[cw: metabolic health, diet] My paternal grandmother died before I was born, apparently of diabetes complications. When I was younger I couldn’t understand what it meant to die of diabetes complications – isn’t diabetes a condition that can be managed? She passed in the 1970s, so I have no idea how healthcare was like back then. Were insulin injections already common? Was she in denial about her condition and refused to get treatment?
It is the 2020s and despite modern treatments, government education and healthcare programs, Singapore still ranks the 1st in diabetes-induced kidney failure. This demonstrates that the prevalence of metabolic conditions like diabetes is not about the availability of treatments or the awareness of it. It is very much about the complicated relationships we have with food, our psyches and our bodies.
However, I am grateful and optimistic about the range of tools and research we now have when it comes to our metabolic health. With these tools and research, managing our metabolic health is no longer so rudimentary like avoid sugar to prevent diabetes. I can imagine people’s confusion when they avoided all the sugar they can see, and still experienced their metabolic health worsen year after year.
I was taught to believe as a child that it is normal to have worsening metabolic health as we age. It is just part of ageing. Not a single middle-aged person I knew then had normal blood pressure. It isn’t surprising at all because as a small dense city-state we probably have higher levels of chronic stress, and we believe that food like porridge, rice, noodles, cereal, etc are healthy. One of the supposed healthiest food we eat especially when we are sick is asian rice porridge.
I think this belief is not entirely wrong because in Singapore it is typical to eat rice cooked in coconut milk and fried chicken for breakfast. Or fried dough, fried carrot cake, toast with coconut jam, etc. Comparatively, asian rice porridge feels really healthy because it is so plain. There was a time when eating a high-carb breakfast was necessary because people expended a lot of physical energy during work, compared to our mostly-sedentary lifestyles now. Our times and lives have changed, but the way we perceive the healthfulness of our food has not.
But thanks to modern research I now know that high-glycemic carbs like rice, no matter how plain they taste (there is so much association with plainness and how healthy it is), can induce metabolic damage if we are not careful. I also know that as a short small woman my metabolic needs are a lot lower than the average person, but the portion sizes and dietary macros are catered towards them. A man can probably ingest half a bowl of rice with not much issue, but the same amount would send my blood sugar rocketing. But we don’t think about these metabolic differences when we dine with people. A macdonalds meal is a macdonalds meal. People of different genders, young, old – most people eat the same meal, even if the metabolic effects of that meal is vastly different.
Unlike people of earlier times, I don’t have to rely only upon the advice of doctors and outdated mainstream guidelines like the food pyramid. The latest research on metabolic health is just a click away. I can also search for other people’s real world experiences instead of data based on the general average population.
There is also a problem of having too much data, of course. Nutrition and health research can often be contradicting and in conflict. Eating more vegetables is supposedly obviously more healthy, but some people think plants are toxic because they have natural built-in defences so we should avoid all of them. Pick any so-called nutrition “fact”, and we can probably find research that is for and against it.
But for me, having more knowledge is better than less. At least there is an opportunity to make choices, even though there is an additional responsibility felt when making those choices. Previously we could simply do what the doctors told us, now that there is a realisation that doctors can be extremely backwards, so if we choose to act upon newer research we have to shoulder that responsibility ourselves instead.
Still, every now and then it occurs to me that I am so grateful for these advances in both research and technology. If not I would be flying blind when it comes to my metabolic health. I could only rely upon those annual blood tests to give me some picture of it.
Now, I can freely prick my fingers to see how dietary choices affects my blood glucose, if I want to and can afford it I can wear a continuous glucose monitor, these days there is even a continuous ketone monitor. In learning to improve my metabolic health I have learnt the pros and cons of eating low carb, learnt more about cholesterol than the average doctor, understood how my lifestyle choices can affect my heart rate during sleep, and how in turn that impacts my overall health. I wear a tiny ring that tells me metrics that was previously only available in a sleep lab.
Some tools are free and potentially easy. If my blood glucose is stubbornly high I can intermittently fast to bring it down. If I want to I can only choose to ingest food only when my blood glucose is low enough, so I know I am only eating because I am truly hungry. Something as simple as a 15 minute walk can dramatically bring down blood glucose levels after a meal.
Since I have a family history of type 2 diabetes I have to be careful if I want to avoid the same fate. Without these tools I would feel like I have to be more “all or nothing” with my dietary choices. But because I have these tools I can now continually experiment with exercise, diet, food order, etc to have a wider variety of food. I used to believe that cake and pasta are terrible and avoided them for years. But after some experimenting I learnt that they don’t spike my blood glucose as much as I would have thought. I still don’t eat them regularly, but once in a while I have them as a treat.
