2. Fast

This habit changed my world, and I share it with EVERYONE

My second daily task developed through curiosity, ambition, and - dare I say it - desperation.

We Catholics “fast” every year during Lent when we give up meat on Fridays leading up to Easter. That’s what we did in my house, anyway. I tried being stoic for a day in middle school once and tried to abstain from all food for 24 hours. I made it about 14 hours and then had at least 3 bowls of cereal and probably a bunch of other junk, all right before bed, too. My parents were amused and unsurprised. All I remember was that those were the best-tasting bowls of Honey-Nut Cheerios I ever had…

My REAL fasting journey started about 3 or 4 years ago. I was pregnant with my middle son Henry. I conceived him about 6 months after losing our daughter, so I went almost immediately from the third trimester to a fresh pregnancy. My body had almost no time to recover, so most of the pregnancy weight I had gained with Evelynn was still there at the start of the next pregnancy, and only began to increase throughout.

At the time, I was also a new diabetic. I had gestational diabetes with my first pregnancy which was “diet-controlled,” meaning not requiring medication. In hindsight, I probably needed medication because my sugars were elevated despite being on an almost ketogenic diet. After I finished my first pregnancy, 6 weeks later I did a 2-hour oral glucose challenge to test my insulin sensitivity. And I failed. Royally.

My obstetrician advised me to see my primary doctor to get treatment. Well, lucky me - I am a primary doc! So I tried to be my own. I put myself on metformin 500 MG twice a day and carried on with residency, and I had my colleagues at my disposal to write my prescriptions. I never checked my blood sugars. My diet was about as bad as you would expect for a resident working 80-hour weeks with at least two 24-hour shifts a week and nursing a newborn. My weight wasn’t good. It certainly wasn’t the worst it had ever been; that was probably during my sophomore year of high school when my 4-foot-11 frame was carrying 170 pounds. But little did I know that my whole childhood carrying that extra weight was causing insulin resistance that eventually turned to full-blown diabetes at the age of 27.

Pictured above: Halloween my sophomore year of high school at my heaviest weight

Pictured: Me in residency at my workspace

Let’s take a break from my story and talk about insulin. This guy is the topic of conversation in at least 50% of my patient encounters daily. Insulin is made by the pancreas and is the metaphorical key that opens the “door" to our cells, escorting glucose (sugar) inside so it can be used for energy. Insulin resistance, which is the crux of the problem with diabetes, is when the cells are saturated with sugar, so they start removing the locks from the doors to the cells so that the keys - insulin - become insufficient to let glucose in. That is how blood sugars become elevated and destroy many things in the body, causing diseases many of us are familiar with, like coronary artery disease, neuropathy, blindness, and kidney failure, to name a few.

When my doctor gave me a glucose challenge test, it was testing my insulin efficacy, and it was not great.

That was how I developed diabetes after my first pregnancy. As I mentioned earlier, I put myself on metformin and carried on as usual, although far more stressed and with much lower self-esteem.

Two years later I got pregnant with Evelynn. Per the “gold standard” of diabetes care in pregnancy, I was started on insulin by my maternal fetal medicine consultant and required to count my carbs and email my blood sugars every week so they could adjust my dosing. It was incredibly difficult being on insulin; counting carbs was aggravating and felt like a guessing game every day. When I took the medication, sometimes it would cause hypoglycemia or very low blood sugar, and to avoid fainting I had to eat more, which perpetuated this cycle of more carbs and calories and more insulin. I felt sluggish and fat and bitter that I couldn't just relax and enjoy pregnancy.

At 28 weeks gestational age, I learned that my daughter's heart had stopped in the womb. She had passed. Someday I'll tell you the full story, but not today.

Flash forward to my pregnancy with Henry, my sweet rainbow baby. I was taking insulin again, but my pre-pregnancy weight was at least 20 lbs more than it had been with my second pregnancy just 6 months ago. I was in my final year of residency and I had an elective rotation coming up. I had the opportunity to work with the specialist of my choice in an academic setting to expand my knowledge within a particular field. I could have done nephrology or cardiology or radiology, all very highly esteemed specialties. But Providence would have it otherwise and a unique opportunity fell into my lap. My colleague’s brother was a family medicine doctor who specialized in weight loss. He worked at a weight loss clinic and invited any interested resident to come to work with him for a month and see what he did.

Boy was I interested.

My first assignment from my attending was to read Jason Fung’s The Obesity Code. Now, as honored as I am that you have chosen to read my post, I would not be offended if you stopped reading now and went out and got this book. Truly, this book changed my life. Maybe even saved it.

Pictured above: about 28 weeks pregnant with Henry at the very beginning of the COVID-19 pandemic

Spoiler alert: Dr. Fung is a big proponent of fasting. I was skeptical at first, naturally. As I read the book, I hopped between Google Scholar and my med school online library to look up every single citation and reference in the book to read the studies for myself. I strongly urge anyone who reads anything informative from someone else, even this Substack, to question everything. Do the research, satisfy your own curiosity, and decide for yourself if you believe what you read. I even tell my patients to do this and hand them a list of my own diet and exercise resources. So that's what I did with The Obesity Code, and I was astounded at the wealth of evidence out there, but that no one was talking about, not even doctors! I was sold. I decided to try taking Dr. Fung’s advice. I had already lost a child, I was not prepared to lose anything else to my diabetes or my obesity.

