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Top 10 Advanced Keto Secrets

Recently, I’ve answered a variety of questions about ketogenic eating and thought I might address some of them here in one blog article.

  1. One of the most common issues I’m asked to address is the impact of exercise on glucose.  The answer for each person is different, because each of us is unique, and our bodies are responding to the internal chemistry in THAT specific moment.  Some people see a significant elevation in glucose during or after exercise, while others see a big drop; others, of course, see little change at all.  Which effect is the “NORMAL” response by the body?  All of the above.  Exercise is a physical stressor and can increase cortisol and adrenaline in some people; on the other hand, exercise can burn glucose for fuel and/or be very relaxing for others, resulting in lower glucose impact.  Typically, I encourage exercise for general health’s sake, but NOT for glucose control or weight loss.  Many studies over the years have shown very little OVERALL impact on glucose levels or weight loss from exercise, even though exercise is great for toning, stamina and endurance – all of which can improve general health and well-being.  When just beginning a low carb eating plan, I usually discourage a lot of exercise; changing the dietary intake is a chemical stressor, and the body can take 3-6 months to fully adapt to efficient fat-burning.  During this short-term transition, exercise may contribute to additional stress on the body, internally, resulting in chemical imbalances that trigger cortisol release as well as glycogen storage release from the liver.  Muscles may also release stored glycogen, adding to the elevated blood sugar levels.  Other low carbers may see lower blood sugar levels because of the use of the glucose for fuel; previously, we thought only glucose could be used for exercise.  That idea is where the concept of “carbing up” before and during exercise originated.  However, we now know that fats can fuel exercise too, but is most efficient AFTER the body has adapted to burning ketones.  So, what is the bottom line?  Every person responds differently to exercise; adjust YOUR daily lifestyle based on glucometer readings.  Avoid stressing the body with exercise if it raises glucose during the transition to ketogenic eating.  Return to exercising after glucose levels stabilize; sometimes a short walk, or some mild yoga, pilates, or Tai Chi can be used as exercise, with minimal glucose impact. Patience is the key, no matter what impact exercise has on glucose readings; on a low carb way of eating, exercising or not, glucose will stabilize.
  2. Another common question I hear often is about electrolytes and supplementation.  I do have a lengthy Facebook Live video on my KetoNurses Facebook page where I discuss this information in detail and answer many viewer questions, but I will try to address the issue here in a quick and short explanation.  Typically, a ketogenic way of eating provides MANY more nutrients than our Standard American Diet did; so for many of us, there are not a lot of supplements needed.  However, we’ve been VERY deficient in many nutrients for so long that a sudden dietary change can make that deficiency more apparent; for others, adding certain supplements just seems natural after reading and watching internet “experts” on ketogenic eating.  However, most of them are just trying to sell their products.   As a general rule, Vitamin D is a necessary supplement for most because we do not get nearly enough sun exposure anymore; we cover up, we apply sunscreen, and we avoid going out nearly nude around noontime.  Unless living near the equator and sunning nearly nude at noon, there’s no way to obtain adequate Vitamin D from sunshine; I have an entire blog article related to more info on Vitamin D if you’d like to read it.  Link is here:  https://ketonurses.wordpress.com/2017/06/14/what-is-vitamin-d-why-do-i-need-it/   In addition, people often begin supplementing magnesium for a variety of reasons, including the need to improve absorption of Vitamin D.  Again, more on this use of magnesium for this purpose in addressed in the article above.  Other reasons to supplement magnesium is the vast array of bodily functions that rely on magnesium; it’s required for over 300 chemical processes, including those related to food digestion, nervous system function, brain health, and protein production/use.  There are a myriad of types of magnesium products and some are combinations of a variety of types.  All magnesium types help with all processes, but most types have a “best” benefit, as described in this graphic.

