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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.

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

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

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

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

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

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

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

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

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

 

 

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

Tips & Tricks to Master LCHF 

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

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

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

Baaaaacon!

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

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

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

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


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

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


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

 

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Teresa Reversed Her Diabetes!

 

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

Teresa Toten, July, 2017

 

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

 

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

June, 2017

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

 

Day 1 of Keto Nutrition, April, 2017

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

 

May, 2017

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

 

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

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

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

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

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

Grain-Free Fake Ziti

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

KetoNurses Easy Fake-Ziti Recipe

2-3 tbsp olive oil or avocado oil

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

nutmeg, freshly ground (optional)

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

2 -3 medium-sized zuchinni, sliced thinly

16-24 oz full fat ricotta

16-24 oz grated parmagiano-reggiano

16 oz shredded fresh mozzarella

salt & pepper to taste

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

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

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

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

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

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

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

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

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

 

 

 

Cholesterol, diet, Fat, Guidelines, insulin resistant, keto, ketogenic, lifestyle, low carb, NAFLD, nurse, nurse practitioner, paleo, PCOS, steroid, supplement, vitamin

Does Cholesterol Cause Heart Attacks? Is fat bad for me?

For the past 50+ years, many agencies and experts have recommended a low fat, low cholesterol diet to manage diabetes, heart disease, and just overall good health.  However, much of this advice began as one man, Ancel Keys, decided that fat “must” be the cause of heart attacks.  More information on Keys’ influence can be found in Barbara’s blog post about the low fat dogma on Feb. 23, 2015.

Low fat nutrition was thought to be the best way to maintain health, get healthy, and prevent many diseases.  However, after 50 years of low fat eating, we have not eliminated, nor reduced heart disease, diabetes, or obesity; in fact, all of those conditions have worsened.

But here is where cholesterol got its bad name:

In 1955, President Eisenhower had a highly publicized heart attack; at the time, his total cholesterol was 165 mL/dL – normal is considered to be less than 200 mL/dL. According to media reports that were held daily during his recovery, Eisenhower ate dry toast and coffee for breakfast every morning.  He was supposedly allowed 1 egg per week as part of his prescribed low fat, low cholesterol diet.  Even though he continued the low cholesterol diet, he suffered several more heart attacks and left office with a 259 mL/dL total cholesterol level; he died of heart disease anyway.

Over the next several years, food manufacturers began producing low fat, low cholesterol products as fast as possible; trying to keep up with all the media attention on President Eisenhower’s health conditions, hundreds of other low fat foods like margarine, skim milk, & corn oil were developed and marketed.  By 1957, margarine outsold butter for the first time. Many of these low fat products contained a large quantity of omega-6 linoleic acid and in excess, this particular fat causes injury and systemic inflammation within the bloodstream and multiple other tissues within the body.

Presidential Influence…

By 1961, Eisenhower left office and left his mark on nutritional history for decades.  This same year, findings from the massive Framingham Heart Study were released; this study showed that overweight men under 50 years old who had high cholesterol, smoked, and did not exercise were at higher risk of heart attacks and heart disease.  One correlation completely overlooked was elevated glucose; no one seemed to make the connection to high blood sugar, but they made famous the Framingham risk factors, which continue to be included in today’s health assessments across the nation. None of the researchers actually ever made any true connection between the elevated cholesterol levels and heart disease.  The “risk factors” made the headlines and drew all the attention.  The other problem with the Framingham Heart Study was that it did not address the highest rate of heart attacks which was in men above the age of 50.  All of the data presented in this huge and well-respected study only presented data from men under 50 years old, the least likely men to suffer from heart attacks or strokes.  Much publicity and media attention was given to the “risk factors” as presented in this study, while no mention was made of the possible relationship to sugar, or the fact that the healthiest population had the highest risk factors.  All of this activity in nutrition and health led to the huge expansion & reach of the American Heart Association; with all the focus on Eisenhower’s health & AHA’s dietary advice, TIME magazine’s January issue hit the newsstands with Ancel Keys on the cover.  Now, the media has a job to do: tell the nation just how terrible fat is for us, and they did quite an excellent job of it… repeatedly…consistently…persistently…frequently…repetitively…doggedly…

The AHA gets involved…

By 1966, the food industry has begun to taint dietary advice when a member of the board of the American Heart Association published a book, Your Heart Has Nine Lives.  Author, Jeremiah Stamler was a friend and support of Ancel Keys, and the publication of his book was funded by Mazola Corn Oil and Fleissmann’s Margarine.

