Recently, another health care provider mocked my use of the phrase, “improving the health of my patients”, saying that it’s vague and not measurable.
Her comments gave me pause, because the goal of every nurse I’ve ever met has been to help people improve their health. Ask any nurse why he or she became a nurse, and you will hear a variety of ways people say it. We nurses help people get well, better, or over a health obstacle. How is that measured?
First and foremost, there are many parameters used by health care providers to measure health. With diagnoses of diabetes and hypertension, we measure glucose and blood pressure, respectively. But we often have difficulty quantifying how people feel when they lower their glucose or blood pressure. When patients return for follow-up and I’m able to tell them their hemoglobin A1c dropped from 8.9 to 6.4 after weeks of diet changes and effort, people are thrilled. They grin from ear to ear. They clap. They shake a fist in the air. They “high five” me. Some even do a “happy dance.” What is measurable here? Yes, the glucose levels are numerical and easy to track. But how does anyone put a scale on happiness or joyfulness? Can the idea that diabetic complications no longer pose a looming hazard to health be measured? How is relief quantified when kidney damage has improved?
These feelings are not measurable, yet they are extremely evident in behaviors and attitude. Patients who work toward improving health exhibit gratefulness that good instruction is provided; is that gratitude measurable?
Measures are important in health care. Measurements of pulse or blood pressure provide vital information to us who render the care. I decided that some of you might be interested in knowing what measures we use for certain conditions so you can track your own progress over time.
With diabetes, one of the most important measures is glucose, of course; in addition, the hemoglobin A1c that tells us the average glucose levels over the past 90-100 days provides a good correlation to patient effort in managing the condition. While mainstream medicine will say that “good” diabetes control occurs when the A1c is around 7, many studies have shown that diabetic complications occur when the A1c runs higher than about 6.2 or so. Normal A1c levels run around 5 or less; why should people diagnosed with diabetes be forced to run glucose levels so high that we KNOW organ damage will occur? Is that going to help patients “improve their health”?
Elevated blood pressure is often associated with diabetes because high glucose levels cause thick, sticky blood; demanding that the heart pump thick, sticky blood to an overweight body will eventually result in high blood pressure. The heart will pump harder and with more force to move thick “syrupy” blood through tiny blood vessels, resulting in higher and higher blood pressure readings. When blood pressure increases, the heart muscle becomes compromised and weaker. Daily demands on the heart that continually exceed it’s designed capabilities can contribute to a multitude of vague symptoms which are not measurable, including headaches, fatigue, nausea, dizziness, or even mild swelling. While most of these symptoms have no quantifiable scale, patients will describe how much better they feel once blood pressure is lowered. While blood pressure is measurable, the feeling of lower and healthier blood pressure is described by patients as “improved health.”
If blood pressure remains untreated or poorly managed, heart failure and/or kidney damage begin to occur. Highly pressurized blood flow moving through the kidneys will damage the fragile vessels, reducing the filtering ability of the kidneys. Elevated glucose can also damage these tiny vessels, resulting in inflammatory responses by the body that are designed to patch and repair damage – but this natural response by the body can result in blood vessel blockages. Think scar tissue.
In this photo below, notice that cholesterol is serving as the patch, relating the damage to the blood vessel. Cholesterol isNOT the cause of clots; it’s part of the damage control/repair team of the body. In summary, how do we measure “improved health”? How can we quantify patient comments when they express gratitude for how they feel? How can we count the number of clinic visits these patients will NOT have? How do we track hospitalizations that do NOT occur for these patients? What evidence do we see when ER visits are no longer the norm for people with “normal” glucose or blood pressure? We can’t. But these numbers ARE real. These people ARE changing their lives and IMPROVING HEALTH!
If you want to take charge of YOUR health, email us for more info at KetoNurses@gmail.com
Oftentimes, a patient will come in or post on Facebook that new symptoms have occurred and evaluation is now needed. Today’s blog article will discuss some of the most common symptoms that bring patients in for diagnosis and treatment. We’re going to give 2 fictitious patients a run through a visit with me: Dick and Jane will be our patients today.