mag uses

3.  Other supplement questions I get often concern B vitamins, CoQ10, ALA, cinnamon, chromium, zinc, and berberine. I do often recommend B vitamins, but a very specific type of B, not the usual ones that contain cyanocobalamin as the active Vitamin B12.    Cyanocobalamin is the most common and one of the least expensive forms of B12, but it’s estimated that about half of us cannot break the cyanide molecule away from the cobalamin molecule.  If not separated, these chemicals remain bound and completely unusable by our bodies, resulting in poor absorption of Vitamin B12.    Usually, I recommend B complex vitamins that contain methylcobalamin and a calcium-methylfolate for most people because using this form is adequate for the majority of people, will not harm people that CAN utilize cyanocobalamin, and is readily available in many supplements.  These people often have a gene mutation that prevents normal absorption and utilization of B12, which is essential to many body processes and functions.   Often seen as MTHFR, the mutation impacts the production of methylenetetrahydrofolate reductase, and when this enzyme is absent, methylation cannot occur properly.  What is methylation? Methylation is a necessary metabolic process that repairs DNA, turns genes on and off, and is used to separate a variety of chemical compounds into smaller and more absorbable nutrients.  Some people have NO symptoms or problems when they have the MTHFR gene; others have severe symptoms and health conditions.  And some health professionals/organizations recognize MTHFR very differently.  In addition, there are a few people who cannot even absorb or utilize the methyl form of Vitamin B12; these people often have to use a prescription form of hydroxycobalamin.  For more info about B12, this video is a good source:   https://m.youtube.com/watch?v=BvEizypoyO0

Other supplements are mostly personal choice and may be helpful for some people, but a more specific health history is needed to make that call; I do schedule phone consults to help people sort through these specifics.  I never recommend shakes, programs, or other expensive keto-based products to my clients; I try to keep recommendations to a minimum, keeping costs and convenience in mind as well.  As for berberine, I have written an article about its use as well; it compares nicely to metformin and as such, should NEVER be taken WITH metformin.  Choose.  My article on berberine can be found here:   https://ketonurses.com/2018/08/berberine-worth-it-or-just-a-mythical-unicorn/

Another supplement issue that sometimes comes up is related to blood thinners. Many people with diabetes also have atrial fibrillation, clot history, or other need for anti-coagulation therapy.  It is important that you are aware that MANY supplements and medications can act as a “blood thinner” when taken regularly.  It is VITAL that you share this information with your prescriber so that adequate adjustments can be made in your treatment plan BY YOUR PRESCRIBER.  Many health care providers are NOT aware of side effects of many OTC supplements; they often are not even aware of supplement action or purpose; they almost certainly are unaware of potential side effects.  If you are in doubt or are concerned, use drugs.com, rxlist.com, or epocrates.com to research your meds/supplements.  Aspirin is often recommended/prescribed for those with history of heart attack, certain strokes, many types of clots, or as prevention of such problems.  Aspirin prevents the “clumping together” of blood cell components; it does NOT directly “thin” blood, although that is what we call its action. In addition, NSAIDs, like ibuprofen, naproxen, indomethacin, and meloxicam also list bleeding as a side effect.   It is important to notify your prescriber o of any additional supplements if you are taking aspirin, NSAIDs,  or any blood thinning medication.  Fish oil, in high doses – over 2000 mg per day – can be a significant anti-coagulant; turmeric also labeled as curcumin acts as and anti-inflammatory agent and may contribute to bleeding too.  Vitamin C may also “thin blood” and so should be taken with caution if on any of these other agents.

Many folks also ask about using protein shakes, supplements, or ketone supplements. As a general rule, these are unnecessary and pricey.  There are a very few patients with very specific conditions that can benefit from these products, but again, a phone consult to thoroughly discuss your specific medical history and medication use are vital.  It’s extremely important to develop a patient-client relationship with a medical provider or health coach who is knowledgeable about medications and lab results; do NOT rely on social media and “friends” to help you decipher life-impacting medical treatment.

