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Top 10 Advanced Keto Secrets

Recently, I’ve answered a variety of questions about ketogenic eating and thought I might address some of them here in one blog article.

  1. One of the most common issues I’m asked to address is the impact of exercise on glucose.  The answer for each person is different, because each of us is unique, and our bodies are responding to the internal chemistry in THAT specific moment.  Some people see a significant elevation in glucose during or after exercise, while others see a big drop; others, of course, see little change at all.  Which effect is the “NORMAL” response by the body?  All of the above.  Exercise is a physical stressor and can increase cortisol and adrenaline in some people; on the other hand, exercise can burn glucose for fuel and/or be very relaxing for others, resulting in lower glucose impact.  Typically, I encourage exercise for general health’s sake, but NOT for glucose control or weight loss.  Many studies over the years have shown very little OVERALL impact on glucose levels or weight loss from exercise, even though exercise is great for toning, stamina and endurance – all of which can improve general health and well-being.  When just beginning a low carb eating plan, I usually discourage a lot of exercise; changing the dietary intake is a chemical stressor, and the body can take 3-6 months to fully adapt to efficient fat-burning.  During this short-term transition, exercise may contribute to additional stress on the body, internally, resulting in chemical imbalances that trigger cortisol release as well as glycogen storage release from the liver.  Muscles may also release stored glycogen, adding to the elevated blood sugar levels.  Other low carbers may see lower blood sugar levels because of the use of the glucose for fuel; previously, we thought only glucose could be used for exercise.  That idea is where the concept of “carbing up” before and during exercise originated.  However, we now know that fats can fuel exercise too, but is most efficient AFTER the body has adapted to burning ketones.  So, what is the bottom line?  Every person responds differently to exercise; adjust YOUR daily lifestyle based on glucometer readings.  Avoid stressing the body with exercise if it raises glucose during the transition to ketogenic eating.  Return to exercising after glucose levels stabilize; sometimes a short walk, or some mild yoga, pilates, or Tai Chi can be used as exercise, with minimal glucose impact. Patience is the key, no matter what impact exercise has on glucose readings; on a low carb way of eating, exercising or not, glucose will stabilize.
  2. Another common question I hear often is about electrolytes and supplementation.  I do have a lengthy Facebook Live video on my KetoNurses Facebook page where I discuss this information in detail and answer many viewer questions, but I will try to address the issue here in a quick and short explanation.  Typically, a ketogenic way of eating provides MANY more nutrients than our Standard American Diet did; so for many of us, there are not a lot of supplements needed.  However, we’ve been VERY deficient in many nutrients for so long that a sudden dietary change can make that deficiency more apparent; for others, adding certain supplements just seems natural after reading and watching internet “experts” on ketogenic eating.  However, most of them are just trying to sell their products.   As a general rule, Vitamin D is a necessary supplement for most because we do not get nearly enough sun exposure anymore; we cover up, we apply sunscreen, and we avoid going out nearly nude around noontime.  Unless living near the equator and sunning nearly nude at noon, there’s no way to obtain adequate Vitamin D from sunshine; I have an entire blog article related to more info on Vitamin D if you’d like to read it.  Link is here:  https://ketonurses.wordpress.com/2017/06/14/what-is-vitamin-d-why-do-i-need-it/   In addition, people often begin supplementing magnesium for a variety of reasons, including the need to improve absorption of Vitamin D.  Again, more on this use of magnesium for this purpose in addressed in the article above.  Other reasons to supplement magnesium is the vast array of bodily functions that rely on magnesium; it’s required for over 300 chemical processes, including those related to food digestion, nervous system function, brain health, and protein production/use.  There are a myriad of types of magnesium products and some are combinations of a variety of types.  All magnesium types help with all processes, but most types have a “best” benefit, as described in this graphic.

