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Teresa Reversed Her Diabetes!

 

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

Teresa Toten, July, 2017

 

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

 

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

June, 2017

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

 

Day 1 of Keto Nutrition, April, 2017

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

 

May, 2017

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

 

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

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

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

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

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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.

 

 

 

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Fiber – Useful or Harmful?

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

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

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


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

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


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

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

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

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

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

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

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

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

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What is Vitamin D & Why Do I Need It?

vit d pathwayVitamin D is called a vitamin; it’s often called a hormone. It’s often called a vitamin that acts like a hormone.  So, which is it?  It’s actually all of the above.  Vitamin D is a fat-soluble agent with a chemical structure similar to a steroid.  Which makes sense, as Vitamin D is one of the major ingredients of all steroid-based hormones produced in our bodies. Our bodies were created and designed to absorb sunshine via skin and then a variety of chemical reactions would occur so our bodies actually made its own vitamin D.  However, since the skin cancer scare of the 1970s, the general population applies thick layers of sunscreen and we rarely remove enough clothing to bare our skin for this natural process to occur.  This long-term lack of sunshine on our skin is producing entire generations of significantly deficient people in our society.

What happens when we are low in vitamin D? How does a vitamin D deficiency affect people’s health? Because vitamin D is vital to numerous human processes, it can be quite complex to discuss its actions, roles, and benefits to our bodies.  We will attempt to explain vitamin D as simply as possible, describing the intricacies and complex utilization of vitamin D.

 vit d image

The oldest known function of vitamin D is the role in bone growth and development; we’ve all seen photos of young children with rickets (legs bowing outward) because of a severe deficiency of vitamin D. Without adequate D in the bloodstream, bones cannot grow or develop properly.  For years, calcium was reported to be the “hero” of the skeleton.  People with weakening bones were urged to take high doses of calcium daily “to protect your bones” and prevent osteoporosis.  However, in recent years, that advice has been scaled back a bit; no longer is it general health advice to recommend calcium supplementation unless there is known osteoporosis or osteopenia.  Even where there is evidence, many providers won’t recommend it lightly; they take great care in explaining the risks/benefits and often encourage vitamin D in place of or at least along with the calcium.  So, just what does the vitamin D do for bones?  It’s most recognized benefit is that it aids absorption of calcium from the intestines; it’s the reason vitamin d is added to milk and other dairy products.  Milk/dairy products do NOT naturally contain vitamin D; it is added to promote calcium absorption into the bones for effective use in growth & development. Vitamin D helps keep bones strong and also helps prevent weak, brittle bones in the elderly.

In addition to bone health, vitamin D is recognized for its effects in the brain; it has been called “the depression vitamin” among health care professionals for many years because it is a vital component of neurotransmitters in the brain. Three major neurotransmitters in the brain requiring adequate amounts of vitamin D include serotonin, oxytocin, and vasopressin; serotonin is a neurotransmitter vital for transmitting nerve impulses. Serotonin is also important for mood regulation; pain perception; gastrointestinal function, including perception of hunger and satiety; and other physical functions. Oxytocin is released from the brain when it is needed for a variety of body needs, including labor & delivery at the end of pregnancy, during sexual arousal, and it is often referred to as “the love hormone” because of its impact on emotional relationships. Vasopressin is an anti-diuretic hormone that regulates fluid balance within the body and bloodstream. It works to prevent excess fluid loss and helps maintain homeostasis (normal internal chemistry) by maintaining the concentration of dissolved particles, such as salts and glucose, in the blood. Reviewing all 3 of these neurotransmitters and their major functions is vital to understand brain chemistry; can you see how a shortage of vitamin D would impact nearly all normal body functions and even our relationships, moods, and emotions?

Vitamin D’s impact on glucose has only recently been identified; multiple studies show conflicting data as this area is new to research. However, knowing that vitamin D is an essential ingredient of vasopressin, and that vasopressin helps maintain healthy glucose concentrations, does it not then make perfectly logical sense that a shortage of vitamin D will result indirectly or directly in elevated glucose levels?