Another common concern is a bit more complex; it’s about the “cause” of our diabetes; most of the people who follow my blog, Twitter, IG, and Facebook page have type 2 diabetes, Polycystic Ovarian Syndrome (PCOS), insulin resistance, obesity, elevated cholesterol/triglycerides, or some combination, often referred to as metabolic syndrome. While we did it to ourselves, we did NOT cause the problem.  We were following dietary advice provided by medical practitioners, nutritionists, and all sorts of agencies that TOLD us how to eat “healthy.”  Nina Tiecholz has written extensively about how we were all “grainwashed” over the past 50+ years; her book, The Big Fat Surprise, provides information about the “science” that was used to develop and publish dietary guidelines.  She debunked all the famous studies and provides great information about how the health of Americans was impacted by those studies and strong personalities.  I believe that EVERY medical professional, nutritionist, nurse, and dietician should be required to read her book as part of school/training.  Her work with the Nutrition Coalition is extremely important to the future health of Americans; if you are not following her work, now is a good time to find and follow her.  She more recently has begun to speak about the politics of food; her 2017 video presentation here discusses the statistics and shows how Americans HAVE followed dietary advice and yet, we continue to get sick. https://www.youtube.com/watch?v=FXjB-5-uzuw   Other authors have also written about the relationship between high carb intake and metabolic dysfunction; one of my favorite books on the topic is The Art & Science of Low Carb Living by Jeff Volek and Steve Phinney; Dr. Jason Fung’s The Obesity Code is another.  Jeffrey Gerber and Ivor Cummins’ new book, Eat Rich Live Long is another fave, as is Keto Living Day by Day, by Kristie Sullivan.  All of these books have great information about the relationship of carbohydrate intake and out health problems.  Do your research, but do NOT “blame yourself” for your health.   We were “just following the rules.”


Probably THE most common question I hear today is about cholesterol and medicines used to treat or prevent heart problems “caused by high cholesterol.” Again, this topic requires some research based on YOUR personal health, labs, and medical conditions. In general, many studies over recent years have begun to show that cholesterol, in and off itself, is NOT a health hazard.  Cholesterol is essential to health, and about 85% of it is MADE BY OUR BODIES; only about 15% of our cholesterol in our bodies comes from the foods we consume – keep those numbers in mind.  The liver produces cholesterol for our bodies to use multiple processes, especially making and maintaining cell membranes.  Every single cell – all 38 TRILLION cells – require cholesterol.  Cholesterol is the base ingredient for many hormones, especially reproductive ones, like estrogen and testosterone.   How can we expect reproductive processes to function normally if we use drugs that completely destroy the body’s natural production of essential-to-life hormones?  I cannot imply that you should or should NOT take any medication; that decision is between YOU and YOUR prescriber.  But I will recommend that you do your research, study cholesterol and the medications; we should NEVER accept anyone’s word at face value any more.  Today’s world is full of technological advances, and information is available at our fingertips.  Yes, medical professionals will prescribe, encourage, and even bully patients into taking medications, but always remember the Hippocratic Oath that includes “do no harm” first and foremost.  We are trained to prescribe drugs to “fix” the problem; we were NOT taught to use diet, nutrition, or “lifestyle medicine” as recommended treatments.  We are learning right along WITH YOU.

Another common problem that arises with any dietary change is slow gut motility, often called constipation. The most common cause of abdominal pain in all patients today is chronic constipation. And most Americans (estimated to be 80% or more) suffer from chronic constipation at least on occasions. And changing what you eat will impact the gastrointestinal (GI) tract and its motility because the gut must learn about its new contents – but let me be clear, LCHF does not cause constipation; it actually can contribute to loose stools because of the fats causing everything to be slick, “lubed up” if you will.

To decide if you might have constipation, ask yourself these questions; do you:

have more than 1 day a week that you do NOT poop?

have watery stools?

have hard balls for poop?

ever have explosive diarrhea?

ever have tiny smears of blood on tissue with a BM?

ever strain or wait for long periods of time to poop?

ever feel like there should be more poop in the toilet?

ever feel like there’s more poop inside that should be emptying?

have lower abdominal pains/cramping?

feel bloated and overly full, even short of breath at times?

suffer with reflux, indigestion or heartburn?

have reported diverticulosis on imaging or colonoscopy?

