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Connecting the dots… How Chronic Diseases Manifest

Oftentimes, a patient will come in or post on Facebook that new symptoms have occurred and evaluation is now needed. Today’s blog article will discuss some of the most common symptoms that bring patients in for diagnosis and treatment.  We’re going to give 2 fictitious patients a run through a visit with me:  Dick and Jane will be our patients today.

Jane is a 43 year old female, who comes in with a new complaint of “just tired all the time”. She occasionally takes a multivitamin, but not much else.  She reports no previous major medical history, but does report that her dad had a stroke at age 61 and is now disabled because of weakness on the left side.  She reports that her mom does have thyroid problems and takes some meds for it but she’s not sure of the exact problem.  During a review of systems, she also reveals that she is beginning to have trouble sleeping through the night, her hair seems brittle, and she’s only having 2 bowel movements a week.  She reports mostly normal menstrual periods, with occasional skipping of a month.  She says over the past 3 years, she’s probably missed 3-4 periods; all pregnancy tests were negative.  She also admits to very slow weight gain over the past 5-6 years; she says she used to weigh around 130 for most of her life.  During the physical exam, Jane appears pretty normal except for these findings:  weight is 214 lbs (height is 5’4”), her skin appears quite dry and even scaly on her arms & legs, very sluggish bowel sounds in all 4 quadrants of her abdomen, and her face just appears fatigued.  She denies problems with depression, but is beginning to think that she might be depressed because many mornings upon awakening, she is exhausted and dreads getting out of bed.  She requests lab work to help identify what is going on.

Image result for blood test image

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

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

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

Image result for cholesterol test image

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

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

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

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

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

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

 

 

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Teresa Reversed Her Diabetes!

 

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

Teresa Toten, July, 2017

 

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

 

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

June, 2017

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

 

Day 1 of Keto Nutrition, April, 2017

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

 

May, 2017

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

 

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

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

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

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

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How Do I Eat LCHF?

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

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

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

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

Staples for your low carb kitchen:

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

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

how to use oils photo

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

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

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

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

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

 

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

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

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

Meats and Veggies

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

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

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

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

Sample meals:

Breakfast – Eggs and bacon

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

Meal Ideas

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

Taco-less Salad

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

2-3 oz shredded cheese – your favorite

1 Tablespoon finely chopped onions

½ of a sliced avocado

1-2 tablespoons of regular sour cream

2 halved or quartered grape tomatoes

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

Sugar-free (preferably homemade) salsa

Hamburger Steak with Asparagus

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

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

Breadless Sandwiches

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

Add veggie pieces (your faves) or sliced cheese

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

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

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

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Nurses as N=1? Let’s Do This!

As nurses, we are trained in critical thinking processes and much of our classroom and clinical experience is designed to facilitate practical application of critical thinking, logical reasoning, and actions and consequences.  We are taught to use these skills as we deliver care to our patients.  We are encouraged to utilize these reasoning skills even as we follow physicians’ and other provider’s medical orders.  For example, when a provider writes an order for a medication, we are taught to calculate it for ourselves, read and re-read the label, and even certain medications require verification by another nurse.  If we find that the order seems different from the expected order, we are obligated to notify the original prescriber to verify and ADVOCATE for the safety of the patient.  Over the years, I have seen many nurses and nursing students confront many providers over orders that seemed “not quite right” or somehow seemed unsafe.  I’ve seen labor & delivery nurses put their jobs on the line advocating on behalf of sick women who are in a most vulnerable state during labor and pre-birth situations.

Advocates – that’s what we are.  We are taught by some of the best advocate nurses in the nation.  We learn logical and reasonable process skills that help us determine the best method to advocate for our patients.

As patient advocates, nurses change the world…. or at least the world of the patients for which we provide care.  We make significant changes that patients remember; during some of the most dire moments in hospitals, nursing homes, private homes, and clinics, we hold hands, offer support, and administer treatments. We assist our clients and families make changes that improve quality of life.

Over the past 15 years or so, nurses have been recognized as the most trusted profession; we are trusted because we are advocates, and we help patients maneuver the health care system, medications, and treatment schedules with only the interests of the patient in mind… and patients SENSE that we are truly interested in their lives.  We laugh and we cry with our patients – sharing emotions helps build trust.

