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Why Won’t My Glucose Fall?

I get questions all the time about elevated glucose readings even after eating low carb for several weeks. This article will discuss more details about the physiology and glucose readings.

When beginning a low carb nutrition plan, it is important to monitor glucose readings before and after eating to understand exactly what is happening to the blood levels in response to food intake. To determine how to do this, see my previous article, “Do You Check Your Glucose?”

Many people who cut carbohydrates will notice that glucose levels actually increase after awakening – this effect is called dawn phenomenon and there are loads of adequate resources available for reading if you’ll simply Google the term; there isn’t a great need to go into detail here about it. Suffice it to say that the liver is simply trying to “help” you by secreting glucose out into the bloodstream when food intake is unavailable – such as during sleep. If you awaken and still do not eat for several hours, the liver will continue “helping” you out, secreting more and more stored glycogen, thinking that you “need” the glucose for energy.  This DP effect is also another reason I discourage fasting for the first 6 months on a ketogenic eating plan.

On our low carb way of eating – especially the first several months – the body may seem a bit “confused” about fuel source. The body is accustomed to using glucose for fuel, but with low carb eating the glucose intake becomes scarce, so the liver acts as a back-up system and releases stored glycogen in the form of glucose to help raise blood levels of the fuel.   Fat-adaptation is the term we use to describe how the body becomes accustomed to used fats for fuel and typically takes 4-6 weeks for most people.  However, it can take 2-3 months for some people to become completely fat-adapted.  Fat adaptation means that the body has learned to use ketones (simple fats, broken down into smallest useable components) for fuel.

Many people also report continued high glucose readings even with very low carb eating; this phenomenon is often difficult to understand. The first thing to remember, though, is that it took MANY YEARS of poor eating habits and very HIGH carbohydrate intake to get us to where we are.  We cannot expect to see perfect glucose readings the first week of low carb eating.  Yes, MANY people DO report significant drops in glucose, but not everyone fits into this category.  Think about a “bell curve” used in data collection.  An easy to understand example is test scores in a classroom.  If there are 100 students who take a math test, by far, the majority of students will have an average score; but there will be a very few students who ace it or score very high, and there will be a very few students to score very low.  This proportionate report is referred to as a “bell curve” as pictured below.

Bell-Curve
Standard Bell Curve

So, now that we understand how averages and the majority of people respond, understand that everyone fits on the bell curve SOMEWHERE. It can take many, many weeks to locate your particular placement on that curve.

What happens when glucose levels are falling but people report symptoms of low glucose? This phenomenon occurs because your body has become accustomed to elevated glucose levels and now perceives the high glucose as “normal” even though it truly is NOT.  People often report tremors, nervousness, shakiness, headaches, and even nausea when glucose is running 100-120. Consider, though, that the body had been experiencing glucose levels sometimes as high as 200 – 400 on a regular basis before LCHF eating.  To the liver and the brain, even a 150 can seem very low, when the body was used to a 400 most of the time.   When dropping glucose levels this drastically, many people will experience uncomfortable symptoms and think that the “correction” for this event is to consume some carbohydrates, sugars, or other unhealthy foods/drinks.  Keep in mind, that it is NEVER a good idea to treat a NORMAL glucose level – NEVER.  Treating a normal glucose level with sugar/carbs will only raise glucose even more, resulting in more effort to get it lower.

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Health care providers around the world recognize that the biggest threat to people with diabetes is hypoglycemia – low blood sugars.  We never medicate a LOW and we never medicate NORMAL glucose whether with food or medication.  THE ONLY EXCEPTION is if you take SPECIFIC glucose-lowering drugs (NOT metformin) and have symptoms of a low glucose, you might need to consume a GLUCOSE TABLET, specifically for treating a low.  We never recommend chasing lows with sugary food items.  Always use a specified amount of glucose so that you will KNOW exactly how glucose will respond.  You MUST work with a KNOWLEDGEABLE provider to help you lower medications appropriately when first beginning a low carb nutrition plan.  If you cannot locate one, you should contact a health coach with medication knowledge, like KetoNurses, to provide you with adequate information to make YOUR OWN CHOICES, to provide for your own safety.

