Cholesterol, diabetes, diet, Fat, Grain free, Guidelines, hormone, immune system, insulin, insulin resistant, keto, ketogenic, lifestyle, low carb, Media, NAFLD, nurse, nurse practitioner, paleo, PCOS, steroid, Uncategorized, vitamin

Connecting the dots… How Chronic Diseases Manifest

Oftentimes, a patient will come in or post on Facebook that new symptoms have occurred and evaluation is now needed. Today’s blog article will discuss some of the most common symptoms that bring patients in for diagnosis and treatment.  We’re going to give 2 fictitious patients a run through a visit with me:  Dick and Jane will be our patients today.

Jane is a 43 year old female, who comes in with a new complaint of “just tired all the time”. She occasionally takes a multivitamin, but not much else.  She reports no previous major medical history, but does report that her dad had a stroke at age 61 and is now disabled because of weakness on the left side.  She reports that her mom does have thyroid problems and takes some meds for it but she’s not sure of the exact problem.  During a review of systems, she also reveals that she is beginning to have trouble sleeping through the night, her hair seems brittle, and she’s only having 2 bowel movements a week.  She reports mostly normal menstrual periods, with occasional skipping of a month.  She says over the past 3 years, she’s probably missed 3-4 periods; all pregnancy tests were negative.  She also admits to very slow weight gain over the past 5-6 years; she says she used to weigh around 130 for most of her life.  During the physical exam, Jane appears pretty normal except for these findings:  weight is 214 lbs (height is 5’4”), her skin appears quite dry and even scaly on her arms & legs, very sluggish bowel sounds in all 4 quadrants of her abdomen, and her face just appears fatigued.  She denies problems with depression, but is beginning to think that she might be depressed because many mornings upon awakening, she is exhausted and dreads getting out of bed.  She requests lab work to help identify what is going on.

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Dick has made an appointment today because of several issues that don’t seem to be linked. Although he’s done some internet research, the symptoms he’s experiencing aren’t really connected, he reports.  He is somewhat tired, but not every day, and certainly not all day; fatigue just seems to hit randomly, requiring a nap to get through the rest of his day.  He does report a history of mild elevated blood pressure for which he sometimes takes his Lisinopril – averages about 3-5 days a week.  He also reports a recent onset of an annoying dry cough without fever or sinus/allergy drainage – which he does have a history for.  He says he had a biometric screening done several weeks ago at work and brings in a copy of those results for review.  His vital signs:  heart rate 84, BP 168/108, O2 sat of 90%, temp 98.5, respiratory rate 22.  During the physical exam, these abnormalities are noted of this 54-year-old male:  waist circumference is 52 with very protuberant abdomen (no distention, more of a “beer-belly” appearance), lung sounds are clear, but deep breathing triggers his cough, and an extra heart sound (S3) is noted.  In addition, he exhibits trace bilateral pedal edema, but normal pedal pulses.  In review of his biometric results, he has a random glucose level of 186, LDL 201, HDL of 32, Total cholesterol 259, and Triglycerides of 276.  He says they offered health coaching to him, but he hasn’t decided whether to do that or not; he says he wanted to be seen for good physical first.

During Jane’s visit, we decide to obtain some lab tests; drawing a Complete Blood Count (CBC) will help us recognize a possible anemia or subtle infection she may have. A CMP (compete metabolic panel) will tell us about her electrolyte balance, kidney and liver function, while thyroid studies will help identify thyroid problems.  In addition, we obtained a urine dip and a hemoglobin A1c in the office.  We discussed a variety of home remedies and OTC medications/supplements that can help improve fatigue in general, until we can review lab results.  Jane is much relieved to hear that B complex vitamins, Vitamin D, and magnesium are easy to access and often improve fatigue in many people.  She prefers to use supplements and lifestyle changes if possible.  She leaves the clinic feeling better about her outlook and has an appointment for a 2-week follow-up.

In reviewing Dick’s biometric results, we discuss the likelihood that he has diabetes; he agrees that he’s thought the same for a while now, but never tested for it. Reports his mom was diagnosed with Type 2 DM as an adult many years ago and has now progressed to insulin use with possibility of dialysis in the near future.  He expresses great concern over dialysis and states emphatically that he does NOT want to go down that road at all.  We draw similar labs on Dick as Jane had; we also get a BNP (brain natriuretic peptide) level and an office UA and A1c before sending him home with an appointment Friday for review of all the results; we also schedule an appointment for an EKG and an echocardiogram – both are tests to help determine cardiac muscle injury. The BNP is a blood test that helps us determine possible weakening of the heart muscle that often accompanies poorly controlled blood pressure and diabetes.

