For any of you who have never checked your glucose, maybe it’s worth a try. It is truly the only way to know how food directly impacts glucose.
Use a glucometer to check and monitor your glucose level. They can be purchased over the counter. For inexpensive ones, ask your local pharmacy about the least expensive to use over time. I believe Walmart has one that is fairly inexpensive; it’s the Relion meter.
I recommend testing first thing in the morning, and then after meals to determine how food impacted your glucose. Standard post-meal testing is at 2 hours. Some people, however are not textbook. I usually recommend testing after several different meals over a few different days every 30 minutes after eating to determine your personal peak… once you determine this time frame, you’ll only need to test before and after once. No need to test every single meal at first if you’re worried about costs of testing OR running out of fingers. 😉
But pick a few meals at different times of day. If costs are a factor in buying strips, it’s really important to test before and after different meals — example: test before and after breakfast on Mon, Wed, & Saturday for 2 weeks, before & after lunch on Tue, Thurs, & Fri for 1 week, and supper on Sunday, Tues, Thurs, Sun, for the 2nd week.
Once you’ve determined your personal glucose peak, you can then limit testing to before meals and around your peak.
To determine the impact of certain food on glucose level, test before and after at your personalized peak. Ideally, the readings should not be very different, but readings are allowed to be about 10 numbers diff.
Example: pre-meal is 97; post-meal highest should be about 107 for optimal glucose control.
Even non-diabetics can use meters and learn for themselves how food impacts glucose.
This is where we get the phrase, “eat to your meter.”
This photo COURTESY of the Facebook group, Type 2 Diabetes Straight Talk.
Testing glucose is the absolute best method for determining how foods impact your glucose. Knowing how food will affect glucose levels is very important for people on a low carb diet, especially those who take medicines to lower glucose directly. If glucose goes up more than 10 points, it’s probably not a good idea to continue eating that food.
If you’d like help learning to eat to your meter or learning how to eat low carb high fat to reduce the impact of disease on the body, please email me at firstname.lastname@example.org for more information.
This is the story of a friend who wishes to remain anonymous. His words. His experiences. And they are amazing!
“I joined this group (a FB group) to help my mother who is 69 years old, has had type 2 diabetes for about twenty years now and has developed many complications although none of them are quite life threatening YET. She also has Alzheimer’s which makes it very difficult. She had followed the ADA guidelines yet she got progressively worse and now needs insulin. With her Alzheimer’s the doctor put her on a pump. Either one of my sisters, myself, or a visiting nurse checks on her twice a day to make sure she is under control. Recently one of my sisters or myself have been staying with her. She will go to the kitchen and eat huge bowls of cereal with skim milk or anything sweet or carby that is in the refrigerator so her levels have sky rocketed. My sisters have said its okay.
About a year ago I noticed a woman at my gym who I see periodically and has been losing a lot of weight. Then a few months ago I overheard her talking to some other people about her keto diet. I finally talked to her and she told me about her diabetes, she told me about this group, and she suggested ways to get my mother on it but my sisters did not agree at all and it has created a lot of fighting with them. I will admit that they do much more of her monitoring then I do but about three weeks ago I convinced them to take a break and I have been living with her 24/7. I know this woman Karen at the gym is not a health care professional but I hired her to come to the house to help get rid of the foods that are not on the diet and to stock the refrigerator with good foods. I was very afraid that my mother would start complaining about what I fed her especially because she was always complaining that we were trying to starve her even though she’s over a hundred pounds overweight and was eating three or four meals a day plus snacks. I should add that she has neuropathy and because of her Alzheimer’s she forgets to use her walker and so she also falls.
Karen went way beyond the time I paid her for and cooked some meals and visited with my mother. We never told her that we were changing her diet. After a few days she stopped complaining about being hungry even though she was already eating a lot less. Her blood sugar used to be from 60 to 350 and sometimes over 400. Now it has never gone above 172 and is usually under 140.
I cannot believe it in three weeks. She has also lost 18 pounds and is not falling. The biggest surprise to me is that she is not as confused and her memory is so much better that I can not believe it.
My sisters had been out of town but they came back and saw my mother one yesterday and the other two days ago. I showed them her insulin use which is less than half what it has been and her blood sugar levels. But they both cried when my mother started asking them questions about their trips and acted like a completely different person. She remembered their names and when my one sister said she was visiting her son my mother asked what college he was in. Well, she used to ask when he was going to graduate from high school. When my mother told her it was Lehigh she apologized and said oh yes, I’m sorry I forgot what is he studying? She said engineering and my mother was happy and said oh, just like his grandfather he would have been so proud.
We both cried again because my mother used to ask where he was and why he hasn’t come home yet. The other sister has a house down the shore and my mother asked her if that is where she was on her vacation. She never once yelled at them for not visiting her which she used to do even when they would come every day. And she is remembering to use her walker every single time now so she is not falling.
My sisters are now onboard. I have invited one to the group and the other promises to follow whatever I say. We have not seen her doctor yet but she has an appointment in a few weeks.
