly fat, while maintaining muscle mass
  • Inflammation levels
  • Blood pressure and heart rate

 

How does it do all that?

Honestly, I have a bit more research to do in this area but I will keep you up to date as I learn more. In the initial articles I’ve read, the authors credit ketosis as the cause of many of the benefits listed above. When humans fast for or avoid carbohydrates for a prolonged period of time, they basically run out of glucose energy from food, so the liver starts producing ketones to use as an alternative energy source. It’s sort of like a tank of gas on a hybrid car – if the battery runs out, you can run on gasoline instead. What I need to learn now is why supporters of intermittent fasting believe these ketones are so beneficial. I have some reading to do!

 

What changes will you be making?

I’m starting out by using a 16:8 protocol and setting my eating window from 10 am to 6 pm. There will likely be a little trial-and-error involved, I imagine. I’m keeping my workouts the same (30 mins cardio, heavy weight lifting, and 30 mins yoga 5 days per week) and eating the same types of food I usually do. I expect that I may have to play with my workout schedule a little bit since I haven’t done well with working out on an empty stomach in the past. Tune in tomorrow to see how I did on my first day!


Oftentimes I will have patients with diabetes whose blood sugars are high, and they think, logically, that if they eat very few (or no) carbohydrates, that will help. Unfortunately, they are working against themselves, and here’s why:

The body has what I like to refer to as a savings account of glucose in the liver. When the cells in the body aren’t getting the glucose they need for energy (like when someone skips a meal or when their cells are resistant to insulin), they start complaining all over the body trying to get someone to fix their problem. Word gets to the liver that the cells are starving and he wants to help. The trouble is, liver is a busy guy. He’s got many, many jobs. I often joke that managing this savings account is his “side gig.” He’s not particularly good at it.

In people with diabetes, liver sometimes starts dumping glucose from his savings account into the blood when he doesn’t really need to, and also he doesn’t know when to stop. He just keeps pouring and pouring sugar into the blood and before you know it, this poor person who is trying their darnedest to avoid eating carbs in order to get their blood sugars down has a sky-high blood sugar because they haven’t eaten!

It’s the most frustrating thing in the world because it’s totally backwards to what we would naturally think.

Moral of the story: don’t skip meals, and don’t over-restrict carbohydrates! It’s just as important to eat enough as it is to not eat too much to manage blood sugars in diabetes (side note: that’s true for weight loss as well!).

Bonus sub-moral of the story: If you have something frustrating going on with your blood sugars or your weight that you can’t explain, seek out a Registered Dietitian or a Certified Diabetes Educator to help explain all the funky things that your body might be doing without your realizing it! You don’t have to be frustrated and helpless. You can be empowered to better understand your body!


_export-4I wrapped up carb counting yesterday, and I would be lying if I said I wasn’t relieved that I don’t have to poke my fingers anymore. I’m glad I did it – I got some good ideas for tips on how to make it hurt less (the side of the finger is the spot!). I did miss my insulin one day – I was on an overnight girls’ trip and thought I brought everything (got my meter, lancets, blood sugar log, and vitamin) but I somehow managed to leave my syringe behind. Phooey. There goes my perfect record.

As far as carb counting goes, it’s not awful. It gets tiresome and Halloween was definitely tough, but it wasn’t the hardest part. Getting the 30 minutes of activity 5 days per week was a challenge, but not the end of the world. Now, getting the 3 minutes of activity per every 30 of sitting – that was the sticker. Fortunately, the apps I discussed in this post made it easier. I’ll be writing a post reviewing the two apps soon! Even with the apps, it was downright impossible to do that every single thirty minutes. You know, I have 60-minute appointments and on girls’ day I drove for two hours there and two hours back. No exercise there. But I did the best I could and honestly, it really felt good to get up and get the blood flowing and joints moving on a regular basis.

  Carb Counting Goal Week #1 Week #2 Week #3
# of days nutrition recommendations met 7 7 6 6
Average carbohydrate intake per meal 45-60 grams 52.4 55.2 50.4
Weight change   -2 lb +1 lb -2 lb
Waist change   -.5″ 0” +.5″
Grocery Budget Change   +18% 0% -2%

 

As a special treat, my husband and I completed the #DiabetesDanceDare for Diabetes Awareness. Enjoy!