In addition, a recent study shows that fasting glucose levels, insulin levels and insulin resistance all improved with vitamin D supplementation. Additionally, this study suggests that pro-inflammatory cytokines that are thought to contribute to insulin resistance were down-regulated with this vitamin D supplementation. Translation: with high carb/high sugar intakes, we are finding significantly elevated levels of inflammatory markers, like cytokines, that are more linked to heart disease, heart attacks and strokes than we ever imagined. Vitamin D supplementation appears to reduce that inflammation as part of the body’s normal healing/tissue repair processes.

However, let’s review again: former advice to take calcium for bone health came with advice to also take vitamin D to aid absorption of the calcium. Just as calcium needs vitamin D for absorption & effective utilization, so vitamin D needs some help. Magnesium and vitamin K2 are necessary for the absorption and use of vitamin D. Recent studies have shown even the very high doses of vitamin D prescribed by health care providers (50,000 IUs) as a weekly regimen barely raised vitamin D levels at all after 4-6 weeks, the usual recommended time frame for dosing. Once study participants added a magnesium and/or vitamin K supplement to their regular dosing regimen, vitamin D levels immediately began to rise. These studies are why we typically recommend vitamin D, magnesium, and vitamin K2 to most people with insulin resistance and type 2 diabetes.

Recently some reports are suggesting that vitamin D is integral to our immune system; some experts and studies are recommending to add or increase vitamin D supplementation during a variety of illnesses, including colds, flu, respiratory illness, asthma, and more.

What about doses of these supplements? There are limited studies and recommendations because this field is so new and mainstream medical providers are hesitant to make recommendations to patients without a large body of support. The Endocrine Society has stated that a deficiency of vitamin D exists when lab levels fall below 20 ng/mL; however, many reputable experts and organizations say that level should be 40 or even 50 ng/mL. Because of limited evidence, it’s difficult to specify a particular dose. Even more recently, various mainstream medical organizations like the Endocrine Society have stated that health care providers should not draw a vitamin D level on patients anymore, because we’re all deficient anyway, & the test is very expensive; most insurances won’t cover the costs either. So how are we supposed to know what dose to take? Well, the current recommendations for dosing are not clear and without a known vitamin D level, finding your perfect dose may be tricky, but many people find that 1,000 – 2,000 IUs daily is a good maintenance dose; some people just beginning to supplement find that taking 5,000 IUs daily for a few weeks is very helpful at reducing many vague symptoms that they often never connected to poor nutritional status. You can ask for the blood test to be done; you should also ask for the pricing of the test prior to having it drawn so you’re aware of the likely expense. Manufacturers of supplements are meeting the market demand by producing combinations of D, magnesium, vitamin K, and/or iodine for patient convenience.

One warning of NOTE: vitamin K2 is vitally important in blood clotting; if you are taking a blood thinner or have been told you SHOULD take a blood thinner, including aspirin, you should discuss adding this supplement with your provider BEFORE taking it. While vital for normal body processes, vitamin K can contribute to increased clotting within blood vessels; clots are known contributors to heart attacks and strokes.  

In conclusion, the general consensus on Vitamin D includes:

  1. Each increase of 4 ng/mL of vitamin D in the blood is associated with a 4% lower risk of type 2 diabetes.
  2. There is a significant and inverse relationship between blood levels of vitamin D and the risk of type 2 diabetes among a wide range of vitamin D levels and among a wide variety of populations, so that it is difficult to specify “normal” lab reference values and recommended daily dosing. Translation: The lower your vitamin D level is, the higher the risk of development of type 2 diabetes.

For further information about Vitamin D, it is recommended to ask your regular health care provider.

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How Do I Eat LCHF?

