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Do you check your glucose?

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

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

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

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

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

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

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

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

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

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

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

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

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Metformin – The Good, The Bad, & the Useful

Many people with diabetes, gestational diabetes, insulin resistance, polycystic ovarian syndrome (PCOS), and/or metabolic syndrome (MetS) are taking metformin, a drug that has been around for about 60 years. It is one of the oldest and safest medications used in the management of diabetes. Most people who take this medicine believe that it lowers glucose in the blood, but that is not how it works.  Metformin works in 3 major ways, and these processes result in a lower glucose through INDIRECT means.  Insulin and some other diabetes medications DO directly lower glucose in the blood, but metformin is not one of these types of drugs.  Let’s discuss how metformin works and how it benefits people who take it.

metformin pic for met articleMetformin is classified as a “biguanide” drug and is prescribed for a range of metabolic disorders as mentioned above; it is the preferred medicine and is considered the first line therapy for these conditions. It works to reduce the amount of glucose produced in the liver; it also reduces the amount of glucose absorbed through the intestines, and it improves insulin sensitivity by increasing peripheral glucose uptake and utilization. These physiological and chemical reactions occur at the cellular level, but are very effective at improving glucose and insulin utilization.

The action of metformin within the intestines is the cause of the most common side effect, diarrhea and sometimes abdominal cramping. As metformin is absorbed in the small intestine and enters the bloodstream, its direct impact is seen, almost immediately in some people. Metformin acts to stop absorption of excess glucose and this increased glucose within the small intestine exerts a laxative effect, resulting in diarrhea and belly cramps. This side effect occurs in about 50-55% of people who take metformin, and is the reason that many prescribers will titrate (increase) the dosing over many weeks. Most people can adapt to the use of metformin with a slow and gradual increase in dosing, but others seem to have issues no matter how low and slow the dosing is. Also note that it can take up to 3 weeks for enough metformin to actually lower glucose levels; because its major action is within the liver, one dose is not likely to demonstrate any impact on your bloodstream today.GI tract for met article

Gastrointestinal side effects like diarrhea and belly cramping are usually easy to overcome with very slow and gradual dose increases; I have seen prescribers use a variety of schedules and dosing recommendations. Some work for some people, while others do not. My suggestion is this: if you have GI symptoms related to your metformin use, ask your prescriber about a slower titration schedule. I often work with clients who increase dosing over 6-8 weeks for optimal results with minimal side effects. Other tips that can be helpful:

  • Eat with metformin dosing, no more than 5 minutes between food & medicine
  • Take metformin IN BETWEEN bites of food at a meal
  • Take metformin near bedtime with supper or small snack
  • Some people find a multi-strain probiotic helpful
  • Avoid using MCT or coconut oil within 2 hours of metformin dosing
  • Ask pharmacy about switching brands of metformin
  • Ask prescriber for extended release formula as these offer less impact on the gut

In addition, taking metformin can lead to a RARE and very dangerous side effect called lactic acidosis. In my 10 years as a prescriber, and after having hundreds and hundreds of patients on this medication, I have only seen lactic acidosis begin in one patient; I immediately stopped the metformin, and retested the Complete Metabolic Panel (CMP) which came back normal. Lactic acidosis is an accumulation of excessive acid due to a problem with the body’s metabolism of lactic acid, induced by certain medications or the body’s response to a medication; lactic acidosis is more likely to occur in people with impaired kidney function. It is the major reason that prescribers are encouraged to perform lab tests, like a CMP before and after starting metformin. Lactic acidosis cannot be overcome or treated with gradual dosing increase; in this particular instance, metformin is listed as an allergy on a patient’s chart and never prescribed this medication ever again. Lactic acidosis can be fatal; however, please note that this side effect is extremely rare. (FYI: Lactic acidosis is NOT the same as ketoacidosis.)

kidney image for met article
Kidneys

 

In addition to GI side effects & lactic acidosis, metformin may also contribute to kidney stress; it is sometimes very difficult to determine if the diabetes itself is causing the kidney disease, or if it is the medication. When this confusion occurs, many mainstream medical providers will stop the metformin and perform a trial of other medications to see if kidney function improves. This method sometimes works, but sometimes it does not help. Using our low carb nutrition plan will significantly lower glucose and reduce the stress on the kidneys, often reversing diabetes and kidney disease. Even if metformin contributes to mild kidney stress, it is often continued because of the risk/benefit consideration: metformin MIGHT be contributing to kidney stress, but we KNOW elevated glucose causes kidney stress and ultimately kidney failure; it is why so many patients with diabetes end up on dialysis. So, even if your kidneys begin showing signs of injury, it is often seen as a beneficial medication. Some providers will often suggest a lower dose or less frequent dosing regimen; talk to your provider to share your specific concerns and ask questions about your specific health condition. Kidney stress from the disease AND the meds can be a great reason to keep your lab tests up to date; always ask about your GFR, BUN and creatinine levels so you can be an informed patient.

