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Berberine – Worth It or Mythical Unicorn?

berberine plant

Metformin has been the first-line treatment drug for many years for people with a Type 2 Diabetes (DM2) diagnosis; over recent years, it is becoming common to use it “off-label” for a variety of metabolic syndrome symptoms as well, including weight loss, polycystic ovary syndrome(PCOS), and insulin resistance (IR) as calculated by the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) method. However, studies continue to show that significant  numbers of people report side effects that prevent its use; various studies show that as many as 53% of people who start taking metformin report significant diarrhea and about 10% report abdominal cramping; and so these people often stop the medication.

While there are methods that can help patients overcome these side effects, there are multiple factors that contribute to continued avoidance of metformin.  I have had patients report that health care providers never taught them how to slowly and gradually increase the dose or even tell them to simply take metformin in-between bites of food at mealtime.  These simple strategies can improve compliance in some people, but convincing them to try these methods AFTER suffering embarrassing GI effects can be quite difficult.

So, is there anything else that can be recommended? As an advocate of low carb nutrition, I find that many people want to avoid medications, but will take herbs, supplements, and vitamins if provided with adequate information.  For years, I have taught my clients to use specific supplements for optimal nutrition, but to avoid any that seem to be “miracle cures” or “magic pills.”  Media hype always seeks to offer “snake oil” remedies for “anything that ails ya.” Until recently, I believed and taught my patients that berberine was one of these such remedies.  A couple of months ago, I was reading something authored by Dr.  Jeffry Gerber who mentioned berberine, so I began to study and research.  Studies I found astonished me; so I studied even more.  I sought advice from a couple of well-educated professionals who read and studied a couple of links to research articles I had found.   They came to similar conclusions as I did.  To be honest, we were all pretty amazed to find the use of berberine actually seems to be of more clinical benefit than metformin without the troublesome gastrointestinal side effects.  Here is detailed information about what we found.

Used as far back as 3000BC, berberine has been used by Ayurvedic  and Chinese  practitioners for diarrhea and dysentery with good results; obtained from the berberis vulgaris plant, berberine may have beneficial effects on a myriad of conditions in addition to diabetes.  It appears to show improvements in cholesterol levels, hepatitis infections, stomatitis, obesity, cardiovascular disease, cancer, and inflammation.

In a 2008 study published in the Journal, Metabolism, Yin et al published a pilot study with 36 participants and concluded that further testing should be done, but that berberine is a cost-effective and beneficial treatment for diabetes, and it also demonstrated a modest anti-cholesterol effect. More studies have been done, and in February 2018, Wang et al reviewed a large number of studies presenting evidence of recent progress in understanding the actions of metformin and berberine as compared to one another; this study was published in Oncotarget.

Most studies using berberine have used a daily dosing protocol of 500 mg three times daily and reduced doses when participants developed GI side effects.  While berberine and metformin do seem to act in similar pathways, berberine seems to have a much lower impact on the intestinal tract, compared to metformin.  While metformin seems to have a 50% or higher rate of GI side effects, berberine appears to have about a 10% rate of diarrhea and/or abdominal cramping.  With such a dramatic difference in GI symptoms, it may be very beneficial for many patients with diabetes and/or insulin resistance to ask health care professionals about a trial of berberine.

As you can see in the chart below, Yin et al showed that participants in the 2008 study had A1c levels drop from 9.47 to 7.48, over the 13 week study.  Fasting blood sugars dropped from 190 mg/dL (10.6 mmol/L) to 122mg/dL (6.8 mmol/L), and post-prandial glucose levels dropped by nearly half.   Other numbers, including all cholesterol numbers also dropped; HDL showed almost no change at all.  In addition, liver and kidney function tests showed no adverse effects from the berberine; in fact, liver enzymes showed a modest decrease, even in normal, healthy livers.