mag uses

3.  Other supplement questions I get often concern B vitamins, CoQ10, ALA, cinnamon, chromium, zinc, and berberine. I do often recommend B vitamins, but a very specific type of B, not the usual ones that contain cyanocobalamin as the active Vitamin B12.    Cyanocobalamin is the most common and one of the least expensive forms of B12, but it’s estimated that about half of us cannot break the cyanide molecule away from the cobalamin molecule.  If not separated, these chemicals remain bound and completely unusable by our bodies, resulting in poor absorption of Vitamin B12.    Usually, I recommend B complex vitamins that contain methylcobalamin and a calcium-methylfolate for most people because using this form is adequate for the majority of people, will not harm people that CAN utilize cyanocobalamin, and is readily available in many supplements.  These people often have a gene mutation that prevents normal absorption and utilization of B12, which is essential to many body processes and functions.   Often seen as MTHFR, the mutation impacts the production of methylenetetrahydrofolate reductase, and when this enzyme is absent, methylation cannot occur properly.  What is methylation? Methylation is a necessary metabolic process that repairs DNA, turns genes on and off, and is used to separate a variety of chemical compounds into smaller and more absorbable nutrients.  Some people have NO symptoms or problems when they have the MTHFR gene; others have severe symptoms and health conditions.  And some health professionals/organizations recognize MTHFR very differently.  In addition, there are a few people who cannot even absorb or utilize the methyl form of Vitamin B12; these people often have to use a prescription form of hydroxycobalamin.  For more info about B12, this video is a good source:   https://m.youtube.com/watch?v=BvEizypoyO0

Other supplements are mostly personal choice and may be helpful for some people, but a more specific health history is needed to make that call; I do schedule phone consults to help people sort through these specifics.  I never recommend shakes, programs, or other expensive keto-based products to my clients; I try to keep recommendations to a minimum, keeping costs and convenience in mind as well.  As for berberine, I have written an article about its use as well; it compares nicely to metformin and as such, should NEVER be taken WITH metformin.  Choose.  My article on berberine can be found here:   https://ketonurses.com/2018/08/berberine-worth-it-or-just-a-mythical-unicorn/

Another supplement issue that sometimes comes up is related to blood thinners. Many people with diabetes also have atrial fibrillation, clot history, or other need for anti-coagulation therapy.  It is important that you are aware that MANY supplements and medications can act as a “blood thinner” when taken regularly.  It is VITAL that you share this information with your prescriber so that adequate adjustments can be made in your treatment plan BY YOUR PRESCRIBER.  Many health care providers are NOT aware of side effects of many OTC supplements; they often are not even aware of supplement action or purpose; they almost certainly are unaware of potential side effects.  If you are in doubt or are concerned, use drugs.com, rxlist.com, or epocrates.com to research your meds/supplements.  Aspirin is often recommended/prescribed for those with history of heart attack, certain strokes, many types of clots, or as prevention of such problems.  Aspirin prevents the “clumping together” of blood cell components; it does NOT directly “thin” blood, although that is what we call its action. In addition, NSAIDs, like ibuprofen, naproxen, indomethacin, and meloxicam also list bleeding as a side effect.   It is important to notify your prescriber o of any additional supplements if you are taking aspirin, NSAIDs,  or any blood thinning medication.  Fish oil, in high doses – over 2000 mg per day – can be a significant anti-coagulant; turmeric also labeled as curcumin acts as and anti-inflammatory agent and may contribute to bleeding too.  Vitamin C may also “thin blood” and so should be taken with caution if on any of these other agents.

Many folks also ask about using protein shakes, supplements, or ketone supplements. As a general rule, these are unnecessary and pricey.  There are a very few patients with very specific conditions that can benefit from these products, but again, a phone consult to thoroughly discuss your specific medical history and medication use are vital.  It’s extremely important to develop a patient-client relationship with a medical provider or health coach who is knowledgeable about medications and lab results; do NOT rely on social media and “friends” to help you decipher life-impacting medical treatment.