All this groundwork I’ve laid out serves to arrive at this point…Patients TRUST nurses…

For the past 50 years or so, nurses have taught the standard American diet rules: high carb, low fat, and encouraged many highly processed food-like items as food.  We listened to the “experts” who told us that President Eisenhower’s heart attack was caused by high cholesterol.  We heeded the warnings of the American Heart Association that issued statements connecting high fat intake to heart attacks and strokes.  We participated in teaching patients to adhere to the American Diabetes Association’s guidelines encouraging patients to consume upwards of 160 grams of carbohydrates daily.  We were GOOD nurses.  We listened. We learned.  We followed the rules.  We taught those rules.

We were wrong.

We have betrayed our patients.  We were wrong to blindly heed advice that goes against all our common sense, logical reasoning, and critical thinking.

Even ants will seek out the sweet urine of a person with diabetes.  That is how diabetes acquired its name; diabetes means siphon, and mellitus was added later as it means honey – diabetes mellitus… the disease where sugar is siphoned into urine.

In the early 1900s, diabetic patients were given a strict diet; there was no insulin.  There were no fancy medications.  Early practitioners made the logical and reasonable connection between sugar-in & sugar-out; they advised patients to have no more than 10 grams of carbohydrates, 75 grams of protein, and 150 grams of fat daily.  This nutrition plan also allowed for 15 grams of alcohol and provided approx. 1800 calories per day.  Patients were instructed to eat meats, poultry, game, fish, clear soups, gelatin, eggs, butter, olive oil, coffee, and tea.   This nutrition plan is a FAR-cry from the 160+ grams of carbohydrates recommended today.

Once our nation entered the industrial era following World War 2, companies and manufacturers began to produce massive quantities of food items.  Many of these floundering companies and small-time farmers petitioned and lobbied the government for grants and subsidies to help them reduce consumer costs so they could invest millions of dollars into more machines, planting, harvesting, and processing techniques – techniques that could save time and money, so the companies could invest more into production.  It was a vicious cycle and the American family thrived on this new form of employment.  The returning military veterans often transitioned back into society with handicaps and trauma, and at the time, there was little known or recognized in our mental health care system that helped these wounded warriors.  Many of these vets settled into assembly work easily; there was a set schedule, with pre-determined tasks and responsibilities, easy methods to do their jobs and bring home a paycheck.  Wives, often now widowed, entered the workforce like never before; many of these women had been denied education and thus were considered unskilled laborers.  Factory work suited many people, singles, marrieds, separated, etc.  No one questioned the plans.  Not that anyone had real plans then.  It was just the many pieces of the puzzle coming together.

As many companies made arrangements with government, grains in particular became much less expensive to grow and process.  With a growing season of approximately 4 months, wheat required a huge labor force and many hours in fields; too costly to really become profitable, governmental subsidies allowed companies to purchase smaller farms and bigger machines & equipment.  Researchers began looking for ways to shorten the growing season and reduce weed and insect infiltration.  As generation after generation of seeds were harvested and modified, the processing costs were absorbed by governmental grants and subsidies, providing companies with increasing profits.  This vicious cycle has continued into today’s modern American society; this subsidy program is why a box of cereal costs you about $4 at the supermarket, but actually costs about $8 to produce a box of cornflakes.

Then, President Eisenhower had his heart attack while in office; his care was widely publicized; many doctors and scientists capitalized on his illness by using the TV time to make claims that high cholesterol was going to kill all our citizens.  The media played a huge role in pushing the low-fat, low cholesterol theory, showing the President eating his dry toast and egg whites every AM for weeks.  The SCIENCE they all failed to mention is that at the time of his heart attack, Eisenhower’s cholesterol level was actually NORMAL.  By the time he left office, however, and while eating his low cholesterol diet, his cholesterol level climbed to over 250, well above normal limits.

As fat intake was discouraged and fat content in dairy products and other foods plummeted, the grain-producing manufacturers had an “aha” moment: “if fats were so unhealthy for us, then grains are not fatty and thus we can make millions of dollars selling all kinds of low-fat foods!”  And that is exactly how we came to be where we are today.

Nurses, are you angry yet?  The “system” has used us…. Used our connection to patients…. Used our ability to care…. Used our compassion…. Used our education… used our hard-earned trust….