Recently, experts have begun to warn about the risks of vitamin B12 levels falling due to metformin use. While it is a risk, there is currently no organization or expert that has released guidelines or recommendations for monitoring B12 levels in patients who take metformin. So, this responsibility rests with each individual patient. One of the earliest signs of B12 deficiency is fatigue, and so it’s usually easy to justify the lab test for insurer; the main reason providers won’t order extra tests is insurance regulation. Another obstacle is that by the time the B12 level has fallen below normal, the patient often has more problems that have developed. Some low carb experts are beginning to start their patients on a good quality B complex vitamin, no matter the blood level. If you have seen any of my videos or read my blog articles, you’ll know that I typically recommend a methylcobalamin for the active B12 ingredient, instead of the more-common cyancobalamin. Also note that B12 is poorly absorbed and utilized when taken alone; it needs multiple co-factors, like B3, B6, & folic acid for optimal absorption and use, thus the reason most low carb experts recommend a B complex vitamin, instead of the single B12.

As you can see, pharmacology is a complex science, especially in the context of abnormal metabolism, such as what occurs with metabolic disorders like diabetes and insulin resistance. While I do understand that learning all this information can seem daunting and overwhelming, it is VITAL for each person taking medicines to learn all you can about the medicine and its impact on your body.

What about metformin and other medicines? I strongly encourage you to use a reputable website to look for drug-drug interactions, specifically between metformin and other medicines. I will discuss only a handful of issues here. First of all, we KNOW that metformin ALONE does NOT contribute to abnormally low glucose levels – remember, it works in the LIVER and the GI tract, not in the bloodstream. However, certain combinations of anti-diabetes medicines CAN change the impact on blood glucose. For example, we know that insulin is used specifically to directly lower glucose in the blood; when combined with metformin, metformin IMPROVES insulin sensitivity and because of this action, metformin CAN cause a lower glucose than taking insulin ALONE. Read this sentence again:

When combined with metformin, metformin IMPROVES insulin sensitivity and because of this action, metformin CAN cause a lower glucose than taking insulin ALONE. Other anti-diabetes medications can also interact with metformin, resulting in this “synergistic” effect – drastically lowering glucose to unsafe levels.A1c chart for met article

Keep in mind that the lab reference range for glucose is 60 -100 mg/dL (3.3 – 5.5 mmol/L). These levels are considered NORMAL glucose readings without addition of medication. We prefer for fasting glucose levels to be less than/around 85mg/dL (4.7 mmol/L), because numbers lower than 85 (4.7) tend to show us that insulin and glucose are working more appropriately than when numbers are higher. When patients begin taking anti-diabetes medications, glucose often falls quickly, resulting in feelings of hypoglycemia – even when glucose levels are within this 60-100 (3.3-5.5) range. This phenomenon occurs because the liver and the body have become accustomed to your higher/abnormal glucose readings. All anti-diabetes drugs, including metformin, can contribute to these feelings of low glucose. It is imperative that you check glucose when experiencing these symptoms so that you know the appropriate action to take. If your glucose level is NORMAL, 60-100 (3.3 – 5.5), and you are only taking metformin, the only action that may be needed is to have your normal meal. If you are shaky, nervous, trembling, and have a headache, check your glucose, PRIOR to deciding to treat a “low glucose.” If these symptoms occur in the presence of NO medication (or metformin ONLY) AND normal glucose levels, most low carb experts recommend having your usual low carb meal or some salty broth and waiting for these symptoms to subside. Once the liver and the brain learn to respond more appropriately to your new low carb lifestyle, these symptoms disappear.

If you experience these symptoms while taking medication that DIRECTLY lowers glucose, always check glucose level and treat accordingly with glucose tablets. Keep in mind that 1 gram of glucose will raise glucose about 5 points, give or take; it is no longer accepted practice to consume candy bars, soda or sugared orange juice to raise glucose because these items cause such a wide variety of responses based on the amount and speed consumed. If these food items are consumed in response to a low glucose level, the body’s response can become a terrible day of fighting high glucose levels, interfering with normal physiological responses as well as an emotional & tiring rollercoaster for the remainder of your day. If you take glucose-lowering medication, it is advisable to purchase glucose tabs at the pharmacy and keep them with you and easily accessible all the time.

