The Imaginary Sheet Cake and Cheeseburger Buffet

TWO eggs? Oh please, that’s too much!

If you looked at me, you might imagine that somewhere just outside the frame there is a cheeseburger, a bucket of fried chicken and a sheet cake with my name on it. There is not. There is an egg, sometimes a slice of whole grain toast, and on particularly reckless occasions, there may be two eggs… although I recently discovered that two eggs constitutes an eating event of such magnitude that I apparently need to lie down afterward. Two eggs is like a Thanksgiving dinner for me.

I am five-foot-one, German and Polish, descended from a long line of short, round people who look as though we were selectively bred to survive a long winter siege. The women are built like little tanks, and the men are the same. My mother and grandmother, my cousins on both the Polish and German sides are built like this. We are not delicate woodland creatures, we are little battle bots genetically primed to survive just about anything a long winter without food could do to us. And so despite appearances, we don’t spend our afternoons hiding behind the barn eating sheet cake and fried chicken.

I was thinking about all of this today because I started taking a medication called glimepiride for blood sugar. My glucose has been running high while I’ve been on another medication - prednisone - which is a form of steroids. My doctor prescribed the tiniest dose of the blood sugar med imaginable - half of a one-milligram tablet before eating to combat the sugar issues caused by the prednisone.

Because this was my first dose I wanted to be careful. My Endocrinologist suggested that I eat some protein and carbohydrate with it, so I proposed my usual sort of breakfast: 1 egg and 1 piece of whole grain oat toast. The doctor suggested two eggs.

TWO eggs? I never eat two eggs, that is way too much food for me. I complied though, because it’s what the doctor said I must do. Halfway through this enormous banquet, I began feeling nauseated and my Nurse became concerned that perhaps the new medication was lowering my blood sugar quickly, so I checked it.

It was 169. When I woke up this morning my fasting sugar was around 90, but then I took my steroids, on an empty stomach, and the sugar flew up to 169… just from the steroids. This is not unheard of with steroid use, it is called glucocorticoid-induced hyperglycemia. So I took the glimepiride to lower the sugar and ate immediately, as instructed by my medical team. I bravely ate the 2 eggs with whole grain toast and felt very full after such a huge meal. Eventually my glucose went up to 187 and I was still nauseated, at which point I had to explain to the nurse that two eggs and toast constituted two meals for me. There was a moment of silence from the phone.

And this is where appearances become interesting.

I am fat. I have been fat, to varying degrees, for most of my life. I was already around 180 pounds when I was 26 years old. If you had seen me then, you might have assumed I was eating too much. People are extraordinarily confident about knowing how bad other people’s diets are. They can apparently perform a complete endocrine workup from across a parking lot. But when I was 26, the only way I ever managed to get my weight below 150 pounds was to restrict myself to around 600 calories a day.

600 Calories a day… and I am not alone in this. Many of my cousins and relatives on both Polish and German sides are just the same as I am. We look at food and fat cells multiply. It’s an ingenious survival technique developed by our DNA which comes from the shores of the Baltic, where winters were long and very cold, and food was always scarce. Those that survived were champions of fat storage. My ancestor’s bodies developed very efficient fat storage mechanisms and we thrived. In fact, many of my fat or roly poly Polish relatives live to be in their early 100s. If you don’t make it to 95 in our family then you are deficient. Even with all of the chub, my ancestors typically lived to be 100! Chew on that, why don’t you?

I am not recommending that people get fat to live longer and I’m also not claiming that 600 calories represents some scientifically measured metabolic requirement for my body to trim down, but I’m telling you my story and my family story. 600 calories a day is what I had to do, and my Mother and some of my cousins had to do to make the scale move to a lower number.

Eating 600 calories a day is miserable, for anyone. Try it if you don’t believe me. And even after all that deprivation, I was still not tiny. I was simply a smaller and more compact battle bot. I have starved myself into a size four a few times and I can also tell you that it’s not an easy thing to sustain after you get there…. the weight always wants to come back.

There were clues that something more complicated was going on. Hypothyroidism runs through my medical history and through my family. The women in my family have also had polycystic ovary syndrome, or PCOS, which is strongly associated with insulin resistance. Looking around at my relatives is like looking at an old family photograph and realizing that somebody has been hitting “duplicate” for several generations.

Then came steroids. I was also lucky enough to have been born with a genetic auto immune disorder called Lupus that has required me to be on and off corticosteroids for years. Steroids can be miraculous drugs, but they can also behave like tiny pharmaceutical demons who enter your body, putting out one fire and then reorganizing the entire house while they’re there.

They can raise blood sugar. They can increase insulin resistance. They can cause horrifying fluid retention. They can change where your body stores fat. They can alter appetite and metabolism. And after long-term treatment, you can’t necessarily just stop taking them because you’ve become annoyed with what they’re doing to your waistline. You have to carefully taper off of them, which can, for some people, take years.

