This post ended up quite lengthy so I broke it up to several sections. Feel free to skip some parts:
Why I am on a diet
First off, I really like to eat. So much that I think I have a food addiction. If not for my chronic migraines I may have continued to consume a very unhealthy diet for a very long while until visible symptoms (diabetes, high blood pressure) from metabolic issues would inevitably surface as I get older. When I was growing up I was taught to believe that having high blood pressure is the norm as you get older. As a child I knew no one above the age of 40 who diid not have high blood pressure. I guess this is the norm when one of our popular breakfast options look like this…
…and other popular meal options are also delicious food full of carbs. Now I am not demonising carbs, I envy people who can eat them and sustain good-enough metabolic health throughout their lives. I am sadly not one such person. Even before I learnt that migraines could be related to glucose metabolism I had food comas right after meals and chronic drowsiness in general. Back then, I didn’t know enough to realise those were symptoms of unhealthy glucose metabolism (when I first started testing my blood glucose I was close to the pre-diabetic range). From childhood till my 20s I could eat McNuggets at 3am and not suffer from obvious side effects, so I thought that would be my norm for the rest of my life.
I have never realised that short people are at a disadvantage metabolically until recently. We require less calories to thrive, but the food portions of most meals are geared towards tallish men. This is especially true in the US, where I am pretty sure a typical meal can feed me 3x a day metabolically. But I was conditioned not to waste food, so I ate a full meal like my tall peers regardless of where and what I was eating, even when I lived in the US.
Imagine I need about 1200 calories to survive – maybe 1500 calories as a moderately active person – but I could eat a 800 calorie meal with bubble (boba) tea *and* dessert. Seriously, this was my norm for a long time. Again, if I could not suffer metabolic consequences I would do this everyday, because that’s how much I love to eat.
I wrote all of that to express how much being on a diet for health reasons can be difficult for me. But I really wanted to see if it would work to manage my migraines, so I had to try. I resisted doing this because of how much I love eating.
I’ve been on low-ish carb meals on and off throughout the years but from end-December last year till end-March this year it was the first time it was sustained for so long with almost no deviations, and also the first time I cooked most of my meals to control my macros, and avoid seed oils and high heat cooking.
It worked. I avoided having migraines completely for my last menstrual cycle. I cannot say it worked 100% because of my diet, because I did other things in tandem like getting 10,000 steps everyday, supplementing iron for the first time among many other supplements I take daily, and fasting at least 16 hours. I also stopped any form of intense exercise during my luteal period to reduce as much oxidative stress as possible.
In exchange I had terrible sleep for some nights and a horrible rash. So I started adding carbs back to my diet in order to heal from the rash, and I decided to take a break around end March, coinciding with our monthly anniversary and my birthday celebrations.
Biometrics from the Oura Ring
In those days I ate dinner later than usual, had 3 meals (usually I do 2), and I ate a lot of what I wanted and have been missing: noodles, waffles, french toast, french fries, cakes, a tamago sandwich (omg). It was still within reasonable control: I still ate half portions of the noodles, and I shared almost everything else with my partner.
Not surprisingly I could immediately see the effects on my Oura ring – my resting heart rate spiked for days:
Compare the above to my last “worst” day of my previous cycle, during my luteal phase:
My resting heart rate went up by 7bpm! And it took almost a week to get back to my recent norm of around 50bpm – 52bpm during my luteal phase. My heart rate variability tanked to levels I have not seen for many months.
My heart rate also spiked till the 80s during sleep, and took longer than usual to recover to a restful heart rate:
Compare the above to the “worst” day of my last cycle – it still has spikes but it barely hit 70bpm, and my average heart rate was also 7bpm lower.
On a good night it could look like this – early recovery and barely any spikes:
Observations and lessons
At first I felt like I had “relapsed” and “failed”, but I realised it took me a pretty short time to bounce back into moderately healthy eating because I didn’t have to restart from scratch. I was restarted with compounded knowledge and skills from previous attempts. Also the feasting phase taught me valuable lessons about myself as well. If I didn’t give myself a break to feast I wouldn’t have known how far I could go.
I attempt to share these in the following:
Lessons learnt during the three-ish months I was on a strictish diet
- cooking the right way for myself to sustain eating almost the same food everyday
- cooking in way shorter time as I learnt to experience how to manage food prep, dishwashing, and cooking methods
- the portion and ingredients I can use to keep me satiated for a long while
- what spikes my blood glucose in general
- learning to weigh my food so now I can roughly gauge how many grams is in a fistful of raw ingredients – this is to ensure I get the right macro-nutrients
- long-term ketosis is not very good for my sleep and rashes, for now until I learn how to deal with it
What I have learnt from my feasting phase
Morning blood glucose started to trend much higher
I learnt that if I eat more carbs than I should for a day my body was quick to recover. Eat badly for a few days in a row my morning blood glucose trended 0.6mmol higher than normal. This effect lasted for a few days even after I restarted low-carb again. This is because our glycogen stores fill up rather quickly, and whatever that cannot be converted into glycogen remains in the blood stream and/or gets converted into fat.