It is time we take on our advocate role – more seriously than ever before.  It is purely common sense that intake of carbohydrates causes glucose levels to climb, forcing the pancreas to secrete more insulin, but eventually the pancreas is working so hard, something happens that changes the insulin; the insulin is no longer effective at transporting glucose into the body’s cells for use.  Over time, insulin resistance and continued unlimited carbohydrate intake worsens, and patients become diabetic.  This effect can easily be measured by using a glucometer to check fasting glucose levels, then eat a carbohydrate, and monitor glucose levels every 15 minutes for 3 hours.  Charting glucose levels is a simple and scientific method for monitoring the effect of any food on a patient’s blood.  It is much more expensive to check insulin levels, but that can be done at any health care provider’s office or lab.  Beginning to record this effect will help cement the concept that carbs are killing us, while fats were never the evil nutrient we were told.

Once the concept of “sugar-in, sugar-out” really registers, it is vital to start changing your own way of eating.  Eliminating the

C – carbonated drinks

R – refined sugars

A – artificial sweeteners & colors

P – processed foods

becomes easier.

This simple plan is such a great way to start your journey to a healthier you, and in turn, you will begin leading the way to improved health for your family, friends, patients, and colleagues. Yes, you can become a test case.   While N=1 experiments used to be frowned upon, the internet, social media, and bloggers are all promoting N=1 trials and experiments.

Nurses, it is time we band together, use our logical reasoning, and ADVOCATE for the health and well-being of ourselves, our families, and our patients.  N=1 usually means N is the number of participants in a research study for an experiment; let’s use it to mean millions of NURSES are working as 1 when it comes to advocacy & improved health for our patients; let our ONE voice be heard.

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Get Started – Add Fats: We aren’t taking foods away…. YET!

As nurses, one of our best attributes is helping people learn; we love to teach people how to take better care of themselves.  Hospital nurses spend hours providing discharge education; home health nurses thrive on sharing that one little secret tip that gives homebound patients a brighter day.  Clinic nurses have reams and reams of printed materials they distribute and review with patients on a daily basis.

As nurse practitioners, Barbara and I want to give each of you the real, down-to-earth tidbits to get you started on the best and healthiest journey of your life!!

First, take stock of where you are in your health.  What symptoms or illnesses or health conditions do you have?  What would you MOST like to get rid of?  It is important to start right where you are, or you really won’t know where you are heading.  I always suggest a diary or journal for starters.  A written record not only records where you are RIGHT NOW, but as time goes forth, it will be a boost to your ego and a record of just how far you’ve come.  In your journal, include some of your disease markers: your blood pressure, your weight, your waist circumference, your thigh & upper arm circumferences, your hemoglobin A1c, your cholesterol and LDL/HDL numbers, and even your BUN/creatinine or your liver enzymes.  It depends on your health care provider’s policies if they will provide you with an actual copy of your results; many clinics now offer online patient portal access.  If you haven’t signed up previously, now might be a good time to do so.  Record the names of any medications AND the doses you take.  As your LCHF journey progresses, you will find that your health care provider will be reducing your doses AND medications.  Write down how you feel about your conditions and medications; your feelings and thought processes are important.  Take photos if possible and add them to your journal; even a selfie in the bathroom mirror will provide enough evidence once the inches fall away.  Once you have your current health status recorded, you are truly READY to begin a whole new journey to improved health with FEWER risk factors than ever before thought possible.

Now that you have prepared your history, it is time to plot your agenda.  Rather than focus on the foods you can’t have, I propose that you start by ADDING fats to your current way of eating (WOE).  Healthy fats include fats closest to natural states; bacon or side meat grease is a great seasoning that we all relinquished when the heart experts said it was so bad for us.  But, guess what??! It’s not bad!  Start saving your bacon grease and use it to season vegetables or add to hamburger meat dishes.  We make a bacon-cheeseburger meatloaf sometimes, and we add bacon grease to increase the bacon flavor.  Add good, healthy butter to veggies and meats. When you have that potato (for now – you can have it; we are just getting started, remember?), LOAD that puppy up with cheese, butter, FULL-FAT sour cream, and bacon chips… real chips… from bacon YOU actually cooked.  Eat more avocadoes, guacamole, coconut oil, and olive oils.  I use a LITE olive oil more often than the extra virgin olive oil (EVOO).  Lite olive oil tastes less strong and less like olives.  EVOO has a much stronger olive flavor than I like.