One of the most common questions I am asked is, “well, what do you eat if you’re not eating carbs?” The answer seems easy, but I find that explaining it can be quite tricky and complex for a lot of the people with whom I share LCHF (low carb high fat) information. First, let’s start with a review of current dietary recommendations.  If you look at the American government’s nutrition advice at “myplate.gov”, you’ll find a colorful plate that suggests half your plate be covered in fruits and grains and an additional serving of dairy off to the side.  The rest of the plate should include vegetables and meat. Notice, there is no longer a place on this plate for fats.  Over the past 50 years, more and more “experts” have recommended less & less fat intake over time, even though there is absolutely NO scientific evidence that supports that recommendation.  In addition, the current dietary guidelines for people with diabetes recommend 45-60 grams of carbs per meal and 15-30 grams of carbohydrates per snack, with 3 meals and 2 snacks recommended; do the math.  45 grams x 3 meals = 135 grams; 15 grams x 2 snacks = 30; even on the lowest carbohydrate plan from the American Diabetes Association, that’s 165 grams of carbs per day.  On the higher end, that’s 60 grams x 3 meals = 180 grams and 30 grams x 2 = 60, for a grand total of recommended carbohydrates PER DAY of 240 grams.  When you realize the bloodstream only needs 4 grams of carbohydrates for a 24 hour period, you quickly begin to see why current dietary guidelines are failing our bodies and contributing to sickness all across our land.  The body must use or store this excess energy; when it can no longer store any more glucose, it begins to make triglycerides from the excess carbohydrates or leave the excess inside the bloodstream, resulting in hyperglycemia, also called diabetes mellitus.  SO, how many grams of carbs do we actually need?  Another controversial response.  While carbs have never been shown to be essential to body functions like proteins or vitamin C, most experts agree that having some carbohydrates is good, ok, or allowed.  I typically recommend about 20 grams of carbs per day for most patients with glucose, insulin, triglyceride, or weight problems.  People cutting carbs for general health’s sake can often tolerate up to 50 grams per day without significant health problems.

Mainstream medical providers will usually prescribe medications that will help lower glucose, but no medication will stop the progression of diabetes as long as an overload of carbohydrate continues. And there is NO medication to stop the “carbage” from going in our mouths.  People who truly desire to reverse their diabetes or stop progression, at the very least, must significantly decrease carbohydrate intake.  Many people immediately think of sweets, candy, cakes, brownies, and soda as high carb/sugar items and usually give them up immediately upon diagnosis of diabetes or insulin resistance.  However, there is a much more complex event at work here, as all carbohydrates CONVERT into sugars like glucose or fructose – both of which are linked to a variety of chronic disease states, like insulin resistance and diabetes.  So, what is considered a carbohydrate? What foods convert into sugars?  All breads, tortillas, crackers, chips, beans, pasta, rice, corn, oats, quinoa, rye, and barley convert into GLUCOSE.  Yes, ALL of them.  YES, even the “healthy” whole grains.  YES, anything made with flour.  YES, all cereals convert into SUGARS.  All of these grains contribute to elevated glucose levels, high triglycerides, and increased states of inflammation which create the perfect storm to ill health in the form of heart attacks and strokes.

Cutting carbs to gain health is probably one of the best choices anyone can make today. Between all the planting, harvesting and processing that goes into producing our bagged, boxed and pre-packaged food items and the terribly high amounts of them we’ve been consuming, it’s no wonder that heart disease, diabetes, and all chronic conditions are on the rise.  Once you’ve decided to cut carbs, pat yourself on the back! That is an amazing first step.  Now, it’s time to clean out the pantry; start by reading every single label of every single package.  Look at the carb count per serving AND the ingredient label.  Do you always ONLY eat 1 serving of that item? Or do you eat 2-3 servings?  Most of us have NEVER paid any attention to this part of a nutrition label, but it’s time we read.  If the carb count PER YOUR PREFERRED amount is higher than about 5-7 grams, it’s probably not very healthy to keep it.  Toss it or donate it.  Once the pantry is clean, you can start FRESH, stocking your kitchen with a variety of healthy foods that will not only lower your glucose, but also provide a wide variety of essential nutrients for your body’s healing.

