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Just What is Ketosis?

I often get the question, “what is keto?” Sometimes, I hear, “keto’s dangerous.”  Various myths surround the word “keto” and ketogenic eating.  So, I thought I’d address some of these common myths and tell you the real truth about keto.

Ketogenic diets were first used therapeutically in the early twentieth century; prior to the development of medications for seizures, a keto diet was prescribed to manage epilepsy and seizure disorders with fairly good results.  Today, it is prescribed by medical providers and typically provides 3 or 4 grams of fats, preferably medium-chain triglycerides, to every gram of protein consumed.  Ketogenic eating is often closely monitored by medical providers and dieticians when used to control or reduce seizure activity.  Studies have shown a 50% reduction in seizure frequency in half the people who try it, and in about 1/3 of people that use it, a 90% reduction.

Stories abound of medical providers in the early 1920s of “curing” seizure patients with fasting and low carbohydrate eating; once medications were introduced, ketogenic eating fell by the wayside until media mogul, Jim Abrahams, had a son with epilepsy that was difficult to manage with medications.  Dateline featured Charlie on an episode in 1994, where the family discussed their great success with ketogenic eating to reduce seizures.  This huge improvement prompted Abrahams to create The Charlie Foundation to help educate others about ketogenic eating as a treatment for seizures.  Throughout the 1990s, much scientific interest focused on ketogenic eating, and eventually, the movie, Do No Harm, was released; Meryl Streep starred in the story about a boy whose seizures were managed with a low carb, ketogenic diet.

Not long afterwards, Dr. Robert Atkins made the Atkins diet very popular among dieters; he published books and products geared to help people lose weight using high protein versions of ketogenic eating.  Atkins popularized keto eating significantly and his diet books and products remain popular today, even though the newest version of “the Atkins diet” is much higher in carbohydrates than his original plan.

With the use and popularity of the internet, more and more information became available over the last 20 years or so.  Research articles that once only appeared in expensive medical journals were making their appearance online and to the average consumer.  People tired of using the same old diet advice they’d heard for 50+ years, only to discover they gained weight, became diabetic or even BOTH.  Bloggers began writing about their personal successes with keto dieting; their before and after photos spoke volumes and their following amassed.

However, many nurses and doctors began to strike fear in the hearts of these keto-ers, and they began to say ketogenic eating is unhealthy & dangerous. Because their only knowledge of keto had always been associated with diabetic ketoacidosis, most providers shunned keto diets, and instructed their patients to “stop it immediately because it’s terribly dangerous.”  Patients were then stuck between a rock and a hard spot, so to speak.  They respected their providers – well-trained and highly educated physicians, nurses, & dieticians, but they also were firm in the belief that their health was better than ever before – terrific weight loss, lower glucose, improved A1c, and even healthier cholesterol levels.  How could this be?  How could something so helpful to so many be disregarded with prejudice by such educated medical professionals?

As I mentioned before, diabetic ketoacidosis is a very dangerous complication of diabetes and very, very high glucose levels; it’s most common in Type 1 diabetes, but does occasionally occur in Type 2.  When DKA occurs, glucose levels are typically over 300, ketone levels in the blood are very high, and electrolyte levels get really out of balance.  Potassium levels most often go very high, and this is one of the major reasons DKA can be life-threatening.  Potassium is vital for all muscle function in the body; too much potassium can cause extra-excitability or overstimulation to muscles – the heart muscle just cannot tolerate such stimulation; this excess stimulation can result in very dangerous heart beats and rhythms; some are deadly.

Can you see now, why many providers hear only PART of the word and freak out?  Let’s take a look at the entire phrase: diabetic ketoacidosis.  It occurs in people with diabetes and typically with very high glucose levels, usually over 300.  Normal glucose is less than 120.  The blood and urine will both exhibit high levels of ketones AND, electrolyte levels get so imbalanced that the blood is very acidic.  When this state persists for even a few hours, the person:

can become terribly confused,

complain of fatigue and loss of appetite,

may have shortness of breath, blurry vision, vomiting,

or exhibit an imbalanced gait.

All of these signs and symptoms are observed in concert, NOT in isolation, to make the diagnosis of DKA.  This condition requires careful insulin dosing and specific medical treatment, and is done within the hospital because of the dangerous electrolyte imbalances that can trigger fatal symptoms.  People are often on heart monitors, IV fluids, and round the clock glucose checks and routine insulin injections for 2-5 days.