So here I am now, gradually trying to reduce one of my steroids while simultaneously taking medication to deal with the blood sugar problems that the steroids helped create.

And eating an extra egg, if pressured.

What strikes me about all of this is how little of my medical history is visible. You can’t look at me and see the doctor’s diagnosis of hypothyroidism, you can’t see insulin resistance. You can’t see PCOS written across the generations of women in my family unless you understand that our alopecia goes along with the thunder thighs and round bellies. Fat, bald little battle bots in fluffy wigs…. that’s a clue you’ve met a Halpuczynski girl, or any woman with PCOS … because I know so many women who have lost their hair and wear wigs because of it as well. You can’t see my prescription bottles full of prednisone but you can see my moonface and fluid retention. You can’t see my glucose meter, and you certainly can’t look at my thighs and determine what I had for breakfast.

But people do it anyway. We have turned body size into a character reference in modern times.

You can also see that nature has gifted me with other things… like my IQ which is around 140. You can hear me sing and know that I was born with a talent for music and lovely vocal cords which have brought me international acclaim. You can read my Wall Street Journal review or my DownBeat reviews to confirm this. You can see my face and imagine that its symmetry is attractive… but for some reason all of that good stuff gets discounted, sometimes viciously, when a person looks below my neck to my waistline and thighs.

A thin person can walk through the supermarket with cookies in her cart and nobody thinks much of it. Let a fat woman buy the same cookies and suddenly an invisible jury convenes near the frozen peas. Aha. We knew it. There is the evidence!

Never mind that she’s buying them for her grandchildren. Never mind that they may sit in her cupboard for six months. Never mind that she might eat one cookie every Sunday afternoon with a cup of tea. The jury has seen the cookies. Case closed.

And somewhere, presumably, there is still that sheet cake.

I’m not arguing that calories don’t matter. Of course they matter. I’m not arguing that weight is completely beyond anyone’s control either. Human metabolism obeys physics just like everything else in the universe. But human beings aren’t laboratory rats.

We have genetics, hormones, diseases, medications, sleep issues, age, muscle mass, activity, stress, insulin sensitivity and metabolic adaptations. We retain water. We lose muscle. We get sick. We recover. Women go through pregnancy and menopause. Some people take medications that make weight management substantially harder.

Two people can live very different metabolic lives inside bodies that look superficially similar.

And sometimes the person you assume is overeating is sitting at her kitchen table staring suspiciously at a second egg. That’s the part I wish people would consider, you don’t really know.

You don’t know what the thin person eats, either. You don’t know whether the muscular person is healthy. You don’t know whether the fat person exercises. You don’t know whether the woman pushing a cart through the grocery store has eaten 600 calories today or 3,000. You don’t know what medications are in her purse or what diagnoses are buried in her medical chart.

You only know what she looks like. That’s all.

At 26, I desperately wanted my outside to tell the world a different story about me. I thought if I could just become small enough, perhaps I would finally look the way a woman who ate carefully was supposed to look. Maybe people would be nice to me instead of scowl at me all of the time, because I was a few sizes larger than they thought I should be. So I starved my little Polish/Germanic battle bot body down as far as I could. Decades later, I have a different perspective.

My body has carried me through an awful lot, but it has also driven me completely crazy… we have an extremely complicated relationship. But I’ve finally realized that I don’t owe strangers a dietary explanation for its shape. Nor does anyone else for theirs.

Someone suggested GLP’s to me a month ago. Well, I had already tried them and paid a small fortune for them. They did NOTHING because the steroids counteracted any weight loss that the GLP provided. The scale never moved and I spent thousands of dollars on NOTHING. How would you like to be out several grand and not lose an inch? It wasn’t a fun time, so please keep your GLP advice to yourself, you are not my doctor.

The next time you see a fat person eating lunch, please resist the temptation to write the rest of the menu in your imagination. Maybe she eats too much, maybe she doesn’t. Maybe she has diabetes, maybe she has PCOS. Maybe she’s taking prednisone, or other medications because she’s recovering from something you know nothing about. Maybe that’s the first thing she’s eaten all day. And maybe—just maybe—there isn’t a sheet cake hiding behind the barn.

You can’t judge a book by its cover. You are not a doctor, you have not seen her blood work. Are her private health issues any of your business anyhow? There are HIPAA laws for a reason…. and do you have a medical degree?

Maybe putting someone else down makes you feel superior for a moment. But you don't know my story any more than I know yours. I am not here to judge you, and maybe you shouldn't judge me

And please consider that sometimes two innocent eggs on a plate really are a lot of food for some people, even if they look like they have just eaten a bucket of fried chicken.

Go in peace brothers and sisters. Life is too short to be negative, carry joy in your heart for as long as you can.