Image result for cholesterol test image

When Dick returns for his Friday appointment, we first begin with review of the abnormal test results, beginning with the mild abnormalities and working our way toward the more serious problems. His urine is mostly normal, except his protein which is mildly elevated and specific gravity is 1.030 which often indicates poor water intake as it shows high urine concentration.  Elevated blood pressure and diabetes will both contribute to protein spilling into urine – each for different reasons. High blood pressure will cause it because of the force of blood being pushed into the kidneys and the tiny little blood vessels literally burst sometimes.  Diabetes will cause protein to spill into urine because of tiny little “beaver dams” in blood vessels – thick, sticky, syrupy blood causes tiny components of glucose, triglycerides, and inflammation markers to bunch together, forming a bit of a “beaver dam” inside blood vessels.  When these blockages occur, protein is not filtered properly through the kidneys’ processing system and it spills out into urine.  Since Dick has both high BP and diabetes (DM2), it’s difficult to pinpoint his cause of protein in urine.  Moving along, his A1c is 7.8, meaning his blood sugars are averaging around 200 mg/dL. Review of the CMP reveals slightly elevated AST (a liver enzyme), slightly elevated BUN (kidney function test), but normal creatinine, and his BNP is somewhat elevated at 278 pg/mL.  Normal BNP is less than 100; CHF (congestive heart failure) is most likely over 400.  His EKG is mildly abnormal, but shows no significant electrical problem with his heart.  However, the ECHO (echocardiogram) does indicate weakened heart muscle, with an ejection fraction of about 45%.  Normal EF is approx. 50-65%, meaning that during each beat/contraction of the heart, approximately 65% of blood inside the heart is pumped out during that one beat.  Remember, Dick, that the heart’s 4 chambers each contain blood and only the ventricles (the 2 bottom chambers are pumping blood OUT of the heart during that beat, and the RIGHT ventricle is pushing blood to the lungs, while the LEFT ventricle is pushing blood out to the body for use by its cells.  The EF is calculated based on how much blood is leaving the LEFT ventricle during one beat.  You don’t want the EF to be 100%, or your heart would not be able to keep working properly.  It should push out 50-65% of its contents during any given beat or contraction.  When the EF falls too low, it signals that the heart muscle is trying to beat stronger and stronger to push out the blood for the body to use.

Dick expresses a bit of confusion and so we continue to explain. Have you ever been to the gym to work out?  What happens when you start working out? Lifting weights?  Your biceps get bigger and stronger, right?  But the heart muscle is NOT like skeletal muscle at all; when the heart muscle works more and harder, it gets weaker – NOT stronger.  Asking the heart to pump thick and stick blood to an overweight body is not healthy and will cause organ damage – in this case – heart muscle injury, kidney injury; the mild liver damage, likely non-alcoholic fatty liver disease (NAFLD) is related to long-term insulin resistance/high carb intake/elevated glucose & triglycerides. Dick says he’s beginning to understand how all of these health problems are related to one another and now wants to know how to reverse this damage.  He says he’s determined to improve his health. So, looking at Dick’s chart, and reviewing everything with him, we list the following as current medical diagnoses in his record:  hypertension, type 2 diabetes, congestive heart failure, hypercholesterolemia, proteinuria, & NAFLD.  Dick asks if all of this can be reversed without medications and is leery of taking home a shoebox full of meds today. We review the most important problems of high BP and heart injury and decide that these do need some medication, at least for now; Dick agrees to start on BP meds and a diuretic to reduce the workload of the heart.  After much discussion of diabetes meds, he agrees to start on metformin which does not directly lower glucose, but aids in liver health and insulin resistance.  He agrees to start other meds if needed, but wants a real chance with nutrition changes to see if he can eat better to get healthy.  We agree on a monthly visit schedule for a while, just to help and support Dick through these life-changing diagnoses; he came in for one visit and now has multiple life-altering diagnoses with multiple meds and a whole new outlook on life.

Jane is back today for her 2-week follow-up and review of her lab results. Most of her results are pretty normal; her random glucose is 146.  Her thyroid levels are within normal ranges, but just barely.  Her TSH is at the very upper end of the normal reference range; her T4 is pretty normal, but her T3 is right on the lower end of normal.  Her liver enzymes are all slightly elevated, but not very high at all.  Her A1c is 6.3; her urine is pretty normal, except her specific gravity is also 1.030.  It is determined that Jane has subclinical hypothyroidism, pre-diabetes, and likely NAFLD/insulin resistance.  Much of our discussion with Jane is similar to our meeting with Dick, except the heart failure topic.  We discuss starting her on thyroid meds, vitamin D and magnesium regularly with follow-up thyroid labs in about 6-8 weeks because it can take many weeks for thyroid hormone levels to improve.  Jane is thrilled to have some answers to her symptoms and agrees to start on thyroid meds.  We caution her to take thyroid meds, completely alone, with no other food/med for at least 30 minutes because thyroid meds bind easily to caffeine, calcium, and many chemicals/foods.  Jane agrees and leaves with hope that she will feel better soon, but she also asks about her sluggish bowel movements and wonders what she can do to become more “regular”.  We discuss many possible remedies for constipation, including various brands of colon cleansers, OTC laxatives, and foods that can trigger faster GI motility.  She agrees to find something when she picks up the thyroid prescription at the pharmacy.  She schedules her follow-up for about 6 weeks out.

Both of these patients teach us a lot about general health. First, we all minimize many of our symptoms from time to time, thinking it’s just growing older, being too busy, or just not resting well.  But we should always take note of even mild/vague symptoms that don’t improve after a week or so.  Secondly, there are many reasons for fatigue, and if a good evaluation by a provider reveals no likely source, trying vitamins or supplements might help boost energy levels.  Thirdly, there can be many, many mild abnormalities going on internally, that we cannot see, feel, or easily identify without lab tests.  And lastly, both patients had some carbohydrate intolerance, as evidenced by even mildly elevated glucose levels, weight, and missing menstrual periods.

I am a firm believer that high carbohydrate nutrition has led us all down a path to poor health, vague symptoms, and a variety of chronic health conditions. Look at nutrition labels for any processed food; very little actual nutrition, yet agencies PUSH us to eat that stuff. Why? Because Big Food has paid billions of dollars in advertising and donations to organizations like ADA, AHA, AMA, etc.  There was absolutely NO scientific evidence that our bodies EVER needed carbohydrates; if so, they would be considered ESSENTIAL to our health, but carbs are NOT essential.  The body will make any necessary glucose it needs from proteins and fatty acids. Start eliminating carbs today and reclaim your health!

