Bright Spots Lab – What I’m Trying This Month
By Adam Brown
UndermyFork: CGM + Meal Photos in awesome new app; Two paradigm-shifting books on stress, depression, and anxiety
Welcome to “Bright Spots Lab” – a short-form column that shares the most helpful diabetes tips, tricks, and reading I’ve discovered of late. Each update will be added here at the same link, with all previous editions below for easy reference.
Like my book, Bright Spots & Landmines (free PDF, paperback, free audiobook), this column will focus on food, mindset, exercise, and sleep. Please let me know what you’re trying and finding helpful this month!
This Month – UndermyFork: CGM + Meal Photos; The Upside of Stress & Lost Connections
#2 – Easy low-carb bagels, Mexican “rice” skillet, Waking Up meditation app
#1 – Low-carb English muffins, Atomic Habits, Digital Minimalism, Fitbit
1. UndermyFork: CGM + Meal Photos!
UndermyFork is an excellent new iPhone app for diabetes food logging with photos. Similar to the no-longer-available Meal Memory, UndermyFork overlays glucose data on a meal photo, enabling useful pattern recognition: what foods keep my glucose in-range (Bright Spots) vs. driving it out-of-range (Landmines)? I’ve been using it with the Dexcom G6 continuous glucose monitor (CGM), and the app pulls glucose data automatically from Apple Health. Logging a meal requires just a few clicks – take a photo and hit “save” (no typing required). Then, I return to see the CGM response associated with that meal photo. The enclosed pictures are my own data.
UndermyFork reports time-in-range in the two-hour period after a meal (green badge on left side), and an “Insights” section sorts meals into high, medium, and low time-in-range – it’s useful for recognizing Bright Spot and Landmine patterns, and you can customize the range (e.g., 70-140 vs. 70-180). Impressively, the app can often recognize what’s in the meal based on the photo alone (it pulls up the appropriate tags, like “asparagus”), though it’s not perfect – I’d say about 75% correct, which still saves time, and presumably it will get better. Finally, it lets you search for previous entries, which enables useful learning: “What happened the last time I ate ____?”
The app is available now on iPhone and the team is seeking feedback – I encourage you to try it if you have a Bluetooth-enabled CGM or blood glucose meter that sends data to Apple Health. Dexcom CGM users on iPhone will be the most likely target market based on the current design. The UndermyFork team told me that insulin logging and smarter pattern recognition are top priorities to add to the app. (Both are still somewhat manual for now.) I’m finding UndermyFork useful for capturing food experiments in a low-hassle way – it took under two minutes to set up and has proven sustainable for logging over 150 meals now. We firmly believe that food photos – paired with CGM data and simple pattern recognition – offers huge potential to improve time-in-range.
2. Two Paradigm-Shifting Books on Stress, Depression, and Anxiety: The Upside of Stress and Lost Connections
The Upside of Stress by Dr. Kelly McGonigal – Is it helpful to believe that “stress is toxic?” This persuasive book urges a reframing of beliefs around stress, shifting from a “stress-is-toxic” to a “stress-is-enhancing” mindset. Dr. McGonigal has a TED talk with 20 million views on this same topic, and Stanford has a great one-hour free video course summarizing more of the research.
These two grounding insights are what got my attention:
“Stress is what arises when something you care about is at stake … Stress and meaning are inextricably linked. You don’t stress out about things you don’t care about, and you can’t create a meaningful life without experiencing some stress.”
“Most people don’t choose the stress in their lives; they deal with it. When asked what is most stressful about their lives, people typically name things like a loved one’s health problems, money worries, academic pressure, work stress, and parenting demands. We can’t just excise these things from our lives to reduce stress. When people can’t control what is stressful about their lives, how does it help to tell them that the reality of their lives is unacceptable?”
From these viewpoints, a life with “zero stress” is undesirable and impossible - it would mean not caring about anything and having complete control over everything! I really appreciate this framing, since it changes the game in a major way – from an unrealistic goal to “eliminate all stress” to the more realistic “stress is going to come up – because I care about things – but it’s possible to deal with it.” The Upside of Stress has good tips on how to cope with stress productively, along with fascinating science on “stress mindsets” – how beliefs about stress might impact the actual hormonal impact stress has on the body.
Lost Connections by Johann Hari – This marvelous book disrupts the paradigm that depression is simply a “chemical imbalance” in the brain with a simple pill fix. Hari persuasively argues that depression and anxiety are highly driven by many levels of “disconnection” in our lives: from meaningful work, other people, the natural world, a hopeful and secure future, and more. The book summarizes nine causes of anxiety and depression, and then it offers a “different kind of antidepressant” – seven types of “reconnection.” Hari struggled with depression for many years, and the book combines his personal experience with great science writing. Like Why We Sleep, Lost Connections has certain pages in which I underlined almost everything. Paired with The Upside of Stress, these books paint a far more comprehensive and nuanced picture of negative mental states – especially for those of us with diabetes who might cope with stress and disconnection almost daily.
