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Danbee Shin

👊🏼 A nutrition science blog about learning to make your own food decisions 🌞 Based in sunny Singapore 📖 Annotated reference lists on the blog

http://confidencenotes.com/

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. 😎 Sleeping is “in” . Okay, this method for improving insulin sensitivity is more appealing than exercise — but I personally find it just as hard to practice. It’s sleep. . There’s a sleep revolution in the air and chances are, you’ve already heard that our bodies heal themselves while we sleep. . 😴 5 hours is not enough . It probably won’t come as a surprise then, to learn that sleep directly affects insulin resistance. Sleep actually has an almost immediate effect on how well your body responds to insulin. . Studies (though admittedly with small sample sizes, often looking at about 10 people at a time) show that it takes just one night of restricted sleep for your body to become less sensitive to insulin. Sleep restriction often means 4-5 hours of sleep a night in these studies. Scarily, this wasn’t unusual for me just a few years ago! . For this series on insulin resistance, I’m focusing just on answering the question, “What is insulin resistance?” — so I’ll save in-depth research about the effect of sleep on insulin resistance for another time. . 👩‍🔬 Annotated reference list here: confidencenotes.com/sleep-helps-maintain-insulin-sensitivity

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. 🏃🏻‍♀️ Not all organs are equal . Remember how having insulin resistance means your body is less sensitive to increases in your insulin levels? This in turn means your body is less efficient at producing energy from the food that you eat. . New fact: insulin resistance can affect specific parts of your body. For example, your skeletal muscles (the muscles we can move voluntarily, not the ones that make up our hearts or our stomaches) could be less sensitive to insulin than your liver, or your fat tissue. . The glucose that your body turns into energy using insulin? Skeletal muscles use up most of that. We obviously want *all* of your body to be insulin sensitive, but we especially want your skeletal muscles insulin sensitive. . 🏋🏻‍♀️ Good news: we have exercise . Exercise can overcome insulin resistance in skeletal muscles. (I know — this good news is also kinda bad.) . When put to work, your skeletal muscles become better at taking up glucose and using it for energy. The more you use them, the more efficient they get. . I mentioned lipotoxicity in my previous post. This is when fatty acids accumulate where they shouldn’t. This is anywhere outside your fat tissue, including kidneys, liver, heart, and — skeletal muscle. Fatty acids damage and kill the cells they occupy. . When you exercise, you also help break down fatty acids accumulated in your muscles more quickly, reducing lipotoxicity. This allows your muscles to work more efficiently. . This is certainly enough to get me in the pool 🏊🏼‍♀️ tomorrow morning! . 👩‍🔬 Annotated reference list here: confidencenotes.com/exercise-can-overcome-insulin-resistance

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. 🧀 Recap: making energy for an insulin sensitive body . After glucose from carbohydrates, fatty acids from fats are our second source of energy. My favourite fat-rich choices are macadamias and walnuts — perfect on a big cheese board (camembert, gruyere, and gorgonzola, anyone?). . So what happens after we gobble up all this delicious food? . Carbohydrates are broken down into glucose, proteins into amino acids, and fats into fatty acids and glycerol. . You’ll remember that an increase in blood glucose levels tells our body to release insulin. . When this happens, your body begins converting the new, incoming fatty acids into triglycerides and storing them in your fat cells. . Your body also stops breaking down your existing fat storage. In other words, it stops turning triglycerides back into fatty acids. . All of this changes between meals, when insulin levels decrease. With low levels of insulin, the opposite happens: triglycerides are broken down into free fatty acids, which are then used to produce energy. . 🥓 Making energy for an insulin resistant body . When it comes to making energy from fats with insulin resistance, it’s not so much what happens immediately after a meal that’s important, it’s what happens *between* meals (when insulin levels drop). . With insulin resistance, your body releases a lot more free fatty acids into the blood than it would if it were sensitive to insulin. . 🥥 The problem with too much free fatty acids . Free fatty acids accumulate in organs that are not designed to store fat — like your kidneys, liver, heart, and skeletal muscle. . Why is this so dangerous? It makes it difficult to use free fatty acids for energy. It also leads to cell dysfunction and death in those organs. This condition is known as lipotoxicity. . 🥜 Fatty acids with insulin resistance . In short: with insulin resistance, fatty acids are not used efficiently for fuel, but accumulate outside of fat cells, causing damage to important organs. . 👩‍🔬 Reference list here: confidencenotes.com/fatty-acids-to-energy-insulin-resistance