Now it’s time to make a meal plan; starting with simple vegetables and meats is best and easiest. It typically takes about 20-30 minutes to prepare/cook most low carb meals, but many newbies find it difficult to see that.  They imagine all sorts of complex recipes with foreign ingredients and spending hours in the kitchen.  If you develop a meal plan for a week or 2 at a time, you can make your shopping list accordingly and save hundreds of dollars a year by buying only what you need for known meals.

Staples for your low carb kitchen:

Your favorite spices are usually fine, but avoid combos or read labels carefully; many combos include casein (milk) or wheat (anti-caking agent) and a variety of “natural” flavors which often include sugars. Pink Himalayan salt is my favorite salt as it supposedly contains trace minerals we need.  We eat a lot of black pepper, garlic, and onion powders, so these are vital for our kitchen.  You find the spices that make you happy and stock those.  Salt is necessary, so don’t skimp on salt.  When cutting out all the processed foods, we’re also cutting out TONS of salts and salty preservatives – most of these chemicals we don’t need.  But sodium is required for normal muscle functions and a variety of major body processes, so don’t cut salt on LCHF – INCREASE salt intake, but only salt foods that have never been salted before.

In addition to a good quality salt, choose oils based on this chart: Olive, avocado oils are good, but heating them for certain cooking processes isn’t the best choice.  I use butter or refined coconut oil (no coconut flavor) for high-heat searing of most meat.  I cook most of my veggies in butter and/or bacon grease.

how to use oils photo

Avoid margarine period. It was invented to make turkeys/poultry fatter faster; what do you think it’s doing to US? Never buy “low-fat” or “lite” foods.  Always purchase full-fat products as these contain the fewest sugars and best fats.

Nut flours like almond or coconut can be used in small quantities, on occasion, but I teach patients to avoid using these for at least 30 days on LCHF eating. Subbing these ingredients out for wheat flour to make a pan of brownies is defeating your REAL purpose in making these changes and prevents your palate from resetting.  Giving in to sugar cravings by making a low carb sweet can continue the cravings and make your body more confused.  Teaching your body to do what YOU want is more important than satisfying a “sweet tooth.”  After glucose is under control or once weight is lost and you’re happier with your health, it is usually safe to try some of the low carb breads, pizzas, and desserts – but I always caution people to NOT expect it to taste or feel like “it used to.”  The consistency, flavor, and texture will be different.

Sweeteners are not typically recommended on LCHF eating because they often trigger the same exact response in the liver and pancreas as sugar; again, I typically recommend avoiding any type of sweetener for 30 days – 30 days won’t kill ya! Once you’re past the 30 days and/or glucose levels/weight are down, you can test sweeteners to see how your body responds. Test glucose prior to consuming a sweetener of choice and test again an hour or 2 afterwards.  Testing is the only way to know for certain how a food or ingredient impacts your glucose. Once you’re past the first 30 days and are looking for more variety in your recipes, you can try erythritol, a sugar alcohol that is poorly absorbed and less likely to cause glucose spikes – but TEST to know for sure!

Find or make a low carb mayo; most commercial mayonnaise contains sugars, corn syrup or other sweeteners. If you can find a low carb mayo in the store, that’s AWESOME! Many of us make our own, but since we can’t have breads, making mayo becomes a very rare occasion.  I make it 3-4 times a year when I want tuna or chicken salad.  Full-fat sour cream can sometimes be used in place of mayo or yogurt in recipes.

Image result for mayonnaise nutrition information
This label is a great example of how sneaky companies are; notice ZERO carbs, but SUGAR is listed as an ingredient!

