Sneak Peek: How Decades of Dieting and Muscle Loss Can Lead to Blood Sugar Problems
Here’s another sneak peek into the book I’m working on tentatively titled, “Hack Your Blood Sugar.” Here, I share a story from my early days of being a nutritionist over in the UK.
When I first started working in the field of nutrition in 2003, I was living in the west of England (Bristol, to be exact) and seeing patients in a private practice. I’d finished grad school in Seattle and had moved to England to be with my boyfriend (now husband). I was a new healthcare provider and excited to help people. I’ll never forget working with a patient I’ll call Ellen, because she helped me understand the work I’d be doing for the coming decades.
Ellen was a 53-year-old woman. She was a mom with grown children and worked full-time in an administrative job. She’d always been careful with her diet, and like many her age, she had been “slimming” since she was in her 20s. In England, ‘slimming’ means she was conscious of not eating too much in order to keep her figure.
At that time, people were told to keep calories down and reduce fat intake. The message was also to limit meat due to the cholesterol content. As a result of this, she did keep her calories modest, but there was a lot of what I call “tea and toast.” This is when people eat as little as possible to stave off hunger but never really eat a proper meal of adequate protein, healthy fats, and non-starchy vegetables. For Ellen, this resulted in small, frequent meals and cups of milky tea throughout the day to stave off hunger.
Ellen was not obese; she was 5 feet 5 inches and 160 pounds. Her usual strategies to drop a few pounds weren’t working anymore, and she wanted to lose some weight to look less “flabby,” as she put it. Technically, Ellen was about 20 pounds overweight. I could also tell from her body shape and her history that her body composition was skewed. She had lost muscle mass over the years and gained a disproportionate amount of fat.
When I looked at Ellen’s diet, it was almost all carbohydrates. She would have a small bowl of cereal with fat-free milk for breakfast, a small low-fat muffin with tea at 10 am, and lunch would be a salad with nonfat yogurt. Then she’d have milky tea with a few crackers at 3 pm to stave off hunger, then dinner. She often passed a candy dish in the office and popped a candy in her mouth, but never went crazy with it. At dinner, she would often make a low-calorie ready meal (something she could take out of the freezer and microwave). At night, in front of the TV, she’d grab some unbuttered popcorn as a low-calorie snack to munch on.
Her tea always had low-fat milk (the typical British style), and she liked a popular brand of yogurt that was fruit-flavored and fat-free to fill her up without the extra calories.
Because Ellen’s nutrition strategy was essentially to eat as few calories and as little fat as possible to stay slim, she was unknowingly creating a metabolic problem for herself. When trying to avoid fat, she was limiting a lot of high-quality protein sources as well. This is because many of our better protein sources also come with fat. Think about meat, eggs, cottage cheese, and even nuts. These are all good protein sources, but they are also sources of fat, and, with the exception of nuts, all contain cholesterol. This marked them as “bad” foods in Ellen’s mind.
From a lifetime of eating this way, I knew Ellen’s muscle mass was likely very low. Eating a low-fat and low-protein diet also meant she wasn’t feeling full. Satiety signals (satiety = feeling full) come from eating protein, fat, and/or fiber. That’s why she needed to keep snacking every two hours.
I have seen many people, especially women, in both the UK and the USA over the years who have taken this low-fat and low-cholesterol message to heart, and have been using an approach similar to Ellen’s. The more patients I saw, the more I saw the same pattern. A whole generation of women had been doing their very best to follow the current dietary guidelines as they understood them. The result wasn’t just a low-fat diet. It was a low-fat, low-protein diet, and a proportionately high-carbohydrate diet.
As a result of chronically undereating protein, people were losing muscle mass more rapidly. So, if Ellen started with 100 pounds of lean mass (muscle and bone) in her 20s, I’d bet money that she is down well below 85 pounds of lean mass now. Therefore, percentagewise, more of her weight was fat.
Between the cereal, toast, crackers, popcorn, and sipping milky tea all day in between meals, she was getting a steady stream of glucose coming in all day long. I didn’t have continuous glucose monitors in my toolbox back in 2003, but I had a good idea of what was going on. Ellen was keeping her insulin levels chronically elevated. Because insulin regulates fat storage, her fat storage switched on from 7 am until 2 am instead of toggling off between meals and for a more extended period overnight.
This caused two problems for her.
Problem #1: Cronically elevated insulin levels kept her in fat-storage mode, so she couldn’t drop body fat.
Problem #2: Lower muscle mass meant it was harder to regulate blood sugar. This meant more insulin was required for the same amount of food, further driving up insulin levels.
💬 Tell me in the comments, does this sound familiar to you??