The federal government’s Women, Infants, & Children’s program, also known as WIC, adopted the AHA’s stance for low fat nutrition for all pregnant women and children; basing nutrition on the low fat mantra, WIC began distribution of vouchers for low fat and skim milk products in 1970. Later in the 1970s, George McGovern organized and hosted a series of hearings where politicians and other government employees gathered to argue the nutrition science, now widely publicized.  While most were pretty biased against fats, none of them, including McGovern, had any real scientific background.  The hearings were argumentative and truly not based on any research studies, but rather, on opinions of strong-willed politicians who were able to influence decisions and entire agencies.

Why didn’t someone stop them?

I know by now, many of you are asking, “why didn’t someone stop them?” “How come other scientists didn’t publish an opposing opinion or research study?”  Well, a wide variety of people attempted to publicize other data; several scientists, including Margaret Albrink, Peter Kuo, Lars Carlson, Joseph Goldstein, Pete Ahrens, and several others continued to report that elevated triglycerides appeared to be a higher risk for heart disease.  Even as far back as 1957, a well-respected children’s obesity expert said, The great progress in dietary control of obesity was the recognition that meat was not fat producing; but that it was bread and sweets which lead to obesity.”

No one could hear the opposition, however.  Keys developed close ties to the White House during Eisenhower’s unhealthy years after the heart attack, as he tried to help “heal” Eisenhower’s heart disease with his low fat diet.  Power and strong personalities led the media where they wanted, and opposing viewpoints were silenced quickly by removing grant funding from some researchers.  Others were simply “un-appointed” to nutrition committees, or touted as fakes or quacks who did not want to follow the AHA’s new “rules”.

Sugar touted as “safe”…

When these low fat rules were actually finally release in 1977, the American Medical Association was quite skeptical and at first, refused to succumb to the AHA’s recommendations.  However, the media hype was intense and repetitive, and by the mid-1980s, the AMA enthusiastically joined the low fat bandwagon. Also in 1986, the Food & Drug Administration (FDA) issued statements that there was “no conclusive evidence” that sugar contributed to disease, and even said that up to 25% of all calories could come from sugars, although this recommendation completely eliminated nutrients, vitamins, or fiber.

As the “war on cholesterol” raged in the late 1980s, statin manufacturers were busily researching and developing medications that would lower cholesterol;  the first one was moved through the FDA rapidly and released to market in 1987.  Since 1990, the rate of congestive heart failure has more than doubled, and some experts believe the increase is directly related to the massive number of statin prescriptions filled daily.

After only 14 years of encouraging sugar intake up to 25% of total daily calories, the diagnosis of type 2 diabetes had begun to skyrocket.  About 80% of diabetic patients were dying of heart disease. While per capita sugar intake jumped from 15 pounds in 1830 to 150 pounds in the year 2000, fat intake dropped from 18 pounds to 4 pounds in the same time period.  Obesity had become an epidemic, as 30% of Americans were overweight and still gaining weight.

Massive media blitz…

Between 2005 – 2009, many organizations including the Corn Growers Association has begun spending millions of dollars, lobbying Congress and the public with the massive media message that high fructose corn syrup is safe for toddlers and children. Gyms and workout centers abound in every community, as Gary Taubes became an advocate of exercise to lose weight and be healthy.  Nutrition and health science has become quite the booming business, all while the incidence of heart disease continues to climb, and the rate of diabetes has jumped from 1 in 30 Americans in 1910, to 1 in 3 by 2008.

Just a few weeks ago, in early 2015, the US Dietary Advisory Council issued a statement saying that it would retract its recommendation for a low cholesterol diet.  However, in the body of the news release, the Council continues to advocate for a diet high in unsaturated fats like those found in nuts, fish, olives, & vegetable oils.  While this statement is the FIRST baby step in the right direction, the low carb science continues to build support in a wide array of settings.  Small journals publish articles and studies, but mainstream medical journals continue refusing to print these studies, likely because millions of advertising dollars come from statin & insulin makers.  Social media has become a source of nutrition advice and specialized groups have developed on Facebook & Twitter, where patients have taken control of their own health.  They share stories of medical providers who refuse to listen to reason and dieticians who teach them how to eat 130 – 150 grams of carbohydrates DAILY, while taking multiple medications to help manage the elevated glucose readings and life-changing complications like vision loss, nerve pain, and kidney failure.  These Americans are facing their diseases head-on, with dedication and persistence; they share meal ideas, recipes, and tips on how to reduce medications, because physicians and health care providers don’t.  They help each other cope with sugar addictions, cravings, and “missing” carbs.  They help interpret lab results when the clinic doesn’t really offer much education in reading the near-hieroglyphics printed out.