 

Heavy cream is preferred over milk when eating LCHF; all milks contain sugars, but cream contains barely any sugar at all because it is the fat that is removed from milk at the dairy. Yes, it’s heavy whipping cream, found in cardboard milk containers most often.  You can use it to make gravies, sauces, toppings, etc. for a wide variety of LCHF recipes.

If you can afford it, buy grass-fed butter, dairy and meat products. Find a local farmer to buy from. Google a dairy nearby.  The closer our food products are to the farm, the less likely that additives, hormones, and antibiotics are tainting our foods.

Healthy cheeses include the ones with the least amount of chemicals/additives listed in ingredients; avoid processed cheese like Velveeta, cheese slices, and cheese sticks. Use full fat cheeses whenever possible. Some people do find that dairy products can trigger inflammation, bloating, swelling, and glucose/insulin spikes and must limit or avoid them altogether.

Meats and Veggies

When shopping for meats, choose the cheaper cuts as these also contain the most fats; saturated animal fats have never been shown to be unhealthy. We just believed people when they said they were.  Purchase the 70%/30% ground beef products or the closest possible.  Buy the steaks with the most marbling.  Buy roasts with thick layers of fat on them. When shopping for lunch or deli meats, really be “on your toes” with regard to ingredients; most ham is smoked in brown sugar or honey.  Many lunchmeats have corn syrup added to them during processing.  Pepperoni, salami, pork rinds, and summer sausage usually have little to no sugars/carbs.

All meats are approved for LCHF eating: beef, deer, moose, caribou, elk, pork, chicken, turkey, lamb, duck, fish, seafood, etc.  Consideration must be taken into account for processed meats; since companies are seasoning and prepping the meat, always read nutrition and ingredient labels.  There are over 60 names for sugar or natural sweeteners; companies are learning to “hide” sugar by using more “natural” or healthy-sounding words.  Be aware.  Read and do your research.  We often find “side meat” and cook it like bacon; it is often found in a meat deli or butcher shop and is fresh, not cured, not soaked in chemical preservatives.  Many people equate LCHF eating to the old “Atkins diet” and believe we low-carb-ers also eat high amounts of protein/meat.  But that is not the case; Dr. Atkins was on to something with his low carb diet plan, but he missed the mark just a bit with his philosophy on proteins.  The “missing link” that I believe he omitted was that excess protein, in the absence of carbohydrates, will be converted into glucose.  LCHF is not a “meat free-for-all” but rather, it is keeping meat portions very small to help minimize gluconeogenesis – converting protein into glucose.  In general, keeping protein intake to about 15-20% of daily intake is ideal; athletes will need more protein than sedentary people, so keep in mind your personal life when calculating dietary intake of your macronutrients.  To calculate your protein needs, identify your ideal body weight or lean body mass – this weight can be found in a variety of online calculators published and determined by insurance companies.  Convert this weight into kilograms (kg) by dividing your weight in pounds by 2.2.  Then multiply this number by 0.8 – 1.6, as this is the range of needed protein per kg per day.  EXAMPLE:   A 40-year-old female office worker weighs 175 lbs; her ideal body weight/lean body mass, based on her height of 5’6” is approx. 140 lbs.  Divide 140 lbs/2.2 = 64 kg is her weight in kilograms. Multiply 64 kg x 0.8 kg of protein per day = 51.2 grams of protein is ideal for this particular lady.

Vegetables are often confusing to people, since so many GRAINS are also called veggies by restaurants and even in diet literature. AVOID all grains: corn, rice, and quinoa.  Avoid root vegetables most of the time; root vegetables include potatoes, turnips, onions, carrots, and any other starchy vegetables.  Using a few slivers of a carrot atop a salad isn’t a terrible choice, but having 1 small serving of “penny carrots” could result in elevated glucose for a week! You may also use onions for seasonings or toppings, but keep your portion of it to a tiny “garnish” type of amount.  Recommended vegetables include:  alfalfa sprouts, arugula, asparagus, bamboo, bok choy, broccoli, broccoli sprouts, Brussel sprouts, cabbage, cauliflower, chard, chives, cucumber, celery, eggplant, jalapeno, kohlrabi, kale, kelp, lettuce, mushrooms, mustard greens, okra, parsley, pickles (sugar-free), radicchio, rutabaga, salad greens, snow peas, spinach, string (green) beans, sweet (colored) peppers, zucchini.  Keep serving to about 2/3 cup per meal for best results.  Add fats to all servings.