caution sign
GET MEDICAL ADVICE for YOUR specific situation

Be consistent and persistent with your low carb intake. Keep carb intake to 6-7 grams PER MEAL; do not “save up” carbs for a “splurge” because this technique can contribute to even more erratic glucose levels.  The real goal is to have almost no rise or fall in glucose levels.  Glucose readings should be maintained at a fairly stable level all the time, even after eating.  I teach my clients that if glucose level increases more than 10 points with eating, there were probably too many carbs in that meal. How do you figure that out?  By measuring foods.  Most of us measure foods BEFORE cooking, and most nutritional data is listed before cooking, but ALWAYS read nutritional info carefully. Vegetables are measured by volume – in a measuring cup, not by weight on a scale.  Imagine weighing 4 ounces of spinach! LOL It would be a HUGE amount of spinach, likely more than a person could consume in a whole day.  However, meat is measured by weight; a kitchen scale can be a very important tool in your low carb journey.  Most of us have a terrible, preconceived notion of what a 4-ounce piece of steak looks like.  We are accustomed to restaurant portions, which are often massively oversized.  Also, keep in mind that during the first 4-6 weeks of low carb eating, we do NOT encourage portion control.  Our major focus during this initial phase of lifestyle change is learning WHAT to eat and how to cook with real fat. We really want people to learn this new way of cooking and eating without undue stress; eat when physically hungry and learn to determine first signs of fullness.  Learning how the body works is also a really important task in improving your health.

After you have mastered what to eat and how to cook with healthy fats, it is then time to cut portions back. Start by calculating your personalized macro goals; we base protein needs on AVERAGE IDEAL BODY weight – NOT current weight, and NOT on some randomly chosen arbitrary goal weight.  Used by experts and medical providers for over 100 years, basal protein needs are calculated this way; this method is still taught in nursing, medical, and nutrition programs today.  Again, this AVERAGE ideal body weight is based on a “bell curve” and many people will NOT fit the average. There will be some people with weights all along the spectrum that we call “normal.”  However, we base protein needs on this AVERAGE, since MOST of us will fit in with the majority; after some time on LCHF eating, the body will “find” its own healthy weight – so using this IBW chart to determine goal weight is UNNCESSARY.  See my previous blog article, “Do the Math” for more details on macro calculations.

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Another major concept to utilize when beginning a low carb nutrition plan also includes relearning how to respond to “head” hunger, or “habit” hunger. Many of us eat to a schedule on a high carb intake; this habit occurs because of the natural and rapid rise and fall of glucose levels on standard high carb intake.  If you have not watched my video, “What Happens to All That Glucose?” now might be a good time to locate it on the KetoNurses Facebook page. When we were consuming many carbs – every 2 hours, typically – our bodies became used to the frequent intake.  It is sometimes quite difficult to overcome this bad habit.  Our bodies were designed to go many hours without food intake, but current dietary advice runs amuck with recommendations to “graze” or eat every 2-3 hours.  The frequent intake has trained our brains to prepare for food; our mouths water with anticipation of food, and often we even experience tummy growls.   However, true physiological hunger occurs when glucose levels are approximately 70 – again, remember the “bell curve” because many people will experience true hunger well away from 70ish.  Another phenomenon that occurs in many people with out-of-control diabetes and severe insulin resistance is “near constant hunger.”  Near-constant-hunger will often occur when glucose levels are 200+ simply because the glucose cannot move into cells, so the brain mistakenly believes the person is hungry and needs fuel.

glucose fluctuations
Avoid these glucose fluctuations

In addition, medications can significantly affect your glucose levels, including those NOT prescribed for diabetes. Blood pressure drugs, cholesterol medicines, steroids, and many others will contribute to elevated glucose levels.  Insulin users often find that they have very erratic glucose levels when beginning a low carb eating plan. It is very important to research your specific medications and learn exactly how they work and what side effects you can expect.  Knowing this information will help you feel much more confident in eating low carb and learning how your body responds.

A major factor to also keep in mind is that it takes TIME for the body to heal. It takes TIME for glucose levels to normalize.  It takes TIME for the liver to release all the excess stored glycogen.  It takes TIME for the body to become less dependent on medications.  It takes TIME for our brains to learn to respond appropriately to TRUE hunger.  There is no “magic cure” for the inadequate, high carb, nutrient-poor intake we have endured for many years.

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The real “magic cure” is in consistent and persistent low carb intake, with adequate fat and protein intake. Provide highly nutritious “close to the farm” intake for the body.  The quality nutrition found in real food will provide your body with many nutrients you have been missing, but time for healing will still be required.  Anytime you accidentally consume too many carbs during the first 4-6 weeks will impact your body’s healing process, raising glucose and slowing healing and fat-adaptation.