We will follow-up with Dick and Jane in a few weeks to see how they are doing.  Make sure to follow us on Facebook for our latest posts!

 

 

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Cholesterol, diabetes, diet, Fat, gluten-free, Grain free, Guidelines, insulin, insulin resistant, keto, ketogenic, lifestyle, low carb, nurse practitioner, Uncategorized

Tips & Tricks to Master LCHF 

Sometimes life impacts our food choices and our intake of processed foods increases, although they may be higher in fat or lower carb. Many times, I get messages, asking for our “approval” to consume off-plan foods like keto breads and ice creams. While some of these foods’ ingredients may be included on the LCHF food list, I strongly encourage people to consume the majority of your intake from real foods. Real meats. Real vegetables. Real fats. Eating from a bag, box or can/jar provides very few essential vitamins and minerals because many manufacturing methods contribute to decreased nutrients. Vegetables contain a lot of micronutrients and phytonutrients our bodies use daily; some have to be replaced regularly. Going days or weeks without any vegetables at all can contribute to a variety of vague symptoms, including increased fatigue, headache, & nausea. There are no magic vitamins in a bottle that can replace your veggies. Meats are strongly encouraged on LCHF as they also contain many essential nutrients, especially red meat – beef, venison, & other wild game. Red meat is about the only source of high quantities of b12 & iron – both of which are essential to our health. Chicken, turkey & pork contain only minuscule amounts of iron,if any at all. Iron is what gives meat its red color, thus the need for red meat. (Yes, vegetarians can eat LCHF, but must pay very special attention to the iron and b12 sources or risk poor health.) 

Do not fear red meat. Red meat has been falsely accused of causing health hazards. People survived eating red meat and its fat for centuries before the industrial revolution came along and packaged all our food. Manufacturing processes, including planting, harvesting, & packaging always decrease nutrient density – meaning everything that comes from a company and packaged, contains very little nutrition. Choose real bacon over turkey bacon. Choose 30% fat in burger meat. Choose real butter over margarine. Choose preservative-free foods when possible. 

Questions about bacon always surface… LOL Bacon IS best with fewest additives, or if you can find pork belly or side meat, it usually doesn’t have added sugars or preservatives; even so, most bacon is still way better for us than most anything in a bag or box. 

Baaaaacon!

Reading nutrition labels and ingredient lists is required reading for truly gaining control over health. Just because a nutrition label says 1.5 grams of carbs per serving doesn’t always mean it’s good for you. Look at ingredients –

Watch for hidden grains, sugars, and dextrin components. There are over

60 different terms that companies use to disguise sugar. Become aware of how companies sneak sugars and sweeteners into their packages. If the 1.5 grams of carbs come from wheat, and you’re sensitive to it, those carbs might send your glucose jumping! And then you’ll battle that glucose spike for hours or even days. Also, remember to check serving size. An example is a 20 ounce soda which is typically 2.5 servings; nutrient info then is NOT for the entire bottle.

Choose water over soda, sparkling drinks, and commercially prepared flavored waters – most of these items contain added sweeteners of one sort or the other and will almost always impact glucose level. Avoid ALL foods labeled as sugar-free and read labels extremely carefully. If it’s sugar free, the company has added SOMETHING to it to make it palatable and desirable. Manufacturers are catering to our “sweet tooth” by making foods sweeter and sweeter; heck, they are even modifying our fruit for maximal sweetness!!
Speaking of fruits… avoid them! In low carb nutrition, we recognize the horrible impact of fruits on our glucose levels. But most people who’ve followed the ADA way for many years are totally unaware that fruit has such an impact. They still believe fruits are good for us, but they aren’t. Only occasional berries – AFTER glucose normalization occurs – are allowed on our LCHF way of eating. If in doubt, perform your own experiment. Test before and after. For experts and such highly educated people to proclaim that fruits and grains are good for us over the past 50 years, is beyond my comprehension. They claim their diet is based on scientific data – tests – measurable numbers. But they’ve never run REAL tests! Their diet is based solely on hypothesis and conjecture. Our way of eating is based on 70+ scientific studies AND thousands of people who live LCHF every day.  
Read vitamin & supplement labels! Many contain cellulose, maltodextrin, corn syrup solids, and wheat as binders and fillers; these items will cause elevated glucose levels. Be very wary of any vitamin drink, protein shake, or miracle concoction that promises symptom relief or improved health. Most of these mixes are completely filled with difficult-to-pronounce chemicals, not foods. Even the “all-natural” ones are loaded with sugars. (Just a side note: cyanide & arsenic are natural.) Our bodies were meant to eat/chew food, not obtain empty calories from chemical concoctions. It’s important for the brain to perceive intake, and part of that process includes chewing. Drinking calories totally bypasses that signal to the brain, and so the body can still feel hungry and not satiated, even with hundreds of calories consumed. 


