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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.

Bell-Curve
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.

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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 UNNCESSARY.  See my previous blog article, “Do the Math” for more details on macro calculations.

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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.

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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. 

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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.”

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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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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One Person at a Time – We CAN Change the World

 

It is truly a shame that mainstream medical providers, highly trained and well-educated professionals, continue to encourage hundreds of grams of carbohydrate intake on a daily basis when simple logic shows that the approach is not helping to reduce elevated glucose, decrease weight, lower blood pressure, or improve health in any form at all. For many years, now, the nutritional guidelines have encouraged an intake of 200+ grams of carbohydrates daily, even though our bloodstream only requires 4 grams.  For a person with diabetes and insulin resistance, this advice is detrimental to health.  This recommendation contributes to significant over-eating, poor nutrient intake, and terrible internal chemical imbalance – all of which contribute to chronic metabolic conditions.

This advice does NOT differ for Type 1 diabetics, Type 2 diabetics, or for anyone with insulin resistance. Type 1 patients require insulin administration daily so they can metabolize & properly manage the carb & protein intake.  Type 2 patients often end up using insulin injections because the tablets and diet do not provide enough assistance internally to lower glucose and organ damage.  Patients with insulin resistance often require hundreds of units of insulin a day just to keep glucose levels less than 200.  (Less than 100 is NORMAL.)

Anyone with an over-the-counter glucometer can determine this simple and logical conclusion quite easily. Test glucose prior to eating; test again about 2 hours after eating.  If glucose level changes more than 10 numbers, there are likely many carbohydrates in that meal.  So, next meal, test again, leaving out those particular carbohydrates.  Determine for yourself just how to eat with minimal impact on glucose level.

Even a non-scientist understands the simple anatomy and physiological response within our bodies.

“The problem is that carbohydrates break down into glucose, which causes the body to release insulin—a hormone that is fantastically efficient at storing fat. Meanwhile, fructose, the main sugar in fruit, causes the liver to generate triglycerides and other lipids in the blood that are altogether bad news. Excessive carbohydrates lead not only to obesity but also, over time, to Type 2 diabetes and, very likely, heart disease.” – Excerpt from The Wall Street Journal, https://www.wsj.com/articles/the-questionable-link-between-saturated-fat-and-heart-disease-1399070926, retrieved 2/21/2018.

Why is testing like this necessary? Testing glucose is necessary to gain control of your own illness and health. Medical providers are trained to prescribe medications that are produced and sold to provide a source of steady income to drug companies.  Medical providers need a steady and full schedule of patients in order to provide a steady income for their staffs and themselves.  Medical providers have NO coursework in nutrition, except for a freshman or sophomore course as a pre-requisite to professional medical, nursing, or nutrition school.  There is NO training whatsoever for medical providers to learn how to incorporate nutrition as a part of therapeutic treatment for chronic metabolic conditions.  They never hear the word ketogenic nutrition; they have no idea what normal and natural ketosis is.

That said, mainstream providers do the best they can with info and training they’ve been provided; none of them actually WANT us sick or on meds. It is simply all they know.  Medical providers have guidelines and “standards of care” to which we’re held responsible.  These guidelines encourage us to prescribe certain medications as diabetes is diagnosed and then progresses. We are to obtain certain lab testing at specified intervals.  We are trained to tell patients that an A1c of 7 or less is “NORMAL for a diabetic.”  We are trained to use these guidelines as our “logic” and reasoning, even though very little of the guidelines has any actual research supporting the use; most of the research quoted has been debunked many times over the past 5-8 years by independent experts without financial interest in the outcomes.

Why do our trusted and trained medical providers offer such flawed advice? It goes back 50-70 years.  It started in the 1950s when President Eisenhower suffered a heart attack while in office.  Some strong personalities were already studying and researching diet and the impacts of diet on health.  Ancel Keys is credited with starting this avalanche of low fat diet advice, but others quickly hopped on his bandwagon.  The often-quoted and cited Framingham Study also released only part of the data collected and was used as “evidence” that saturated fats caused high cholesterol which caused deadly heart disease. However, Dr. William Castelli, a former director of the Framingham Heart study, stated in a 1992 editorial published in the Archives of Internal Medicine:

In Framingham, Mass., the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person’s serum cholesterol. The opposite of what… Keys et al would predict…We found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories, weighed the least and were the most physically active.”

This major piece of data was NOT released as part of the study; it only came out later as part of the editorial by the former director of the study. By 1980, so much money and time had been invested in low-fat dietary research, it seemed no one could stop it. Thus, the “Standard Dietary Guidelines for Americans” was published. Later, the American Heart Association also joined in the support of these guidelines; the American Diabetes Association also began to support these guidelines.  No science.  No independent research data. Thus, we the people were “fleeced” and fell right in line with this dietary advice.  We began cutting fats and one of the first fats to go was milkfat, and then animal fats.

milkfat pic          animal fat pic

However, look at what happened to the weight of Americans.