It is not vital to consume “organic” or grass-fed. While some of these foods do provide slightly higher nutritional value, some people just cannot afford them. 

organicquestion

Choose the best products you can afford and do NOT feel guilty or shamed by anyone for your choices; these feelings can quickly contribute to stress, which in-turn will raise glucose.

There are so many other factors that raise glucose: pain, emotional stress, physical illness, worry, changing a schedule, parenthood struggles, financial stress, and nearly any other life event. Be aware of these impacts on life, mentality, and physical health.   Solve the ones you can, and give NO time or effort to those you cannot change because the additional stress will only compound the stress and impact to glucose levels.  Be aware of your body’s signals.  Learn to recognize symptoms that require management.  Learn to listen to your body; recognize your body’s needs and respond. Finally, if you need help, ASK for it!

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Do you check your glucose?

For any of you who have never checked your glucose, maybe it’s worth a try. It is truly the only way to know how food directly impacts glucose.

Use a glucometer to check and monitor your glucose level. They can be purchased over the counter. For inexpensive ones, ask your local pharmacy about the least expensive to use over time. I believe Walmart has one that is fairly inexpensive; it’s the Relion meter.

I recommend testing first thing in the morning, and then after meals to determine how food impacted your glucose. Standard post-meal testing is at 2 hours. Some people, however are not textbook. I usually recommend testing after several different meals over a few different days every 30 minutes after eating to determine your personal peak… once you determine this time frame, you’ll only need to test before and after once. No need to test every single meal at first if you’re worried about costs of testing OR running out of fingers. 😉

But pick a few meals at different times of day. If costs are a factor in buying strips, it’s really important to test before and after different meals — example: test before and after breakfast on Mon, Wed, & Saturday for 2 weeks, before & after lunch on Tue, Thurs, & Fri for 1 week, and supper on Sunday, Tues, Thurs, Sun, for the 2nd week.

Once you’ve determined your personal glucose peak, you can then limit testing to before meals and around your peak.

To determine the impact of certain food on glucose level, test before and after at your personalized peak. Ideally, the readings should not be very different, but readings are allowed to be about 10 numbers diff.

Example: pre-meal is 97; post-meal highest should be about 107 for optimal glucose control.

Even non-diabetics can use meters and learn for themselves how food impacts glucose.

This is where we get the phrase, “eat to your meter.”

This photo COURTESY of the Facebook group, Type 2 Diabetes Straight Talk.

Testing glucose is the absolute best method for determining how foods impact your glucose. Knowing how food will affect glucose levels is very important for people on a low carb diet, especially those who take medicines to lower glucose directly. If glucose goes up more than 10 points, it’s probably not a good idea to continue eating that food.

If you’d like help learning to eat to your meter or learning how to eat low carb high fat to reduce the impact of disease on the body, please email me at ketonurses@gmail.com for more information.

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Metformin – The Good, The Bad, & the Useful

Many people with diabetes, gestational diabetes, insulin resistance, polycystic ovarian syndrome (PCOS), and/or metabolic syndrome (MetS) are taking metformin, a drug that has been around for about 60 years. It is one of the oldest and safest medications used in the management of diabetes. Most people who take this medicine believe that it lowers glucose in the blood, but that is not how it works.  Metformin works in 3 major ways, and these processes result in a lower glucose through INDIRECT means.  Insulin and some other diabetes medications DO directly lower glucose in the blood, but metformin is not one of these types of drugs.  Let’s discuss how metformin works and how it benefits people who take it.

metformin pic for met articleMetformin is classified as a “biguanide” drug and is prescribed for a range of metabolic disorders as mentioned above; it is the preferred medicine and is considered the first line therapy for these conditions. It works to reduce the amount of glucose produced in the liver; it also reduces the amount of glucose absorbed through the intestines, and it improves insulin sensitivity by increasing peripheral glucose uptake and utilization. These physiological and chemical reactions occur at the cellular level, but are very effective at improving glucose and insulin utilization.