Hopefully, these tips will help y’all get a better grasp of how I eat and teach people to eat and how so many people are able to drastically reduce glucose levels and lose weight. If you are at a stall — your glucose just won’t fall any more, or your weight just isn’t budging — it may be time for re-evaluation of your intake; take a real look at the packaging you’re eating from. Look at all labels. Look at all ingredients. Look at serving sizes. Eat fresh or frozen veggies – without added sauces and such. Canned veggies can be ok – but always check labels.  
Record all intake and verify nutrient info in your app with google or label on package. The more accurate your info, the healthier your intake will be. Many apps are “editable” by users – meaning you could enter data that says your avocados only have 1 gram of carbs per avocado – very untrue. But if that’s what you select in your app, your numbers will not be accurate and it will show in your glucose level — but you will be posting about how frustrating it is to eat from the list but still have high glucose. 
If you’ve reached a stall, you should also re-evaluate your macros – the fats, proteins, & carbs – you’re consuming. There are many methods of identifying ideal weight, but this is the one I use. For the first 5 feet, one is allowed 100 pounds. For females, we’re allowed 5 pounds for every inch over 5′. Males are allowed 6 pounds for every inch over 5′. Divide your ideal weight by 2.2 and this will give you an approx protein need for you at your ideal weight. This is the number of grams of protein you’ll need in one day, and should be approx 15-25% of calories you consume daily. Divide this number of grams by the number of meals you typically have daily and then you’ll know how many grams of protein you’ll need in one meal; also remember that on average, there are approx 7 grams of protein in 1 ounce of meat. For instance, a 4 ounce filet would contain approx 28 grams of protein for one meal of your day. 

To determine your fat needs, double the number of fat grams per day. For example, if your protein needs are 56 grams per day, you should need approx 112 grams of fat in your meals daily, preferably evenly divided over all meals. 


For a female who is approximately 5′ 5″ tall, her protein needs would be approx 57 grams per day, and fat needs would be approx 114 grams per day. 20 grams of carbs would be the maximum allowed. Now, to calculate how much of this is CALORIC intake percentage, we have to convert grams into calories. Carbs provide 4 calories per gram, so for our female client here, that would be 20 x 4 = 80 calories. Protein also provides 4 calories per gram, so this lady would consume 57 x 4 = 228 calories of protein daily. Fats provide 9 calories per gram; 114 x 9= 1,026. Total these: 80 + 228 + 1026 = 1334 calories per day. Then, figure percent of caloric intake: 80/1334 = 6% of intake comes from carbohydrates. 228/1334= 17% of calorie intake is from protein. 1026/1334 = 77% of calories will come from fat. To calculate YOUR needs, follow this example carefully, & you will figure your grams and percentage of calories quite easily. 
If you use current weight or too high of an ideal weight to determine your macro needs, you’re likely to reach stalls and plateaus, becoming frustrated. If you’re very active, your protein needs will be a bit higher; if you’re pretty sedentary, your protein needs will be a bit less. 
I realize I’ve rambled on far too long, now. Sorry about that. I just wanted to share some of these tips because I see many of you struggling with these concepts and questions. 

 

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Teresa Reversed Her Diabetes!

 

I am VERY honored to introduce y’all to a very special friend of mine.  I have known Teresa since our children were in kindergarten together, about 25  years ago.  She recently reached out to KetoNurses, looking for something different.  Here is her story in her words.

Teresa Toten, July, 2017

 

My name is Teresa, and I live in rural Mississippi.  I am a wife, a mother of four boys, and a grandmother to four.  Over the years, I have worked and taken care of my family, but I really did not pay attention to my health.  My weight slowly continued to creep up on me; after the birth of my children, I never really did go back to my pre-pregnancy weight.  I accepted the “fluffiness” as my new norm.  I worked, I came home, and the cycle repeated itself daily for years, leaving little time for exercise.

 

I have worked as a legal assistant for almost 17 years, during which time most of my work surrounded workers’ compensation claims and social security disability claims.  Little did I know, that I would also be injured on the job.  On February 20th, 2015, I underwent a multi-level anterior cervical discectomy and fusion (ACDF).  Recovery was slow and painful; in addition, I suffered another injury just weeks after my ACDF surgery – this time to my sternoclavicular (shoulder) joint and collarbone.  The doctor felt that the best course of action would be to undergo steroid injections along with trigger point injections.  Over the course of the next two years, I underwent many of these injections with little to no relief.

June, 2017

In July, 2016, I noticed that I was losing weight without trying; my hair was thinning and falling out in clumps; my face was red and splotchy; my vision was rapidly blurring, and I just all-around did not feel good at all.  I assumed that I was having an issue with my thyroid as thyroid problems do run in my family.  So, in August, 2016, I decided to see a doctor about my concerns.  He ordered the usual rounds of blood work and said he’d get back to me within a few days with the results.  Two days passed, and I received a call from the doctor’s office and said I needed to come in immediately to discuss the results.  I just knew it was my thyroid but at least I had an answer.

 

Day 1 of Keto Nutrition, April, 2017

I went in to the appointment the next morning, and he asked me if anyone had ever talked to me about the big “D”.  I must have looked confused so he patted me on the knee and said that it was diabetes.  We discussed my family history of diabetes (grandmother was diabetic; mother was hypoglycemic).  We discussed my personal history, my eating habits, my lack of exercise, my weight (200 pounds) and my recent surgery and ongoing injections.  He was concerned that my workers’ compensation doctor had not disclosed to me the dangers of rising blood glucose levels while on the injections, and I had been getting them for two years. He told me that my A1C was 12.8.  He explained to me that my blood was telling him the average blood glucose over the last three months was around 375; he also told me that those numbers were not good at all.  He immediately started me on Metformin ER, 500 mg twice a day but also wanted to test my kidney function before beginning.  The results came in… kidneys were okay.  So, he started me out on a long acting one called Tresiba.  I started out at 10 units.  My numbers remained high.  The next week, he added 2 units.  My numbers continued to climb.  My fasting blood glucose levels remained above 200.  My afternoon glucose levels barely dropped.  Insulin dosage increased.  So, after months of trying to stabilize my blood glucose levels, he added Novolog at mealtime.  This addition of mealtime insulin helped my afternoon blood glucose numbers come down a bit, but not where they needed to be.  So, he increased my Metformin to 2000 mg a day.