Another common concern is a bit more complex; it’s about the “cause” of our diabetes; most of the people who follow my blog, Twitter, IG, and Facebook page have type 2 diabetes, Polycystic Ovarian Syndrome (PCOS), insulin resistance, obesity, elevated cholesterol/triglycerides, or some combination, often referred to as metabolic syndrome. While we did it to ourselves, we did NOT cause the problem.  We were following dietary advice provided by medical practitioners, nutritionists, and all sorts of agencies that TOLD us how to eat “healthy.”  Nina Tiecholz has written extensively about how we were all “grainwashed” over the past 50+ years; her book, The Big Fat Surprise, provides information about the “science” that was used to develop and publish dietary guidelines.  She debunked all the famous studies and provides great information about how the health of Americans was impacted by those studies and strong personalities.  I believe that EVERY medical professional, nutritionist, nurse, and dietician should be required to read her book as part of school/training.  Her work with the Nutrition Coalition is extremely important to the future health of Americans; if you are not following her work, now is a good time to find and follow her.  She more recently has begun to speak about the politics of food; her 2017 video presentation here discusses the statistics and shows how Americans HAVE followed dietary advice and yet, we continue to get sick. https://www.youtube.com/watch?v=FXjB-5-uzuw   Other authors have also written about the relationship between high carb intake and metabolic dysfunction; one of my favorite books on the topic is The Art & Science of Low Carb Living by Jeff Volek and Steve Phinney; Dr. Jason Fung’s The Obesity Code is another.  Jeffrey Gerber and Ivor Cummins’ new book, Eat Rich Live Long is another fave, as is Keto Living Day by Day, by Kristie Sullivan.  All of these books have great information about the relationship of carbohydrate intake and out health problems.  Do your research, but do NOT “blame yourself” for your health.   We were “just following the rules.”


Probably THE most common question I hear today is about cholesterol and medicines used to treat or prevent heart problems “caused by high cholesterol.” Again, this topic requires some research based on YOUR personal health, labs, and medical conditions. In general, many studies over recent years have begun to show that cholesterol, in and off itself, is NOT a health hazard.  Cholesterol is essential to health, and about 85% of it is MADE BY OUR BODIES; only about 15% of our cholesterol in our bodies comes from the foods we consume – keep those numbers in mind.  The liver produces cholesterol for our bodies to use multiple processes, especially making and maintaining cell membranes.  Every single cell – all 38 TRILLION cells – require cholesterol.  Cholesterol is the base ingredient for many hormones, especially reproductive ones, like estrogen and testosterone.   How can we expect reproductive processes to function normally if we use drugs that completely destroy the body’s natural production of essential-to-life hormones?  I cannot imply that you should or should NOT take any medication; that decision is between YOU and YOUR prescriber.  But I will recommend that you do your research, study cholesterol and the medications; we should NEVER accept anyone’s word at face value any more.  Today’s world is full of technological advances, and information is available at our fingertips.  Yes, medical professionals will prescribe, encourage, and even bully patients into taking medications, but always remember the Hippocratic Oath that includes “do no harm” first and foremost.  We are trained to prescribe drugs to “fix” the problem; we were NOT taught to use diet, nutrition, or “lifestyle medicine” as recommended treatments.  We are learning right along WITH YOU.

Another common problem that arises with any dietary change is slow gut motility, often called constipation. The most common cause of abdominal pain in all patients today is chronic constipation. And most Americans (estimated to be 80% or more) suffer from chronic constipation at least on occasions. And changing what you eat will impact the gastrointestinal (GI) tract and its motility because the gut must learn about its new contents – but let me be clear, LCHF does not cause constipation; it actually can contribute to loose stools because of the fats causing everything to be slick, “lubed up” if you will.