The action of metformin within the intestines is the cause of the most common side effect, diarrhea and sometimes abdominal cramping. As metformin is absorbed in the small intestine and enters the bloodstream, its direct impact is seen, almost immediately in some people. Metformin acts to stop absorption of excess glucose and this increased glucose within the small intestine exerts a laxative effect, resulting in diarrhea and belly cramps. This side effect occurs in about 50-55% of people who take metformin, and is the reason that many prescribers will titrate (increase) the dosing over many weeks. Most people can adapt to the use of metformin with a slow and gradual increase in dosing, but others seem to have issues no matter how low and slow the dosing is. Also note that it can take up to 3 weeks for enough metformin to actually lower glucose levels; because its major action is within the liver, one dose is not likely to demonstrate any impact on your bloodstream today.GI tract for met article

Gastrointestinal side effects like diarrhea and belly cramping are usually easy to overcome with very slow and gradual dose increases; I have seen prescribers use a variety of schedules and dosing recommendations. Some work for some people, while others do not. My suggestion is this: if you have GI symptoms related to your metformin use, ask your prescriber about a slower titration schedule. I often work with clients who increase dosing over 6-8 weeks for optimal results with minimal side effects. Other tips that can be helpful:

  • Eat with metformin dosing, no more than 5 minutes between food & medicine
  • Take metformin IN BETWEEN bites of food at a meal
  • Take metformin near bedtime with supper or small snack
  • Some people find a multi-strain probiotic helpful
  • Avoid using MCT or coconut oil within 2 hours of metformin dosing
  • Ask pharmacy about switching brands of metformin
  • Ask prescriber for extended release formula as these offer less impact on the gut

In addition, taking metformin can lead to a RARE and very dangerous side effect called lactic acidosis. In my 10 years as a prescriber, and after having hundreds and hundreds of patients on this medication, I have only seen lactic acidosis begin in one patient; I immediately stopped the metformin, and retested the Complete Metabolic Panel (CMP) which came back normal. Lactic acidosis is an accumulation of excessive acid due to a problem with the body’s metabolism of lactic acid, induced by certain medications or the body’s response to a medication; lactic acidosis is more likely to occur in people with impaired kidney function. It is the major reason that prescribers are encouraged to perform lab tests, like a CMP before and after starting metformin. Lactic acidosis cannot be overcome or treated with gradual dosing increase; in this particular instance, metformin is listed as an allergy on a patient’s chart and never prescribed this medication ever again. Lactic acidosis can be fatal; however, please note that this side effect is extremely rare. (FYI: Lactic acidosis is NOT the same as ketoacidosis.)

kidney image for met article
Kidneys

 

In addition to GI side effects & lactic acidosis, metformin may also contribute to kidney stress; it is sometimes very difficult to determine if the diabetes itself is causing the kidney disease, or if it is the medication. When this confusion occurs, many mainstream medical providers will stop the metformin and perform a trial of other medications to see if kidney function improves. This method sometimes works, but sometimes it does not help. Using our low carb nutrition plan will significantly lower glucose and reduce the stress on the kidneys, often reversing diabetes and kidney disease. Even if metformin contributes to mild kidney stress, it is often continued because of the risk/benefit consideration: metformin MIGHT be contributing to kidney stress, but we KNOW elevated glucose causes kidney stress and ultimately kidney failure; it is why so many patients with diabetes end up on dialysis. So, even if your kidneys begin showing signs of injury, it is often seen as a beneficial medication. Some providers will often suggest a lower dose or less frequent dosing regimen; talk to your provider to share your specific concerns and ask questions about your specific health condition. Kidney stress from the disease AND the meds can be a great reason to keep your lab tests up to date; always ask about your GFR, BUN and creatinine levels so you can be an informed patient.

Recently, experts have begun to warn about the risks of vitamin B12 levels falling due to metformin use. While it is a risk, there is currently no organization or expert that has released guidelines or recommendations for monitoring B12 levels in patients who take metformin. So, this responsibility rests with each individual patient. One of the earliest signs of B12 deficiency is fatigue, and so it’s usually easy to justify the lab test for insurer; the main reason providers won’t order extra tests is insurance regulation. Another obstacle is that by the time the B12 level has fallen below normal, the patient often has more problems that have developed. Some low carb experts are beginning to start their patients on a good quality B complex vitamin, no matter the blood level. If you have seen any of my videos or read my blog articles, you’ll know that I typically recommend a methylcobalamin for the active B12 ingredient, instead of the more-common cyancobalamin. Also note that B12 is poorly absorbed and utilized when taken alone; it needs multiple co-factors, like B3, B6, & folic acid for optimal absorption and use, thus the reason most low carb experts recommend a B complex vitamin, instead of the single B12.