As for squash, zucchini is pretty low carb, but many of the other squashes are higher in carbs, so if you choose to have a winter squash, be prepared to see some rise in glucose levels; some people can tolerate more of these foods than others. Individualize your meals based on your meter readings. Tomatoes and artichokes also fall into this “gray” area of choices.  They may impact some glucose levels with a minimal response, while shooting other glucose levels through the roof.  Base your food choices on your glucose readings; over time, your body will teach you what is safe for you.

Sample meals:

Breakfast – Eggs and bacon

When I first began eating LCHF, I would usually have 2-3 eggs and 2-3 slices of bacon every morning in addition to my fatty coffee, also known as bulletproof coffee(BPC). Over several weeks, I found I couldn’t eat that much on a regular basis; I’m now eating 1 slice of bacon and 1 egg with my BPC. This decrease is a normal reduction of intake when eating LCHF; as time progresses, we often find that we eat less quantity as well as less often.  Eating 5-6 small meals per day has become the “norm” for most of us for a couple reasons.  First, we’ve been told to do so by our nutritionists, dieticians, and health care providers; secondly, when eating high carb, the carbs are used or stored within minutes, making us feel hungry again triggering need for repeated meals.  Once our bodies adapt to burning fats instead of carbs, we no longer feel hungry as often; fats provide a much longer period of satisfaction, curbing hunger and urges to snack all the time.  When I have BPC, 1 egg and 1 slice of bacon in the morning, I usually don’t feel hunger again until 3-4 pm, meaning I can skip lunch without feeling deprived or hungry.  I don’t feel the urge to snack or eat because my brain is being fueled by ketones that are broken down from the fats I’ve eaten.  Sometimes, I do make a low-carb pancake breakfast, or make egg muffins with cheese and meat – no flour.  Walden Farms actually makes a sugar-free syrup that some people are able to use without significant glucose spikes.  There are now hundreds of low-carb recipes to satisfy any “hankering” you may have when you just want something different from eggs and bacon.  However, I LOVE eggs and bacon!!  If I’m in a hurry, I will sometimes have a small chunk of cheddar cheese with a boiled egg – easy and fast for those “on-the-go” days. But NO toast!

Meal Ideas

Some of our favorite entrees are provided below; most meats can be seared on high heat in refined coconut oil in about 20 minutes or less. Toss some veggies in a skillet of bacon grease or butter and they are done in about the same time.  Quick, simple, and very healthy.  We often cook extra so that we have “ready-to-eat” meals on hand for busy days.   Sometimes we make a pasta-less lasagna or ziti, freezing portions of it for later use.  Some people will make cloud bread for use as buns for burgers; some people will use zucchini for “noodles” – we call them “zoodles”.  Eating LCHF is fun and exciting for multiple reasons, including experimenting with new and different foods, spices, etc.  But most of all, it’s exciting to see glucose control, weight loss, and improved health overall.

Taco-less Salad

3 oz browned hamburger meat, seasoned with NO sugars, chilis, garlic, onion/chili powder – your favorites

2-3 oz shredded cheese – your favorite

1 Tablespoon finely chopped onions

½ of a sliced avocado

1-2 tablespoons of regular sour cream

2 halved or quartered grape tomatoes

About 1 cup salad greens (the more colorful, the more nutrients)

Sugar-free (preferably homemade) salsa

Hamburger Steak with Asparagus

Brown 3-4 oz hamburger patties in butter or bacon grease; season to taste; use highest fat content meat

Chop asparagus into 2” pieces – you can season them and roast them in oven on 400 degrees for 20 min/stirring halfway through, OR you can stir-fry in butter/bacon grease on stovetop for about 12 -15 minutes. In fact, any vegetable can be prepared using this method.