Warning: DO NOT DO WHAT I AM ABOUT TO DESCRIBE. I did not consult a physician before altering my diet during pregnancy, and I STRONGLY advise that anyone who wishes to take any drastic health measures during your pregnancy consult your physician before doing so. As I mentioned earlier, I didn't have a primary care physician to consult, so I took matters into my own hands (again, I acknowledge that was a stupid thing to do, but I was desperate). I started fasting a minimum of 16 hours every day, most of which was overnight. I ramped up my protein intake and got rid of all refined sugars in my diet. I did this for well over a month.

And a surprising thing happened.

The whole time, while Henry continued to gain weight in my belly, I was losing fat. My waist was expanding as my tiny human developed inside me, and in the meantime, my pants were sagging in the butt and thighs, something that NEVER happened in my entire life! My face started to shrink. My weight plateaued (if you recall, I was already ahead of the game when it came to pregnancy weight because of how recent my last pregnancy was). And the most impressive thing of all to me, as a diabetic and a physician, was that my diabetes nurse practitioner no longer increased my insulin each week! For me, it was nothing short of miraculous.

Flash forward to postpartum life: no sooner than I was allowed to eat in the hospital (vaginal birth #3 without epidural, by the grace of God evading a c-section once again) I went right back to high fat and protein diet, 16-hour minimum fasting while breastfeeding. Again CONSULT YOUR DOCTOR before even thinking about doing any of the stupid things I did, but I did what I knew was right for me. I had at least 40 pounds to lose and a chronic disease to beat, so I was motivated as all get-out.

I hadn't exercised in over three years, between pregnancies and the busyness of residency, my once athletic gym-rat self found every excuse to relax on the couch instead of exercise after work. And in case you're confused, yes, I did play a ton of sports as a kid, every season: soccer, basketball, volleyball, and track were the usual rotations. My sister and I learned a different sport every summer based on what my parents wanted us to try: tennis, horseback riding, swimming. Where I failed in keeping a healthy physique was 100% due to my eating habits, which were poor enough to undo all that activity. Even as an adult in college and med school, I used to go to the gym religiously. However, my diet never changed, so neither did my insulin and glucose levels.

Speaking of exercise, I'll be writing more on this later, as well as the fine line between exercise or fasting and an eating disorder, as this is an extremely important topic and something I can also closely relate to. More on that in future posts. Thanks for sticking around ;)

So anyway. I hadn't exercised in three years, so to get my body accustomed again, I started doing yoga daily, about two weeks postpartum. I found an app with amazing videos for all levels (linked here in case you're curious: https://play.google.com/store/apps/details?id=com.dailyyoga.inc ) I had actually started this ritual after the loss of my daughter, for both mind and body. As a Catholic, I don't necessarily subscribe to the spiritual components of yoga practice, so I replaced that part of it with traditional Christian prayer and reflection. With their powers combined, yoga and prayer got me through the most difficult months of my life, and I reenlisted their help once again after having Henry.

Just before I hit the 6-week-postpartum mark, I was listening to a podcast on the evolution of the human butt. I kid you not. It was one of those NPR series, and the gist of it was that for ages we believed four-legged animals were better equipped to run than we are, but the truth is that while they are designed to run faster, we are designed to run farther. This has to do with how an animal’s organs slam into its respiratory diaphragm when they run, limiting its lung capacity when running long distances. For humans, though, as we run forward, our diaphragm moves up and down, uninhibited by the jostling of our organs. And so, while animals’ legs evolved for sprinting, limited by their horizontal lung capacity, our glutes evolved for endurance running.

Again, don't take my word for it, look it up. NPR. Good stuff.

Despite playing soccer almost my whole childhood, I hated distance running with a passion, as most heavier people do because of the mechanical burden on your joints, and of course how winded you get. But after listening to that podcast episode, I figured now I had no excuse. I had already overcome so much, my next challenge had become clear.

I downloaded one of those trendy couch-to-5k apps (here's the one I used: https://play.google.com/store/apps/details?id=com.clearskyapps.fitnessfamily.Run5K ). Gradually, with a little persistence and help from my husband who held down the fort so I could go outside and run, I became a runner. I loved it. I finally understood what the heck a runner’s high was. And it was even better when I ran first thing in the morning when I was still fasting. I was losing fat, my blood sugars had normalized, and for the first time in my life, I achieved a normal body mass index, or BMI.

That was three years ago from the time this was posted. And I haven't stopped doing it. Even with my most recent pregnancy. My son Adam was born in 2022, and when I was pregnant with him, I stayed on my metformin and I did take insulin, but not very much. I kept running a 5k three days a week well into my 2nd trimester when it didn't really feel good to do anymore. And I kept fasting. Even if it was only 14 hours compared to my usual 16, 18, or 20.

And guess what?

I delivered a healthy-weight, term baby. No complications. No NICU stay.

God is good.

So many women cannot claim the same success with their health or their pregnancies, and please know that for all those moms out there who are reading this and wishing for an alternate reality, from the bottom of my heart, I empathize with you. I am praying for you. And also know that there is hope, always. For me, I found it in fasting. I rarely go a day without it because it makes me feel lighter, healthier, and my blood tests are in the non-diabetic range

Above: action shot of me now. I swear it took me half an hour to find any picture of me, I'm usually behind the camera getting shots of the kids!

Again, disclaimer: talk to your physician before doing any major diet overhauls, especially if you are on medications. This is not meant to be medical advice. But it is a testimony to the fact that there is a light at the end of the tunnel.

Thank you so much for reading my post. Stay tuned for #3 on my to-do list to appear later this week: Nourish, not Binge.

"Seek first His kingdom and His righteousness, and all these things will be provided to you. So do not worry about tomorrow, for tomorrow will worry about itself.” Matthew 6:33-34