To decide if you might have constipation, ask yourself these questions; do you:

have more than 1 day a week that you do NOT poop?

have watery stools?

have hard balls for poop?

ever have explosive diarrhea?

ever have tiny smears of blood on tissue with a BM?

ever strain or wait for long periods of time to poop?

ever feel like there should be more poop in the toilet?

ever feel like there’s more poop inside that should be emptying?

have lower abdominal pains/cramping?

feel bloated and overly full, even short of breath at times?

suffer with reflux, indigestion or heartburn?

have reported diverticulosis on imaging or colonoscopy?

If you answer yes to 2 or more of these questions, I can promise you that the problem is most likely chronic constipation. It can be VERY subtle but it’s there.

The most common cause of chronic constipation is our SAD (standard American diet), full of poorly digested carbs and processed/breaded meats. All those carbs act like glue in our intestines, and will eventually push on the pockets along the colon, forcing enlargement of the pockets; this stretching and enlargement is known as diverticulosis. In addition, almost every single medication on the market today lists constipation as a common side effect. Multiply that effect by the 3-5 meds most people take, and its TROUBLE in the gut.

Many people will occasionally use a laxative or colon cleanser to completely empty the gut. While not safe to use daily, it might help to try one and see if your symptoms are relieved. High fat intake will eventually retrain a constipated gut to go more regularly. High fat intake will also eventually heal some of the damaged gut lining; how does gut damage occur? From a lifetime of poor nutrient intake. Nutrients are absorbed along the way as food is digested. There is only a very thin layer of protective mucus that lines the intestines. Easily injured from wastes moving through too slowly, intestines with a damaged membrane of mucus are not repaired easily and can contribute to leaky gut syndrome, various infections, and chronic constipation.

So, you still don’t think you’re constipated? But you’re having heartburn, indigestion, or reflux? A study from a couple years ago suggested that 85% of people with reflux/severe indigestion actually suffered from constipation and theorized that the constipation is the most likely cause or contributing factor for their reflux symptoms – because if wastes aren’t coming out normally from the bottom, they have nowhere else to go but up. And that makes totally logical sense. So, you’re finally you’re convinced you may have some poop still stuck along your GI tract and maybe have some damaged gut lining. How do we fix it?

First of all, LCHF provides most of the necessary nutrients and best sources of healing factors for our bodies, including the gut. However, many people find that when altering diet intake, the gut responds in an uncomfortable way by slowing down even more. It’s the change in nutrition, combined with not enough water, and usually a lack of magnesium and salt that cause this reaction. Sodium and potassium are required for muscle contraction; deficiencies in these minerals are frequent while learning LCHF eating and are common side effects of many medications, especially ones for blood pressure and diabetes. In addition, most of us are deficient in magnesium which aids in gut motility, and we’ve been deficient for quite some time. Most LCHF experts will typically recommend drinking salty bone broth to relieve headaches, but people drink a cup or so and are done for the day not realizing the variety of muscles that need the minerals in that broth. More is usually better, but there’s not an amount that we recognize as helpful for everyone – I’d venture a guess at about a quart of broth daily during the first week or two of LCHF eating, but that’s a total guess. Others may have a recommendation as to the amounts they’ve used to help them; my suggestion is to read all the suggestions and then try different amounts on different days for your own experiment. As for magnesium supplementation, keep dose low to avoid diarrhea; some people will increase dosing every few days to minimize gut impact. Most people’s guts will react violently to doses over 400 mg a day; as you review the graphic I provided above, you’ll see that some forms of magnesium impact the gut more than others.  Threonate, glycinate and taurate rarely contribute to loose stools.

Healing of the gut will also be encouraged by consuming pre-biotics…. foods from which the gut can produce its own probiotics. Fermented foods are optimal sources of pre-biotics. Fermented foods include sauerkraut and kimchi. Sometimes kumbucha can be low carb enough to drink in small quantities, but read labels carefully if using pre-packaged pre-biotics to be certain of carb/sugar content. You can also find probiotics over the counter or online, but refrigerated ones typically contain highest colony counts of healthy bacteria. In addition to eating pre-biotics, butyrate is necessary to gut health. Butyrate is an essential fatty acid – essential means our bodies MUST have it for normal body processes. Best source of butyrate? Butter. Real. Natural. Butter. So be certain to consume a lot of butter; cook in it. Add it at the table. Add it to coffee or tea.