 

Multiple resources offer similar trends in weight; notice the trend of weight gain began during the 1970s and 80s, when low-fat dietary advice was pushed forward as “healthy.”

disease trends

Using some simple common sense and logic, we can review history and data and draw some logical conclusions based on these numbers. As fat intake declined, obesity and heart disease rates increased.  What replaced the fat?

carb intake

474 grams of carbohydrates will be converted into 118 TEASPOONS of glucose – that’s 2.5 CUPS of sugar. Just what do medical experts EXPECT our bodies to do with this much glucose?

Even at the lowest ADA recommended intake of 165 grams of carbs per day, those carbs convert into nearly 7 ounces of glucose – almost 1 whole cup of glucose.

Think about our most vulnerable of our population: our children. Then, narrow down that population to Type 1 children. Current recommendations for managing this illness is to eat high amounts of carbohydrates and to administer higher and higher amounts of insulin to lower the glucose load.  How does this advice even seem normal, now that we’ve seen the data? Do their brains develop normally with such significantly elevated glucose levels? Some experts are calling Alzheimer disease Type 3 diabetes because we now recognize the brain damage done by high glucose and high insulin levels – yet, it’s the “standard” treatment for our most vulnerable population?  Why would we actually WANT our children to consume hundreds of grams of carbohydrates daily, just to be able to dose higher amounts of insulin? Why should we continue to advise high carb intake when it has now been linked to higher rates of non-alcoholic fatty liver disease, infertility, and even cancer – even in our children? I fail to see the logic.  Our children deserve better.  Our children deserve NORMAL glucose levels.  They should not be at risk for developing “double diabetes,” because we continue to encourage high carb intake and high insulin use, forcing their bodies to become insulin resistant over time.  These children are one of our most valuable resources; why can’t we provide better advice and care?

One person at a time. One medical provider at a time.  One conversation at a time, we are taking charge of our own health.  We are doing the “research” by checking our own glucose.  We track our intake.  We, at the grassroots level, are doing research that government and agencies and companies should have done half a century ago.  We are cutting out the highly inflammatory grains.  We are cutting out sugar.  We are eliminating the cause of our metabolic disease, and our health improves because we are PRO-active instead of reactive.  We are using food as our medicine…. Isn’t that what Hippocrates said?  “Let food be thy medicine and medicine be thy food.”  And our medical physicians take the Hippocratic oath, which includes the phrase, “do no harm.”  I think it’s time we hold our providers accountable for their advice.  What do YOU think?

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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/

biscuit, breakfast, diet, gravy, insulin resistant, keto, ketogenic, NAFLD, paleo, Recipes

KetoNurses’ Biscuits & Gravy

Biscuits & Gravy with Chopped Steak
Biscuits & Gravy with Chopped Steak

Biscuits:

1/3 cup almond flour

¾ cup grated mozzarella cheese

1 Tbsp coconut flour

½ tsp baking powder

½ tsp xanthan gum

1 egg

2 ½ Tbsp melted butter

Pre-heat oven to 350.

Mix all ingredients together in small bowl. I use a fork for easy mixing.

Shape into 4 evenly-sized balls and place on parchment-lined baking pan.

Bake for 10-12 minutes.  Watch bottoms carefully – the bottoms will brown much faster than tops; tops will NOT brown much at all & will still be done.

 Gravy:

¼ – ½ pound sugar-free sausage (or leftover steak, chicken, or chops from a recent supper – my fave)

2 Tbsp. grass-fed butter (optional)

½ cup heavy cream

Black pepper to taste

While biscuits bake:

Brown ¼ – ½ pound of sugar-free sausage in skillet and remove from pan. Do NOT drain fats off.

If using leftover meat, you will need the butter for heating/browning it.

In same skillet as above, and after removing cooked meat, add 3 Tbsp grass-fed butter & allow to melt over low or medium-low heat. Butter should NOT sizzle, but just melt.

Pour ½ cup heavy cream into melted butter; using whisk, stir pretty constantly.  Add pepper to taste.  Simmer and stir for about 3-5 minutes, until cream just begins to thicken.

Add the previously cooked/heated meat and stir in.

Serve over open baked biscuits.

Cholesterol, diet, Fat, Grain free, Guidelines, insulin, insulin resistant, keto, ketogenic, lifestyle, low carb, macros, nurse, nurse practitioner, paleo

Our Beginnings…

Jenni Gallagher
Jenni Gallagher

About 5 years ago, I attended a workshop led by a doctor of osteopathy, or DO, who had been in family practice for years.  Over the years, his practice became mostly one dealing with very high risk patients, like those with heart attacks, strokes, obesity, poorly controlled diabetes, and hypertension.  During his presentation, he relayed a story about a phone call from that state’s largest insurer who was frustrated that he was ordering some of the most expensive diagnostic tests on every single patient in his practice, but amazed that none of his patients EVER had to be admitted for interventional procedures, like balloons or stints, or for diagnoses like heart attacks or strokes.  THOSE statistics completely blew me away, and I immediately began cutting back on some processed foods.  He’d described the diet information that he used to help patients improve their health, and I began to make some of those same changes.