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. 🥑 Recap: making energy with glucose – insulin *sensitive* body . What happens when we eat food that contains carbohydrates — like red lentil soup, avocado toast, or chocolate praline? . As we digest the food, the carbohydrates are broken down into glucose, which enters your blood stream. When your blood glucose rises, your body releases insulin. . If your body responds well to insulin, it will use the new glucose for energy. It will stop breaking down glucose storage (i.e. glycogen), and convert excess glucose in the blood into glycogen to store for later. . 🍠 Making energy with glucose – insulin *resistant* body . If your body does not respond well to insulin, it won’t be very good at using the new glucose for energy. This means blood glucose levels rise. . It will continue to break down glycogen into glucose, which means blood glucose levels rise even higher. . Finally, new glucose won’t be converted into glycogen, which means (surprise, surprise) blood glucose levels rise higher still. . 🥐 What’s wrong with high blood sugar levels? . High blood sugar (hyperglycaemia) can be dangerous if it’s sustained over many years. It can damage blood vessels. This increases the risk of heart disease and kidney disease, as well as damage to the retina and to the nervous system. . 🍙 Where do the high blood insulin levels come from? . Because your body is unable to use insulin well, your pancreas tries to compensate by making more insulin. This results in abnormally high insulin levels in your blood. (This is what we’re looking for in those tests that I talked about four posts back.) . 🥞 So why is insulin resistance dangerous? . To sum it all up: If you have insulin resistance, glucose is not used efficiently for fuel, but stays in the blood stream, potentially causing a number of life-threatening conditions. . 👩‍🔬 See the annotated reference list for this post here: confidencenotes.com/glucose-for-energy-insulin-resistance . 📎 Link to blog in bio!

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. 🥓 Glucose, amino acids, and fatty acids and glycerol . Before we get into what happens when you have insulin resistance, let's get the basics down: what happens if you have a healthy body, sensitive to insulin? . When we digest food, carbohydrates are broken down into glucose, proteins into amino acids, and fats into fatty acids and glycerol. . Glucose is a sugar and the preferred source of energy for most organs — including the brain, kidneys, liver, and skeletal muscle — and is used up first. Excess glucose is stored as glycogen, mostly in the liver and skeletal muscles (the ones we can move voluntarily – what we usually think of when we say, “muscles”). . Amino acids are used immediately to make proteins and are not stored. . Fatty acids are the heart’s preferred source of energy. Excess fatty acids and glycerol are stored in the body as triglycerides, mostly in adipose cells (fat cells) under our skin and around our organs. . To produce energy from the food we eat, we use glucose (from carbohydrates) and fatty acids (from fats). . 🍓 Glucose up, insulin up . When we eat, glucose is released into the blood stream. When blood glucose levels rise, the pancreas releases insulin. . Insulin attaches to cells (mostly in the liver, skeletal muscles, and adipose tissue) and tells them to: . 1. Absorb glucose, amino acids, and fatty acids and glycerol, and use as needed. . 2. Stop breaking down glycogen into glucose, protein into amino acids, and fats into fatty acids and glycerol (There’s a fresh source from the food we just ate.) . 3. Start building glycogen from excess glucose, start building proteins from amino acids, and start building fats (triglycerides) from excess glycerol and fatty acids. (We need to save some for later.) . 🍪 Insulin provides and stores energy . In short, insulin tells our bodies to use glucose and fatty acids from food for energy, to stop using existing energy stores, and to start building new energy stores. If our bodies are sensitive to insulin, we can carry out all these tasks with no problem. . 👩🏻‍🔬 Annotated reference list: confidencenotes.com/food-to-energy-insulin-sensitive