The maximum dose of metformin that is approved by the FDA for use in the US is 2500 mg daily, and it is usually in divided doses. Some prescribers will “max out” the dose and write the prescription something like this: metformin 500 mg tabs: take 2 tabs morning and night, and 1 tab at lunch. Other prescribers simply write for 1000 mg twice daily. Many prescribers will start metformin at 500 mg, planning to increase dose over time to help minimize GI side effects; sometimes the providers forget to go back and increase the dose. If you have been taking the minimally effective dose of 500 mg daily for a long time, it may be a good idea to ask your medical provider about a possible increase.

Because metformin does NOT directly lower glucose and its major impact on health is improving insulin sensitivity, most low carb providers will not lower metformin dose or stop prescribing metformin when your hemoglobin A1c or your glucose fall into more normal ranges. We typically continue this particular medication, even when glucose numbers are more normal, because of metformin’s significant impact on improving insulin sensitivity; metformin is helping your liver learn to metabolize glucose much more efficiently. Why would you suddenly want to stop teaching your liver about your new way of eating? Some providers may lower the dose, but continue some metformin; some will want to stop it because they may not understand its direct action does not occur in the blood. Most low carb providers that understand the actions of metformin typically continue this medicine until the A1c remains around 5 for 6 months to a year. When metformin doses are lowered or the medicine is stopped completely, it can take 2-3 weeks before you see any change in glucose levels; glucose levels usually do increase when meds are lowered or stopped, but be aware that the method and action of metformin cause a much slower response than say insulin or sulfonylureas.

Other medicines are often stopped or significantly lowered immediately upon beginning low carb eating; it is VITAL that your provider be kept “in the loop” with regards to your glucose levels, medications, and low carb eating. Most of them have NO idea that our way of eating AND your glucose-lowering meds will put your very life at risk if medications are continued at high doses, typically used to treat very high glucose levels caused by VERY high carbohydrate intake. Call the provider’s office every single day if needed. Fax glucose records to them daily. Ask specifically about medications BY NAME when your glucose is within normal range. And keep in mind this one fact: we do NOT treat NORMAL glucose levels. Even prescribers get busy and overlook medication action sometimes. Be very specific with your questions. Example questions:

  • Should I keep taking 80 units of Lantus daily with my glucose level at 96 (5.3)?
  • Is it dangerous to keep taking my 3 meds (name all 3) with a glucose level of 104 (5.7)?
  • I’m taking metformin and (name other med) and my glucose today is now 100 (5.5); what should I do?

As with any health problem or medication, ALWAYS consult your health care provider for more specific information. This blog article is provided for information only and should NOT be taken as medical advice. Your health care provider knows the most about you and your health, but most of them know very little about low carb nutrition. You may have to help them understand that you are eating healthy meat, fats, and veggies, and only skipping non-nutritious calories that raise your glucose. You may have to present them with logs and records of your glucose levels for them to believe you. You may have to help teach them the simple science of low carb nutrition and its impact on your glucose levels. You may ultimately have to make some of your OWN decisions if you believe your safety is at risk. BUT always keep your provider aware of what is happening.

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Reversing Dementia IS Possible

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

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

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

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

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

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

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

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

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

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

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

—Anonymous

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Just What is Ketosis?

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

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

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

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

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

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

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

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

can become terribly confused,

complain of fatigue and loss of appetite,

may have shortness of breath, blurry vision, vomiting,

or exhibit an imbalanced gait.

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

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

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

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

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

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

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

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

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

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Keto Pepper Poppers

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

12 jalapeños, seeded and halved

8 ounces of softened cream cheese

3 tbsp. sour cream

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

2 tsp minced garlic (More can be used)

1/2 tsp onion powder

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

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

Serve.

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

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Creamy Keto Soup

This recipe is a great base for most any type of creamed soup you enjoy. I used frozen spinach in my batch, but sautéed Brussels sprouts,  mushrooms, or asparagus would work just fine instead.


Creamy Keto Soup

32 oz heavy cream

1 1/2 cup water or broth

6 oz cream cheese

1 cup shredded white cheddar

1 tsp minced garlic or 1/8 tsp garlic powder

1/4 tsp salt

1/4 tsp pepper

1/8 tsp cayenne pepper powder (optional)

Heat all ingredients in medium saucepan over low heat, stirring nearly constantly. Add additional seasonings to taste after about 20 minutes and all ingredients have melted and mixed well.