Breadless Sandwiches

Take 2 slices of sugar-free lunch/deli meat and cover with a thin layer of full-fat cream cheese

Add veggie pieces (your faves) or sliced cheese

You can roll these up OR add more meat for a flat, more normal-looking sandwich.

Place 2 more slices of lunch meat on top and cook in buttered skillet for 5-8 minutes or just until cream cheese melts and meat begins to brown. Cut into triangles and serve with veggie of your choice.  Can dip into home-made dressing or mayo, olive/avocado oil.

Here at KetoNurses, we truly hope you benefit from our information and that this article offers you a solid foundation for your new “keto” lifestyle! Don’t forget to follow us on Facebook!

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How did I get fat? How did I get diabetes?  How did I get so unhealthy?

My daddy used to love my mama’s peas and cornbread, but watching him eat them was quite fun. Mama usually prepared his plate and took it to his recliner, where he ate on a TV tray while watching the news. Inevitably, he would finish off his cornbread first and still have peas on his plate. Well, being a faithful member of the “clean your plate club,” he figured he HAD to have another piece of cornbread to go with those peas. Then, he’d run out of peas, but still had cornbread, so he got more peas. This crazy process went on for 3-4 trips back to the kitchen until he could finish his plate evenly.  By now, you’re probably thinking 2 things for sure: 1)My daddy was a bit silly 2) Why the heck is this story here on the KetoNurses’ blog?


Well, to answer the first question, yes, my daddy could be quite the prankster and his antics brought much laughter to our lives over the years. His story of “peas & cornbread” illustrates a very valuable lesson for us. Today, we’re going to discuss cravings in the context of how the liver processes the carbohydrates we overconsume. Let’s first take a look at normal glucose-related processes in simple terms.

SIMPLE VERSION: When healthy people eat carbohydrates, the pancreas secretes insulin to immediately control the amount of glucose entering the bloodstream. The bloodstream only needs about 4 teaspoons of glucose in a 24 hour period; what happens when we consume carbs that convert into 10-15 teaspoons of glucose? Insulin from the pancreas comes to the rescue and immediately latches on to glucose molecules entering the bloodstream from the digestive tract, then trucks it into cells. Moving glucose out of the bloodstream is vital to maintain internal chemical balance, but storing all the extra carbs is quite a feat. There is only so much insulin to go around, so another process is triggered. Overconsumed carbs trigger the liver to store some of the glucose as glycogen. Glycogen is like having a reserve gas tank on your car; if your main tank runs low/out, the car will automatically start pulling fuel from the reserve tank and so it is with glycogen. But there is only so much storage space in muscles and liver for glycogen. Glycogen is the most available form of stored energy, but it’s in pretty small quantities in the muscles, and the glycogen stored in the liver is meant for more long-term, “survival of the species” type of storage. The liver doesn’t WANT to give up the stores of glycogen, just in case it’s needed for a period of famine – our bodies are pretty good at self-preservation.

Glucose is rapidly removed from the bloodstream in normal and mildly abnormal metabolism. Remember the last time you were hungry and ate an apple? You likely noted hunger about 20-30 minutes later, because the energy it provided was quickly used and stored. Glucose enters the digestive system and is easily passed into the bloodstream rather quickly; so there’s instant energy available, and there’s stored energy, but there doesn’t remain much glucose available for right AFTER eating. It seems there’s a “gap” in this system of fuel processing. Glucose was never meant for steady energy for all body processes; it literally was intended to be a quick way to have energy.