Managing diabetes is a struggle. It can be overwhelming and exhausting to try to keep your blood sugar under control. Here are 7 reasons I think people find it challenging to do the things they know would be good for them:

  1. They are confusing. Nobody can agree. You get one recommendation from your doctor, one from an article you read online, one from a library book, and three others from your friends with diabetes. So who’s right? Sometimes no one, sometimes all of them. Diabetes recommendations (and bodies!) are so, so individual. Just because something is recommended for your friend or even the general public, doesn’t necessarily mean it’s right for you. Discuss your questions with your doctor and your dietitian. They should be able to help you weed out what’s right for you.
  2. They are overwhelming. So much to do, so little time: checking blood sugars (sometimes 4-6 times a day!), taking medications, dosing insulin, watching your diet, and staying active. I get it – I’m living it temporarily and I’m already starting to wonder how people do this all the time. Managing diabetes is no joke. Sometimes I feel like, as health professionals, we throw too many tasks at patients at one time. Be sure to communicate what’s realistic for you and tell your care team if you need to prioritize changes into smaller steps.
  3. Presentation is key. Along the same lines, nutrition information for diabetes is often presented in a tsunami of recommendations to idealize someone’s diet and prevent every chronic condition under the sun. I have sat in on and (I hate to say it) helped teach classes that covered carbohydrates, proteins, portion control, fiber, saturated fat, unsaturated fat, heart healthy recommendations, exercise, and mental and sexual health in one mind-numbing three hour stint. How likely is it that those poor people are going to retain anything useful? In fact, I meet with patients on a weekly basis who have attended those types of classes and flat out told me, “I didn’t learn anything. There was way too much information.” My plea to my profession: BREAK IT UP, PRIORITIZE, and EMPATHIZE.
  4. Portion does not mean portion. This is a big one. Diabetes educators and dietitians have adopted a term called “diabetes portion” or “carbohydrate portion.” This amount of a food has about 15 grams of carbohydrate and is intended to make carb counting easier. After learning the portions, someone can simply choose 3-4 per meal, 5-7 per meal, or however many their dietitian recommends, rather than track and count grams of carbohydrate. The unfortunate reality is that the word “portion” sends the message that that amount of carbohydrate is all they can have at once. I can’t tell you how many people I’ve worked with who say dejectedly, “So-and-so told me I could only ever have 1/3 cup rice at a time and that’s just never going to happen.” This misconception is suuuuuuper defeating for people who want to manage their diabetes, because they think they have to starve to do it. My solution? Change “carbohydrate portions” to “carbohydrate choices” or something less confusing so people know they can still eat!
  5. It’s not black and white. Eating for diabetes is not a list of “good foods” and “bad foods,” which can be confusing. Carbs are not bad and they give us energy, but people with diabetes simply can’t process too many carbs at one time. It’s not total avoidance, it’s moderation. Sometimes that’s hard to grasp.
  6. The media. Ohhhhhh the media…so useful in some ways, so full of garbage information in others.
  7. It’s a moving target. Recommendations for managing blood sugar are based on a conglomeration of research in the field. You know what that means? New research = new recommendations. Every few years, the recommendations change a bit based on new information. That’s why it’s important, even if you’ve had nutrition education before, to meet with your doctor regularly and a dietitian at least once a year to keep up on what’s new.

For me, snacks are key to carb counting survival. In general, I feel satisfied after eating a carb-controlled meal but I’m finding myself hungry 2-3 hours after the meal. Snack time!

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Ideally, a carb-controlled snack for my plan would have 15-20 grams carbohydrate and some protein (even better if it adds in fiber too!). The carbohydrates keep my energy up while protein helps keep the carbohydrates from raising blood sugar too quickly. My struggle is I’m finding the protein portion tough for some reason. Some of my favorite example snacks include:

  • 6-8 whole grain crackers with cheese
  • ¼ cup unsalted nuts with 2 Tablespoons dried fruit
  • 1 small apple with 2 Tbsp peanut or almond butter
  • 3 cups popcorn with a drizzle of olive oil, dash of salt, and garlic powder, rosemary, and thyme (it’s delicious – and even though this one doesn’t have much protein, it’s a whole grain, it’s high in fiber, and the portion is no joke)

My challenge is that often snack time ends up being on my breaks at work, and proteins are either tough to pack or they need preparation and/or refrigeration. I did a stint with mozzarella cheese sticks and they worked out really well but I got a little bored with them. I haven’t been able to make it to Winco to get the bulk mixed nuts at a decent price (I refuse to pay the prices at most grocery stores), and I’ll be honest, I’ve been too lazy to get a little container to put peanut or almond butter in. I could hard boil a bunch of eggs to have ready and take with me, but here again – too lazy, too busy. Gah.

Many times this last week, my snack has ended up being 15-20 grams carb only, without the protein. That’s less than ideal because besides regulating blood sugar, protein helps a snack be more satisfying for longer.

As I gradually add in diabetes recommendations to follow, I have to say that there is a LOT to it. I hear that from my patients all the time, and they aren’t kidding. Remembering to pack a lunch is pretty much habit, but the snacks are often a last-minute afterthought and making sure there’s protein with them seems like a nice idea that only happens when the planets align just right.

Anyway, this is all good experience for me as an RD and it backs up what I hope I communicate to my patients: do the best you can, take one step at a time, and be prepared that life is going to push you back. Life happens. Life gets crazy. Motivation comes and goes. Just be steady and do your best. After all, your life is worth fighting for!


