Kelsey Kinney: No, not necessarily. With carbohydrate intake, I really play it to the individual. If I have someone with PCOS, we’re going to be taking blood sugar measurements and we’re going to be comparing the blood sugar measurement to the amount of carbs in that meal. Now, we know there are definitely some problems with home glucometers, so I would recommend … I think I’ve mentioned this in another Q&A, but if you can have them take their glucometer to whenever they’re getting a blood sugar level tested through their doctor and take it at the same time and then compare them when they get the two levels back, so whatever the lab had and whatever their glucometer said, you can at least get a sense of how off it might be so that you know to not freak out over a 10-point level over what’s normal because you know that maybe your glucometer is off by 10 points normally. That would definitely be the first thing I would do just to make sure we’re not freaking out over things that we don’t need to worry about.
Then from there, I would have them test their blood sugar every day. That would mean a fasting level… And not all of these need to be every day, especially if they’re really pretty consistent with eating habits and everything, but I would at least want to see an initial fasting level in the morning; a before-breakfast level, so right before they sit down to eat breakfast; one hour after breakfast, two hours after breakfast, three hours after breakfast; again the same thing for lunch and dinner; and then a before-bed level as well. In terms of carbohydrate intake, I would base that off of what those numbers look like. If they are getting high blood sugar at lunch, for example, I’m going to look at lunch and say, “OK, what’s going on here? How many carbs are you eating, what are you combining it with, and why are we getting a high blood sugar level here?” If they’re, for example, just eating a lot of carbs and not a whole lot of protein or fat, so it’s not balancing the blood sugar very well or it’s not blunting that spike that would normally occur, we definitely would want to maybe add some protein or add some fat to help blunt that. Or if it’s overall looking like a pretty good meal, we may just need to lower the carb intake in general.
You can also recommend exercise as a way to very quickly get blood sugar levels down. If there’s just a time of day that this person is typically getting a high blood sugar reading, you could, of course, lower carbohydrate intake a bit, but then you could also just recommend that they take a 15-minute walk after they eat that meal. That will help to bring blood sugar levels down as well.
Then over time, you can look at their A1c levels and see how you’re doing overall. If you’re still seeing that that’s high, but you’re kind of noticing that a lot of the blood sugar readings are pretty normal, in that case I would maybe just overall decrease carbohydrate intake a little bit and see if that improves anything. Yeah, in general, there’s no one condition other than something like epilepsy or something where I’d want to do a ketogenic type of diet right off the bat pretty much. With everything else, I really do make sure that I’m individualizing the carbohydrate recommendations so it’s not just this flat plan for everybody with any sort of metabolic disease. I’m really kind of making sure that they’re eating enough carbohydrate for the types of activity that they’re doing and what their body probably needs and then making sure that as we’re doing that we are not getting high blood sugar levels. So we’re making sure to keep blood sugar in a good space and the person is feeling good energy wise, and we just play carbohydrate to those levels.
Hopefully that helps. “One size fits all” is not my motto here. Personalization is where it’s at, for sure, and that’s oftentimes what people pay you for too. They want to know that they’re doing something right for their body, and you are helping them determine that. It’s a bit of an experimentation process, but it’s really, really useful, and it makes this stuff so much easier for people. For some people, being on a very-low-carbohydrate diet is not very pleasureable either, and it might be stressful. Making sure that they can get to this level that’s good for them, they don’t have to worry about it too much, and they know that their blood sugar is at a good level—that means a lot to people. Definitely personalizing things is the way to go.