So, what happens to the extra glucose molecules still causing elevated glucose? If neither of these processes cannot adequately move glucose out of the bloodstream, the liver begins to knit together chains of triglycerides – a form of cholesterol that is like having a 55 gallon drum of gas in your yard for fuel when the main AND reserve gas tanks run low. It’s easy to pull up in your own yard and fill up. So the liver is storing your extra glucose for later use. This process can take up to 4 days to complete the process. However, if we continue consuming large amounts of carbs at every meal, the liver never gets a chance to rest.


These 3 processes are the major methods for glucose storage in a normal person without diabetes or insulin resistance. When excess glucose is continually forced into this system, there is never a chance for “catching up.” The liver is constantly trying to move excess glucose out of the bloodstream while insulin is secreted by the pancreas in larger and larger amounts; more fat cells receive some of the glucose, causing weight gain. Eventually, the system begins to fail, resulting in insulin that no longer moves glucose out of the bloodstream effectively. The liver is overflowing with glycogen & becomes stressed from making triglycerides, and now, triglycerides are accumulating in blood vessels. The liver does not have a brain to tell it to STOP storing all that glycogen; when this process is overwhelmed, non-alcoholic fatty liver disease develops, the liver enlarges, and liver enzymes often increase.

When these processes are overwhelmed, we can also become insulin resistant and diabetic– meaning the insulin that the pancreas secretes just isn’t responding normally, so the pancreas tries to make more and more, but it’s just not effective at moving enough glucose out of the bloodstream. An analogy that I sometimes use with patients helps people understand; imagine you are employed on a production line in a manufacturing plant. You get paid based on your production. Everything is going along quite well with your organized and efficient workflow; you work and you make 100% production every day and take home a paycheck with which you’re happy. Suddenly, your boss comes along and says you must double production or be fired. What happens to your nice, organized workflow? You are working faster and faster, getting more nervous, even becoming frantic that you will lose your job if you can’t keep up. So you work harder and faster. What happens to the items you’re producing? Are you able to produce the same amount of high quality products moving this fast? No, of course not. And your organs are highly specialized to perform certain functions efficiently and without our thought or effort; but when we put demands on those organs and ask them to double or triple production, they cannot efficiently perform their usual functions.

Let’s review the third process of glucose storage for a moment. Ingredients for triglycerides include sugars like glucose and fructose. When excess sugars are not needed for current energy use, these molecules thicken blood from a watery consistency to more like that of syrup, while the liver is knitting together some sugars into long chains of triglycerides. Triglyceride production can sometimes trigger cravings for food in order to ensure the liver’s ability to production. It’s like my daddy’s “peas & cornbread.” The body is trying its best to keep up, but it wants more and more glucose to process – I know it sounds contradictory; you’d think that if there was excess, the body wouldn’t want more. But once the process is triggered, the liver is just following procedure. Now, the liver is producing thick, sticky chains of triglycerides and sending them out into thick syrupy blood, contributing to a “perfect storm” inside the tiny blood vessels. It’s like building a beaver dam right inside our arteries! These sugars accumulate in the blood vessels and they are sticky – imagine if you will, drying syrup. If you leave a drop of syrup on a table or plate for a few hours, what happens? The syrup begins to dry and the sugars left begin to crystalize and harden. This imagery can help us understand what sticky, spiked molecules of triglycerides might resemble under a microscope. Now imagine these clumps of sticky molecules moving through tiny, forked, meandering blood vessels all over our bodies. Does this picture in your mind help you see where many complications from diabetes originate? Thick, sticky blood congregating in tiny vessels can slow or even halt blood flow. Slow wound healing, nerve pain, visual difficulties, numbness and tingling in hands/feet, kidney damage, heart attacks & strokes are the direct result of the formation of tiny beaver dams all over the blood stream.

Although my daddy’s peas and cornbread are high carbohydrate foods and his story is a bit silly, I think the analogy they provide is quite helpful at understanding some fairly complex concepts. I hope this information is helpful to you; please feel free to share our articles on your Facebook, Twitter, Instagram, and other social media accounts. We appreciate it!