Having high blood glucose is mostly invisible. By the time it is bad enough that symptoms show, the pancreas is already in a state of damage. Previously it was believed that this damage is irreversible, but again with the wonders of modern research it is now argued that such damage can be reversed, though it is not clear how far is the actual reversal. There are also previously diagnosed type 2 diabetic people who go into remission by simply going on a low carb diet.
With regular monitoring of my blood glucose level, I can ensure that it doesn’t ever get to the stage where it is slowly piling up into a chronically unhealthy state. It is one thing to have temporarily high fasting blood glucose levels for a few days because of festivities, but it becomes concerning when it refuses to budge even after. I try to ensure both my fasting and post-meal glucose levels don’t get too crazy too often. It is not just about developing diabetes, but temporary spikes can also cause endothelial damage. The data makes it difficult for me to be in denial.
I have also learnt that zone 2 exercise and strength-training can have several amazing metabolic benefits. Many people don’t even know what is zone 2 training. But it feels amazing to me that all of these is out there if we want to learn and know. We can now perform zone 2 exercise with a heart-rate monitor, which is a gadget that is only widely available in recent times. Again, people of earlier times wouldn’t be equipped with such knowledge to improve their metabolic health. There is this passive resignation to the weakness and ill health that comes with age. Isn’t it amazing we now have simple enough tools to improve our metabolic health, should we choose to?
Having a chronic illness can make a person feel very helpless. For years I have struggled with my migraines and they did not improve despite several drastic interventions, including quitting my job so I can properly heal. I chanced upon some information that migraines may be related to impaired glucose metabolism and electrolyte imbalance, thus setting me off this entire learning journey. My chronic migraines significantly improved once my metabolic health improved, especially when I started to become fit enough to perform zone 2 exercise.
But the truth is I didn’t immediately act upon these newly acquired information. It took me a few more years until I was desperate enough. I love to eat, and it was very difficult for me to make changes to my diet. Would I have been this interested in improving my metabolic health if it wasn’t for my migraines? If I was a migraine-free person, would a diagnosis of pre-diabetes be enough for me to make significant lifestyle changes? I honestly do not know, because there is no discomfort being pre-diabetic except for the intellectual discomfort that one is now having an impaired health. The pain of my migraines are horrendous, disabling and life-draining.
Would my grandmother be still alive had she had access to these things? The reality is that many people find it extremely challenging to make lifestyle changes even with the tools and knowledge available, myself included. But I think it is amazing that they are available with low barriers of entry of one wants to make a change. One can go very far with their metabolic health with simply walking more, intermittent fasting and reducing some carb intake. It can be half a bowl of rice and more protein, for example. It doesn’t have to be all or nothing (though I can’t eat rice at all, sadface). There are also carb substitutes that aren’t too bad, like cauliflower rice – we can buy ready-made cauliflower rice in frozen packages now, something that is also only an outcome of modern times. Protein is also more widely available and affordable, compared to older times when eating protein is a sign of wealth.
The world depresses me in general, but this is one area that I am constantly amazed with. There are companies like Levels which is trying to make monitoring our metabolic health more mainstream. Athletes and bio-hackers are measuring and monitoring all sorts of biometrics to optimise their health. We don’t have to accept being in a vague state of weakening health. We can now consciously improve it with research, tools and data.
Some people may think this is all too much, but I guess I have that sort of personality that finds all of this empowering. I am acutely aware that I am only able to do these things at this point in time. I am glad that this has allowed my life to be more flexible: I can tolerate a wider variety of food without going into food comas, I am used to not eating for 16 hours a day and no longer get hangry so taking a flight without eating to avoid covid doesn’t faze me a single bit, I can walk and run longer distances without tiring – previously even walking 500 metres felt tiring – and in my latest development, I can now lift heavier weights.
There are a lot of things in reality that we do not have the power to change, but it has been fascinating for me to experience the very obvious changes with my body after applying what I’ve learnt, especially after being so unfit for most of my life. I like that at the very least improving my fitness is actionable and has visible positive feedback loops. With biometric data, the feedback can be pretty immediate and obvious (it is quite interesting how many people have quit or lessened their alcohol intake after wearing an oura ring).
I can only hope that we make similar strides and advancement in other areas, like post-viral conditions. There are so many people suffering, so much so that some of them are choosing euthanasia – I just wistfully and unrealistically wish that the human species can be less preoccupied with power, and be more concerned about the overall well-being of our people.