As you can see, pharmacology is a complex science, especially in the context of abnormal metabolism, such as what occurs with metabolic disorders like diabetes and insulin resistance. While I do understand that learning all this information can seem daunting and overwhelming, it is VITAL for each person taking medicines to learn all you can about the medicine and its impact on your body.

What about metformin and other medicines? I strongly encourage you to use a reputable website to look for drug-drug interactions, specifically between metformin and other medicines. I will discuss only a handful of issues here. First of all, we KNOW that metformin ALONE does NOT contribute to abnormally low glucose levels – remember, it works in the LIVER and the GI tract, not in the bloodstream. However, certain combinations of anti-diabetes medicines CAN change the impact on blood glucose. For example, we know that insulin is used specifically to directly lower glucose in the blood; when combined with metformin, metformin IMPROVES insulin sensitivity and because of this action, metformin CAN cause a lower glucose than taking insulin ALONE. Read this sentence again:

When combined with metformin, metformin IMPROVES insulin sensitivity and because of this action, metformin CAN cause a lower glucose than taking insulin ALONE. Other anti-diabetes medications can also interact with metformin, resulting in this “synergistic” effect – drastically lowering glucose to unsafe levels.A1c chart for met article

Keep in mind that the lab reference range for glucose is 60 -100 mg/dL (3.3 – 5.5 mmol/L). These levels are considered NORMAL glucose readings without addition of medication. We prefer for fasting glucose levels to be less than/around 85mg/dL (4.7 mmol/L), because numbers lower than 85 (4.7) tend to show us that insulin and glucose are working more appropriately than when numbers are higher. When patients begin taking anti-diabetes medications, glucose often falls quickly, resulting in feelings of hypoglycemia – even when glucose levels are within this 60-100 (3.3-5.5) range. This phenomenon occurs because the liver and the body have become accustomed to your higher/abnormal glucose readings. All anti-diabetes drugs, including metformin, can contribute to these feelings of low glucose. It is imperative that you check glucose when experiencing these symptoms so that you know the appropriate action to take. If your glucose level is NORMAL, 60-100 (3.3 – 5.5), and you are only taking metformin, the only action that may be needed is to have your normal meal. If you are shaky, nervous, trembling, and have a headache, check your glucose, PRIOR to deciding to treat a “low glucose.” If these symptoms occur in the presence of NO medication (or metformin ONLY) AND normal glucose levels, most low carb experts recommend having your usual low carb meal or some salty broth and waiting for these symptoms to subside. Once the liver and the brain learn to respond more appropriately to your new low carb lifestyle, these symptoms disappear.

If you experience these symptoms while taking medication that DIRECTLY lowers glucose, always check glucose level and treat accordingly with glucose tablets. Keep in mind that 1 gram of glucose will raise glucose about 5 points, give or take; it is no longer accepted practice to consume candy bars, soda or sugared orange juice to raise glucose because these items cause such a wide variety of responses based on the amount and speed consumed. If these food items are consumed in response to a low glucose level, the body’s response can become a terrible day of fighting high glucose levels, interfering with normal physiological responses as well as an emotional & tiring rollercoaster for the remainder of your day. If you take glucose-lowering medication, it is advisable to purchase glucose tabs at the pharmacy and keep them with you and easily accessible all the time.

The maximum dose of metformin that is approved by the FDA for use in the US is 2500 mg daily, and it is usually in divided doses. Some prescribers will “max out” the dose and write the prescription something like this: metformin 500 mg tabs: take 2 tabs morning and night, and 1 tab at lunch. Other prescribers simply write for 1000 mg twice daily. Many prescribers will start metformin at 500 mg, planning to increase dose over time to help minimize GI side effects; sometimes the providers forget to go back and increase the dose. If you have been taking the minimally effective dose of 500 mg daily for a long time, it may be a good idea to ask your medical provider about a possible increase.