Now, imagine that the above setting is the only place you’ve ever head the word part, keto.  What would YOU think if you heard it at the local community center?  Or in a chat with a friend? Or maybe online in a social media post?  Thus, the fear of the word “keto” was born.

Have no fear, however! Keto is a word PART – not a whole word.  As a word part, all it means is that ketones are produced in the body.  Just as we discussed above, ketones ARE present and elevated in DKA.  But ketones can also be present during a stomach bug because vomiting & diarrhea can alter the body’s use of fuel, causing a NATURAL state of ketosis.  Ketosis simply means that the body is burning fats instead of sugars for energy.

Burning sugars for fuel is easier for the body and so, the body will follow the path of least resistance; it will burn glucose for fuel as long as it’s present in the bloodstream.  However, the bloodstream only WANTS about 4 grams or 1 teaspoon of glucose floating around in it all the time.  So there may not always be a steady amount of glucose for all the activities your body wants to enjoy.  A good example is a workout at the gym; how many of you “carb-up” prior to your workouts? Why? Because the 4 grams of glucose is not sufficient to meet the energy needs of your workout.  The major problem is that the body isn’t going to let all that glucose STAY in the blood and a lot of it won’t be needed for exercise; so, intake of glucose triggers the pancreas to release insulin.  Insulin’s job is to quickly move glucose OUT of the bloodstream; insulin transports glucose out of the blood and INTO fat cells for storage.  If we were meant to consume huge amounts of carbohydrates, don’t you think our bodies would be much more tolerant of having hundreds of grams of glucose INSIDE the bloodstream?  This erratic process results in very high glucose levels that alternate with very low glucose levels, and can eventually contribute to symptoms of fatigue, thirst, and frequent urination – or diabetes.

However, if we restrict carbohydrate intake, the blood level of glucose stabilizes, less insulin is needed to manage the carb intake, and the fluctuating peaks and valleys of glucose control fades into a much more stable range  because the body learns to be fueled by ketones.  Ketones are made in the liver from fatty acids.  Fatty acids are the smaller components of the fats we eat.  One of the most common ketones is beta-hydroxybutyrate that is a fatty acid our bodies obtain during the digestion and breakdown of butter; in fact, it is butter’s namesake.  This particular ketone is used for energy and is also helpful in digestive processes; it crosses the blood-brain barrier, and is thought to be of clinical relevance in treatment of epilepsy, depression, anxiety, and even cognitive impairment.  Now, don’t you want to add MORE butter to your plate today?

Can you see now, how the use of ketones for fuel is actually healthy and beneficial?  And how ketosis and ketoacidosis are 2 totally different and separate concepts?  Ketosis is a natural process the body uses for fueling activities, and ketoacidosis is a terrible and dangerous health condition associated with out-of-control sugar levels.

Another common question I hear often is about testing for ketones “to be sure I’m in ketosis.”  Well, you certainly CAN test for ketones, but testing can get expensive and if you’re consuming less than 20 grams of carbohydrates daily, your body WILL go into ketosis.  It won’t have a choice.  Our bodies need fuel – either glucose or ketones are the preferred fuels.  During the transition period, people do report bad breath as a result of increased ketones in the blood.  The body actually is a bit confused at first; it’s been burning glucose for all these years and now, there’s no glucose coming in to the system.  So, the body senses a need to rid itself of “excess” ketones, so you exhale some and some are expelled in urine; a few accumulate in blood.  After about 4-8 weeks (on average), most people will have become “fat-adapted” and will no longer experience bad breath or ketones in the urine.  Why? Because the body has learned to utilize all the energy available; it won’t continue to “spill” or waste the fuel it needs for body processes.  Testing after this length of time is often frustrating to people who think that somehow, they are no longer in ketosis.  That is NOT true, however.  It’s simply a matter of efficiency; the human body doesn’t waste much; it’s wired to conserve, reserve, and reuse many chemicals and products.  Ketones are fuel for the body and will NOT be routinely wasted.