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. 🙊 PCOS == insulin resistance? . When my fasting glucose and fasting C-peptide test results came back normal, I should have questioned whether I had insulin resistance. . Instead, my brain immediately reconciled the two conflicting “truths” without skipping a beat: Oh, I have insulin resistance, it just isn't as serious as I had thought. . I had polycystic ovarian syndrome PCOS – of course I also had insulin resistance. Hadn’t the doctor described insulin resistance as almost a prerequisite for PCOS? . Yes, my fasting glucose is normal, as is my fasting C-peptide. That just means my insulin resistance isn’t bad enough to make me prediabetic. (In case you haven’t been following my previous posts: this is *not* a logical conclusion.) . 🙉 My brain is lying . Apparently this is called self deception and we all do it. Our minds refuse to accept facts that question our sense of identity. (Check out the 14/11/17 episode of @roseveleth’s Flash Forward podcast.) . It was only when I learned that a significant proportion of women with PCOS do not have insulin resistance, that I slowed down. . 🙈 PCOS != insulin resistance . One research team at the Stanford University Medical Center found that PCOS was “not independently associated with insulin resistance”. They concluded that “insulin resistance status ... should not be assumed based on PCOS status alone”. . A 2000 study conducted at the University Hospital of Oulu in Finland reported, “results suggest that insulin resistance in PCOS women is, at least partly, related to obesity and fat distribution and not entirely to PCOS itself”. . 🐵 Science don’t lie . It was hard to ignore the facts, reading paper after paper. I stopped after I found a review article with a whopping 20-page reference list of 594 sources that stated, “it is clear that some women with PCOS have normal insulin sensitivity“. . A PCOS diagnosis doesn’t mean that you have insulin resistance. It's true: many women with PCOS are insulin resistant. But the only way to know whether you fall into this group is to get tested. . 👩🏻‍🔬 Annotated reference list: confidencenotes.com/pcos-not-insulin-resistance

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. 💉 Fasting C-peptide test . Insulin tests aren’t available at my local clinic. . This was a problem when I wanted to get tested for insulin resistance. You’ll remember from my previous post that measuring insulin levels together with glucose levels is crucial for diagnosing insulin resistance that hasn’t yet resulted in prediabetes. . Thankfully, the clinic was able to provide a fasting glucose test and a fasting C-peptide test. . 🤷🏻‍♀️ What is C-peptide? . It’s a molecule made of many amino acids — yes, the same amino acids that join together to form proteins. . When insulin is produced in the body, the same amount of C-peptide is produced as part of the process. C-peptide remains in the blood for longer than insulin does. This makes it a good proxy for measuring insulin levels. . 💁🏻‍♀️ What can it tell us? . If your fasting glucose level is within normal range, a normal fasting C-peptide level will confirm that your body is using glucose and insulin — well, normally. . A low fasting C-peptide level indicates your body is not producing enough insulin. For example, if you have type 1 diabetes, your body is unable to produce insulin. . A high fasting C-peptide level suggests insulin resistance. If your body is less sensitive to insulin, it will produce more insulin to compensate. . While a fasting C-peptide test isn’t ideal for diagnosing insulin resistance, I found it a helpful alternative to insulin tests that my local clinic did not offer. . 👩🏻‍🔬 See the annotated reference list for this post here: confidencenotes.com/c-peptide-insulin