If you answer yes to 2 or more of these questions, I can promise you that the problem is most likely chronic constipation. It can be VERY subtle but it’s there.

The most common cause of chronic constipation is our SAD (standard American diet), full of poorly digested carbs and processed/breaded meats. All those carbs act like glue in our intestines, and will eventually push on the pockets along the colon, forcing enlargement of the pockets; this stretching and enlargement is known as diverticulosis. In addition, almost every single medication on the market today lists constipation as a common side effect. Multiply that effect by the 3-5 meds most people take, and its TROUBLE in the gut.

Many people will occasionally use a laxative or colon cleanser to completely empty the gut. While not safe to use daily, it might help to try one and see if your symptoms are relieved. High fat intake will eventually retrain a constipated gut to go more regularly. High fat intake will also eventually heal some of the damaged gut lining; how does gut damage occur? From a lifetime of poor nutrient intake. Nutrients are absorbed along the way as food is digested. There is only a very thin layer of protective mucus that lines the intestines. Easily injured from wastes moving through too slowly, intestines with a damaged membrane of mucus are not repaired easily and can contribute to leaky gut syndrome, various infections, and chronic constipation.

So, you still don’t think you’re constipated? But you’re having heartburn, indigestion, or reflux? A study from a couple years ago suggested that 85% of people with reflux/severe indigestion actually suffered from constipation and theorized that the constipation is the most likely cause or contributing factor for their reflux symptoms – because if wastes aren’t coming out normally from the bottom, they have nowhere else to go but up. And that makes totally logical sense. So, you’re finally you’re convinced you may have some poop still stuck along your GI tract and maybe have some damaged gut lining. How do we fix it?

First of all, LCHF provides most of the necessary nutrients and best sources of healing factors for our bodies, including the gut. However, many people find that when altering diet intake, the gut responds in an uncomfortable way by slowing down even more. It’s the change in nutrition, combined with not enough water, and usually a lack of magnesium and salt that cause this reaction. Sodium and potassium are required for muscle contraction; deficiencies in these minerals are frequent while learning LCHF eating and are common side effects of many medications, especially ones for blood pressure and diabetes. In addition, most of us are deficient in magnesium which aids in gut motility, and we’ve been deficient for quite some time. Most LCHF experts will typically recommend drinking salty bone broth to relieve headaches, but people drink a cup or so and are done for the day not realizing the variety of muscles that need the minerals in that broth. More is usually better, but there’s not an amount that we recognize as helpful for everyone – I’d venture a guess at about a quart of broth daily during the first week or two of LCHF eating, but that’s a total guess. Others may have a recommendation as to the amounts they’ve used to help them; my suggestion is to read all the suggestions and then try different amounts on different days for your own experiment. As for magnesium supplementation, keep dose low to avoid diarrhea; some people will increase dosing every few days to minimize gut impact. Most people’s guts will react violently to doses over 400 mg a day; as you review the graphic I provided above, you’ll see that some forms of magnesium impact the gut more than others.  Threonate, glycinate and taurate rarely contribute to loose stools.

Healing of the gut will also be encouraged by consuming pre-biotics…. foods from which the gut can produce its own probiotics. Fermented foods are optimal sources of pre-biotics. Fermented foods include sauerkraut and kimchi. Sometimes kumbucha can be low carb enough to drink in small quantities, but read labels carefully if using pre-packaged pre-biotics to be certain of carb/sugar content. You can also find probiotics over the counter or online, but refrigerated ones typically contain highest colony counts of healthy bacteria. In addition to eating pre-biotics, butyrate is necessary to gut health. Butyrate is an essential fatty acid – essential means our bodies MUST have it for normal body processes. Best source of butyrate? Butter. Real. Natural. Butter. So be certain to consume a lot of butter; cook in it. Add it at the table. Add it to coffee or tea.