Testing for ketones is pretty unnecessary for most people eating a low carb diet; for people with very high glucose levels, it may be necessary during the transition phase from high carb to low carb eating, because of the risk for developing DKA.  Urine & breath testing aren’t always reliable, and once fat adapted, you won’t be spilling any ketones in either of these waste products.  Blood ketones can be tested, if necessary, and is the most accurate measure.  The image below is from the book, The Art & Science of Low Carb Living, by Jeff Volek and Steve Phinney.  In this image, you can see the area of optimal blood ketones is MUCH lower than those typical of a patient in ketoacidosis (far right).  You can also see by the rise in the green curve that the brain and muscles function optimally in this healthy range of blood ketones.  Ketosis is the natural process by which the body uses fats, or specifically ketones, for fuel.  It is normal and natural.  It is not dangerous.  It won’t cause harm.

Hopefully, this article has provided you with a decent amount of information that will help you understand ketosis and how it impacts our bodies and health.  For more personalized help, please feel free to send me a PM via Facebook or Twitter.

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Keto Pepper Poppers

Just in time for the big game, we have a delicious low carb finger food to add to the table!

12 jalapeños, seeded and halved

8 ounces of softened cream cheese

3 tbsp. sour cream

1/2 cup grated cheese (any type or combo)

2 tsp minced garlic (More can be used)

1/2 tsp onion powder

Preheat oven to 375. Mix all in mixer until well blended. Spoon into pepper halves. Place in baking dish or on cookie sheet.

Bake for 9 minutes and then turn to broil for 3-5 minutes, just until tops begin to brown.

Serve.

Depending on the types of cheeses you choose, carb count is approx 1 gram per jalapeño half, or 1.5 -2 grams for every whole pepper.

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Do the Math – Calculate Your Macro Goals

I use the simplest keto calculator available, using IDEAL body weight NOT current body weight – as many calculators do.

First, determine your ideal weight. There are many ranges and charts available, but I use the simplest version from nursing school many years ago. We use ideal weight because we want to lose weight or maintain a healthy weight. If we use current weight for our calculations, then our macro goals will be set to sustain our current weight.

Start with your current height — females are allowed 100 pounds for first 5 feet and 5 pounds per inch over that. Males are allowed the same 100 pounds for the first 5 feet and 6 pounds per inch over.

Example: a 5’5” female would have an AVERAGE ideal weight of 125 lbs, while a male of same height would have average ideal weight of 130lbs. (Let me offer this one tidbit: I understand that many people freak out with these weights, but they really are ideal for the heights. Google images of people from 1950 – BEFORE the low fat craze. People were much thinner and were perfectly healthy. We’ve become desensitized to body weights for lots of reasons, but it has skewed our perspective of what a body should look like.)

Now that you’ve calculated your ideal weight, we will use that number to identify our protein needs per day. At 5’5”, a female’s average ideal weight would be around 125 lbs. Convert that to kilograms using the standard conversion factor, 2.2.

Math would look like: 125/2.2 = 56.8. So your weight in kg is 56.8. For people of average daily activity, the recommendation is 1 gram of protein per 1 kg if body weight.

So, protein needs would be approx 56.8 grams per day — divided into 2 or 3 meals per day, based on lifestyle and personal choices.

For our way of eating, we calculate our protein needs and then use that to determine our fat needs – approx double the protein goal. So you would need about 114 grams for fat per day.

Carb grams are counted as total carbs bc fiber carbohydrates DO impact some people’s glucose levels. Max carb goal should be 20 grams per day or 6-7 per meal.

I hope I’ve kept this as easy and simple as possible. Yes. There are many keto calculators but most do NOT account for metabolic disorders or they are athlete-based, resulting in very high protein intake and excess proteins will be converted into glucose in the absence of carbs — not good for anyone with insulin resistance or diabetes.

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Creamy Keto Soup

This recipe is a great base for most any type of creamed soup you enjoy. I used frozen spinach in my batch, but sautéed Brussels sprouts,  mushrooms, or asparagus would work just fine instead.


Creamy Keto Soup

32 oz heavy cream

1 1/2 cup water or broth

6 oz cream cheese

1 cup shredded white cheddar

1 tsp minced garlic or 1/8 tsp garlic powder

1/4 tsp salt

1/4 tsp pepper

1/8 tsp cayenne pepper powder (optional)

Heat all ingredients in medium saucepan over low heat, stirring nearly constantly. Add additional seasonings to taste after about 20 minutes and all ingredients have melted and mixed well.

Add 1 – 1 1/2 cups of frozen chopped spinach or other veggie of choice. Most veggies will do best if sautéed or parboiled prior to adding to creamed mixture.