Fiber. So, did you notice it wasn’t my first “miracle cure” for constipation? Fiber has been the mainstream medical providers’ cure-all for constipation for years. But recently it’s come under fire for contributing to constipation and irritating bowels. Fiber acts to BULK. Bulking is the process whereby fiber absorbs water from the gut until the fiber has swollen to maximal capacity. The theory behind increasing fiber is that this swelling fiber would fill all the diverticula (pockets) in the colon, and slowly, very slowly, the fiber would be forced through the intestines, moving wastes out. But for most people this bulking causes terrible bloating, gas and abdominal pain; some people have even developed obstructions from bulking agents becoming stuck, especially in some of the sharper turns of the GI tract. Some studies are even suggesting fiber is contributing to IBS, UC, Crohn’s and some GI cancers. Early studies suggested fiber helped with gut motility, but none of recent date have been able to reproduce similar results, leading many experts to believe there are “confounding factors” that were not taken into account in earlier studies. While SOME people can use fiber supplements with good results, it’s very individualized. If you have very watery stool that you have investigated thoroughly and KNOW the cause is a medicine (like metformin), a trial of fiber supplementation may prove helpful as the fiber will absorb lots of that extra water, resulting in more normally formed stools. This type of use is typically my only recommendation for using fiber nowadays.

Rory is a good friend and great low carb expert; he says, “Research is showing that optimizing bowel health involves both the use of prebiotics, such as inulin and/or a galacto-oligosaccharide, and also, a probiotic containing multiple strains of healthy bacteria. Inulin (not a misspelling:  inulin–not insulin) does contain some amount of carbohydrate in the one or two teaspoons that might be appropriate. So, if you chose to use it, you would need to account for the carbs as part of your daily allowance.  Dr. William Davis, who has emerged as one of the most knowledgeable doctors on gut health, was the source for my information to you. He teaches that this approach is better. If you want more information, I’d encourage you to purchase one of his books that discuss this.”

What salt do I eat is another common question.  It really is a personal choice.  Just keep in mind that iodine is added to table salt to help ensure that we get adequate iodine for thyroid health.  When we cut out all the processed carbs, the iodized salt intake also drops significantly, putting thyroid health at risk.  Pink Himalayan, sea, and other specialty salts do NOT have iodine added, nor do any of them have adequate amounts of iodine NATURALLY. Many people will use a combination of specialty salts and table salt; others will take an iodine supplement.  Some vitamin D supplements contain iodine or sea kelp.  Check labels to be sure.  In addition to the iodine, we need more salt than we think.  Previous recommendations have suggested we need approximately 4000 – 5000 mg of salt per day; some low carb experts are suggesting even more.  Salt is essential.  Don’t shortchange yourself.  Keep an eye on your thyroid labs, if you completely eliminate iodized table salt from your intake.


Our last question deals with blood pressure on keto. Some low carb experts are beginning to suggest that high blood pressure may be the earliest sign of insulin resistance.  Long before glucose or Hgb A1c rises, and long before obesity develops, blood pressure may be creeping upwards in response to insulin resistance, according to some experts.  We’ve seen frequent reports of lower blood pressure with the drop in glucose in many people.  There is sometimes a mild rise in BP during the first few weeks, as the body transitions to our new way of eating, but it generally settles down and stabilizes within a few weeks; there is no “standard rule” for how long it takes to see stable and normal BP.  Some report normal readings in 3-4 weeks, while others report normal numbers at 4-6 months.

The main take-away points from this article?  Keto is NOT a perfect plan with exact results for every person in any given time frame.  Keto works.  Keto heals.  Keto repairs organs.  Keto reverses MANY chronic conditions.  But the keys: consistency, persistency, and PATIENCE.