Because metformin does NOT directly lower glucose and its major impact on health is improving insulin sensitivity, most low carb providers will not lower metformin dose or stop prescribing metformin when your hemoglobin A1c or your glucose fall into more normal ranges. We typically continue this particular medication, even when glucose numbers are more normal, because of metformin’s significant impact on improving insulin sensitivity; metformin is helping your liver learn to metabolize glucose much more efficiently. Why would you suddenly want to stop teaching your liver about your new way of eating? Some providers may lower the dose, but continue some metformin; some will want to stop it because they may not understand its direct action does not occur in the blood. Most low carb providers that understand the actions of metformin typically continue this medicine until the A1c remains around 5 for 6 months to a year. When metformin doses are lowered or the medicine is stopped completely, it can take 2-3 weeks before you see any change in glucose levels; glucose levels usually do increase when meds are lowered or stopped, but be aware that the method and action of metformin cause a much slower response than say insulin or sulfonylureas.

Other medicines are often stopped or significantly lowered immediately upon beginning low carb eating; it is VITAL that your provider be kept “in the loop” with regards to your glucose levels, medications, and low carb eating. Most of them have NO idea that our way of eating AND your glucose-lowering meds will put your very life at risk if medications are continued at high doses, typically used to treat very high glucose levels caused by VERY high carbohydrate intake. Call the provider’s office every single day if needed. Fax glucose records to them daily. Ask specifically about medications BY NAME when your glucose is within normal range. And keep in mind this one fact: we do NOT treat NORMAL glucose levels. Even prescribers get busy and overlook medication action sometimes. Be very specific with your questions. Example questions:

  • Should I keep taking 80 units of Lantus daily with my glucose level at 96 (5.3)?
  • Is it dangerous to keep taking my 3 meds (name all 3) with a glucose level of 104 (5.7)?
  • I’m taking metformin and (name other med) and my glucose today is now 100 (5.5); what should I do?

As with any health problem or medication, ALWAYS consult your health care provider for more specific information. This blog article is provided for information only and should NOT be taken as medical advice. Your health care provider knows the most about you and your health, but most of them know very little about low carb nutrition. You may have to help them understand that you are eating healthy meat, fats, and veggies, and only skipping non-nutritious calories that raise your glucose. You may have to present them with logs and records of your glucose levels for them to believe you. You may have to help teach them the simple science of low carb nutrition and its impact on your glucose levels. You may ultimately have to make some of your OWN decisions if you believe your safety is at risk. BUT always keep your provider aware of what is happening.

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Keto Shepherd’s Pie

1-1.5 lbs of ground beef

1/2 chopped onion

5-6 chopped, small sweet peppers

3 tsp minced garlic

Allspice

Salt & pepper to taste

1.5 cups leftover cauli-mash

1 can string beans

1/2 – 2/3 cup grated cheeses of choice

Preheat oven to 350.

Brown ground beef in skillet. Sprinkle lightly with allspice once all meat is thoroughly cooked. Stir in chopped onions & peppers and cover. Stir a couple times to ensure veggies cook until just soft.

Once veggies are done, pour meat & veggies into small casserole dish, approx 6×9 or 8×8. Cover evenly with sprinkled cheeses.

Heat leftover cauli-mash in skillet or microwave while stir-frying green beans in the skillet you just poured meat from. Salt and pepper to taste, stirring a couple of times. Heat for about 5-6 minutes. Spread the warmed cauliflower-mash over meat mixture & cheese. Then top with green beans. I usually pat them down just a bit with a flat spatula.

Bake on 350 for about 25 minutes, or just until edges of cauliflower mash begins to brown.

Serve!

Uncategorized

Avocado Fries

Avocado Fries

Avocados

Butter

Melt 2 tbsp butter in skillet over medium heat.

Halve avocados and remove pit. Slice each half into 4 slices. Place in skillet. Allow to brown and then turn each piece.

Allow to brown. Turn heat off and remove from skillet. Serve.

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Keto Cauli-Taters

1 head of cauliflower, cut into florets

1/2 stick of butter, softened

3-4 ounces of cream cheese

1 cup grated white cheddar

1 tsp garlic powder

1/4 cup (or less) heavy cream ( optional)

Salt & pepper to taste

Preheat oven to 350 degrees, and grease or butter casserole dish.

Place chopped cauliflower into microwaveable bowl, cover & microwave on high for 6-9 minutes or until all florets are cooked though and softening. (You could steam if you prefer, but drain all water used.)

Add cauliflower, butter, & cream cheese to mixing bowl and mix well. (Sometimes, I throw some of the florets into the blender to get pieces even smaller. I do this before adding the butter and cream cheese.)