 

May, 2017

I attended every class that this small town offered to help me learn to manage my diabetes.  I followed the ADA guidelines to the letter.  My numbers continued to rise even though I was eating the way a diabetic is instructed to do.  I just did not understand why I could not get a grasp on my health, and this diabetes was trying to take over my life.  I meticulously kept a log of what I would eat on a daily basis, making sure that I had the proper amounts of protein, carbs and vegetables per the ADA recommendations.  My numbers continued to rise.  Yes, I managed to lose a few pounds in the process but was still grossly overweight at 188 pounds.
So, in frustration and heartache, I reached out to a friend of mine here at KetoNurses for advice on lowering my numbers.  She sent me links to articles on the blog, and she added me to a Facebook group whose main goal is to educate people on methods to use nutrition to help lower glucose and reverse diabetes.  I mean, what did I have to lose besides 2000 mg of Metformin, 30 units of Tresiba, and 16 units of Novolog (per meal) three times a day.  I was ready to get my life back in order, take control of my health, and come off of the medication I was on.

 

So, in April 2017, my keto food list in hand, I made my way to the grocery store to start my new way of eating.  I loaded my cart with items from the meat department, and produce department.  I did not shop down the center aisles for anything.  There were no foods in packages, boxes or bags.  There were no cereals, pastas, rice or potatoes.  There were no fruits, candies, cakes or cookies.  The only thing in my cart was good, wholesome and keto approved foods  I was ready to tackle this way of eating.

On day 1, I took a full length photo of myself.  I weighed in at 188 pounds.  And, I ate.  And, I ate.  I cooked using bacon grease.  I added fat to my vegetables.  I made a cinnamon apple butter tea.  I tracked everything that I did.  I measured all of my food so that my logs were precise.  Day 2 was more of the same.  On or about the 4th or 5th day, keto flu kicked in.  My friend advised me to drink salted broth.  I did and I muddled through the aches and tiredness.  Weeks went by, and I continued to count, to log, to experiment with my foods and my fats.  I got the hang of it.  However, it was not until my first doctor’s appointment after I started this way of eating that the realization kicked in.

My doctor made note of my weight.  He made note of my leaner appearance.   But what really got his attention was my blood glucose numbers; they rapidly fell and stabilized.  So, he had me decrease my insulin dosages and instructed me how to decrease it on my own so that I could do it by myself.  This visit was the first positive appointment I had with him since my diagnosis in 2016.  I was impressed.  So, I continued this way of eating.  I began to notice that my pants were looser, my acne was disappearing, my face was losing its puffiness, my energy levels were increasing, and I just felt better.  I discontinued my Novolog (3 injections a day) and my numbers did not go back up.  I was consistently getting blood glucose readings in the 80’s and 90’s which were a far cry from the 250-300 I was used to seeing.  So, I cut back on my Tresiba.  My dose was 30 units and I am down to 14 units per day.  I also saw my doctor this past week, and he said that he was proud of me.  He said that with the way I am going, that I should be off of my medications (blood pressure meds included) within the next 6 months.

My most recent A1C was done last week and the results are in…..  Last year it was 12.8…  Last week, it was 5.2.  What a tremendous drop!  My cholesterol was a little high at 205 but all other numbers were fantastic.  I enjoyed a great checkup, a great prognosis, a resounding “I’m proud of you” and a “keep up the great work” from my doctor.  He said to keep doing what I am doing, it obviously works. So, I will keto on and continue this way of eating.  It has saved my life, one buttery delicious morsel at a time.
As nurses, we recognize that diabetes has always been considered a progressive condition that always worsens, but we are here to offer another perspective and a totally different outcome for Type 2 Diabetes.  While diabetes may remain on your medical chart as a permanent diagnosis, it IS possible to reverse the condition to a point where complications are minimized or completely eliminated. 

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Joining forces…

I’m currently working as a family nurse practitioner part-time in a family practice and part-time as a nursing professor. One of the physicians with whom I work is a certified lipidologist. He is a physician who specializes in the metabolism of fat. Two years ago, I had 40 pounds to lose. I had tried everything. Nothing worked. I decided to try the low-carb, high fat way of eating and lost all the weight and have kept it off. I found this plan is a very sustainable way of eating! I was warned by many of my medical colleagues that this “diet” was very unhealthy and would skyrocket my cholesterol. I found just the opposite! Two years later, I continue to eat this way, have maintained a healthy weight and my cholesterol readings are perfect.

I work with many who suffer from type II diabetes.

Cholesterol, diabetes, diet, Fat, gluten-free, Grain free, insulin resistant, keto, ketogenic, lifestyle, low carb, NAFLD, paleo, PCOS, Recipes

Grain-Free Fake Ziti

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After seeing an awesome segment on “Rachael”, I wanted to try making a low carb & grain-free Ziti. So I began with her simple recipe and tweaked it a bit.  Full of vitamins, nutrition, & healthy fats, it was an amazing dish to finish out the holidays with a bit of convenience and delicious twist of flavor.

KetoNurses Easy Fake-Ziti Recipe

2-3 tbsp olive oil or avocado oil

5-6 cloves of garlic (1 bulb is fine)

nutmeg, freshly ground (optional)

10-12 oz thawed, drained & chopped spinach (can use 1 lb.)

