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Why Won’t My Glucose Fall?

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

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

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

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

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

Bell-Curve
Standard Bell Curve

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

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

a1c-chart-dcct

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

caution sign
GET MEDICAL ADVICE for YOUR specific situation

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

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

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

glucose fluctuations
Avoid these glucose fluctuations

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

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

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

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

organicquestion

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

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

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Do you check your glucose?

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

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

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

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

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

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

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

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

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

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

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

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

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Keto Cauli-Taters

1 head of cauliflower, cut into florets

1/2 stick of butter, softened

3-4 ounces of cream cheese

1 cup grated white cheddar

1 tsp garlic powder

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

Salt & pepper to taste

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

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

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

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

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

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

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Reversing Dementia IS Possible

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

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

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

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

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

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

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

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

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

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

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

—Anonymous

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One Person at a Time – We CAN Change the World

 

It is truly a shame that mainstream medical providers, highly trained and well-educated professionals, continue to encourage hundreds of grams of carbohydrate intake on a daily basis when simple logic shows that the approach is not helping to reduce elevated glucose, decrease weight, lower blood pressure, or improve health in any form at all. For many years, now, the nutritional guidelines have encouraged an intake of 200+ grams of carbohydrates daily, even though our bloodstream only requires 4 grams.  For a person with diabetes and insulin resistance, this advice is detrimental to health.  This recommendation contributes to significant over-eating, poor nutrient intake, and terrible internal chemical imbalance – all of which contribute to chronic metabolic conditions.

This advice does NOT differ for Type 1 diabetics, Type 2 diabetics, or for anyone with insulin resistance. Type 1 patients require insulin administration daily so they can metabolize & properly manage the carb & protein intake.  Type 2 patients often end up using insulin injections because the tablets and diet do not provide enough assistance internally to lower glucose and organ damage.  Patients with insulin resistance often require hundreds of units of insulin a day just to keep glucose levels less than 200.  (Less than 100 is NORMAL.)

Anyone with an over-the-counter glucometer can determine this simple and logical conclusion quite easily. Test glucose prior to eating; test again about 2 hours after eating.  If glucose level changes more than 10 numbers, there are likely many carbohydrates in that meal.  So, next meal, test again, leaving out those particular carbohydrates.  Determine for yourself just how to eat with minimal impact on glucose level.

Even a non-scientist understands the simple anatomy and physiological response within our bodies.

“The problem is that carbohydrates break down into glucose, which causes the body to release insulin—a hormone that is fantastically efficient at storing fat. Meanwhile, fructose, the main sugar in fruit, causes the liver to generate triglycerides and other lipids in the blood that are altogether bad news. Excessive carbohydrates lead not only to obesity but also, over time, to Type 2 diabetes and, very likely, heart disease.” – Excerpt from The Wall Street Journal, https://www.wsj.com/articles/the-questionable-link-between-saturated-fat-and-heart-disease-1399070926, retrieved 2/21/2018.

Why is testing like this necessary? Testing glucose is necessary to gain control of your own illness and health. Medical providers are trained to prescribe medications that are produced and sold to provide a source of steady income to drug companies.  Medical providers need a steady and full schedule of patients in order to provide a steady income for their staffs and themselves.  Medical providers have NO coursework in nutrition, except for a freshman or sophomore course as a pre-requisite to professional medical, nursing, or nutrition school.  There is NO training whatsoever for medical providers to learn how to incorporate nutrition as a part of therapeutic treatment for chronic metabolic conditions.  They never hear the word ketogenic nutrition; they have no idea what normal and natural ketosis is.

That said, mainstream providers do the best they can with info and training they’ve been provided; none of them actually WANT us sick or on meds. It is simply all they know.  Medical providers have guidelines and “standards of care” to which we’re held responsible.  These guidelines encourage us to prescribe certain medications as diabetes is diagnosed and then progresses. We are to obtain certain lab testing at specified intervals.  We are trained to tell patients that an A1c of 7 or less is “NORMAL for a diabetic.”  We are trained to use these guidelines as our “logic” and reasoning, even though very little of the guidelines has any actual research supporting the use; most of the research quoted has been debunked many times over the past 5-8 years by independent experts without financial interest in the outcomes.

