Should I just gnaw on a head of lettuce?
May 1, 2010 3:07 PM   Subscribe

I've had insulin resistance and PCOS for about 8 years now. I've been on metformin off and on for most of that time. My lab results this week show elevated liver enzymes, which means I have to stop the metformin. But it also showed elevated blood sugars over the last 3 months, which means I have to get the sugars better controlled. Since I can't take the metformin right now, I have to try to manage this with diet. I have no idea what to eat. Can you help?

Relevant info: 34/female, single, no children, overweight by about 30 pounds (although BMI says I should lose 50 pounds...I'm not OK with that). Insulin resistance and PCOS diagnosed about 8 years ago. On birth control pills to regulate my cycle and keep the cysts under control.

Metformin is prescribed as 1,000 mg twice a day, but I've maybe taken that much for about 5 days in the past year. Most days I can get 1,000 mg in, but I'm not consistent AT ALL with taking it, and I've gone at least a month or two at a time not taking it. Over the past month I've done better, but it's still not a daily thing.

I have been taking 5HTP for not quite 30 days, 100mg at night. I don't drink a lot...I'll drink a bottle of wine over the course of a week, then won't drink any for another week or two. Definitely not enough for liver damage.

My labs this week had elevated ALT/SGPT of 137 and elevated AST/SGOT of 82. Doc said both should be around 35. She wants me to stop the metformin for a month and retest, since metformin can cause elevated liver enzymes.

My A1C test (review of blood sugars over the past 3 months) was 6.2, and I think she said my average BS was 131 (but at that point I was trying to write all this down so I may have that incorrect). I'm being sent to an endocrinologist for that. I'm also going to try and see a dietitian as well.

Here's the problem: I know I need to get serious about this...I've neglected myself for too long. I need to lose weight and I need to eat a diet that will control my blood sugar and will help my liver. The problem is that I have NO IDEA what to eat. I know that I need lots of protein to control the sugar, but it sounds like that's the last thing I need for my liver (too much fat).

In short, I'm overwhelmed, a little scared, and I don't know where to start. Reading the internet is overwhelming me even more. Right now I need someone to tell me "here, eat this on Monday, this on Tuesday, and this on Wednesday." In other words, I am horrible at structuring my diet and putting it all together. And I'm scared that I won't be able to get this under control.

Can you offer me any good ideas on what I should be eating and what I shouldn't? I don't mind cooking, and would love to learn new skills, so recipes are acceptable. I DO NOT LIKE FRUIT OF ANY KIND, so don't tell me to eat fruit or smoothies for breakfast. Not happening.

What should I be eating that will keep my blood sugar within the normal limits, and will also be good for my liver?
posted by MultiFaceted to Health & Fitness (21 answers total) 11 users marked this as a favorite
Ask your doctor for a referral to a nutritionist. You'll probably get some good advice here, but it seems like you have enough issues going on that your diet could influence in some way that a professional's opinion would be worth it. He or she can also help you work out a meal plan of the sort you're requesting.
posted by MadamM at 3:14 PM on May 1, 2010

Best answer: My husband is diabetic, and his A1C is similar to yours. I can't weigh in at all about the liver issues, but I can offer some guidelines about proper eating (and some other things) to control blood sugar.

The primary thing you can do is to keep the carbohydrates relatively low and consistent from day to day. This doesn't mean eating a low-carbohydrate diet. But it does mean that you shouldn't pig out on carby foods, particularly those that are sugary or starchy. (YMMV, but my husband seems to be very sensitive to things like bread, pasta, and potatoes. Fortunately, he doesn't have much of a sweet tooth, so I'm not sure how reactive his blood sugar is to sweets.) Fruit juices are particularly bad for you, as they will make your blood sugar spike very quickly.

Vegetables and the like are also carbohydrates, but they don't seem to have much impact at all with the exception of the very carbohydrate rich ones like the aforementioned potatoes and carrots. Be careful about condiments like ketchup, which is loaded with sugar-based carbs.

Learn to read nutrition labels. One serving of carbs is about 15 grams worth. The dietitian (who you should definitely see) will probably tell you to stick with around 2-3 carb servings at breakfast, 2-3 at lunch, and 3-4 at dinner. Don't make a meal on just carbs; be sure to include some protein as well. Protein sources like skinless chicken breasts, eggbeaters, pork tenderloin, fish, and shellfish are all pretty low in fat.