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. ✋🏼 If your answer is “yes”… . Do you carry extra fat around your waist? . Are you struggling to lose weight? . Have you been diagnosed with polycystic ovarian syndrome? . Did your last health check reveal high blood sugar? . These are a few hints you may be insulin resistant. . There are a couple of tests you can talk to your doctor about. They will most likely refer you to an endocrinologist, who will order the tests after a consultation. . ☝🏼 Fasting glucose and insulin test. . After fasting overnight (about 8 hours), a blood sample is taken to measure your blood glucose and insulin levels. This test checks whether your body is producing and using glucose and insulin as expected. . ✌🏼 Oral glucose tolerance test (OGTT) with insulin . This test starts with a fasting glucose and insulin test. You’ll then drink a concentrated glucose beverage(3 times sweeter than a Coca-Cola Classic!). Additional blood samples are drawn at regular intervals for the following 2 hours. This longer test collects information about how your body responds to glucose intake using insulin. This is the most accessible and reliable option available for most of us. . 👉🏼 Make sure insulin is included . In both cases, if your glucose levels are very high, you may be diagnosed with prediabetes or diabetes. . But it’s possible for someone with insulin resistance to have normal glucose levels. For them, it’s the high insulin levels that would indicate insulin resistance. . This is why it’s so important to measure both glucose and insulin. . 👊🏼 My first OGTT . One of the first things I’m doing for my health in 2018 is getting an OGTT done – my appointment is on 10 January! There is something very exciting about learning what your body can tell you in concrete numbers. . I was told I was insulin resistant when I was diagnosed with polycystic ovarian syndrome (PCOS) 6 years ago, but I have never taken the OGTT. . In my next post, I’ll share which tests I have taken. If you don’t have access to a large endocrine centre or specialist, these may be an option at your local clinic. . 👩🏻‍🔬 See the reference list here: confidencenotes.com/insulin-resistance-tests

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. 🦄 Why you might also care about insulin resistance . Insulin resistance is probably only interesting if you have it. . If you do, you might be like me. . You might want to lose weight so you can feel healthy and strong, instead of wanting to stay in bed all day. . So you can get dressed and *not* feel frustrated with how your back fat feels against your bra band — don’t even get me started on the flab below the underwires. . So you can sit down for a meal and *not* worry about how you’d skipped your morning workout that day. . Are you asking why the hell it’s so hard to lose weight even though you’re eating clean and training mean? . For me, a big part of the answer was insulin resistance. . Understanding the basics about insulin resistance helped me make impactful lifestyle changes. I’m losing weight, and feel like I'm on my way to becoming the best version of myself. . I hope this information will help you, too. . Do you think you might also have insulin resistance? My next post will be about blood tests you can ask your doctor to order.

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. Reversing insulin resistance has been my personal mission for the past three years. I tell myself, “I’m the kind of person who makes decisions based on whether they help me reverse my insulin resistance.” . I learned I had insulin resistance when I was diagnosed with polycystic ovarian syndrome (PCOS). PCOS is a condition where women have too much of some hormones, and too little of others. This imbalance causes a whole suite of problems, from weight gain and excess hair to migraines and infertility. There is no cure. . I was 21 years old, and had been living on breakfast cereals and Starbucks cakes for most of my undergraduate life. My body fat percentage must have been in the unhealthy range above 30%. . Insulin resistance had probably contributed to my weight gain over the previous few years. It was also making it harder for me to lose weight. . Ironically, managing insulin resistance required losing weight. So did improving PCOS symptoms. . Sadly not much changed for years — I failed time and again to lose weight. I learned enough about nutrition and fitness to know what would work, but struggled to put it all into practice. . The breakthrough was figuring out the “what would my ideal self do?” trick. . I imagined a happier version of myself, a “better me” who could make the decisions that “current me” so wanted to make but couldn't. At every turn this version of myself asked, “Which option is going to help reverse my insulin resistance?” . This way of thinking was beyond unnatural for me. I’m a no-nonsense kind of a person. Talking to myself made me feel silly and uncomfortable in a way that reminded me of role playing and improv. . But I couldn’t deny its effects. This simple change in perspective made it so much easier to get back on track after slipping off, or — let’s be honest — intentionally hopping off. . That “better me” was also me. It didn't take long for me to start thinking, “I make decisions that lead to better insulin sensitivity”. . Reversing insulin resistance has been a big part of my identity for years now, and I’d like to break this complex condition into its simplest parts over the next few weeks.