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Why Won’t My Glucose Fall?

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

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

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

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

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

Standard Bell Curve

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

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


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

caution sign
GET MEDICAL ADVICE for YOUR specific situation

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

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

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

glucose fluctuations
Avoid these glucose fluctuations

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

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


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

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


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

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

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Do you check your glucose?

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

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

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

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

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

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

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

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

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

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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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.”


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What is Vitamin D & Why Do I Need It?

vit d pathwayVitamin D is called a vitamin; it’s often called a hormone. It’s often called a vitamin that acts like a hormone.  So, which is it?  It’s actually all of the above.  Vitamin D is a fat-soluble agent with a chemical structure similar to a steroid.  Which makes sense, as Vitamin D is one of the major ingredients of all steroid-based hormones produced in our bodies. Our bodies were created and designed to absorb sunshine via skin and then a variety of chemical reactions would occur so our bodies actually made its own vitamin D.  However, since the skin cancer scare of the 1970s, the general population applies thick layers of sunscreen and we rarely remove enough clothing to bare our skin for this natural process to occur.  This long-term lack of sunshine on our skin is producing entire generations of significantly deficient people in our society.

What happens when we are low in vitamin D? How does a vitamin D deficiency affect people’s health? Because vitamin D is vital to numerous human processes, it can be quite complex to discuss its actions, roles, and benefits to our bodies.  We will attempt to explain vitamin D as simply as possible, describing the intricacies and complex utilization of vitamin D.

 vit d image

The oldest known function of vitamin D is the role in bone growth and development; we’ve all seen photos of young children with rickets (legs bowing outward) because of a severe deficiency of vitamin D. Without adequate D in the bloodstream, bones cannot grow or develop properly.  For years, calcium was reported to be the “hero” of the skeleton.  People with weakening bones were urged to take high doses of calcium daily “to protect your bones” and prevent osteoporosis.  However, in recent years, that advice has been scaled back a bit; no longer is it general health advice to recommend calcium supplementation unless there is known osteoporosis or osteopenia.  Even where there is evidence, many providers won’t recommend it lightly; they take great care in explaining the risks/benefits and often encourage vitamin D in place of or at least along with the calcium.  So, just what does the vitamin D do for bones?  It’s most recognized benefit is that it aids absorption of calcium from the intestines; it’s the reason vitamin d is added to milk and other dairy products.  Milk/dairy products do NOT naturally contain vitamin D; it is added to promote calcium absorption into the bones for effective use in growth & development. Vitamin D helps keep bones strong and also helps prevent weak, brittle bones in the elderly.

In addition to bone health, vitamin D is recognized for its effects in the brain; it has been called “the depression vitamin” among health care professionals for many years because it is a vital component of neurotransmitters in the brain. Three major neurotransmitters in the brain requiring adequate amounts of vitamin D include serotonin, oxytocin, and vasopressin; serotonin is a neurotransmitter vital for transmitting nerve impulses. Serotonin is also important for mood regulation; pain perception; gastrointestinal function, including perception of hunger and satiety; and other physical functions. Oxytocin is released from the brain when it is needed for a variety of body needs, including labor & delivery at the end of pregnancy, during sexual arousal, and it is often referred to as “the love hormone” because of its impact on emotional relationships. Vasopressin is an anti-diuretic hormone that regulates fluid balance within the body and bloodstream. It works to prevent excess fluid loss and helps maintain homeostasis (normal internal chemistry) by maintaining the concentration of dissolved particles, such as salts and glucose, in the blood. Reviewing all 3 of these neurotransmitters and their major functions is vital to understand brain chemistry; can you see how a shortage of vitamin D would impact nearly all normal body functions and even our relationships, moods, and emotions?