A meal plan might look like this:
Breakfast - an omelet made with eggbeaters and a piece of toast
Lunch - a salad with some meat on it and a small roll, or a cup of fat-free yogurt
Dinner - a piece of lean meat, some vegetables, and a starch (1/2 - 3/4 cup)

Cooking Light can be a great source of recipes, many of which are very simple, because they're generally very healthy and list all the nutrition information right there with the recipe.

Exercise is also very important. Muscles gobble glucose (thereby bringing your blood sugar down). Try walking, bicycling, swimming; anything that uses your leg muscles will help keep your blood sugar lower.
posted by DrGail at 3:28 PM on May 1, 2010 [3 favorites]

You need to exercise for at least an hour every day. My husband has diabetis as well and his numbers skyrocket if he misses even one day of exercise. In addition, the "eat clean" diet seems to work fairly well. Some meat, some fruit, lots of vegetables, and whole grains. Lay off the sugar, refined flour, processed grains (ie: white rice=not good, brown rice=much better) and anything with a list of chemicals on it.
posted by MsKim at 3:33 PM on May 1, 2010 [1 favorite]

Disabuse yourself about the concern that the protein in your diet is going to hurt your liver. That just isn't so. The best lifestyle things you can do for your liver is to lose weight (period), increase your physical activity, and avoid alcohol. And where did you get the idea that lots of proteins necessarily means too much fat? It doesn't. What you are eating is important, but just as important (probably far more so) is how much you should be eating. Don't let your concerns about the exact proportions of macro and micronutrients in your diet get in the way of simple portion control.

Talking to a nutritionist will do you wonders, I suspect, because they will not only be able to guide you an dietary adjustments, but will also be able to do a far more thorough job of investigating your current dietary habits to figure out the most feasible changes you (in particular) might need to make.

And definitely see an endocrinologist.
posted by drpynchon at 3:48 PM on May 1, 2010

Best answer: I'm right where you're at now, only my blood sugar level is under control. Firstly, the advice to see a nutritionist is sound. If you can't manage that, though, I suggest you look at keeping to a low-GI diet. Rather than giving up carbs, switch to complex carbohydrates rather than simple ones. So, eat bread but make it a grain-heavy bread. Eat some rice but steer away from white and go for brown or basmati. Because the complex carbs take longer for your system to process, not only will it prevent your blood sugar from spiking, but you'll feel full longer and that will help with weight loss. Also consider having three medium sized meals during the day but supplement with small snacks - it will keep your blood sugar at a more constant level thus avoiding spikes or the horrible feeling of a "hypo" episode.

I disagree with MsKim about the exercise - I think an hour a day is unrealistic, especially if your fitness level is currently low. Try for 10 minutes, twice a day. It's a low goal and easily do-able and you can increase it to two 20 minute sessions and go from there.

If you want a helpful book, I found "The Low GI Diet 12 Week Plan" very good. It's simple, comprehensive and very sensible. I followed the diet plan (and still do) and found that the weight slowly came off without deprivation or too much exercise. It's an Australian book, so your state or national diabetes association might suggest something better - contact them and see what they say.

And lastly, good luck. If you get on top of this thing, you'll feel a lot better - partly because your blood sugar levels and weight are where they should be but also because you'll be in control rather than the other way around.
posted by ninazer0 at 4:40 PM on May 1, 2010

My dayghter, who has PCOS has had good experiences with a diabetic exchange diet - "diabetic exchange diet google "diabetic exchange diet" and you can find menus tailored to your desired calorie levels and details on serving sizes, plus other information it's very flexible - my daught4er is not a breakfast person, so we would sometimes move a breakfast exchange to an afternoon snack, for example.
posted by path at 4:44 PM on May 1, 2010

I don't mean to hijack this thread, so please, moderators, if I do delete this post. My wife was just diagnosed with insulin resistance as well. Her stats are alot like yours and I am wondering if this means she HAS diabetes and will be on medication to control it the rest of her life.

Her diet sucks as well, so I will be VERY interested to read what everyone says about this.
posted by TheBones at 4:45 PM on May 1, 2010

Best answer: You might want to check out Professor Loren Cordain's paleo diet. He has some info on PCOS on his site.

Basically it's no sugar, none, plus no processed carbs or grains at all. Ouch. At least you don't like fruit, so you don't have to worry about sugar from that. But you can have all you can eat lean protein- salmon, sea bass, bison, ostrich, chicken breast, venison, grassfed beef.