I only use the heavy cream when above mixture seems just a bit thick. Sometimes, I use it. Sometimes I skip the heavy cream. I think it depends on how much water is in each head of cauliflower. I don’t like runny taters, but I also don’t want them thick and pasty either. 😂

Add salt, garlic & pepper to taste. Stir in cheddar. Pour into the casserole dish and bake at 350 for about 20-25 minutes. During last 2-3 minutes, you can add a bit more grated cheddar or Parmesan cheese and finish baking.

<<
her options for finishing your taters include topping with chopped onions, bacon crumbs or even grilled chicken bits. You can also serve with a piece of avocado or dollop of sour cream.

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Reversing Dementia IS Possible

This is the story of a friend who wishes to remain anonymous. His words. His experiences. And they are amazing!

“I joined this group (a FB group) to help my mother who is 69 years old, has had type 2 diabetes for about twenty years now and has developed many complications although none of them are quite life threatening YET. She also has Alzheimer’s which makes it very difficult. She had followed the ADA guidelines yet she got progressively worse and now needs insulin. With her Alzheimer’s the doctor put her on a pump. Either one of my sisters, myself, or a visiting nurse checks on her twice a day to make sure she is under control. Recently one of my sisters or myself have been staying with her. She will go to the kitchen and eat huge bowls of cereal with skim milk or anything sweet or carby that is in the refrigerator so her levels have sky rocketed. My sisters have said its okay.

About a year ago I noticed a woman at my gym who I see periodically and has been losing a lot of weight. Then a few months ago I overheard her talking to some other people about her keto diet. I finally talked to her and she told me about her diabetes, she told me about this group, and she suggested ways to get my mother on it but my sisters did not agree at all and it has created a lot of fighting with them. I will admit that they do much more of her monitoring then I do but about three weeks ago I convinced them to take a break and I have been living with her 24/7. I know this woman Karen at the gym is not a health care professional but I hired her to come to the house to help get rid of the foods that are not on the diet and to stock the refrigerator with good foods. I was very afraid that my mother would start complaining about what I fed her especially because she was always complaining that we were trying to starve her even though she’s over a hundred pounds overweight and was eating three or four meals a day plus snacks. I should add that she has neuropathy and because of her Alzheimer’s she forgets to use her walker and so she also falls.

Karen went way beyond the time I paid her for and cooked some meals and visited with my mother. We never told her that we were changing her diet. After a few days she stopped complaining about being hungry even though she was already eating a lot less. Her blood sugar used to be from 60 to 350 and sometimes over 400. Now it has never gone above 172 and is usually under 140.

I cannot believe it in three weeks. She has also lost 18 pounds and is not falling. The biggest surprise to me is that she is not as confused and her memory is so much better that I can not believe it.

My sisters had been out of town but they came back and saw my mother one yesterday and the other two days ago. I showed them her insulin use which is less than half what it has been and her blood sugar levels. But they both cried when my mother started asking them questions about their trips and acted like a completely different person. She remembered their names and when my one sister said she was visiting her son my mother asked what college he was in. Well, she used to ask when he was going to graduate from high school. When my mother told her it was Lehigh she apologized and said oh yes, I’m sorry I forgot what is he studying? She said engineering and my mother was happy and said oh, just like his grandfather he would have been so proud.

We both cried again because my mother used to ask where he was and why he hasn’t come home yet. The other sister has a house down the shore and my mother asked her if that is where she was on her vacation. She never once yelled at them for not visiting her which she used to do even when they would come every day. And she is remembering to use her walker every single time now so she is not falling.

My sisters are now onboard. I have invited one to the group and the other promises to follow whatever I say. We have not seen her doctor yet but she has an appointment in a few weeks.

I have also been eating this way because that is what I have been feeding her and even though I don’t have diabetes I feel a hole lot better.

I want to thank everyone in this group. I have not said anything before because I’m not like that but I had to speak up now and thank every one. I also have to thank Karen V. for introducing me to this. She never asked for money but I had to pay her for some of her time. I’m sure she would have come out for free because she is so into this diet and promotes it at the gym all the time. I honestly thought at first that she must be selling something but I was surprised that no one here is selling anything accept getting healthy.

And one more thing. My mother has stopped asking for more of her Cinnamon Toast Crunch cereal or hot chocolate and now asks for more of the yummy bullet proof coffee which I sometimes make with tea instead.”

—Anonymous