Vitamin D’s impact on glucose has only recently been identified; multiple studies show conflicting data as this area is new to research. However, knowing that vitamin D is an essential ingredient of vasopressin, and that vasopressin helps maintain healthy glucose concentrations, does it not then make perfectly logical sense that a shortage of vitamin D will result indirectly or directly in elevated glucose levels?

In addition, a recent study shows that fasting glucose levels, insulin levels and insulin resistance all improved with vitamin D supplementation. Additionally, this study suggests that pro-inflammatory cytokines that are thought to contribute to insulin resistance were down-regulated with this vitamin D supplementation. Translation: with high carb/high sugar intakes, we are finding significantly elevated levels of inflammatory markers, like cytokines, that are more linked to heart disease, heart attacks and strokes than we ever imagined. Vitamin D supplementation appears to reduce that inflammation as part of the body’s normal healing/tissue repair processes.

However, let’s review again: former advice to take calcium for bone health came with advice to also take vitamin D to aid absorption of the calcium. Just as calcium needs vitamin D for absorption & effective utilization, so vitamin D needs some help. Magnesium and vitamin K2 are necessary for the absorption and use of vitamin D. Recent studies have shown even the very high doses of vitamin D prescribed by health care providers (50,000 IUs) as a weekly regimen barely raised vitamin D levels at all after 4-6 weeks, the usual recommended time frame for dosing. Once study participants added a magnesium and/or vitamin K supplement to their regular dosing regimen, vitamin D levels immediately began to rise. These studies are why we typically recommend vitamin D, magnesium, and vitamin K2 to most people with insulin resistance and type 2 diabetes.

Recently some reports are suggesting that vitamin D is integral to our immune system; some experts and studies are recommending to add or increase vitamin D supplementation during a variety of illnesses, including colds, flu, respiratory illness, asthma, and more.

What about doses of these supplements? There are limited studies and recommendations because this field is so new and mainstream medical providers are hesitant to make recommendations to patients without a large body of support. The Endocrine Society has stated that a deficiency of vitamin D exists when lab levels fall below 20 ng/mL; however, many reputable experts and organizations say that level should be 40 or even 50 ng/mL. Because of limited evidence, it’s difficult to specify a particular dose. Even more recently, various mainstream medical organizations like the Endocrine Society have stated that health care providers should not draw a vitamin D level on patients anymore, because we’re all deficient anyway, & the test is very expensive; most insurances won’t cover the costs either. So how are we supposed to know what dose to take? Well, the current recommendations for dosing are not clear and without a known vitamin D level, finding your perfect dose may be tricky, but many people find that 1,000 – 2,000 IUs daily is a good maintenance dose; some people just beginning to supplement find that taking 5,000 IUs daily for a few weeks is very helpful at reducing many vague symptoms that they often never connected to poor nutritional status. You can ask for the blood test to be done; you should also ask for the pricing of the test prior to having it drawn so you’re aware of the likely expense. Manufacturers of supplements are meeting the market demand by producing combinations of D, magnesium, vitamin K, and/or iodine for patient convenience.

One warning of NOTE: vitamin K1 is vitally important in blood clotting; if you are taking a blood thinner or have been told you SHOULD take a blood thinner, including aspirin, you should discuss adding this supplement with your provider BEFORE taking it. While vital for normal body processes, vitamin K can contribute to increased clotting within blood vessels; clots are known contributors to heart attacks and strokes.  

In conclusion, the general consensus on Vitamin D includes:

  1. Each increase of 4 ng/mL of vitamin D in the blood is associated with a 4% lower risk of type 2 diabetes.
  2. There is a significant and inverse relationship between blood levels of vitamin D and the risk of type 2 diabetes among a wide range of vitamin D levels and among a wide variety of populations, so that it is difficult to specify “normal” lab reference values and recommended daily dosing. Translation: The lower your vitamin D level is, the higher the risk of development of type 2 diabetes.

For further information about Vitamin D, it is recommended to ask your regular health care provider.

Here’s a link to a great study to reinforce our viewpoint: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541280/