I follow a variant on this for IBS/GERD and I know several people with PCOS in the New York meetup who have had success.

My meals typically look like:
Grilled asparagus and striped bass
Sauteed kale with bison meatballs (it's just bison + pepper + other delicious spices like cumin and curry)
A big giant spring green salad with vinaigrette, smoked salmon, pickled ginger, and macadamia nuts

I've been following this for about three years now and as I've improved I've added more fat and some carbs like yams. I've lost about 30 lbs and no longer take any medication. I greatly enjoy the emphasis on fresh vegetables compared to the more meat crazy Atkins, and the internet and local community is fun and supportive. Getting to know my local farmer's market, taking some cooking classes, and generally learning about food has also been a big part of it.

google Paleo diet and there are all kinds of resources from to
posted by melissam at 5:01 PM on May 1, 2010 [3 favorites]

this recent scientific american article details a 350,000 person 5-23 year metaanalysis which clearly shows that it is carbs, and not saturated fat which cause heart disease. (the article goes on to link diabetes with the consumption of 'easy' carbs like white bread)

which argues strongly for the paleo diet as above, or atkins.

this is a great video on the evils of sugar/high fructose corn syrup.
posted by kimyo at 5:24 PM on May 1, 2010 [1 favorite]

Best answer: Endocrinologist, nutritionist or registered dietician, and diabetes educator, in some combination.

Things that work for Mr. F: avoiding milk, avoiding white rice, avoiding citrus. (All of these mess up his blood glucose levels.) If you drink soda, start cutting back. Swap out your white bread for a nice wheat bread (they don't all taste like cardboard any more). Add more fiber to your diet. Switch potatoes for sweet potatoes. Ask your GP if you should start monitoring your blood sugar with a meter (your insurance will probably just send you one; check your benefits summary to see what their coverage of the supplies is like).

Most of all-- you will freak out about this initially, a lot. You'll be upset and you'll kick yourself and you'll cry and it will suck... and it will get better, you'll educate yourself and enlist a good team of medical professionals to help you keep things sorted, and you'll feel a lot better as the changes you make take effect. Mr. F had a lot of small issues that obscurely bothered him when he wasn't watching his diet, and they've all improved over the years. You're gonna be OK, and you'll be OK because you'll make smart choices, backed by solid evidence, and pursue them well.
posted by fairytale of los angeles at 5:47 PM on May 1, 2010

The CSIRO Total Wellbeing Diet Book(s) might be helpful to you. It's pretty much the sensible eating book here in Australia.

It is definitely structured enough for the 'here, eat this on Monday, then this on Tuesday' thing, which might help you lose weight and calm down in the short term, and in the long term you can use it to just maintain healthy eating habits. I know a lot of people who use the book just because they like the recipes. I think the second book talks about food substitutions, which might be relevant if you're not willing to eat any fruit.
posted by Emilyisnow at 5:47 PM on May 1, 2010

Best answer: What should I be eating that will keep my blood sugar within the normal limits, and will also be good for my liver?

Do you have a glucose meter? If not, you need to get one and use it several times, in order to gauge how your glucose levels are doing.

Look, I'm male and a Type II diabetic, been diagnosed for years. I don't know anything about PCOS, but if they goal is to help you eat better, I can help there.

First up: This take a bit of work and won't come all at once, but that's ok, you can do it. Hell, if I could, anyone can. First, don't try to change your entire life in one fell swoop, you'll probably fail and beat yourself up at about it (judging from tone of your post). Concentrate on changing a meal at at time.
Take a gander at EatMe, a compliation of AskMetafilter questions related to food and cooking. Look in the dietary needs section.

There's a a dozen food diets and programs various people will recommend. Try'em if you like, but you're just trying to get through these first weeks without being overwhelmed, here's a few ideas for meals:

Breakfast: yogurt with nuts or granola, 8oz of orange juice. ONE egg with a slice of toast. a mini omelette, use one gg and a bunch of veggies. a peanut butter and jelly sandwich, any lean cuts of meat. Scramble an egg, wrap it on burrito.

Lunch: sandwich, using lean cuts of meat, single slice of cheese. A salad with your favorite veggies and egg or meat.