Many of these people have completely eliminated diabetes and cholesterol medications using a low carb, high fat nutrition plan.  It’s not a 30 day or 90 day fad “diet”. Low carb high fat (LCHF) is a total and complete lifestyle change that is meant to be permanent.  LCHF offers much nutrient value, satiety or holding power, and much better glucose & cholesterol control.  And this eating plan actually makes really good, logical sense; if sugar is the problem, why not remove sugar from the diet?

Real cause of heart disease…

Over the past 3-5 years, it has become more evident that elevated glucose and high triglycerides contribute to high numbers of heart attacks and strokes; inflammation contributes to another huge portion of heart disease.  Once thought to be safe and free from harm, sugars, vegetable oil, and soy are being linked to increased systemic inflammation within the bloodstream.  Add these inflammatory markers to thick, sticky blood, and even to tobacco use, and you have “3 strikes, you’re out.”  Inflammation, sugary blood, and smaller blood vessels are all linked to the highest incidence of heart attacks, clots, and strokes – so, to answer the original questions…

Does cholesterol cause heart attacks?  Is fat bad for me?  NO… a RESOUNDING NO!  Cholesterol NEVER was found to have any true relationship to heart attacks, as you can see by the history provided here.  Fat was NEVER bad for us; NATURAL fats that come from animals and plants, without massive processing, are necessary for every cell of the body.  The entire cell membrane of every single cell is made of a fatty layer; fats are required for most hormones to function properly.  Natural fats are not unhealthy; the unhealthy fats include those that require many man-made processes.  Corn oil, canola oil, vegetable oil, margarine and shortening are the most common examples of the truly UNhealthy fats.

Healthy fats include coconut oil, butter, ghee, heavy cream, olive oil, pork fats, bacon grease, lard, beef fats, full-fat cheese, avocado, avocado oil, & tree nuts. Start your LCHF nutritious eating plan today!  Eat more fats!!!

Thanks to http://www.dietheartpublishing.com/diet-heart-timeline for a great timeline!

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Diet? Energy Deficit? LCHF?

As many experts have claimed, energy deficits will contribute to weight loss, but historically, patients opt to discontinue the “diet” even after being somewhat successful.  Maintaining a total lifestyle change is required to avoid re-gaining the weight or succumbing to some health condition, i.e. diabetes, hypertension, hyperlipidemia, etc.  Dr. Eric Westman from Duke University has been using a low carb, high fat (NOT truly Atkins) for several years now with good success, and is developing quite a following.  Some of the earliest advocates of low carb, high fat (LCHF) eating were deliberately silenced by Ancel Keys’ strong personality and his aggressive methodologies.  (See Barbara’s entry about low fat dogma.) Even from the beginnings of diabetes, ants recognized the urinary wastes from human contained sugars; somehow, “experts” in the 1950s – 1980s totally believed Keys dogma or were coerced to go along.

In recent years, Jeff Volek & Steve Phinney have published nutrition guidance that supports LCHF eating.  I have begun utilizing LCHF nutrition in my practice and regularly am able to discontinue medications because glucose levels are falling into normal ranges.  Patients come in for visits ecstatic that they have lost weight, lowered glucose, dropped cholesterol, and no longer need some medications.  And most are willing to continue this lifestyle forever.

Nutrition advice should NEVER have come from committees that included insulin or statin manufacturers, cereal producers, or any other profession that could gain from the advice.  Current American Diabetes Association (ADA) guidelines urge diabetic patients to consume about 160 Grams of carbohydrates daily.  No matter what type of diabetic you speak to, each one of them will tell you right off the bat that they can NEVER get glucose controlled eating this way.  They will tell you about spikes and lows and miserable symptoms; it is a terrible battle that most patients are tired of.