Find a bulletproof coffee (BPC) recipe you like; bulletfproof coffee began as a real brand of coffee, but we low-carbers, have adapted it to mean a coffee loaded with fats – that keeps you “bulletproof” for the day.  Bulletproof just means that you won’t be starving all day; your body won’t feel hungry and you won’t feel like you are starving yourself or depriving yourself of anything.  I usually have 1 slice of bacon, 1-2 eggs, and BPC for breakfast every day.  I usually don’t get hungry until 2-3pm most days – and it’s ALL because of the high fat content in my meal & BPC.  I use a BPC recipe that uses coconut oil, Kerrygold butter, unsweet almond milk, and sugar-free coffee flavorings like the fancy baristas use  in the fancy coffee shops. I will say that it took me a while to find the right recipe for me; first, I don’t even LIKE coffee… no, I really don’t!  My hubby started bringing me a cup many years ago, on very cool mornings to help me “warm up.”  So now, it’s just a habit.  And I do LIKE my BPC for more than just the flavor!  It keeps me satisfied and prevents me from getting the “munchies”.  Therefore, I eat less!

Back to finding the right recipe… I like coconut, but I didn’t like it in my coffee; I had to keep tweaking amounts to find the right balance of coconut oil, butter, and milk. And you will need to be patient too.  It probably took me about 2 weeks of trial and error to be quite happy with my recipe.  There are hundreds of recipes out there, and you can make it many different ways; the key is to be sure it contains plenty of fats; no matter what I tweak, I always use at least 1 tablespoon of coconut oil and 1 tablespoon of butter.  Many of the BPC recipes I found early on contained cinnamon; I just couldn’t get used to that flavor.  Finding a BPC or bulletproof tea you like will make a TON of difference in the amount of hunger you experience and the perceived need for snacking.  Homework assignment number 1 from the KetoNurses: find a BPC or BPT and start drinking!

The next step in learning to eat low carb, high fat is to start reading labels… and I mean REALLY reading labels.  I had a patient tell me just a few days ago that Cheerios had 0 carbohydrates.  Bless his heart! I pulled up a pic online of the label; he finally realized he was reading the wrong line! It had 0 FATS!! We both enjoyed a good laugh over his mistake, but he learned a LOT that visit.  Pay close attention to serving sizes.  Try measuring out a few things, just to see what the serving size recommended really is.  Then pour out your regular serving size and measure YOUR serving.  Many cereal labels recommend as little as a ¼ cup for 1 serving.  Did you realize that ¼ cup is actually ONLY 2 ounces?  Other labels claim that ½ cup is a serving; that’s only 4 ounces.  And all the nutrition information listed is PER SERVING.  So, let’s take the Cheerios label I pulled up for the patient the other day; that label said 1 cup – 8 ounces of cereal is 1 serving.  That one serving contains 20 grams of carbohydrates.  And then you add low-fat milk, which is the HIGHEST carbohydrate content of all milks, you have downed your entire day’s carbohydrate content in one little and very UNSATISFYING meal!

See what we are talking about?  For the past 60+ years, we have been told by “experts” that we should eat LOW fat foods; but eating low fat means that companies began producing all kinds of high-sugar foods that were touted as “healthy” or “heart-healthy”.  Think about the rates of heart disease and diabetes back in the 1920s; it was almost non-existent.  Why?  People didn’t eat all the processed and refined carbs and sugars we have available today; they also WORKED much harder and burned off the carbs they DID consume.  Those people ate TONS of higher fat foods; they used lard all the time.  Most of the deaths back then were actually due to infections for which we had no antibiotics and  cancers that had no treatments developed. Think about all the native cultures; go back and do some research into the Inuit of the Artic North or the Maasai people of Kenya, Africa.  These native populations ate very HIGH fat diets for thousands of years and never had incidence of heart disease.  They only consumed fresh vegetables and fruits they found “in season” and rarely farmed or raised plants for foods.  Researchers report these native groups actually consumed approximately 80 – 90% of their daily intake from fats and fatty proteins.

In summary, today’s entry is intended to help you embark on a new, healthier, thinner YOU!  Start where you are.  Record vital information.  Start drinking BPC or BPT daily.  Increase natural fats in all your meals.

Feel free to share some of your stories and photos on our Facebook page, KetoNurses.  We would LOVE to help you become a BETTER you!!!!!