Jane is a 43 year old female, who comes in with a new complaint of “just tired all the time”. She occasionally takes a multivitamin, but not much else. She reports no previous major medical history, but does report that her dad had a stroke at age 61 and is now disabled because of weakness on the left side. She reports that her mom does have thyroid problems and takes some meds for it but she’s not sure of the exact problem. During a review of systems, she also reveals that she is beginning to have trouble sleeping through the night, her hair seems brittle, and she’s only having 2 bowel movements a week. She reports mostly normal menstrual periods, with occasional skipping of a month. She says over the past 3 years, she’s probably missed 3-4 periods; all pregnancy tests were negative. She also admits to very slow weight gain over the past 5-6 years; she says she used to weigh around 130 for most of her life. During the physical exam, Jane appears pretty normal except for these findings: weight is 214 lbs (height is 5’4”), her skin appears quite dry and even scaly on her arms & legs, very sluggish bowel sounds in all 4 quadrants of her abdomen, and her face just appears fatigued. She denies problems with depression, but is beginning to think that she might be depressed because many mornings upon awakening, she is exhausted and dreads getting out of bed. She requests lab work to help identify what is going on.
Dick has made an appointment today because of several issues that don’t seem to be linked. Although he’s done some internet research, the symptoms he’s experiencing aren’t really connected, he reports. He is somewhat tired, but not every day, and certainly not all day; fatigue just seems to hit randomly, requiring a nap to get through the rest of his day. He does report a history of mild elevated blood pressure for which he sometimes takes his Lisinopril – averages about 3-5 days a week. He also reports a recent onset of an annoying dry cough without fever or sinus/allergy drainage – which he does have a history for. He says he had a biometric screening done several weeks ago at work and brings in a copy of those results for review. His vital signs: heart rate 84, BP 168/108, O2 sat of 90%, temp 98.5, respiratory rate 22. During the physical exam, these abnormalities are noted of this 54-year-old male: waist circumference is 52 with very protuberant abdomen (no distention, more of a “beer-belly” appearance), lung sounds are clear, but deep breathing triggers his cough, and an extra heart sound (S3) is noted. In addition, he exhibits trace bilateral pedal edema, but normal pedal pulses. In review of his biometric results, he has a random glucose level of 186, LDL 201, HDL of 32, Total cholesterol 259, and Triglycerides of 276. He says they offered health coaching to him, but he hasn’t decided whether to do that or not; he says he wanted to be seen for good physical first.
During Jane’s visit, we decide to obtain some lab tests; drawing a Complete Blood Count (CBC) will help us recognize a possible anemia or subtle infection she may have. A CMP (compete metabolic panel) will tell us about her electrolyte balance, kidney and liver function, while thyroid studies will help identify thyroid problems. In addition, we obtained a urine dip and a hemoglobin A1c in the office. We discussed a variety of home remedies and OTC medications/supplements that can help improve fatigue in general, until we can review lab results. Jane is much relieved to hear that B complex vitamins, Vitamin D, and magnesium are easy to access and often improve fatigue in many people. She prefers to use supplements and lifestyle changes if possible. She leaves the clinic feeling better about her outlook and has an appointment for a 2-week follow-up.
In reviewing Dick’s biometric results, we discuss the likelihood that he has diabetes; he agrees that he’s thought the same for a while now, but never tested for it. Reports his mom was diagnosed with Type 2 DM as an adult many years ago and has now progressed to insulin use with possibility of dialysis in the near future. He expresses great concern over dialysis and states emphatically that he does NOT want to go down that road at all. We draw similar labs on Dick as Jane had; we also get a BNP (brain natriuretic peptide) level and an office UA and A1c before sending him home with an appointment Friday for review of all the results; we also schedule an appointment for an EKG and an echocardiogram – both are tests to help determine cardiac muscle injury. The BNP is a blood test that helps us determine possible weakening of the heart muscle that often accompanies poorly controlled blood pressure and diabetes.