Improved insulin sensitivity
My insulin sensitivity seems to have improved due to the 3 months of strictish dieting. I can now tolerate a moderate amount of carbs and observe a reasonable glucose spike post-meal instead of hitting terrible numbers like before. I also no longer get food comas in general. So far despite veering off-course my migraines or chronic pain did not get triggered, but I am not done with this month’s menstrual cycle yet so I am still keeping my fingers crossed.
Longer sleep with caveats
On a low-carb diet I could only sleep an average of 6-6.5 hours a night. Since I slept around 10pm it means I woke up around 4-4.30am every morning, wide awake. My mental energy was insane during the mornings, but I found myself needing to take a nap around noon. Some people in the keto community believes that the need for sleep is less because ketones is a cleaner fuel, and the body takes less time to repair and recover. But this is unproven – though there is a study that shows that people who sleep more than 6.5 hours a day was associated with more cognitive decline, another one that says people who sleep 6-7 hours a day live a longer life than those who slept 8 or more.
With more carbs in my body I could sleep till 6-6.30am on average, which is 2+ hours more. But as you could see from the graph above, the heart has to work for a much harder and longer to recover.
Long-term policing versus the impermanence of life
I felt so deprived I probably ate more than I should, but I wasn’t aware that I felt so deprived in the first place. It is like getting used to being homebound all the time that one doesn’t realise how much we’d missed the outdoors. I know that I have an unhealthy relationship with food, but in my opinion life is too short and unpredictable to restrict myself completely for long periods of time. Someone online mentioned that she wanted to eat a bun once in a while, but she ate lettuce wraps instead because she was on a diet, however she developed parosmia (change in smell and taste) and now she wished she had just eaten that bun.
I want to be healthier and migraine-free, but I don’t want to regret not eating that bun once in a while. Who knows war may breakout, food supplies may go into shortage, my health may be compromised in other ways – unpredictable events which may change the food we can consume?
I don’t have to go all or nothing, once again.
Desire to return to a healthier baseline
In my previous attempts I gave up completely once I went back into feasting. But this time around with close monitoring biometrics and data it was clear to me I cannot do this long-term for the sake of my health. It was disturbing to see elevated blood glucose for several mornings in a row especially when I have been managing it so well for a very long while. I also felt extremely uncomfortable and bloated after meals and before sleep. All things considered, I knew I had to return to managing my diet with some modifications from all the lessons learnt.
A few modifications which I’ll experiment for a few months:
Prevent deep ketosis
I am eating more carbs and also eating dinner later (4-5pm instead of 3pm). This is in hope that it would prevent my sleep issues and rashes. I still go into mild ketosis overnight (0.5mmol) if I eat a relatively low carb meal for dinner. Maybe I’ll try going full-on keto again if I am in better shape. I read that ketones can repair the myelin sheath which can get damaged from migraine attacks, on top of healing glucose metabolism. Overall I do feel less inflammed, I used to get these facial, neck and shoulder pain almost everyday, but they are mostly gone for now.
Eat in moderation
Despite the better than expected results from the previous phase I decided that eating in moderation is better than going too strict. On hindsight I realised giving myself a break for a meal or a day occasionally is better than restricting all the way and then having a multi-day break. One of the reasons is because the body gets too used to routines, and eventually what may positively contribute before may lose its intended effect. Based on personal observation I think it is better to expose my body to some measured stress once in a while versus letting it get used to being too “healthy”. I observed that now my heart rate doesn’t recover during sleep if I eat later than 5pm, whereas I used to be able to eat at 6-8pm with minimal issues. I do believe fasting earlier in the day has positive health effects because the body can focus on repair instead of digestion during sleep, but I don’t really want eating dinner at a reasonable time to become detrimental to my health.
Mix it up
I kept a strictish routine during my last diet phase. I ate the same times, cooked roughly the same food. But now I would like to experiment with mixing things up because the body becomes more resilient when we throw a spanner in the works occasionally. So I’ll probably vary my fasting windows and the amount of food, cycle in more carbs once in a while, try different types of exercises.
Push some limits
Like I mentioned I avoided anything else than walking during my last luteal phase, but this time around I have been adding some zone-2 jogging. I thought that if I don’t push my body’s limit and risk having a migraine, I would never become stronger. I don’t want to prevent migraines from purely restriction, I hope to become metabolically stronger so I can endure more stress before a migraine gets triggered. I aspire to have an improving quality of life.
I would like to incorporate strength training soon, so hopefully I can tolerate more food without having heart palpitations and/or food comas from eating. It would be nice to be able to eat a Nasi Lemak (picture above) once in a while.
I know I would probably have undesirable results from my latest modifications, especially if I push my boundaries too far. But failure, and learning what has caused the failure is part of the process of experimentation. If I don’t experiment, I would have to be resigned to my status quo, a state with a reduced quality of life because I am so afraid to trigger a migraine. There were months where I practically did nothing except to recover from my attacks and pain. It is one thing to suffer the physical pain, another thing to endure the mental exhaustion and despair from being in pain and/or recovery all the time.
I am not sure how this will go, and if I am not careful I’ll probably relapse into having frequent migraines again, but I hope to keep on learning and experimenting. Maybe I’ll have to go through many more cycles of “failure” in order to know what truly works and is sustainable for me in the long-term.