Fiber. So, did you notice it wasn’t my first “miracle cure” for constipation? Fiber has been the mainstream medical providers’ cure-all for constipation for years. But recently it’s come under fire for contributing to constipation and irritating bowels. Fiber acts to BULK. Bulking is the process whereby fiber absorbs water from the gut until the fiber has swollen to maximal capacity. The theory behind increasing fiber is that this swelling fiber would fill all the diverticula (pockets) in the colon, and slowly, very slowly, the fiber would be forced through the intestines, moving wastes out. But for most people this bulking causes terrible bloating, gas and abdominal pain; some people have even developed obstructions from bulking agents becoming stuck, especially in some of the sharper turns of the GI tract. Some studies are even suggesting fiber is contributing to IBS, UC, Crohn’s and some GI cancers. Early studies suggested fiber helped with gut motility, but none of recent date have been able to reproduce similar results, leading many experts to believe there are “confounding factors” that were not taken into account in earlier studies. While SOME people can use fiber supplements with good results, it’s very individualized. If you have very watery stool that you have investigated thoroughly and KNOW the cause is a medicine (like metformin), a trial of fiber supplementation may prove helpful as the fiber will absorb lots of that extra water, resulting in more normally formed stools. This type of use is typically my only recommendation for using fiber nowadays.

Rory is a good friend and great low carb expert; he says, “Research is showing that optimizing bowel health involves both the use of prebiotics, such as inulin and/or a galacto-oligosaccharide, and also, a probiotic containing multiple strains of healthy bacteria. Inulin (not a misspelling:  inulin–not insulin) does contain some amount of carbohydrate in the one or two teaspoons that might be appropriate. So, if you chose to use it, you would need to account for the carbs as part of your daily allowance.  Dr. William Davis, who has emerged as one of the most knowledgeable doctors on gut health, was the source for my information to you. He teaches that this approach is better. If you want more information, I’d encourage you to purchase one of his books that discuss this.”

What salt do I eat is another common question.  It really is a personal choice.  Just keep in mind that iodine is added to table salt to help ensure that we get adequate iodine for thyroid health.  When we cut out all the processed carbs, the iodized salt intake also drops significantly, putting thyroid health at risk.  Pink Himalayan, sea, and other specialty salts do NOT have iodine added, nor do any of them have adequate amounts of iodine NATURALLY. Many people will use a combination of specialty salts and table salt; others will take an iodine supplement.  Some vitamin D supplements contain iodine or sea kelp.  Check labels to be sure.  In addition to the iodine, we need more salt than we think.  Previous recommendations have suggested we need approximately 4000 – 5000 mg of salt per day; some low carb experts are suggesting even more.  Salt is essential.  Don’t shortchange yourself.  Keep an eye on your thyroid labs, if you completely eliminate iodized table salt from your intake.


Our last question deals with blood pressure on keto. Some low carb experts are beginning to suggest that high blood pressure may be the earliest sign of insulin resistance.  Long before glucose or Hgb A1c rises, and long before obesity develops, blood pressure may be creeping upwards in response to insulin resistance, according to some experts.  We’ve seen frequent reports of lower blood pressure with the drop in glucose in many people.  There is sometimes a mild rise in BP during the first few weeks, as the body transitions to our new way of eating, but it generally settles down and stabilizes within a few weeks; there is no “standard rule” for how long it takes to see stable and normal BP.  Some report normal readings in 3-4 weeks, while others report normal numbers at 4-6 months.

The main take-away points from this article?  Keto is NOT a perfect plan with exact results for every person in any given time frame.  Keto works.  Keto heals.  Keto repairs organs.  Keto reverses MANY chronic conditions.  But the keys: consistency, persistency, and PATIENCE.

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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.”

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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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.”


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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. 