2 -3 medium-sized zuchinni, sliced thinly

16-24 oz full fat ricotta

16-24 oz grated parmagiano-reggiano

16 oz shredded fresh mozzarella

salt & pepper to taste

Start by turning oven on 350 degrees to preheat, & oil or butter your baking dish.   Heat 2 tbsp. oil in medium skillet over medium heat and stir in garlic.  Add drained spinach and break clumps of spinach up as you stir it into oil/garlic. Stir over medium heat for 1-2 minutes to heat thoroughly. Turn off heat.

Fold in the thinly sliced zucchini  & a bit of nutmeg. Salt & pepper to taste.   Fold in the ricotta & parm  & mix well.

Turn out into baking dish and cover with shredded/grated mozzarella. Bake smaller dish (8×8) for about 30 minutes; if using larger quantities, you will need a larger dish, approximately 9×13.  Larger pans will require longer cooking time.  I used the largest quantities & baked my ziti in a 9×13 pan, so baking time was about 45-50 minutes.  It is done when mozzarella begins to appear golden brown. Let stand out of oven for about 15 minutes prior to cutting & serving. It makes a great leftover dish later in the week or works well even as hor d’oeuvres when cut into small squares.

Options:  Brown a pound of fresh pork sausage or hamburger meat and add to mixture prior to baking. I did use ground beef in my version because my husband refused to eat it without some kind of meat.  LOL

This meal has it all! Loads of protein, iron, & vital nutrients for improving health can be found in the ingredients.  In addition, it’s a very filling meal, meaning you can eat smaller portions.  Served with a small green salad, it is a great meal for entertaining or even carrying to a pot-luck dinner.

Rachael recommended a nice white wine for accompanying her Ziti.  I’m not much of a wine chic, so I’ll take her word for it.

This Fake-Ziti is a very flexible base of ingredients & I hope to try a few other twists to it over the next few months!

I have really enjoyed learning to cook with zucchini as noodles in a wide variety of dishes; zuchinni makes a terrific substitute for grain-based noodles & contain significantly more nutrients than any processed noodle manufactured today.  Using “zoodles” as they are called, can also be a great way to get your kids to eat more veggies!

If you try our low carb Ziti, please share photos and let us know how you like it; find & follow our Facebook page – KetoNurses.

 

 

 

diet, low carb, paleo

Does God care if I’m overweight or unhealthy? Part 1 of 2

I believe God DOES care – a lot! And this is my story and how I learned this important truth.

Many years ago, I took part in a Bible study that focused on losing weight using several different techniques that did help me become thinner. One of the weekly studies focused on a Bible verse from Proverbs 23:
When you sit to dine with a ruler, note well what is before you, and put a knife to your throat if you are given to gluttony.

That verse struck me as quite harsh and shocking. I had never really thought about overeating or eating just to eat might be anything that bothered God or was sinful. I knew He’d set forth all sorts of dietary laws in the Pentateuch, but I never made a connection between HOW & WHAT He wanted us to eat.

So, this verse in Proverbs really rocked my world. I pondered and meditated on this verse for days. I never thought I might be a glutton! That realization was VERY hard to wrap my head around. I tried to rationalize my overeating, my emotional eating, my eating when I was bored. It seemed that everywhere I turned, I heard this verse in my head. I saw evidence that God did not want me to overeat. Various “accidents” happened; I dropped bites of food. I spilled soda. I was repeatedly shocked by the simple methods God used to decrease my food intake.

IMG_6275.JPGFor the past 10 years, I’ve continued to utilize many of the techniques I learned in that Bible study; I’ve even taught patients to use some of them. But I’ve rarely mentioned the verse that stirred such guilt & shame in my own spirit & emotions. I was afraid. I was guilty. I was ashamed. I was shocked. It was very hard for me to recognize that God wanted me to “cut my throat” if I was going to overeat. It sounded so very harsh then and still sounds harsh today. But in the years since I first studied the verse, I’ve begun to come to terms with what I believe God tried to set forth in this verse.

First of all, I know I’m not perfect. I still sometimes overeat or make an unhealthy choice. My goal is to help people see that God knows the desire of our human nature is selfishness – even in eating – and He does not want us to feel so guilty, fearful, or ashamed. He wants us to enjoy eating. He wants us to be joyful. He wants us to LIVE. In Deuteronomy 5, Moses wrote to the Israelites, saying ” Walk in obedience to all that the LORD your God has commanded you, so that you may live and prosper and prolong your days in the land that you will possess.” (NIV, v 33).

Do you see that God wants us to LIVE? Living is not surviving. Living is not becoming overweight, unhealthy or unhappy. Living is being able to overcome & be victorious. Living is joyful – even during trials & tribulations, we can have inner peace & joy when we pursue LIFE. God really does WANT us to live with this idea at the heart of our being; He wants our focus on Christ and His ways so that we can LIVE a long life. Proverbs 10:7 says, “The fear of the Lord prolongs life, but the years of the wicked will be short.” God isn’t saying that life will always be shortened as punishment, but may be a result of poor choices. Scripture is full of evidence of poor choices that resulted in serious consequences. God’s desire is NOT to punish us. His desire is to bless us – over & over again. He wants to give us long, healthy lives. When we make repeated bad choices, often those choices have their own consequences by laws of nature, science, chemistry, or physics. God is not going to override natural laws to save us from ourselves. Some of these consequences include illness and shortened life.