When Dick returns for his Friday appointment, we first begin with review of the abnormal test results, beginning with the mild abnormalities and working our way toward the more serious problems. His urine is mostly normal, except his protein which is mildly elevated and specific gravity is 1.030 which often indicates poor water intake as it shows high urine concentration. Elevated blood pressure and diabetes will both contribute to protein spilling into urine – each for different reasons. High blood pressure will cause it because of the force of blood being pushed into the kidneys and the tiny little blood vessels literally burst sometimes. Diabetes will cause protein to spill into urine because of tiny little “beaver dams” in blood vessels – thick, sticky, syrupy blood causes tiny components of glucose, triglycerides, and inflammation markers to bunch together, forming a bit of a “beaver dam” inside blood vessels. When these blockages occur, protein is not filtered properly through the kidneys’ processing system and it spills out into urine. Since Dick has both high BP and diabetes (DM2), it’s difficult to pinpoint his cause of protein in urine. Moving along, his A1c is 7.8, meaning his blood sugars are averaging around 200 mg/dL. Review of the CMP reveals slightly elevated AST (a liver enzyme), slightly elevated BUN (kidney function test), but normal creatinine, and his BNP is somewhat elevated at 278 pg/mL. Normal BNP is less than 100; CHF (congestive heart failure) is most likely over 400. His EKG is mildly abnormal, but shows no significant electrical problem with his heart. However, the ECHO (echocardiogram) does indicate weakened heart muscle, with an ejection fraction of about 45%. Normal EF is approx. 50-65%, meaning that during each beat/contraction of the heart, approximately 65% of blood inside the heart is pumped out during that one beat. Remember, Dick, that the heart’s 4 chambers each contain blood and only the ventricles (the 2 bottom chambers are pumping blood OUT of the heart during that beat, and the RIGHT ventricle is pushing blood to the lungs, while the LEFT ventricle is pushing blood out to the body for use by its cells. The EF is calculated based on how much blood is leaving the LEFT ventricle during one beat. You don’t want the EF to be 100%, or your heart would not be able to keep working properly. It should push out 50-65% of its contents during any given beat or contraction. When the EF falls too low, it signals that the heart muscle is trying to beat stronger and stronger to push out the blood for the body to use.
Dick expresses a bit of confusion and so we continue to explain. Have you ever been to the gym to work out? What happens when you start working out? Lifting weights? Your biceps get bigger and stronger, right? But the heart muscle is NOT like skeletal muscle at all; when the heart muscle works more and harder, it gets weaker – NOT stronger. Asking the heart to pump thick and stick blood to an overweight body is not healthy and will cause organ damage – in this case – heart muscle injury, kidney injury; the mild liver damage, likely non-alcoholic fatty liver disease (NAFLD) is related to long-term insulin resistance/high carb intake/elevated glucose & triglycerides. Dick says he’s beginning to understand how all of these health problems are related to one another and now wants to know how to reverse this damage. He says he’s determined to improve his health. So, looking at Dick’s chart, and reviewing everything with him, we list the following as current medical diagnoses in his record: hypertension, type 2 diabetes, congestive heart failure, hypercholesterolemia, proteinuria, & NAFLD. Dick asks if all of this can be reversed without medications and is leery of taking home a shoebox full of meds today. We review the most important problems of high BP and heart injury and decide that these do need some medication, at least for now; Dick agrees to start on BP meds and a diuretic to reduce the workload of the heart. After much discussion of diabetes meds, he agrees to start on metformin which does not directly lower glucose, but aids in liver health and insulin resistance. He agrees to start other meds if needed, but wants a real chance with nutrition changes to see if he can eat better to get healthy. We agree on a monthly visit schedule for a while, just to help and support Dick through these life-changing diagnoses; he came in for one visit and now has multiple life-altering diagnoses with multiple meds and a whole new outlook on life.