BPC, BulletProof Coffee, diabetes, diet, hormone, insulin resistant, keto, ketogenic, lifestyle, low carb, NAFLD, nurse, nurse practitioner, paleo, PCOS, Recipes

What is Bulletproof Coffee?

Bulletproof coffee is gaining popularity among dieters and those seeking to improve energy levels,  metabolism and brain function.  About 5 or 6 years ago, a visit to Tibet resulted in the development of the new recipe for coffee; Dave Asprey created the coffee with “upgraded” coffee beans with lower amounts of mycotoxins.  Mycotoxins are toxic fungi that easily colonize crops and can contribute to disease or sickness.  Regular coffee often contains mycotoxins, these organisms may be related to some people’s stomach upset or sensitivities when they drink coffee.  While some recent studies have suggested that up to 4 cups of regular coffee can help postpone symptoms of Alzheimer’s, the “upgraded” bulletproof coffee (BPC) may turn out to be even more helpful.

It is referred to as “bulletproof” because drinking the “upgraded” coffee with lower mycotoxins and higher fat content seems to make people feel better with higher energy levels, improved brain function, and thus feel “bulletproof” – like nothing can stop them.

Adding fats to the coffee has become quite a trend; it’s a hot topic on many blogs and even made it to “The Today Show” a couple of years ago.   More recently, BPC made its debut on “The Queen Latifah Show.”

What fats?  Most people that drink bulletproof coffee start with coconut oil or MCT oil.  MCT oil is a medium-chain-triglyceride, shown in some studies to aid weight loss and possibly increase metabolism.  Medium-chain triglycerides are different from short-chain triglycerides and long-chain triglycerides, in that MCTs do not require bile salts or energy for absorption and digestion. MCT oil is currently being studied as possible benefits for a variety of conditions including Parkinson’s & Alzheimer’s.

In addition to coconut or MCT oil, many recipes include grass-fed butter or ghee; ghee is clarified butter where the butter is heated and solids are separated out.  In the Hindu and Indian cultures, ghee is considered a special part of many religious ceremonies, because it comes from “holy” cows and is “separated” or pure.  It is believed that ghee is much healthier than regular butter because of the separation of ghee from solids, which are thought to be impurities.

Athletes and bloggers began using this bulletproof coffee and claimed to have better test scores, memory function, energy, and moods.  As more people tried it and noticed results, news of this miracle wonder hit the internet on a variety of blogs and social media.  As word spread, BPC no longer was only made with the “upgraded” beans, but with all sorts and brands of coffees.

Many recipes abound today; using coconut oil, MCT oil, butter, ghee, and flavors just like fancy baristas use to prepare gourmet coffee blends are widely published on blogs, Facebook, and Twitter.  While there may not be a lot of research to support the use of BPC, it is quite a drink! Bloggers and Tweeters have shared hundreds of BPC recipes, and people are concocting their own personal twists to flavors.

Benefits of BPC do appear to include keeping people from feeling hungry; other advantages include feeling more energetic and more alert, with less forgetfulness.  Many people drink BP in place of some meals, while other use the BPC with or following meals to help improve satiety and prevent “the munchies” or frequent snacking.  Making BPC is quite simple, and recipes abound. Just perform a Google or Bing search for “bulletproof coffee recipes.”  Choose a recipe with flavors you like; use a blender for a few seconds to thoroughly mix; remember fats and water don’t stir to mix well.  Drink while it’s warm; trust me, congealing fats don’t go down well! LOL

It took me about 2 weeks of tweaking the recipe to get it right for me.  So, if you don’t get it right the first time, keep trying.  Here is my recipe:

1 Tbsp coconut oil

1 Tbsp grass-fed butter

1/4 cup unsweet vanilla almond milk

1 Tbsp sugar free Torani vanilla flavor – like they use in the fancy coffee shops

Approx. 10 ounces of coffee

Blend for 5-8 seconds, and enjoy.  Can be reheated without problems.