I have also been eating this way because that is what I have been feeding her and even though I don’t have diabetes I feel a hole lot better.
I want to thank everyone in this group. I have not said anything before because I’m not like that but I had to speak up now and thank every one. I also have to thank Karen V. for introducing me to this. She never asked for money but I had to pay her for some of her time. I’m sure she would have come out for free because she is so into this diet and promotes it at the gym all the time. I honestly thought at first that she must be selling something but I was surprised that no one here is selling anything accept getting healthy.
And one more thing. My mother has stopped asking for more of her Cinnamon Toast Crunch cereal or hot chocolate and now asks for more of the yummy bullet proof coffee which I sometimes make with tea instead.”
I often get the question, “what is keto?” Sometimes, I hear, “keto’s dangerous.” Various myths surround the word “keto” and ketogenic eating. So, I thought I’d address some of these common myths and tell you the real truth about keto.
Ketogenic diets were first used therapeutically in the early twentieth century; prior to the development of medications for seizures, a keto diet was prescribed to manage epilepsy and seizure disorders with fairly good results. Today, it is prescribed by medical providers and typically provides 3 or 4 grams of fats, preferably medium-chain triglycerides, to every gram of protein consumed. Ketogenic eating is often closely monitored by medical providers and dieticians when used to control or reduce seizure activity. Studies have shown a 50% reduction in seizure frequency in half the people who try it, and in about 1/3 of people that use it, a 90% reduction.
Stories abound of medical providers in the early 1920s of “curing” seizure patients with fasting and low carbohydrate eating; once medications were introduced, ketogenic eating fell by the wayside until media mogul, Jim Abrahams, had a son with epilepsy that was difficult to manage with medications. Dateline featured Charlie on an episode in 1994, where the family discussed their great success with ketogenic eating to reduce seizures. This huge improvement prompted Abrahams to create The Charlie Foundation to help educate others about ketogenic eating as a treatment for seizures. Throughout the 1990s, much scientific interest focused on ketogenic eating, and eventually, the movie, Do No Harm, was released; Meryl Streep starred in the story about a boy whose seizures were managed with a low carb, ketogenic diet.
Not long afterwards, Dr. Robert Atkins made the Atkins diet very popular among dieters; he published books and products geared to help people lose weight using high protein versions of ketogenic eating. Atkins popularized keto eating significantly and his diet books and products remain popular today, even though the newest version of “the Atkins diet” is much higher in carbohydrates than his original plan.
With the use and popularity of the internet, more and more information became available over the last 20 years or so. Research articles that once only appeared in expensive medical journals were making their appearance online and to the average consumer. People tired of using the same old diet advice they’d heard for 50+ years, only to discover they gained weight, became diabetic or even BOTH. Bloggers began writing about their personal successes with keto dieting; their before and after photos spoke volumes and their following amassed.
However, many nurses and doctors began to strike fear in the hearts of these keto-ers, and they began to say ketogenic eating is unhealthy & dangerous. Because their only knowledge of keto had always been associated with diabetic ketoacidosis, most providers shunned keto diets, and instructed their patients to “stop it immediately because it’s terribly dangerous.” Patients were then stuck between a rock and a hard spot, so to speak. They respected their providers – well-trained and highly educated physicians, nurses, & dieticians, but they also were firm in the belief that their health was better than ever before – terrific weight loss, lower glucose, improved A1c, and even healthier cholesterol levels. How could this be? How could something so helpful to so many be disregarded with prejudice by such educated medical professionals?
As I mentioned before, diabetic ketoacidosis is a very dangerous complication of diabetes and very, very high glucose levels; it’s most common in Type 1 diabetes, but does occasionally occur in Type 2. When DKA occurs, glucose levels are typically over 300, ketone levels in the blood are very high, and electrolyte levels get really out of balance. Potassium levels most often go very high, and this is one of the major reasons DKA can be life-threatening. Potassium is vital for all muscle function in the body; too much potassium can cause extra-excitability or overstimulation to muscles – the heart muscle just cannot tolerate such stimulation; this excess stimulation can result in very dangerous heart beats and rhythms; some are deadly.
Can you see now, why many providers hear only PART of the word and freak out? Let’s take a look at the entire phrase: diabetic ketoacidosis. It occurs in people with diabetes and typically with very high glucose levels, usually over 300. Normal glucose is less than 120. The blood and urine will both exhibit high levels of ketones AND, electrolyte levels get so imbalanced that the blood is very acidic. When this state persists for even a few hours, the person:
can become terribly confused,
complain of fatigue and loss of appetite,
may have shortness of breath, blurry vision, vomiting,
or exhibit an imbalanced gait.
All of these signs and symptoms are observed in concert, NOT in isolation, to make the diagnosis of DKA. This condition requires careful insulin dosing and specific medical treatment, and is done within the hospital because of the dangerous electrolyte imbalances that can trigger fatal symptoms. People are often on heart monitors, IV fluids, and round the clock glucose checks and routine insulin injections for 2-5 days.