Dinner: Crock pots and stir frys, yum yum. You pull a frozen chicken or roast from the freezer in the morning, chop up some veggies and a few small potatoes and throw it all in the pot, it'll be ready for dinner. Stir frys regular just a bit of oil, whatever veggies you have on hand and tofu or meat, boom 10 minutes later you got a meal, with potential leftovers from lunch the next day.

Fast food: Subway works grab, get a wrap instead of a sub. Chili from Wendy's, throw it over a plain backed potato.

Eating on the go, too much to think about? Try the Healthy Choice steamers, they can be tasty and perfect when you can't or don't want to think about what to eat. Get a bunch, throw them in the freezer and have'em for dinner too.

Exercise: You need it, do it. It doesn't matter what it is, just pick something. Jog or swim or cycle or aerobics tae bo or a spinning class, whatever, just pick something. You may need to try a few things to figure out what ones you'll like and stick with. DO NOT try to push yourself and do the ones you hate or get bored with, drop those quickly and move on. Get a trainer. Personally I like the Cross Fit program, as it's constantly switching the routine up, so I don't get bored, YMMV. Not sure where to start? Just try walking a bit each day.

One late note:
...but I'm not consistent AT ALL with taking it, and I've gone at least a month or two at a time not taking it

Yeah, stop that doing that shit. If the doctor proscribes pills, you need to take them.
posted by Brandon Blatcher at 6:07 PM on May 1, 2010 [1 favorite]

If you aren't taking metformin as you should be did you let the doctor know that? If that isn't causing the issues with your liver your doctor needs to know so they can check out other things.

As for diet you have to figure out what works for you. Several of the suggestions on here would send my blood glucose through the roof. If I drank 8 ounces of orange juice in the morning I would have high readings all day.

Nutritionists can be a good thing, sometimes. The one I saw recommended way too many carbs a day for me. As long as I stayed on the plan she gave me my readings were insanely high. I eat low carb, leaning toward the South Beach type diet.
posted by SuzySmith at 10:53 PM on May 1, 2010

Best answer: Limit your saturated fat intake to less than 6 percent of your daily calories. From what I understand, your intake of saturated fat has a lot to do with cardiovascular problems (more than anything else). Avoid processed foods and foods high in salt.

Eat a good rice and beans dish prepared in a rice cooker for lunch every day. Make it a big pot. That should cut down on the calories and increase the fiber intake in your diet. I have noticed greater energy levels with this meal.

Eat cereal for breakfast, preferably one low in fat, high in grains, high in complex carbohydrates. Frosted mini-wheats are a good choice. Choose a dinner that includes a small piece of lean meat, a vegetable, and potatoes or rice.

Alli will increase your weight loss by 50%. Use it. Since your liver enzymes are climbing, switch from Metformin to Byetta, an injectable drug that will reduce your appetite while controlling your diabetes. It is the only drug for diabetes shown to decrease weight. If you need additional control, insulin is your best choice.

If there is one thing I could recommend besides these things it is exercise at least thirty minutes per day six days a week. My 76 year old grandmother is an inspiration. She lost weight by exercising daily, and even in her advanced age, she has almost gotten her blood sugar under control. She is almost ready to go off medication.
posted by candasartan at 12:12 AM on May 2, 2010

Best answer: Oh, I've done this!
Cut out pasta, rice, bread, potatoes and sugar. The rest will follow.

Some examples (without fruit):
Breakfast: Omelette with cheese and tomatos and mushrooms, or high-fat yoghurt or fromage frais with cucumbers, some nuts or almonds
Lunch: Lentil or vegetable soup, hummous with raw carrots and cucumbers or raw cauliflower or bell peppers
Dinner: Salad with tuna/beef or chicken and sugar-free dressing, or cheese, olives, or actually any sugar-free pasta sauce on a big serving of vegetables.
Snacks: Nuts, pieces of cheese, peanut butter, beef jerky (sugar-free)

Things to watch out for:
- You can eat all vegetables, but avoid big servings of peas, pumpkin and cooked carrot (not more than a handful)
- You said you don't like fruit, but I'll put this here anyway: You can eat all fruit, but avoid big servings of watermelon, pineapple, grapes and banana.
- Avoid drinking big quantities of coffee and alcohol - very bad for your blood sugar. Completely avoid drinking fruit juices or non-diet soda!