How can we obtain God’s favor and live long healthy lives? It’s easy. We seek His will, guidance & pursue a relationship with Him. We also go back in history to learn how people ate in the past. In Biblical days, many people lived to be well over 100 years old; Moses lived to 120. Joshua died at age 110. Noah lived 950 years. How? Why? Even if years were measured differently then (they weren’t much different), Noah lived a LONG, LONG time. How? Why? Can we adopt any of the habits or culture to help us today? I believe we can.

In Genesis, God gave the Garden of Eden & livestock of the land to Adam & Eve. He gave these to Adam & Eve for their own nourishment. He provided plants and animals for eating & satisfying our need for fuel & nutrients. He wanted us to enjoy eating and so He created a variety of tasty plants.

However, modern society has taken advantage of the earth & altered methods of planting, harvesting, & processing. Many of these methods have adulterated natural foods and removed nutritional value that God intended. One of the most common ways to improve nutrition state, is to cut out most or all of the processed, highly chemical-laden foods. Most processed and prepackaged food items have almost no nutritional value. Read nutrition labels, if you’re skeptical. Compare labels of white bread and whole grain bread, for example. There is very little difference in nutrient content. If whole grains are supposed to so much healthier for us, why is there no increased nutrient density?

Looking back over time, having bread at every meal every day was not common. Breads were difficult to have in large quantities because wheat and other grains have a long growing season & require a large amount of field to grow enough for use. With poor storage methods, grains were used seasonally, not daily. The only time in history that people ate bread daily is when God provided manna from Heaven to the children of Israel. He instructed them to gather it daily except for the Sabbath because it wouldn’t keep well. That manna provided plenty of nutrients because Scripture is clear – they ate manna daily for 40 years – and the people suffered no ill health effects. Other than this specified 40 years, humans have only had breads/grains seasonally. What did they eat the rest of the year? Meat. Meat is the only food source that has always been available.

Fruits & vegetables were only available seasonally. Very few plant products were easily stored for weeks or months on end. They did not use chemical preservatives to keep foods stable on a store shelf for months at a time. They used salt and fat to preserve foods. They built in-ground cellars where temps were cooler, but food was rarely stored for more than a few months.

In summary, God intends for us to LIVE long, healthy lives. How? First, realize that He has provided a way. Next, look to nature for most food sources. Avoid eating food-like items that man has conjured up in a chemistry lab or manufacturing plant. Look to the farm – the closer a food is to nature, the higher the nutrient content. Nutrient-dense foods are from the farm/garden. Foods with the most nutrition are meats, vegetables, & natural fats. Only consume fruits as occasional treats – fruits would only have been available seasonally, not year round. Substituting fruits for unhealthy highly processed carbs may seem like a good option, but remember they still convert to fructose & glucose, and too much can still cause ill health.

Finally, does God care if we are healthy or not? Of course He cares. He wants us to be healthy. He wants a full life for each of us. He’s designed a great way for us to be healthy and live a long time. Our next blog article will offer many tips to do just that!

diabetes, diet, gluten-free, Grain free, Guidelines, hormone, immune system, insulin, insulin resistant, keto, ketogenic, lifestyle, low carb, NAFLD, nurse, nurse practitioner, paleo, PCOS, steroid, supplement, vitamin

Fiber – Useful or Harmful?

Fiber has been encouraged for many years in the hopes that it would improve gastrointestinal motility, and many products have been sold advocating such use. Fiber has been recommended by all sorts of health care providers, including doctors, nurses, nutritionists and therapists. Is fiber truly helpful, though? Recent independent studies indicate fiber may be contributing to more symptoms and problems than it’s helping.  As a bulking agent, fiber is used to literally, fill up the space inside the large intestine. The large intestine cannot absorb fiber, nor break it down any further as it moves through the gut. Fiber that enters the colon will absorb excess water, swelling to its maximal capability, filling every space it can occupy. Over days and even weeks of regular fiber use, more fiber enters the large intestine and swells even more, gently pushing swollen fibers forward through the intestines. This action is very slow and can take 2-3 weeks in an average adult. The slow motility means that taking a fiber supplement today will not contribute to today’s bowel movement – not even tomorrow’s. It is the combination of these 2 factors that make us now question the benefits of fiber supplementation: swelling of the fiber and slow motility through the system. With fiber supplementation, many patients report worsening constipation, bloating, abdominal pain, weight gain, gas, cramping, shortness of breath, obstruction and even diarrhea within days of beginning a supplement. While the theoretical goal of fiber supplementation is to slowly clean out the large intestine, the mechanism by which this system actually occurs is problematic and poses some serious health consequences.

We’ve known for a long time now, that some people who consume a high fiber diet often develop diverticulosis – or enlarged pockets along the large intestine. What we have not known or understood is why/how the enlargement occurs, but I would venture to say with this new research data available, that the most likely causes of diverticulosis would be chronic constipation and/or possible high fiber supplement use. Allowing stool to move too slowly through the gut contributes to build-up of wastes, blocking adequate absorption, filling the pockets and getting “stuck” in them. Over time, these static wastes are pushed further and further into those pockets, forcing them to stretch out of shape and become enlarged, even though some stool continues to pass right on by that stuck stool. No symptoms are typically felt or noticed. This problem can create serious illness and severe complication in the form of diverticulitis and obstruction – both of which can be life-threatening.