Now, imagine that the above setting is the only place you’ve ever head the word part, keto. What would YOU think if you heard it at the local community center? Or in a chat with a friend? Or maybe online in a social media post? Thus, the fear of the word “keto” was born.
Have no fear, however! Keto is a word PART – not a whole word. As a word part, all it means is that ketones are produced in the body. Just as we discussed above, ketones ARE present and elevated in DKA. But ketones can also be present during a stomach bug because vomiting & diarrhea can alter the body’s use of fuel, causing a NATURAL state of ketosis. Ketosis simply means that the body is burning fats instead of sugars for energy.
Burning sugars for fuel is easier for the body and so, the body will follow the path of least resistance; it will burn glucose for fuel as long as it’s present in the bloodstream. However, the bloodstream only WANTS about 4 grams or 1 teaspoon of glucose floating around in it all the time. So there may not always be a steady amount of glucose for all the activities your body wants to enjoy. A good example is a workout at the gym; how many of you “carb-up” prior to your workouts? Why? Because the 4 grams of glucose is not sufficient to meet the energy needs of your workout. The major problem is that the body isn’t going to let all that glucose STAY in the blood and a lot of it won’t be needed for exercise; so, intake of glucose triggers the pancreas to release insulin. Insulin’s job is to quickly move glucose OUT of the bloodstream; insulin transports glucose out of the blood and INTO fat cells for storage. If we were meant to consume huge amounts of carbohydrates, don’t you think our bodies would be much more tolerant of having hundreds of grams of glucose INSIDE the bloodstream? This erratic process results in very high glucose levels that alternate with very low glucose levels, and can eventually contribute to symptoms of fatigue, thirst, and frequent urination – or diabetes.
However, if we restrict carbohydrate intake, the blood level of glucose stabilizes, less insulin is needed to manage the carb intake, and the fluctuating peaks and valleys of glucose control fades into a much more stable range because the body learns to be fueled by ketones. Ketones are made in the liver from fatty acids. Fatty acids are the smaller components of the fats we eat. One of the most common ketones is beta-hydroxybutyrate that is a fatty acid our bodies obtain during the digestion and breakdown of butter; in fact, it is butter’s namesake. This particular ketone is used for energy and is also helpful in digestive processes; it crosses the blood-brain barrier, and is thought to be of clinical relevance in treatment of epilepsy, depression, anxiety, and even cognitive impairment. Now, don’t you want to add MORE butter to your plate today?
Can you see now, how the use of ketones for fuel is actually healthy and beneficial? And how ketosis and ketoacidosis are 2 totally different and separate concepts? Ketosis is a natural process the body uses for fueling activities, and ketoacidosis is a terrible and dangerous health condition associated with out-of-control sugar levels.
Another common question I hear often is about testing for ketones “to be sure I’m in ketosis.” Well, you certainly CAN test for ketones, but testing can get expensive and if you’re consuming less than 20 grams of carbohydrates daily, your body WILL go into ketosis. It won’t have a choice. Our bodies need fuel – either glucose or ketones are the preferred fuels. During the transition period, people do report bad breath as a result of increased ketones in the blood. The body actually is a bit confused at first; it’s been burning glucose for all these years and now, there’s no glucose coming in to the system. So, the body senses a need to rid itself of “excess” ketones, so you exhale some and some are expelled in urine; a few accumulate in blood. After about 4-8 weeks (on average), most people will have become “fat-adapted” and will no longer experience bad breath or ketones in the urine. Why? Because the body has learned to utilize all the energy available; it won’t continue to “spill” or waste the fuel it needs for body processes. Testing after this length of time is often frustrating to people who think that somehow, they are no longer in ketosis. That is NOT true, however. It’s simply a matter of efficiency; the human body doesn’t waste much; it’s wired to conserve, reserve, and reuse many chemicals and products. Ketones are fuel for the body and will NOT be routinely wasted.
Testing for ketones is pretty unnecessary for most people eating a low carb diet; for people with very high glucose levels, it may be necessary during the transition phase from high carb to low carb eating, because of the risk for developing DKA. Urine & breath testing aren’t always reliable, and once fat adapted, you won’t be spilling any ketones in either of these waste products. Blood ketones can be tested, if necessary, and is the most accurate measure. The image below is from the book, The Art & Science of Low Carb Living, by Jeff Volek and Steve Phinney. In this image, you can see the area of optimal blood ketones is MUCH lower than those typical of a patient in ketoacidosis (far right). You can also see by the rise in the green curve that the brain and muscles function optimally in this healthy range of blood ketones. Ketosis is the natural process by which the body uses fats, or specifically ketones, for fuel. It is normal and natural. It is not dangerous. It won’t cause harm.
Hopefully, this article has provided you with a decent amount of information that will help you understand ketosis and how it impacts our bodies and health. For more personalized help, please feel free to send me a PM via Facebook or Twitter.
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.
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!