Jane is back today for her 2-week follow-up and review of her lab results. Most of her results are pretty normal; her random glucose is 146. Her thyroid levels are within normal ranges, but just barely. Her TSH is at the very upper end of the normal reference range; her T4 is pretty normal, but her T3 is right on the lower end of normal. Her liver enzymes are all slightly elevated, but not very high at all. Her A1c is 6.3; her urine is pretty normal, except her specific gravity is also 1.030. It is determined that Jane has subclinical hypothyroidism, pre-diabetes, and likely NAFLD/insulin resistance. Much of our discussion with Jane is similar to our meeting with Dick, except the heart failure topic. We discuss starting her on thyroid meds, vitamin D and magnesium regularly with follow-up thyroid labs in about 6-8 weeks because it can take many weeks for thyroid hormone levels to improve. Jane is thrilled to have some answers to her symptoms and agrees to start on thyroid meds. We caution her to take thyroid meds, completely alone, with no other food/med for at least 30 minutes because thyroid meds bind easily to caffeine, calcium, and many chemicals/foods. Jane agrees and leaves with hope that she will feel better soon, but she also asks about her sluggish bowel movements and wonders what she can do to become more “regular”. We discuss many possible remedies for constipation, including various brands of colon cleansers, OTC laxatives, and foods that can trigger faster GI motility. She agrees to find something when she picks up the thyroid prescription at the pharmacy. She schedules her follow-up for about 6 weeks out.
Both of these patients teach us a lot about general health. First, we all minimize many of our symptoms from time to time, thinking it’s just growing older, being too busy, or just not resting well. But we should always take note of even mild/vague symptoms that don’t improve after a week or so. Secondly, there are many reasons for fatigue, and if a good evaluation by a provider reveals no likely source, trying vitamins or supplements might help boost energy levels. Thirdly, there can be many, many mild abnormalities going on internally, that we cannot see, feel, or easily identify without lab tests. And lastly, both patients had some carbohydrate intolerance, as evidenced by even mildly elevated glucose levels, weight, and missing menstrual periods.
I am a firm believer that high carbohydrate nutrition has led us all down a path to poor health, vague symptoms, and a variety of chronic health conditions. Look at nutrition labels for any processed food; very little actual nutrition, yet agencies PUSH us to eat that stuff. Why? Because Big Food has paid billions of dollars in advertising and donations to organizations like ADA, AHA, AMA, etc. There was absolutely NO scientific evidence that our bodies EVER needed carbohydrates; if so, they would be considered ESSENTIAL to our health, but carbs are NOT essential. The body will make any necessary glucose it needs from proteins and fatty acids. Start eliminating carbs today and reclaim your health!
We will follow-up with Dick and Jane in a few weeks to see how they are doing. Make sure to follow us on Facebook for our latest posts!
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.
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.
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.
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.
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.
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.
Vitamin 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.
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:
Each increase of 4 ng/mL of vitamin D in the blood is associated with a 4% lower risk of type 2 diabetes.
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.
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.
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.
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.
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!
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.
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.
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!
In the last article, we discussed the 3 processes that the body uses to metabolize, utilize, and store glucose. In this article, we will discuss several conditions that occur when those processes become overwhelmed and organs are unable to keep up with their usual functions.
If you’ll recall, the blood stream only requires about 4 grams of glucose for 24 hours of normal daily functions and processes. Four grams is the equivalent to 1 teaspoon. You read that correctly… 1 teaspoon of sugar is all the body requires to maintain body systems every day. That is a tiny amount of sugar! Compare that to a day’s worth of intake suggested and recommended by nutritionists, medical providers, and respected non-profit organizations world-wide; most “experts” recommend 45 – 60 grams of carbs per meal (45 x 3 = 135; 60 x 3 = 180) and at least 15 grams per snack twice daily (another 30 grams). The American Heart and Diabetes Associations are highly regarded as experts in guideline recommendations, but how in the world did they come to THIS conclusion? A human needs 4 grams of glucose, yet we have been told for 50 years to consume approx. 200+ grams daily to maintain health. What happens to all the excess?
The excess carbohydrate intake results in a variety of medical diagnoses, but all have one specific problem – insulin resistance. Insulin resistance is the cause of type 2 diabetes (DM2), hypertension, many types of infertility, polycystic ovary syndrome (PCOS), hypertriglyceridemia, various hormone imbalances, a variety of migraines, non-alcoholic fatty liver disease NAFLD), Alzheimer’s, coronary heart disease, and many other conditions. We will discuss here how all of this chaos occurs within.