Add 1 – 1 1/2 cups of frozen chopped spinach or other veggie of choice. Most veggies will do best if sautéed or parboiled prior to adding to creamed mixture.

Heat thoroughly over low heat with frequent stirring; total cook time for my batch was about 45 minutes.  You can cook over low heat for a longer period of time, but remember that heavy cream will reduce down over time, creating a thicker Soup. Serve.
Makes approx 2 quarts of Soup, unless you cook it down to thicken it more. Keeps well for several days in the fridge. I also think it tastes even better the next day!!

This creamy soup base is totally awesome for cooler fall days! Let us see your version; post pics of your Creamy Keto Soup on our Facebook page.

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Measures of “Improving Health”

Recently, another health care provider mocked my use of the phrase, “improving the health of my patients”, saying that it’s vague and not measurable.
Her comments gave me pause, because the goal of every nurse I’ve ever met has been to help people improve their health. Ask any nurse why he or she became a nurse, and you will hear a variety of ways people say it. We nurses help people get well, better, or over a health obstacle. How is that measured?
First and foremost, there are many parameters used by health care providers to measure health. With diagnoses of diabetes and hypertension, we measure glucose and blood pressure, respectively. But we often have difficulty quantifying how people feel when they lower their glucose or blood pressure. When patients return for follow-up and I’m able to tell them their hemoglobin A1c dropped from 8.9 to 6.4 after weeks of diet changes and effort, people are thrilled. They grin from ear to ear. They clap. They shake a fist in the air. They “high five” me. Some even do a “happy dance.” What is measurable here? Yes, the glucose levels are numerical and easy to track. But how does anyone put a scale on happiness or joyfulness? Can the idea that diabetic complications no longer pose a looming hazard to health be measured? How is relief quantified when kidney damage has improved?


These feelings are not measurable, yet they are extremely evident in behaviors and attitude. Patients who work toward improving health exhibit gratefulness that good instruction is provided; is that gratitude measurable?
Measures are important in health care. Measurements of pulse or blood pressure provide vital information to us who render the care. I decided that some of you might be interested in knowing what measures we use for certain conditions so you can track your own progress over time.
With diabetes, one of the most important measures is glucose, of course; in addition, the hemoglobin A1c that tells us the average glucose levels over the past 90-100 days provides a good correlation to patient effort in managing the condition. While mainstream medicine will say that “good” diabetes control occurs when the A1c is around 7, many studies have shown that diabetic complications occur when the A1c runs higher than about 6.2 or so. Normal A1c levels run around 5 or less; why should people diagnosed with diabetes be forced to run glucose levels so high that we KNOW organ damage will occur? Is that going to help patients “improve their health”?
Elevated blood pressure is often associated with diabetes because high glucose levels cause thick, sticky blood; demanding that the heart pump thick, sticky blood to an overweight body will eventually result in high blood pressure. The heart will pump harder and with more force to move thick “syrupy” blood through tiny blood vessels, resulting in higher and higher blood pressure readings. When blood pressure increases, the heart muscle becomes compromised and weaker. Daily demands on the heart that continually exceed it’s designed capabilities can contribute to a multitude of vague symptoms which are not measurable, including headaches, fatigue, nausea, dizziness, or even mild swelling. While most of these symptoms have no quantifiable scale, patients will describe how much better they feel once blood pressure is lowered. While blood pressure is measurable, the feeling of lower and healthier blood pressure is described by patients as “improved health.”
If blood pressure remains untreated or poorly managed, heart failure and/or kidney damage begin to occur. Highly pressurized blood flow moving through the kidneys will damage the fragile vessels, reducing the filtering ability of the kidneys. Elevated glucose can also damage these tiny vessels, resulting in inflammatory responses by the body that are designed to patch and repair damage – but this natural response by the body can result in blood vessel blockages. Think scar tissue.

In this photo below, notice that cholesterol is serving as the patch, relating the damage to the blood vessel. Cholesterol isNOT the cause of clots; it’s part of the damage control/repair team of the body. In summary, how do we measure “improved health”? How can we quantify patient comments when they express gratitude for how they feel? How can we count the number of clinic visits these patients will NOT have? How do we track hospitalizations that do NOT occur for these patients? What evidence do we see when ER visits are no longer the norm for people with “normal” glucose or blood pressure? We can’t. But these numbers ARE real. These people ARE changing their lives and IMPROVING HEALTH!

If you want to take charge of YOUR health, email us for more info at KetoNurses@gmail.com