Food Bonus: Low-Carb Almond Flour Bread
1. Easy Low-Carb Bagels Made with Almond Flour – Recipe
I rediscovered this phenomenal low-carb, almond flour bagel recipe in the Elana’s Pantry Paleo cookbook, and it is also posted on her blog. The recipe makes six bagels, takes about five minutes to prep, cooks in the oven in 20-25 minutes, and uses straightforward ingredients that were already in my pantry (rare!). Two adjustments I made for simplicity: I mix the ingredients by hand instead of using a food processor (I don’t own one), and I spoon the batter into the baking tin instead of piping them with a plastic bag. Making one bagel batch on Sunday provides enough for the week (they store well in the fridge), and these end up less expensive than the store-bought Mikey’s low-carb muffins (see Lab #1). Sliced in half, I’ve been topping these bagels with sliced avocado or an egg, with little impact on blood sugar. (For me, 1U of insulin covers one bagel, equivalent to ~10 g of carbs.) This recipe is also sustainable – I’ve baked them four times in the past month. I own a pan like this one, but I’d guess the same batter could be cooked in a bread loaf tin or a muffin tin. Get the recipe here!
2. Low-Carb Mexican “Rice” Skillet – Recipe
The All Day I Dream About Food blog really delivers on low-carb creativity. Looking for ideas to share in this column, I attempted a Low-Carb Mexican Cauliflower Rice skillet recipe – it turned out fantastic and easy to make. As soon as my girlfriend and I took a bite, we looked at each other and said, “Wow – this is a keeper!” We used less cheese than the recipe calls for, and, when we cook it next time, I’ll use a bit less chicken broth.
In case it is useful: I save “keeper” recipes in Evernote for easy on-the-go access and searching.
3. App I’m using nearly every day: Waking Up
I’ve followed Sam Harris’s work for a long time, and I highly recommend his new meditation app – Waking Up, available on Apple and Android. I try a lot of health apps, but end up deleting 98% of them. (Apps must add more value than burden, and that is rarely the case.) I’ve not only stuck with Waking Up, but paid for a one-year subscription – it’s that good. The app has a free trial and a money-back guarantee. Sam is a neuroscientist and approaches meditation from a slightly different perspective – mental training for life and a tool to understand how the mind works, rather than simply “stress reduction.” I’ve found meditation to be the most powerful tool for recognizing diabetes thinking traps and negative thought spirals. Waking Up’s three-minute lesson on gratitude is also incredible; I’ve listened to it alone at least ten times, and it immediately improves my mood. Try Waking Up if you are even the least bit intrigued; I also recommend Buddhify, Calm, Headspace, and Ten Percent.
4. Why are Nutrition Headlines So Confusing?
The other day, I was explaining to someone why nutrition headlines in the media are so confusing – how can one diet or food be “healthy” one month and “unhealthy” the next month? Chris Kresser answers that question pretty well in a two-part blog: “Why You Should Be Skeptical of Latest Nutrition Headlines.” Dr. Peter Attia’s weekly email also has an amazing step-by-step rebuke of a recent breakfast study. These two articles provide a thinking toolkit to separate rigorous nutrition science (rare) from sensationalist headlines (common). Personally, I try to combine data from different sources: test different diets and observe the impact on my own health data (time-in-range, hypoglycemia, insulin needs, heart health); read the research; and learn from other people with diabetes.
5. A remarkable book – Motivational Interviewing: Helping People Change by William Miller and Stephen Rollnick
This incredible book is written for healthcare providers and mental health professionals, but is loaded with gems for becoming a better listener and having more effective conversations with anyone. Motivational interviewing (MI) is all about helping people find their own solutions, rather than just giving advice and expecting it to be followed. MI is grounded in a powerful premise: many of us are “ambivalent” about change, meaning we have reasons for and against changing. Interestingly, when a “helper” provides a bunch of reasons in favor of change (“the righting reflex”), an ambivalent person will naturally respond with several reasons not to change. Avoiding the “righting reflex” is a central focus of MI, and it is both conversational art and science. Here’s a thought experiment early in the book that resonated:
Choose something that you have been thinking about changing, but haven’t done so yet. Now, imagine a friend (“helper”) who tells you how much you need to make this change, gives you a list of reasons for doing so, emphasizes the importance of changing, tells you how to do it, and tries to motivate you to get on with it. How would you be likely to respond? Most often, the “helped” person feels defensive, uncomfortable, powerless, or angry. Sometimes, the person being helped even concludes that he or she actually doesn’t want to make the change. That was not the helper’s intention; it’s just how people normally respond to the “righting reflex.”
Motivational Interviewing is more person-centered, anchored in the belief that people are the experts on changing themselves. Imagine the same thought experiment, but instead of the approach described above, the helper asks these questions: Why would you want to make this change? How might you go about it in order to succeed? What are the three best reasons to do it? How important is it for you to make this change, and why? The helper listens, gives a short summary of all the reasons you just shared, and then asks one more question: “So what do you think you’ll do?” With an ambivalent person, there are reasons in favor of change; MI just helps call them out.