The human body was designed with multiple back-up systems and methods for overcoming a variety of stressors, including poor nutrition. Looking back over history, we can see periods of great famine where food was extremely scarce, yet people survived. The human race has not gone extinct; our bodies and our organs were designed and well-prepared to face a variety of environmental & nutritional struggles. Yet, we may have found one obstacle we cannot overcome: ourselves.
After reviewing the “peas & cornbread” article, you will see that our bodies have 3 different processes for metabolizing glucose from the carbohydrates we consume. If any of these processes become overwhelmed, another process will be triggered and more glucose is removed from the bloodstream another way. However, if all 3 processes are too busy and struggle to keep up, the human system gets sick. Have you ever known a basement to flood? Did you see a sump pump trying to remove the water from the house? If the rain/flood waters are coming in faster than the pump can remove it, what happens? The flood continues to rise; more damage is done to the home. So it is with overconsumed carbohydrates over time. As high carb intake continues, the pancreas, bloodstream, and liver work overtime trying to remove all the excess glucose. After months or years, the system cannot keep up; organs never get to rest, even during sleep. These overactive processes often contribute to insomnia, which increases body stress, raising glucose even more; it becomes a downward spiral to poor health.
Many patients, when told of their new diagnosis, often say, “but I don’t feel sick.” And it’s very true. The human body is SO GOOD at managing our internal chemistry, the system can become very imbalanced before any symptoms are noticed; some symptoms are subtle and just disregarded. Fatigue, or feeling tired, is often overlooked or ascribed to our busy lifestyles; gaining weight is often attributed to our genes, our lack of exercise, or even to poor nutrition. Forgetfulness is usually attributed to being distracted or just part of normal aging; muscle aches & joint pains are often called fibromyalgia or arthritis. Sugar cravings are seen as the body’s way of getting us to eat something we “need.” Feeling hungry all the time is often seen as poor thyroid function or just staying too busy to eat. I could go on and on with the vague symptoms people report to medical providers during office visits; most of these symptoms are ignored or regarded as “not pertinent” to today’s problem-oriented office visit. Millions of patients world-wide report these types of symptoms on a daily basis, and then when they are finally confronted with a life-altering diagnosis, most seem utterly shocked and surprised. It truly is a shame; I see it regularly and wish I could do something more to help. People do not seem to understand how they could possibly be diabetic or infertile, or have NAFLD when they’ve been eating according to nutrition guidelines for many years, with only occasional “cheats” or unhealthy foods. They come in and complain that no provider ever told them this or that; they report many years of struggling with food addictions and cravings. They even bring brochures and eating plans from other providers and nutritionists, saying, “I eat exactly according to this plan; how can I now have diabetes?”
It all begins with overworking our human systems; while the body is amazing at maintaining the appearance of health, our organs are often taking the brunt of the illness. Every carbohydrate we consume converts into glucose and/or fructose, triggering the pancreas to secrete insulin so that the excess sugars can be removed from the bloodstream because they do not belong there. Over time, the pancreas either cannot keep up and is unable to secrete enough insulin, or it begins to make faulty insulin – insulin that is no longer functioning to move glucose out of the bloodstream. This one organ, the pancreas, can become very ill, resulting in pancreatitis. Difficult to heal, it can take many months or years for the pancreas to recover, and if carbs continue to be consumed in high quantities, it will never recover.