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. 🔓 Topic 1 is insulin resistance . Drum roll, please – our first topic on Confidence Notes is insulin resistance. . Insulin is a hormone that helps your body use food as as fuel. When sugar levels in your blood go up, your pancreas releases insulin. . If you're insulin resistant, your body is less sensitive to increases in your blood insulin levels. Essentially, it becomes less efficient at turning food into fuel. . Insulin resistance is not the same thing as pre-diabetes or diabetes. You can be insulin resistant without having either of those conditions. . If you do have prediabetes or type 2 diabetes, your body has been insulin resistant for some time. It’s either unable to produce enough insulin or use insulin well. This means sugar from the food you eat stays in your blood instead of providing energy for your cells. . In my next post, I’ll share why I care so much about insulin resistance. . 👩‍🔬 Annotated reference list: confidencenotes.com/insulin-resistance

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. 💻 Working holiday . I realise this is an unusual day to kick off a project of any kind. . This is happening because I really wanted to launch this blog in 2017, and I also have a thing for Mondays. This combination of conditions didn't leave me with many options so late in the year...! . Happy holidays, everyone. Thank you for including me in your reading time, which is probably in short supply between all the hearty meals (both the preparation and the consumption thereof!), long distance travel to friends and family, and the last bit of work emails for the year. . I'm sending out the happiest gratitude-filled vibes from our winter home in the Swiss Alps. (Yes, this is me chilling in the kitchen while the others prepare dinner and make me cocktails.) . 📷 by @seankcsmith.

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. ⚠️ Question all expectations . I've ended up in many arguments because I “ask too many questions”. But I can't help it – I'm a Questioner. . The Four Tendencies framework by Gretchen Rubin (@gretchenrubin) categorises people according to how they respond to external and internal expectations: do they meet them, or resist them? . Questioners meet internal expectations but resist outer expectations. In Gretchen Rubin's own words, they “question all expectations; they’ll meet an expectation if they think it makes sense – essentially, they make all expectations into inner expectations”. . Knowing this about me, you probably won't be surprised to hear I believe in challenging what people say we should or shouldn't be eating. I turn to expert consensus and scientific evidence to help me reach my own conclusions. . Are you also the kind of person who is constantly asking whether all the nutrition advice out there makes sense? How do you assess whether an outer expectation is worth turning into an internal expectation? . P.S. Gretchen Rubin has a quiz you can take to find out where you fall in her framework – just Google “The Four Tendencies quiz”. Come back and share your Tendency!

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. 🙋🏻‍♀️ The good — great, even . Meal plans were useful when I first started learning to eat more healthfully. . They helped me balance micronutrients, teaching me to be intentional about how much of my total energy came from carbohydrates, proteins, and fats. . They gave me tips about basic food prep, like how to put together salad dressing using what I had on hand, and which spices to use when seasoning different kinds of meat. . It felt good to be able to turn fresh ingredients into food that tasted great in my own little kitchen. . 🙅🏻‍♀️ The bad . But after a while, I began resenting meal plans. I got tired of looking for obscure wheat substitutes in my neighbourhood supermarket. I didn’t feel like making smoothies several times a week. I hated weighing and measuring every single ingredient day after day after day. . And of course there were times I just wanted to eat something that wasn’t on the meal plan, especially when dining out with friends. . But the biggest problem of all was how nervous I felt whenever I went off book, both when eating at restaurants and at home — even though I was eating fresh vegetables and meat. . It felt like I was sabotaging my own progress. But I couldn’t even be sure, because I didn’t really get why the meal plans worked in the first place. . 🤷🏻‍♀️ The ugly . I stopped using meal plans a while ago, but I still follow many of their rules — a little out of habit, but mostly out of fear. . I have so many unanswered questions. Why am I using coconut oil when cooking? Does it really make a difference to my body that my beef comes from grass-fed cows, and eggs from free range chickens? Are coconut aminos actually a sensible substitute for soy sauce? What happens in my gut when I eat yoghurt? Should I even be eating dairy? And what is the deal with omega-3 supplements? . I could go on forever. . 💁🏻‍♀️ My alternative . The only way to really be happy about what I eat is to understand how different kinds of foods affect my body. Then I can decide what to eat, knowing fully well the consequences of my choice. . This is what Confidence Notes is all about: knowledge, choice, and consequence.