1 Tbsp grass-fed butter

1/4 cup unsweet vanilla almond milk

1 Tbsp sugar free Torani vanilla flavor – like they use in the fancy coffee shops

Approx. 10 ounces of coffee

Blend for 5-8 seconds, and enjoy.  Can be reheated without problems.

One last tip… some people have a little tummy response to sudden high intake of fats and end up with a bit of urgent need for the restroom.  So, if you are JUST beginning to increase fats, use smaller amounts of fats in your BPC for the first week or two.  Allow your body a little time to adjust to higher fat content.

BPC, breakfast, BulletProof Coffee, Cholesterol, diabetes, diet, Fat, gluten-free, Grain free, Guidelines, hormone, immune system, insulin, insulin resistant, keto, ketogenic, lifestyle, low carb, Media, NAFLD, nurse, nurse practitioner, paleo, PCOS, supplement, vitamin

Get Started – Add Fats: We aren’t taking foods away…. YET!

As nurses, one of our best attributes is helping people learn; we love to teach people how to take better care of themselves.  Hospital nurses spend hours providing discharge education; home health nurses thrive on sharing that one little secret tip that gives homebound patients a brighter day.  Clinic nurses have reams and reams of printed materials they distribute and review with patients on a daily basis.

As nurse practitioners, Barbara and I want to give each of you the real, down-to-earth tidbits to get you started on the best and healthiest journey of your life!!

First, take stock of where you are in your health.  What symptoms or illnesses or health conditions do you have?  What would you MOST like to get rid of?  It is important to start right where you are, or you really won’t know where you are heading.  I always suggest a diary or journal for starters.  A written record not only records where you are RIGHT NOW, but as time goes forth, it will be a boost to your ego and a record of just how far you’ve come.  In your journal, include some of your disease markers: your blood pressure, your weight, your waist circumference, your thigh & upper arm circumferences, your hemoglobin A1c, your cholesterol and LDL/HDL numbers, and even your BUN/creatinine or your liver enzymes.  It depends on your health care provider’s policies if they will provide you with an actual copy of your results; many clinics now offer online patient portal access.  If you haven’t signed up previously, now might be a good time to do so.  Record the names of any medications AND the doses you take.  As your LCHF journey progresses, you will find that your health care provider will be reducing your doses AND medications.  Write down how you feel about your conditions and medications; your feelings and thought processes are important.  Take photos if possible and add them to your journal; even a selfie in the bathroom mirror will provide enough evidence once the inches fall away.  Once you have your current health status recorded, you are truly READY to begin a whole new journey to improved health with FEWER risk factors than ever before thought possible.

Now that you have prepared your history, it is time to plot your agenda.  Rather than focus on the foods you can’t have, I propose that you start by ADDING fats to your current way of eating (WOE).  Healthy fats include fats closest to natural states; bacon or side meat grease is a great seasoning that we all relinquished when the heart experts said it was so bad for us.  But, guess what??! It’s not bad!  Start saving your bacon grease and use it to season vegetables or add to hamburger meat dishes.  We make a bacon-cheeseburger meatloaf sometimes, and we add bacon grease to increase the bacon flavor.  Add good, healthy butter to veggies and meats. When you have that potato (for now – you can have it; we are just getting started, remember?), LOAD that puppy up with cheese, butter, FULL-FAT sour cream, and bacon chips… real chips… from bacon YOU actually cooked.  Eat more avocadoes, guacamole, coconut oil, and olive oils.  I use a LITE olive oil more often than the extra virgin olive oil (EVOO).  Lite olive oil tastes less strong and less like olives.  EVOO has a much stronger olive flavor than I like.