1. Best New Find: Mikey’s Low-Carb English Muffins
I stumbled across these in the frozen section of a nearby grocery store – wow are they awesome! Each Mikey’s English muffin has 8 grams of carbs total (50% from fiber) and seven real-food ingredients: Eggs, Almond Flour, Water, Apple Cider Vinegar, Coconut Flour, Baking Soda, Salt. They have minimal impact on blood sugar in my ten experiments so far. These muffins make a killer breakfast egg sandwich – I put one fried egg on each half and eat it open face. My girlfriend, Priscilla, also enjoyed my grilled cheese attempt (see above). Since the muffins are sold in a frozen four-pack, I thaw one in the refrigerator overnight and then toast it in a hot pan before eating. (I don’t own a toaster oven, though that’s probably the best way to make them.)
The one downside is price: a four-pack ran about $6, meaning each muffin comes to about $1.50 – more expensive per-serving than breakfast chia pudding, but a nice way to mix it up. Mikey’s has a store locator here, and it seems they are available at Whole Foods and Safeway. This past weekend, I found a way to make a similar version of these at home – higher hassle, but far less expensive – and I’ll share that in the next Bright Spots Lab.
I don’t generally eat a lot of packaged foods, but these muffins are great to have in the freezer when time is crunched.
On a related note, La Tortilla Factory’s low-carb, high-fiber, whole wheat tortillas are excellent for breakfast egg burritos, tacos, etc. They have a yellow-branded package (“Low Carb”), are sold at many grocery stores – search your zip code here – and are much cheaper than Mikey’s. Since over 70% of the carbs are from fiber (8 grams of fiber, 11 grams of total carbs), they have a similarly small impact on blood sugar.
2. Favorite New Recipe: Ground Turkey + Broccoli “Rice” Bowl
Broccoli and cauliflower rice are sold pre-blended at stores like Trader Joe’s, offering a low-carb, rice-like, vegetable-only side dish or main course. This recipe is a serious winner – with broccoli rice, it tasted just like a stone-bowl rice dish. We skipped the maple syrup, used soy sauce instead of coconut aminos, and added an egg on top. The recipe says it works with cauliflower or broccoli rice, but it was far better with broccoli rice in my view. If you prefer, you can make cauliflower or broccoli rice at home in five minutes – see here.
3. Outstanding books:
Digital Minimalism by Cal Newport: This book makes a compelling case for re-evaluating one’s relationship with smartphones and social media. The average person spends three hours per day looking at a smartphone screen, with only 12% spending less than an hour. Note: three hours per day = 46 full days per year! I’ve long used related tools like RescueTime, Freedom, and the iPhone Screen Time report. This book provides a good high-level strategy (and tips) for thinking about the place phones and social media should have in our lives. I see huge diabetes opportunity in cutting even 20 minutes per day in screen time, freeing that up for self-care – walking, more sleep, morning breathing, etc. Taking long walks without my phone has been a great addition to my toolbox after reading this book.
Atomic Habits by James Clear: This book has a crystal-clear structure and great stories for explaining how habits work. I loved the emphasis on tiny (“atomic”) changes – e.g., if you get 1% better each day, you will be 38-times better in a year! Atomic Habits builds nicely on the 2012 classic, The Power of Habit by Charles Duhigg. Combined with Switch by Chip and Dan Heath, these are the three best books I’d recommend for anyone trying to improve their habits. The Mindset chapter of Bright Spots & Landmines has many similar themes.
I’ve also been re-reading and recommending Cognitive Behavioral Therapy Made Simple by Dr. Seth Gillihan, especially the chapter on negative thoughts and thinking errors – it is stunningly good for combatting unhelpful diabetes thought loops.
EXERCISE and SLEEP
4. Switching back to Fitbit from Apple Watch.
I used Fitbit from 2011-2016 and loved the motivation to walk more, to encourage my friends, and to get sleep data. In 2016, in a Black Friday moment of inspiration, I splurged on a discounted Apple Watch Series 1; I was mostly excited to get Dexcom CGM data on my wrist. In January of this year, however, I was feeling extra device fatigue and decided to switch back to Fitbit. It’s been an awesome change! I find Fitbit’s wrist-worn tracker and app more motivating and less naggy than Apple Watch. Fitbit has valuable, built-in sleep data, whereas Apple Watch requires third-party apps. Fitbit excels on battery life too, needing only one charge per week. I haven’t missed getting CGM data on my wrist, as it’s one swipe from the iPhone lock screen. In fact, I do less micromanaging and less stressing about my blood sugars now. My time-in-range is identical since the device change.
Over 100,000 copies of Bright Spots & Landmines: The Diabetes Guide I Wish Someone Had Handed Me have been sold/downloaded! Get it as a…