Diabetes should be looked at like it is an allergy to carbohydrates; reducing the recommended carb intake to 20 grams per day or less actually reverses diabetes and many providers and researchers are beginning to have data to support it.  We have many patients who are now well-controlled using LCHF eating, and they express much gratitude for giving them their lives back.

Cholesterol, diabetes, diet, Fat, Guidelines, immune system, insulin resistant, keto, ketogenic, lifestyle, low carb, NAFLD, nurse, nurse practitioner, paleo, PCOS

Where did the low-fat dogma originate?

So, what started the low-fat craze?  Having been in graduate school to become a family nurse practitioner, we learned to follow the “guidelines” about cholesterol. If a patient comes to us with high cholesterol, we are to implement “lifestyle” interventions. We were told to institute a low fat diet and prescribe statins (cholesterol lowering medications) if the low-fat diet didn’t work (which, of course, it DOESN’T work!)

However, there was never a mention of Ancel Keys.  We were not told the history behind the nutritional guidelines.  In fact, we were to read the government’s  Healthy People goals and told to utilize them in our work.  In retrospect, instead of critically thinking, it was almost as if we were being indoctrinated to a dogma and one with an unproven hypothesis!

It wasn’t until I became a practicing Family Nurse Practitioner that I realized low-fat diets and medication were not the answer.  In fact, I found medications actually caused more side effects and some patients felt that since they were taking cholesterol-lowering medications, they could eat whatever they wanted!

The low-fat diet is unpalatable and low-fat products are loaded with carbohydrates.  Thus, many who attempted to follow this failed miserably.  In addition, with the added carbohydrates, they gained MORE weight, became type II diabetic, and suffered with metabolic syndrome that leads to heart disease!

I found many of my patients to have an increase in their blood sugar, muscle aches and memory loss from statin medications.  This was a catalyst for me to delve into research.  I was not comfortable mindlessly “following the guidelines”.  I became interested in ketogenic nutrition and started to follow this way of eating.  I felt 100% better, had more energy, found that my arthritis did not flare and lost 40 pounds!  My lipid levels are wonderful.

I investigated the beginning of the low-fat craze to find a researcher named Ancel Keys.  He became convinced that Americans were suffering from heart disease from eating too much saturated fat.  He developed the hypothesis (which is an UNPROVEN idea) that saturated fat causes heart disease. He was totally WRONG, as you shall see.

Scientists who suffered at the hands of Ancel Keys…

E.H. Peter Ahrens of Rockefeller University in New York City was an expert lipidologist.  He was known for being very meticulous in his research.  During this time in history, the 50’s, most scientists were concerned with serum cholesterol.  Ahrens tried to open dialogue to point out that cholesterol was not the end-point in heart disease and he suggested that carbohydrates might be contributing to obesity, diabetes and heart disease.  Ahrens predicted the low-fat diet would lead to unintended and very unhealthy consequences. He was absolutely correct!

Ahrens focused on triglycerides (molecules made of fatty acids circulating in the blood).  He performed experiments to separate out triglycerides from the blood from 1951 to 1964.  In each of these clinical studies, when carbohydrates replaced fats in the diet, triglycerides consistently rose.  He worked with a physician at Yale University and compared the triglyceride and cholesterol levels of heart patients.  They found high triglyceride to be far more common in heart patients than high total cholesterol.  Several researchers confirmed this over the next decade.  However, it fell on deaf ears.  He continued to caution his colleagues on the dangers of carbohydrates.

Keys was known as a scientific bully, arrogant and relentless in disparaging any scientist who opposed his ideas.  George Mann, a Vanderbilt biochemist, and associate director of the Framingham Heart Study, was a prominent scientist ridiculed by Keys.  Mann studied the Massai in Africa whose total cholesterol levels were among the lowest in the world.  Mann noticed the diet of the Massai people to be high in fat, yet they did not suffer from obesity, diabetes or heart disease.  Keys dismissed this study and commented that the “peculiarities of those primitive nomads have no relevance”.

After Mann spoke out against Keys’ diet-heart hypothesis, his career took a devastating turn. He was barred from the American Heart Association publications, journals would not publish his work, and research grants were canceled. He is one of MANY who suffered from speaking out against Keys’ flawed research.

Mann admitted that the Framingham Heart Study ultimately concluded that the more saturated fat a person ate, the lower their cholesterol and weight. Moreover, 50% of the patients who had heart attacks had cholesterol levels BELOW normal.