Another problem that develops with these high carb intakes is the body’s cells become resistant to the insulin; there’s so much glucose in the bloodstream, that there’s just not enough insulin to transport the glucose out of the bloodstream. Think about magnets for a moment – recall that magnets are polar. One end of a magnet will be attracted to another, but the other end repels the other magnet. Glucose and insulin can become that way in the bloodstream when there are too many glucose molecules in the blood. If glucose repels insulin (or vice versa), glucose accumulates in the bloodstream instead of being moved into cells. This overload of glucose can contribute to thick, sticky blood which significantly contributes to non-alcoholic fatty liver disease NAFLD), Alzheimer’s, coronary heart disease, heart attacks, strokes, and many other conditions. Imagine a family of beavers locating to a new stream. Dad Beaver scouts out a great location and begins bringing limbs and moss to build a new home for his family. Mom and kids soon begin to help out; at first, water flows easily through the creek. As more limbs and debris are placed, water flow slows. Although water is flowing, animals and plants downstream begin to feel the effects of less water. Finally, after some time, the Beaver family stands proudly inside their new home, where no water is able to get through. All the plants and animals downstream suffer. So is the circulatory system within our bodies. Capillaries are the tiniest blood vessels we have; it is through capillary walls that blood delivers oxygen and picks up wastes like carbon dioxide to be transported to kidneys and lungs for excretion. These capillaries are so tiny that they can only allow for 1 tiny red blood cell to get through at a time. Take a look at this picture; the largest circle is of a human hair, greatly enlarged. The darkest circle is the diameter of a red blood cell. Can you see the image of the beaver dam happening inside blood vessels now?
Now, let’s add to this imagery. Think about the beavers building their dam; are they using trimmed up logs that are nice and smooth – like those with which we might build a log cabin? No, of course not. The beavers are using limbs and debris from all over the riverbanks. Crooked and jagged limbs stick together better and are easier for the beavers to use. The jagged pieces literally intertwine and stick together even with waters moving through during early building stages. This image is of a sugar molecule:
Notice how jagged and crooked this molecule is. Even when broken down into glucose and fructose, the molecule remains jagged and easy to snag on other molecules. It’s not smooth like blood cells. Now, imagine hundreds upon thousands of these molecules overfilling blood vessels that are tiny, tiny, tiny. Can you see how circulation becomes terribly impaired, just as when a beaver dam is constructed in a creek? Can you imagine all these sticky, syrup-like molecules just sticking together and building up tiny little beaver dams all throughout blood vessels? This process, reducing blood flow, is what typically results in heart attacks, strokes, and amputations in people with diabetes and insulin resistance. When blood flow cannot reach the target, tissues are deprived of oxygen and nutrients, resulting in beaver dams or microscopic clots in blood vessels. Without oxygen and other nutrients, tissues cannot function properly, nerve tissue ceases to respond to stimuli, and sensation and use are impaired. When enough blood vessels are blocked, tissue is damaged, like with diabetic neuropathy or chronic kidney damage.
In other tissues, this overflow of sticky blood and poor insulin activity also contributes to a myriad of problems. High insulin in the bloodstream triggers many hormone abnormalities. The normal chemical balance in the human body is fragile; anytime one chemical drops low or jumps up high, a wide variety of abnormal processes may begin. In women, one of the most common chemical imbalances results in abnormal reproductive hormones that usually regulate our monthly cycles and fertility. One of the pathways suggested for this imbalance goes something like this: being overweight and/or insulin resistant contributes to hyperinsulinemia (high insulin in blood). Having too much insulin, the bloodstream sends signals to the liver (remember the “peas & cornbread” story) and this effect signals a decrease in growth factor production/release which increases androgen activity; increased androgen activity causes an increase in estrogen and luteinizing hormone (LH). Increases in estrogen and LH levels stimulate ovarian hyperplasia – or the overgrowth of tissue – which can result in endometriosis or polycystic ovaries. Ovarian hyperplasia, overstimulation of ovaries and the increased levels of reproductive hormones all combine to cause anovulation, or ovaries that are not releasing eggs for possible fertilization; thus, infertility occurs.
In the liver the high levels of insulin, glucose, and associated inflammatory processes combine to trigger storage of glucose in the form of glycogen; once the liver has stored all it can hold and blood sugars remain high, the liver doesn’t know what to do with all the excess carbohydrate being ingested. It just keeps storing more and more. Let’s imagine that you decide to put your household garbage in the pantry, instead of taking it outside to the trash bin for collection. Keep doing this. Every time you fill a garbage bag, you pull it out of the can, tie it up, and pile bag after bag in the pantry; then you run out of room, and begin filling kitchen cabinets. Eventually, those cabinets fill as well; so where do you store it now? Over time, the garbage comes to overwhelm the entire kitchen, so much so, that normal function in the kitchen is halted. There is literally nowhere to work or accomplish cooking tasks. That’s what happens in our livers with glycogen storage. There’s room for a little glycogen, so in times of famine, the liver can release a few grams of glucose the body needs, but there’s not room for 200-300 grams of carbs per day for a lifetime. This overwhelming storage of glycogen is what usually triggers non-alcoholic fatty liver disease. (Alcohol can trigger similar, but that’s another whole story.)