Find a bulletproof coffee (BPC) recipe you like; bulletfproof coffee began as a real brand of coffee, but we low-carbers, have adapted it to mean a coffee loaded with fats – that keeps you “bulletproof” for the day.  Bulletproof just means that you won’t be starving all day; your body won’t feel hungry and you won’t feel like you are starving yourself or depriving yourself of anything.  I usually have 1 slice of bacon, 1-2 eggs, and BPC for breakfast every day.  I usually don’t get hungry until 2-3pm most days – and it’s ALL because of the high fat content in my meal & BPC.  I use a BPC recipe that uses coconut oil, Kerrygold butter, unsweet almond milk, and sugar-free coffee flavorings like the fancy baristas use  in the fancy coffee shops. I will say that it took me a while to find the right recipe for me; first, I don’t even LIKE coffee… no, I really don’t!  My hubby started bringing me a cup many years ago, on very cool mornings to help me “warm up.”  So now, it’s just a habit.  And I do LIKE my BPC for more than just the flavor!  It keeps me satisfied and prevents me from getting the “munchies”.  Therefore, I eat less!

Back to finding the right recipe… I like coconut, but I didn’t like it in my coffee; I had to keep tweaking amounts to find the right balance of coconut oil, butter, and milk. And you will need to be patient too.  It probably took me about 2 weeks of trial and error to be quite happy with my recipe.  There are hundreds of recipes out there, and you can make it many different ways; the key is to be sure it contains plenty of fats; no matter what I tweak, I always use at least 1 tablespoon of coconut oil and 1 tablespoon of butter.  Many of the BPC recipes I found early on contained cinnamon; I just couldn’t get used to that flavor.  Finding a BPC or bulletproof tea you like will make a TON of difference in the amount of hunger you experience and the perceived need for snacking.  Homework assignment number 1 from the KetoNurses: find a BPC or BPT and start drinking!

The next step in learning to eat low carb, high fat is to start reading labels… and I mean REALLY reading labels.  I had a patient tell me just a few days ago that Cheerios had 0 carbohydrates.  Bless his heart! I pulled up a pic online of the label; he finally realized he was reading the wrong line! It had 0 FATS!! We both enjoyed a good laugh over his mistake, but he learned a LOT that visit.  Pay close attention to serving sizes.  Try measuring out a few things, just to see what the serving size recommended really is.  Then pour out your regular serving size and measure YOUR serving.  Many cereal labels recommend as little as a ¼ cup for 1 serving.  Did you realize that ¼ cup is actually ONLY 2 ounces?  Other labels claim that ½ cup is a serving; that’s only 4 ounces.  And all the nutrition information listed is PER SERVING.  So, let’s take the Cheerios label I pulled up for the patient the other day; that label said 1 cup – 8 ounces of cereal is 1 serving.  That one serving contains 20 grams of carbohydrates.  And then you add low-fat milk, which is the HIGHEST carbohydrate content of all milks, you have downed your entire day’s carbohydrate content in one little and very UNSATISFYING meal!

See what we are talking about?  For the past 60+ years, we have been told by “experts” that we should eat LOW fat foods; but eating low fat means that companies began producing all kinds of high-sugar foods that were touted as “healthy” or “heart-healthy”.  Think about the rates of heart disease and diabetes back in the 1920s; it was almost non-existent.  Why?  People didn’t eat all the processed and refined carbs and sugars we have available today; they also WORKED much harder and burned off the carbs they DID consume.  Those people ate TONS of higher fat foods; they used lard all the time.  Most of the deaths back then were actually due to infections for which we had no antibiotics and  cancers that had no treatments developed. Think about all the native cultures; go back and do some research into the Inuit of the Artic North or the Maasai people of Kenya, Africa.  These native populations ate very HIGH fat diets for thousands of years and never had incidence of heart disease.  They only consumed fresh vegetables and fruits they found “in season” and rarely farmed or raised plants for foods.  Researchers report these native groups actually consumed approximately 80 – 90% of their daily intake from fats and fatty proteins.

In summary, today’s entry is intended to help you embark on a new, healthier, thinner YOU!  Start where you are.  Record vital information.  Start drinking BPC or BPT daily.  Increase natural fats in all your meals.

Feel free to share some of your stories and photos on our Facebook page, KetoNurses.  We would LOVE to help you become a BETTER you!!!!!