One caveat: The first week on this diet is not nice. You might feel dizzy, hungry, tired and have headaches. With your health history, you might want to work with a nutritionist to ease you into a carb-controlled diet. After the first week, these symptoms completely disappeared for me and I don't miss carbs at all. I have found that even if I eat chocolate, cake or bread from time to time, they don't taste especially good anymore.

(I've been on this diet for 6 months now for managing PCOS. It has gotten much much better already, and more importantly, I feel absolutely great. So great that I would, in fact, never go back to a high-carb diet. I need much less sleep, my moods are better, my digestion is better, my skin is better, and I've lost a lot of weight without ever feeling hungry. I never crave sweets/carbs anymore which just feels great. I'm not shaky/dizzy from low blood sugar anymore, like I used to be every day before lunch. I was not overweight or living an unhealthy life before, but still, the difference is stunning. I go running twice a week for 40 minutes but cutting out carbs had a much bigger effect on me than exercise. If you have any further questions, feel free to drop me a Mefi mail)
posted by The Toad at 7:54 AM on May 2, 2010 [2 favorites]

candasartan, your recommendations would be good for someone with an uncompromised metabolism. Rice, beans, potatoes, and frosted mini-wheats have an intense effect on blood sugar. Despite the other possible risks of fat consumption, fat doesn't affect blood sugar or insulin levels. Even complex carbohydrates which might have a lower glycemic index still have a huge glycemic load.

Adding Alli to the mix seems to my layperson's eye to be even worse -- it prevents the absorption of fat (and fat calories), which by default would make carbohydrates represent an even bigger proportion of calories consumed.

nth-ing the Paleo diet recommendations above! It's the only thing that keeps my PCOS symptoms at a manageable level (and I also take BCP's, but when I eat a lot of starchy foods, the symptoms "break through" the control by the pills).
posted by overeducated_alligator at 8:02 AM on May 2, 2010 [2 favorites]

If I drank 8 ounces of orange juice in the morning I would have high readings all day

There's a low sugar variety which can work well.
posted by Brandon Blatcher at 8:11 AM on May 2, 2010

Most diabetes clinics have nutritionists. You need to see one.
posted by radioamy at 11:18 AM on May 2, 2010

Best answer: Jorge Cruise's BellyFat Cure diet. I have lost 20lbs in 2 months and all my values have fallen into the normal range. Overweight all my life and have tried 1,000's of diets. I seem to be able to stick to this one. Basics- less than 15 grams of sugar per day and 6 servings of carbs, each one 20 grams or under. Real simple. Rarely eat fruit but can have sugar free ice cream and such. No restriction on fat. He has a website.
posted by shaarog at 1:52 PM on May 2, 2010

Response by poster: Thanks all for your suggestions (and encouragement...thanks fairytale of los angeles!). I think I freaked out about the protein being high fat (and not good for my liver) because I wasn't really thinking.

I have read that artificial sweeteners aren't good for your liver, but then they're also suggested in so many diets that I don't know how I can avoid them. I don't really like them anyway, so I try not to eat them. That means a lot of sweet things I must now completely cut out. I'm not too happy about that, and I have no idea how I'll handle the sugar cravings. That freaks me out as well.

Appointments will be made on Monday. Hopefully I won't have to wait too long to see the doctor.

(and yes, I told the doc who prescribed the metformin that I wasn't compliant. It scares me a bit thinking that if the met is causing liver problems that it would have been worse if I had actually been fully compliant with the meds. I'll be honest with the other docs I see as well...I can't afford not to).
posted by MultiFaceted at 10:08 PM on May 2, 2010

I don't use artificial sweeteners precisely because of their (possible) effects on my liver. Some things that work for me are using a stevia sweetener (completely herbal, but not exactly like sugar), agave syrup (ditto) and switching to a lower-GI sugar like LoGi Cane (again, an Australian product but I'm sure there's something similar near you) or a different type of sugar, such as fructose (which is VERY sweet but not absorbed quite as quickly).

My big downfalls are chocolate and cola. I've switched to dark chocolate which seems to squash the cravings with only a bit or two. Coke...well...let's just say that I'm still fighting a losing battle on that one. I try to to make myself walk to the store to get it instead of driving, which often works as I'm also lazy as well as having little will power.

My best advice is...try hard, but don't panic if you succumb. Do a little exercise, modify your diet, keep on your medication - and try not to sweat the small stuff. :)
posted by ninazer0 at 12:55 AM on May 3, 2010

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