In the brain, there’s a massive circulatory system used to control all our normal functions without us ever thinking. Parts of the brain control and manage our thirst, hunger, heartbeat, breathing, even most of our movements aren’t really conscious thoughts. But now think back to the beaver dam analogy from before; most people with diabetes understand their neuropathy, or nerve pain, in their feet are caused by their high sugar levels because our feet are further away from the heart than our hands. However, gravity can also influence blood flow somewhat; combining the physics of gravity and thick, sticky blood, the brain also suffers in a similar way. Because the tiniest blood vessels in the brain are highly specialized to deliver certain neurotransmitters, hormones, and other chemicals to our brains (& control their release from other organs), anything that reduces blood flow in our bodies can also reduce blood flow, oxygen, and vital nutrients to the brain and associated organs. When blood flow is reduced to our brains, areas of the brain cannot adequately signal the nervous system to function properly; organs may be signaled to alter, stop, or begin a process that may become seriously damaging to health. This reduction in blood flow to the brain is often called “microvascular ischemic changes” on a CT scan or MRI report. In fact, many providers will see this on an otherwise normal imaging report, and never mention it to patients because it seems like such a minor problem. However, given time and continued high carb intake, these tiny problems become bigger problems. While most of the general population do attribute forgetfulness to “normal aging”, there’s nothing normal about it. Aging does NOT in and of itself contribute to confusion or minor forgetfulness. It is always worth an office visit for evaluation and workup at any age. In 2008, The Journal of Diabetes Science & Technology published an article calling Alzheimer’s disease (AD), diabetes type 3 because “we conclude that the term “type 3 diabetes” accurately reflects the fact that AD represents a form of diabetes that selectively involves the brain and has molecular and biochemical features that overlap with both type 1 diabetes mellitus and T2DM.” (Retrieved 4/3/17 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769828/)
Even when none of these more serious health conditions are diagnosed, many of us do have these changes occurring inside; hypertension has been called “the silent killer” for many years, but I call insulin resistance the REAL silent killer as many chemical imbalances occur with minimal notice for most people. And mainstream medical providers typically never address root causes of many of these vague symptoms because there’s just not time in most office visits to address them and sometimes, it takes a lot of time & multiple diagnostic tests to identify certain problems. Mild symptoms of hyperinsulinemia can contribute to high inflammatory markers in the bloodstream and if blood tests are not performed, there’s no way to know if inflammation or hyperinsulinemia contributes to your migraine headaches, your fatigue, or your fibromyalgia. Many of us suffer with osteoarthritis, or general joint pains related to overuse or previous injury. High carb diets can contribute to much of the joint pain because of high inflammation within the body; without a blood test and/or radiology to confirm it, many health care providers call it OA and tell you to take some OTC pain relievers.
So, now what? What does all of this physiology mean? It means that we as a people have become terribly unhealthy because of the poor quality of fake foods we have eaten for the past 50 years. We’ve followed the AHA and the ADA; we heeded the dietary advice; there’s recent research to prove it. So, continuing to follow that advice certainly won’t improve our health. What do YOU think would help? After reading this article, I hope you say, “cut the crap.” Literally, that is the best advice ever. Cut out all processed foods, carbonated drinks, artificial foods, fake foods, junk foods, refined sugars, and anything that even looks like it was manufactured in a plant. Eat real food. Eat from the farm. Eat from the edge of the grocery store. Think back in history; what did people eat before boxes of cereal lined the store shelves?
It’s time we the people took charge of our own health; the health care system is broken. We wait months sometimes to see health care providers who don’t have time for thorough medication reviews and physicals. As consumers, we can change the face of nutrition in our homes, families, and our nation by making better choices and eating foods that heal our bodies. In our next article, we’ll cover more details about what to eat and what to avoid eating.