Heat thoroughly over low heat with frequent stirring; total cook time for my batch was about 45 minutes.  You can cook over low heat for a longer period of time, but remember that heavy cream will reduce down over time, creating a thicker Soup. Serve.
Makes approx 2 quarts of Soup, unless you cook it down to thicken it more. Keeps well for several days in the fridge. I also think it tastes even better the next day!!

This creamy soup base is totally awesome for cooler fall days! Let us see your version; post pics of your Creamy Keto Soup on our Facebook page.

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Measures of “Improving Health”

Recently, another health care provider mocked my use of the phrase, “improving the health of my patients”, saying that it’s vague and not measurable.
Her comments gave me pause, because the goal of every nurse I’ve ever met has been to help people improve their health. Ask any nurse why he or she became a nurse, and you will hear a variety of ways people say it. We nurses help people get well, better, or over a health obstacle. How is that measured?
First and foremost, there are many parameters used by health care providers to measure health. With diagnoses of diabetes and hypertension, we measure glucose and blood pressure, respectively. But we often have difficulty quantifying how people feel when they lower their glucose or blood pressure. When patients return for follow-up and I’m able to tell them their hemoglobin A1c dropped from 8.9 to 6.4 after weeks of diet changes and effort, people are thrilled. They grin from ear to ear. They clap. They shake a fist in the air. They “high five” me. Some even do a “happy dance.” What is measurable here? Yes, the glucose levels are numerical and easy to track. But how does anyone put a scale on happiness or joyfulness? Can the idea that diabetic complications no longer pose a looming hazard to health be measured? How is relief quantified when kidney damage has improved?


These feelings are not measurable, yet they are extremely evident in behaviors and attitude. Patients who work toward improving health exhibit gratefulness that good instruction is provided; is that gratitude measurable?
Measures are important in health care. Measurements of pulse or blood pressure provide vital information to us who render the care. I decided that some of you might be interested in knowing what measures we use for certain conditions so you can track your own progress over time.
With diabetes, one of the most important measures is glucose, of course; in addition, the hemoglobin A1c that tells us the average glucose levels over the past 90-100 days provides a good correlation to patient effort in managing the condition. While mainstream medicine will say that “good” diabetes control occurs when the A1c is around 7, many studies have shown that diabetic complications occur when the A1c runs higher than about 6.2 or so. Normal A1c levels run around 5 or less; why should people diagnosed with diabetes be forced to run glucose levels so high that we KNOW organ damage will occur? Is that going to help patients “improve their health”?
Elevated blood pressure is often associated with diabetes because high glucose levels cause thick, sticky blood; demanding that the heart pump thick, sticky blood to an overweight body will eventually result in high blood pressure. The heart will pump harder and with more force to move thick “syrupy” blood through tiny blood vessels, resulting in higher and higher blood pressure readings. When blood pressure increases, the heart muscle becomes compromised and weaker. Daily demands on the heart that continually exceed it’s designed capabilities can contribute to a multitude of vague symptoms which are not measurable, including headaches, fatigue, nausea, dizziness, or even mild swelling. While most of these symptoms have no quantifiable scale, patients will describe how much better they feel once blood pressure is lowered. While blood pressure is measurable, the feeling of lower and healthier blood pressure is described by patients as “improved health.”
If blood pressure remains untreated or poorly managed, heart failure and/or kidney damage begin to occur. Highly pressurized blood flow moving through the kidneys will damage the fragile vessels, reducing the filtering ability of the kidneys. Elevated glucose can also damage these tiny vessels, resulting in inflammatory responses by the body that are designed to patch and repair damage – but this natural response by the body can result in blood vessel blockages. Think scar tissue.

In this photo below, notice that cholesterol is serving as the patch, relating the damage to the blood vessel. Cholesterol isNOT the cause of clots; it’s part of the damage control/repair team of the body. In summary, how do we measure “improved health”? How can we quantify patient comments when they express gratitude for how they feel? How can we count the number of clinic visits these patients will NOT have? How do we track hospitalizations that do NOT occur for these patients? What evidence do we see when ER visits are no longer the norm for people with “normal” glucose or blood pressure? We can’t. But these numbers ARE real. These people ARE changing their lives and IMPROVING HEALTH!

If you want to take charge of YOUR health, email us for more info at KetoNurses@gmail.com

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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.

Image result for blood test image

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!

 

 

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 protein 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.