For a little practice, here is the carbohydrate breakdown for the four meals and two snacks I’ve had so far. Remember that my goal is 45-60 grams carb (3-4 carb portions) per meal and 15 grams carb (1 carb portion) per snack:

Monday Dinner

img_0754

3 oz meatloaf = 15 g carb (1 carb portion)

1 small dinner roll = 15 g carb (1 carb choice)

1/2 c. mashed potatoes = 15 g carb (1 carb choice)

1/3 c. cooked carrots = 7 g carb

1 c. green salad = 0 g carb

1 Tbsp light blue cheese dressing = 0 g carb

Total carbs = 52 grams carb                                                                                                              (3.5 carb portions)

 

Tuesday Breakfast
img_0756

whole wheat English muffin = 30 g carb (2 carb portions)

1 Tbsp fresh ground peanut butter = 2.5 g carb

1/2 medium banana = 15 g carb (1 carb portion)

green tea (with my awesome Mr. Tea infuser!) with Stevia = 0 g carb


Total carbs = 47.5 grams (3 carb                                                                                                      portions)

 

img_0757

 

 

Tuesday Morning Snack

3/4 oz pretzels = 15 grams carb (1 carb portion)

 

 

 

Tuesday Lunch

img_0759                                                                                                        2 slices whole wheat bread = 30 g carb (2 carb choices)
3 oz. turkey deli meat = 0 g carb

1 slice cheddar cheese = 0 g carb

2 leaves lettuce = 0 g carb

2 slices tomatoes = 0 g carb

1 Tbsp light mayo = 0 g carb

1 tsp Dijon mustard = 0 g carb

1 medium apple = 28 g carb                                                                                                               (2 carb portions)

                                                                                         Total carbs = 58 grams (4 carb portions)

img_0760

 

 

 

Tuesday Afternoon Snack

6 oz. light yogurt = 16 grams carb (1 carb portion)

 

 

 

 

Tuesday Dinner

img_0762

1 c. chili w/lean ground beef = 22 g carb (1.5 carb portions)

1 oz. cornbread = 15 g carb (1 carb portion)

1 c. green salad = 0 g carb

1 Tbsp light ranch dressing = 0 g carb

1 Tbsp fat free sour cream = 0 g carb

1 Tbsp Smart Balance            spread = 0 g carb

And I had plenty of carbs left so I topped it off with a square of Ghirardelli dark chocolate (7 g carb)!

img_0763

 

 

 

 

 

 

 

 

Total Carbs = 44 grams carb (3 carb portions)

So far, so good! The food has been tasty and filling, and I haven’t felt restricted. I’m loving the flexibility of this meal plan!

Comment if you have any questions about how the carb counting works (or about anything else)!


Check out this haul from my first grocery shopping trip for Carb Counting!

Yes, we drink a LOT of milk at our house.

Yes, we drink a LOT of milk at our house.

I think I’m going to like this particular meal plan that I am using because it offers more flexibility than other meal plans I have used in the past. It gives lists of sample breakfasts, lunches/dinners, and snacks and allows me to pick and choose the ones I like, as well as repeat meals to use leftovers, which definitely helps with some of the issues I have with meal plans in general (which I described here).

So I thought I’d start out by describing what carb counting is all about. As described here, eating too many carbohydrates at one time can raise blood sugar too high for someone with diabetes. First thing’s first: which foods have significant amounts of carbohydrates?

  • breads and grains like rice, pasta, and oats
  • beans and legumes
  • starchy vegetables like potatoes, peas, and corn
  • milk and yogurt
  • fruit and fruit juice
  • sugars like sugar, brown sugar, agave, syrup, honey and sugary beverages like soda and sports drinks

These are the foods we primarily “count” as we count carbohydrates. The specific goal for carbohydrate intake varies between individuals based on height, weight, gender, activity levels, and blood sugar control goals. If you have diabetes and don’t know how many carbohydrates you should eat, find a Registered Dietitian who can help you find out.

For me, my goal is going to be 45-60 grams of carbohydrate per meal, 15 grams of carbohydrate per snack, as well as meeting the recommended activity goal of 30 minutes of moderate exercise 5 days per week (This can really help blood sugars! More on that in a future post.)

To help make carb counting easier, something called a “carbohydrate portion” or a “diabetes portion” was introduced. This is basically the amount of any carbohydrate food that contains 15 grams of carbohydrate. You can see some examples of carbohydrate portions in the chart below:

screenshot-21

Chart from www.brighamandwomens.org

As you can see by my carbohydrate counting goals, they are in multiples of 15 grams. So basically, at meals I can select 3-4 “carbohydrate portions” and at snacks I can choose 1. I can then fill in the gaps with non-carbohydrate foods like meat, eggs, cheese, vegetables, nuts, or seeds.

Carb counting can be tricky, but with some practice, awareness, and strategy, most people with diabetes find that they can live a relatively “normal” food life. I’ll see if I can make it happen in these three weeks and, if so, hopefully I can pass some useful info on to you!