I developed a “diet sheet” that I started using with my patients, and started helping them reduce some processed foods, breads, cereals, and sodas.  Over several months, many of these patients improved many markers of health, including their hemoglobin A1c, which is an index that we can use to determine the average blood glucose over the previous 90 days.

A normal A1c is less than 5 or 5.5, depending on which expert author you are reading today; an A1c of 5 tells us that the average blood glucose level over the previous 90 days is about 97.  That level is good because it means that high readings of glucose are not likely, and the pancreas is able to pump out plenty of insulin to help manage the glucose consumed in the daily diet.

When diabetes was first recognized, some researchers found that ants were attracted to the urine and feces of people stricken with this illness.  Therefore, it became known as an illness of urination and termed diabetes, which means siphon.  Later, the word mellitus was added as it means honey; diabetes mellitus was recognized to be an illness of diet and many strange attempts were made at treatment, including the “oat diet”, “potato therapy”, and a “starvation diet”.

In the 1920s, a Canadian physician began treating diabetes with a variety of medications and finally was successful with insulin; he was awarded the Nobel Prize in Medicine in 1922.  While they still had no idea about the actual pathways of illness that caused diabetes, pieces of the puzzle were coming together.  Over the past 100 years, diabetes has been one of the most common ailments studied; billions of health care research dollars have been used seeking causes, treatments, and medications to control it.

With all of the early evidence that there were problems with sugars – I mean, even ants were attracted to the waste products of humans afflicted with diabetes – it should have been an easy connection to a low intake of sugar in order to treat or manage the condition. To date, however, all of the dietary advice since the 1950s has used a low fat diet to treat diabetes.

However, over the past 10 years or so, many diabetes experts have begun to question the status quo; physicians, nurse practitioners, and nutritionists have begun using low carbohydrate diet plans to reduce blood glucose levels.  Dr. Eric Westman, at Duke University has been one of the most outspoken advocates of low carb eating.  Although he has published many research articles that support his dietary concepts, this method of eating has yet to be accepted by mainstream medicine.  Many others have produced YouTube Videos, blog articles, and even peer-reviewed professional journal articles, albeit small and less recognized arenas.

Part of the reason for the little fame for the low carb diet goes all the way back to the 1950s when the strong and overreaching personality of Ancel Keys forced opposing viewpoints to the low fat mantra back into the shadows.  He didn’t want any loud opposition to low fat guidelines, and during his next 30 years, he contributed to the loss of jobs of many researchers and experts; he also saw to it that some of his opponents lost research grant money, thus ending their careers.  That mentality continues today, mostly because all of healthcare agencies and the organizations that set our guidelines are all friends, colleagues, and co-researchers who are dependent on the government and organizations who provide funding for the research.  Yes, I know it sounds like a giant conspiracy theory, and in a way,  it is.  However, I truly don’t believe it started out this way.  I like to think that original founders and researchers had America’s best interests at heart.  It was only when government and big pharmaceutical companies went to bed with the food industry that untoward consequences made their way into the lives of regular Americans as disease, obesity, and poor health.

When Ancel Keys was offered a position on an early national nutrition committee, no one could have ever imagined the horrible effects that were to occur over the next 30 years.  While he really wanted to identify a major cause of heart disease, his research methods have since been called into question.  Much of his work has been called fraudulent and unethical, as research findings were released only in support of his opinion.  During recent years and with the advent of the internet and spread of information, more opposition has built against Ancel Keys’ work and a grass-roots effort to change the Standard American Diet (SAD) are occurring in towns and cities all across America.  Even the American Diabetic Association (ADA) recently came out in support of using a low carbohydrate diet as part of the management of diabetes.  Although the ADA hasn’t provided any guidance as to what constitutes a low carb diet, many patients and health care providers are figuring it out on their own.

Blogs, books, infomercials and YouTube videos touting the benefits and “rules” of low carb eating are springing up everywhere; Paleo, Ketogenics, Whole 30, and many other variations of low carb are quite popular on Facebook, Twitter, and other social media.  Patients around the world are taking control of their diabetes and their own health like never before in our nation’s history.

I believe it is time for health care professionals, especially NURSES, to take a stand and speak up for patients; as nurses, some of our most respected qualities are honesty and advocacy.  The goal of this blog is to provide open and honest information with the most current research on diet and nutrition to you, our families, friends, and most of all to our patients so that you can reverse illness, improve health, and enjoy a much longer and happier life.