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. 🙄 I feel fat . I’ve been trying to lose weight for the last ten years. . I don’t like the fact that the first thing I check for in a photo is whether I look fat. I also don’t like having to adjust my pants every time I sit down to tuck that extra bit of fat under my waistband. . I’ve learned — mostly through experimentation — that losing weight requires more than simply using up more calories than you eat. . What you eat and how you exercise matters so much. So does how much and how well you sleep. . 🤔 How (my) stuff works . What I have yet to learn is why. What’s the science behind all this? What exactly is happening in my body? . The “why” is always important to me because it helps me make good decisions. At work (i.e. my day job), I need to know why each task, report, or meeting matters, else I won’t feel motivated to do it well. Make me understand how it helps me be a better tech consultant — and I’m already showing you how much ass I can kick. . It’s no different with nutrition. Understanding why avoiding sugar is important for weight loss, for example, would motivate me to keep up the good habit of minimising the amount of sugar in my food. If I don’t get it, I won’t feel like putting in the effort day after day. . And this is why this blog is so important to me. It’s where I’ll document the process of figuring out not only what I need to do to lose weight and become healthier, but also why that will work. . Do you care about the “why”?

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. 👩🏻 Hello, it’s me . My name is Danbee. It means “sweet rain” in Korean, which is what we call the rain that breaks a long drought. . I’m 28 and currently live in Singapore. It’s a little strange to put that out there because I’m usually a private person online. . With this account, I’m trying something new. I’m going to do more of what I do in real life — share stories and feelings and what’s on my mind with friends. . I’m going to make this account public, and talk about how I’ve been struggling with all sorts of food-related problems — from putting on weight despite obsessively restricting calories, to waking up in the middle of the night with stomachaches even after a full day of eating “clean”. . 🔬 I have strong feelings about eating . If you’re reading this, you’re probably fortunate enough to have options when it comes to food. Eating is such a fundamental part of living — I honestly believe that you should feel happy about every single thing you choose to eat. . We should each make our own decisions about what to eat. How do I want to make mine? Based on scientific evidence and my own individual experience. . ✏️ And I take great notes . I’m starting Confidence Notes to record both what the research says about nutrition, and my personal experience with food. I don’t have a great memory, but with this journal of sorts to back me up, I’m hoping I’ll feel more confident deciding what to eat. . My hope is that you will, too.

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. 👋🏼 Hello, world . I have a little secret. I own an Estonian company called Confidence Notes. . I travelled to Tallinn in the summer of 2016 to sign a few papers, and have been “working on” starting this nutrition science blog since then. Yes – it’s been a long time coming. . And it’s finally here. This is it. . What is it, exactly? It’s a public space where I share what I’m learning as I research how different kinds of foods affect my body. It’s where I take notes that help me decide — for myself, and on the spot — what to eat whenever I sit down for a meal (or a snack!). . 😨 Fear of messing up . Fear. This is what’s been stopping me from making my own decisions about what to eat. . I had great success with meal plans, but then ended up feeling safe only when eating according other people’s rules. Meal plans were helpful and convenient, but they held me back from empowering myself to make my own calls. . I want to make my own decisions. But I also want to feel confident that I’m making the *right* decisions. . This is why I’m starting this blog: to help me build that confidence I want to feel when deciding what to eat. . Are you also learning to feel comfortable calling the shots about your own wellbeing? I hope you’ll find my writing helpful. . 📷 by @seankcsmith.

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