Why do our trusted and trained medical providers offer such flawed advice? It goes back 50-70 years.  It started in the 1950s when President Eisenhower suffered a heart attack while in office.  Some strong personalities were already studying and researching diet and the impacts of diet on health.  Ancel Keys is credited with starting this avalanche of low fat diet advice, but others quickly hopped on his bandwagon.  The often-quoted and cited Framingham Study also released only part of the data collected and was used as “evidence” that saturated fats caused high cholesterol which caused deadly heart disease. However, Dr. William Castelli, a former director of the Framingham Heart study, stated in a 1992 editorial published in the Archives of Internal Medicine:

In Framingham, Mass., the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person’s serum cholesterol. The opposite of what… Keys et al would predict…We found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories, weighed the least and were the most physically active.”

This major piece of data was NOT released as part of the study; it only came out later as part of the editorial by the former director of the study. By 1980, so much money and time had been invested in low-fat dietary research, it seemed no one could stop it. Thus, the “Standard Dietary Guidelines for Americans” was published. Later, the American Heart Association also joined in the support of these guidelines; the American Diabetes Association also began to support these guidelines.  No science.  No independent research data. Thus, we the people were “fleeced” and fell right in line with this dietary advice.  We began cutting fats and one of the first fats to go was milkfat, and then animal fats.

milkfat pic          animal fat pic

However, look at what happened to the weight of Americans.

 

Multiple resources offer similar trends in weight; notice the trend of weight gain began during the 1970s and 80s, when low-fat dietary advice was pushed forward as “healthy.”

disease trends

Using some simple common sense and logic, we can review history and data and draw some logical conclusions based on these numbers. As fat intake declined, obesity and heart disease rates increased.  What replaced the fat?

carb intake

474 grams of carbohydrates will be converted into 118 TEASPOONS of glucose – that’s 2.5 CUPS of sugar. Just what do medical experts EXPECT our bodies to do with this much glucose?

Even at the lowest ADA recommended intake of 165 grams of carbs per day, those carbs convert into nearly 7 ounces of glucose – almost 1 whole cup of glucose.

Think about our most vulnerable of our population: our children. Then, narrow down that population to Type 1 children. Current recommendations for managing this illness is to eat high amounts of carbohydrates and to administer higher and higher amounts of insulin to lower the glucose load.  How does this advice even seem normal, now that we’ve seen the data? Do their brains develop normally with such significantly elevated glucose levels? Some experts are calling Alzheimer disease Type 3 diabetes because we now recognize the brain damage done by high glucose and high insulin levels – yet, it’s the “standard” treatment for our most vulnerable population?  Why would we actually WANT our children to consume hundreds of grams of carbohydrates daily, just to be able to dose higher amounts of insulin? Why should we continue to advise high carb intake when it has now been linked to higher rates of non-alcoholic fatty liver disease, infertility, and even cancer – even in our children? I fail to see the logic.  Our children deserve better.  Our children deserve NORMAL glucose levels.  They should not be at risk for developing “double diabetes,” because we continue to encourage high carb intake and high insulin use, forcing their bodies to become insulin resistant over time.  These children are one of our most valuable resources; why can’t we provide better advice and care?

One person at a time. One medical provider at a time.  One conversation at a time, we are taking charge of our own health.  We are doing the “research” by checking our own glucose.  We track our intake.  We, at the grassroots level, are doing research that government and agencies and companies should have done half a century ago.  We are cutting out the highly inflammatory grains.  We are cutting out sugar.  We are eliminating the cause of our metabolic disease, and our health improves because we are PRO-active instead of reactive.  We are using food as our medicine…. Isn’t that what Hippocrates said?  “Let food be thy medicine and medicine be thy food.”  And our medical physicians take the Hippocratic oath, which includes the phrase, “do no harm.”  I think it’s time we hold our providers accountable for their advice.  What do YOU think?

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Just What is Ketosis?

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

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

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

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

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

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

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

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

can become terribly confused,

complain of fatigue and loss of appetite,

may have shortness of breath, blurry vision, vomiting,

or exhibit an imbalanced gait.

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

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

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

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

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

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

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

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

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

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Keto Pepper Poppers

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

12 jalapeños, seeded and halved

8 ounces of softened cream cheese

3 tbsp. sour cream

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

2 tsp minced garlic (More can be used)

1/2 tsp onion powder

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

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

Serve.

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