Moving on to other nutritional aspects of fiber takes us into the nutritional info of foods. Counting carbohydrates is a common nutrition plan for lowering glucose and reversing many chronic conditions. Many low carb experts often instruct people to subtract fiber grams from total grams of carbohydrates, because the fiber is not absorbed or converted into glucose. For example, 1 cup of almonds contains approximately 20 grams of carbohydrates and 11 of them make up the fiber content; some low carbers will say that eating 1 cup of almonds actually only contains 9 grams of net carbs, and thus you only have to count the 9 grams in your calculation of carbs consumed. However, many people with diabetes find that they will have a rise in glucose above and beyond the 9 grams of carbs in that cup of almonds. Why? Some low carb experts suggest that some of the insoluble fiber can impact glucose in many people; in addition, normal gut flora include a variety of healthy bacteria that ARE able to break down some of that insoluble fiber, possibly resulting in glucose release into the GI tract/bloodstream. In addition, some of these insoluble fibers are used as artificial sweeteners, like mannitol, xylitol, & erythritol; manufacturers are catching on to the “net carb” craze and are beginning to produce and label many processed foods using these sugar alcohols. However, there are a couple of problems here; one problem is the elevated glucose with use of these products. The other problem is because these sugar alcohols are insoluble and not easily digestible, they often trigger abdominal cramping and diarrhea in patients, which alters normal gut flora, resulting in even more damage to the gastrointestinal tract and overall health.


Gut flora? Hey, what is that? Well, our intestines are lined with millions of microscopic bacteria that aid in intestinal lining protection, digestion, absorption, and immunity. In fact, some experts now believe that more than 90% of our immune system lies within our intestines. Nearly all of our bodies’ healthy bacteria are located within the intestines, and the job of these bacteria is to break down fiber that your body wasn’t able to break down. During this bacterial digestion of fiber, short-chain fatty acids, like butyrate, are formed and are used to help maintain a feeling of fullness for a long time and maintain the health of the lining of the intestines.

Once the normal balance of healthy bacteria is altered, digestion and absorption are impaired, the lining of the gut is damaged, and inflammation develops. Inflammation within the gut can trigger a wide variety of symptoms and health conditions, including diarrhea, irritable bowel syndrome, leaky gut syndrome, obesity, diabetes, Crohn’s and more. If altered gut flora is contributing to poor digestion, absorption, and diarrhea, how will the body obtain nutrients? How will the large intestine properly push wastes on through the system? If the short-chain fatty acids are no longer produced by the healthy gut bacteria, we get hungry again and again – we eat more often, and we’re more likely to eat nutrient-poor fake foods. If the specific short-chain fatty acid, butyrate, is not available for increasing energy production and for cell replication, damage to the lining of the intestines may be serious, resulting in a variety of illnesses including cancer. Combine all these factors and significant intestinal conditions develop or worsen and health is impaired.


So what does all of this information mean? In summary, it means that fiber may be useful for digestion, but not as added supplements, tablets, or pills; rather, the body much prefers natural forms of fiber – low carb vegetables and pre-biotic vegetables – but because of likely glycemic impact, fiber grams should always be counted on a low carb nutrition plan. The only way to know for sure if these insoluble fibers impact your glucose is test. Use a glucometer to check blood sugar prior to eating insoluble fiber. At 1 hour increments, re-check glucose levels and watch the trend over 4-6 hours.

Probiotics can be purchased over the counter and come in a variety of formulations; some come in single strains, while others come with a combination of healthy bacteria. Probiotic supplements contain active, live healthy bacteria, that are released during digestion to colonize the intestines. There are no specific recommendations or guidelines to take probiotics, although many people claim daily is optimal, while others say weekly is sufficient.

Another digestive aid is called a pre-biotic, certain vegetables or foods that actually serve as nutrition sources for the healthy bacteria within the gut. Pre-biotics include asparagus, sauerkraut, kefir, kumbucha, fresh garlic, leeks, and onions.

As mentioned previously, short chain fatty acids (SCFAs) are essential to our digestive system. While there are several SCFAs, butyrate is probably the most common and one of the most useful; butyrate is helpful at maintaining intestinal health and one of the best sources of butyrate is real butter.

What causes altered gut flora? Well, let’s start by taking a look at some causes. Smokers often have higher risks of GI conditions, including ulcers. Diabetes and the medicines used to treat it often cause terrible gut flora, especially metformin. Approximately 85% of people with reflux have been found to also have chronic constipation, and the medicines used to treat reflux significantly alter the pH and thus impair the ability of healthy bacteria to enjoy an optimal environment. Antibiotics are designed to kill off fast-growing bacteria, in order to treat infections, but the antibiotics have no idea that they are supposed to only kill the bacteria causing your sinus or skin infection; antibiotics are most commonly recognized for causing abdominal cramping and diarrhea – symptoms of gut flora imbalance. Simple little GI viruses or mild cases of food poisoning nearly completely empty the gut of healthy bacteria. As you can see, almost anything can alter the health of our intestinal tract.

So, what does all this mean? In general, it means that 1.) our guts may need some fiber in the form of non-starchy vegetables, 2.) healthy bacteria are necessary for optimal digestion, 3.) any GI upset can alter the normal gut flora,

causing a wide variety of GI symptoms, that alter health. 4.) Probiotics can be helpful at restoring normal gut flora, and a couple of weeks later, adding in prebiotics is often helpful at maintaining GI health.

One special note: recently, I’ve seen marketing of soil-based probiotics. I’d caution you to avoid using these probiotics, as humans weren’t meant to consume soil. Animals consume soil in small amounts when grazing and can use these types of bacteria in the gut, especially ruminants – like cows. But these probiotics can actually be harmful to humans.