A generation of research on the diet-heart question has ended in disarray….a misguided and fruitless preoccupation—George Mann

The American Heart Association and the National Institute of Health accepted Keys’ hypothesis and gave it strength.  Researchers who questioned it were barred from membership to the AHA, lost research funding and suffered career setbacks. Yet, this very hypothesis is just that—an unproven idea.

The Seven Countries Study

In 1956, Keys embarked on his study.  He wanted to show that a diet high in cholesterol resulted in cardiac disease.  Keys cherry-picked his data and excluded countries that did not fit his idea.Keys claimed his study revealed that heart disease was highest in countries where fat consumption was highest.  Keys purposefully left out countries where people eat a lot of fat, but have very little heart disease, such as Holland and Norway.  He left out Chile, which showed fat consumption is LOW, but heart disease is HIGH.  This highly flawed study gained enormous media attention and had a major influence on the diet of all Americans…to their detriment.

George McGovern

In order to reverse the epidemic of heart disease, a 1977 committee, led by the U.S. Senator George McGovern, instituted the first dietary goals for the country. McGovern, without any medical education, chose to focus on the research of Ancel Keys. The low-fat dogma began. These guidelines received massive criticism by many respected scientists.  The American Medical Association was against them as were many scientific professionals. Americans were told to eat less fat and more complex carbohydrates.  The guidelines were chosen by the United States Department of Agriculture.  How interesting as they are in the business of selling grains.

American Heart Association

The American Heart Association (AHA) was founded in 1924.  It started out as an underfunded organization.  Proctor and Gamble, in 1948, offered to give the association all their funds from the radio show Truth or Consequences.  This opened up vast avenues for publicity and research.  They eventually hired a Bible salesman who devised a very successful fund-raising campaign.  By 1960, the AHA attained esteemed status in the media and medical community and invested millions of dollars in research.  At this point, they did not agree with Keys’ low fat recommendation.

Manipulated…

By 1961, Keys and his colleague, Jeremiah Stamler, a physician from Chicago, joined the U.S. Nutrition committee.  Neither one had any training in nutrition, epidemiology or cardiology.  However, Keys was a master of persuasion and managed to persuade the AHA that the diet-heart hypothesis about cholesterol intake should be center stage.  The AHA adopted this hypothesis and suggested Americans cut their intake of saturated fat and cholesterol.  They advocated polyunsaturated fats, such as soybean and corn oil (so inflammatory, as we know now!)

Discredited studies…

Unfortunately, money talks. Studies illustrating NO causation between heart disease and saturated fat were available, but the food and drug industry has ways to keep these studies from the public. Many studies have been conducted that clearly illustrate NO association between intake of saturated fat and heart disease.  For instance, William Zukel, a researcher, headed to North Dakota to examine patients who suffered a heart attack.  He identified 228 cases with detailed diet and lifestyle data.  He found that smoking was a factor, but could not associate intake of saturated fat with heart disease.

An Irish study examined 100 men under the age of sixty who had a heart attack.  They did a detailed account of diet.  There was NO association between intake of saturated fat and heart disease.

F.W. Lowenstein, in 1964, as medical officer for the World Health Organization, obtained every study about men who were free of heart disease.  He found NO correlation between intake of saturated fat and heart disease.

Credible scientific journals published the above.  However, those who support the Keys’ hypothesis always found a way to discredit these research studies. This continues today.  The pharmaceutical and food industries do not want us to find the truth.

Keys’ research has been discredited.  We are now seeing the result of years of Americans living the low-fat mantra and suffering with type II diabetes, obesity and heart disease.  We can help you change this—one day at a time.

I highly recommend Nina Teicholz’ book, The Big Fat Surprise.  It is well-researched and will give you an extensive background to the corruption in the research that has led us to an epidemic of obesity, type II diabetes and heart disease.

If you have any questions, please do not hesitate to ask us!

I want to add a link to a study. Read the “conclusion”. It clearly states there is no association between eating saturated fat and heart disease! What the researchers DO state is that what is used to REPLACE fat in low-fat products may be the culprit. All low-fat products ADD carbohydrates to make the food taste better.

http://ajcn.nutrition.org/content/early/2010/01/13/ajcn.2009.27725.abstract