Comparison of Metformin and Berberine

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2410097/

So, before all of you rush out and start buying up all the berberine, there are a few facts you should know.  Because berberine and metformin seem to work in the same pathways, it is NOT advisable to take both metformin and berberine, or risks of adverse events will likely escalate.  If you are taking metformin and wish to switch to berberine, you should have this discussion with your prescriber who will likely brush off the whole idea.  But it is still ESSENTIAL to discuss this change with the health care professional responsible for your care.  It is recommended to have cholesterol, A1c, and a complete metabolic panel (CMP) tested prior to beginning berberine – similar to testing prior to beginning metformin.

One of the major side effects of metformin is lactic acidosis; theoretically, it’s possible that berberine can also cause lactic acidosis, but I haven’t found evidence of it yet.  Lactic acidosis can be a serious and even fatal form of acidosis that occurs as a result of underlying conditions most of the time; it’s mild form is most commonly associated with exercise or running for a long time.  Lactic acidosis can occur from exercise in even the healthiest of people, but typically resolves within a few minutes of hard breathing and rest. When a medication is the cause of lactic acidosis, however, it cannot resolve within a few minutes because the medication will remain in the bloodstream for hours and even days sometimes. This type of acidosis can become quite severe in a short amount of time. If you ADD berberine to metformin, it’s highly possible that the combination could result in life-threatening lactic acidosis.

As for drug-herb interactions, be aware that berberine may interact with other diabetes medications, much in the same way as metformin; alone, metformin does not directly lower glucose, but when it is ADDED to other medicines like insulin or glimepiride (or many others), the blood sugar level CAN drop significantly because of the synergistic effects of the 2 medications working together.

Additionally, berberine may interact with multiple other drugs that are metabolized through certain pathways in the liver; drugs like cyclosporine, statins, beta-blockers, sulfonylureas, nitrates, and many others are primarily metabolized in the liver and thus can be significantly INCREASED when other medications are also working through those same pathways.  Increasing the amount of available active ingredient of certain medications can be very dangerous, and so berberine should be avoided when taking these kinds of medications.

What do you think about berberine?  Do you think it may be of benefit to you? If so, and you’ve discussed it with your prescriber, treat it the same as you would any other medication; take it regularly and consistently.  Set specific times to take all medicines, including berberine.  Take berberinewith a meal, not before or more than 10 minutes afterwards; optimal dosing of mealtime medicines is between bites of food to minimize gastrointestinal upset.  Do NOT take berberine while taking metformin – not on the same day or even during the same week.  If taking any other medication for diabetes, check with your health care professional about adding berberine; you may have to provide one or both of the reference links below.  Dosing for general use is typically 500 mg 2 or 3 times a day.  Check glucose regularly, especially upon beginning dosing so you can see exactly how much the berberine impacts your glucose.  How much will berberine impact your glucose?

In the 2008 study published in Metabolism, fasting glucose dropped about 68 mg/dL in the berberine users, while fasting glucose dropped about 53 points in metformin users; berberine dropped fasting glucose 15 points more than metformin did.  Berberine lowered post-prandial (after eating) glucose levels by 153 points, compared to metformin, which dropped post-prandial glucose levels by about 140 mg/dL.  As you can see, berberineappears to be just as effective, if not more so, than metformin, at lowering blood sugar.  When combined with low carb eating, you can see that berberine may be a very effective tool in lowering blood sugar levels, but take notice that berberine was not effective at bringing glucose levels into normal range when glucose levels were dangerously elevated.

Although the levels dropped significantly, it is not clear at just how easily berberinewould be able to “normalize” glucose levels, when blood sugars are running over 250 or so.

For people with mildly elevated glucose levels, or A1c levels less than 8.5%, berberine may be quite beneficial as a single agent.  But for those people with A1c levels higher than 8.5%, berberine is likely NOT going to normalize glucose levels, enough to significantly reduce complications of DM2, including organ damage. However, these lower glucose levels may significantly impact those people with DM2 who are trying to avoid prescription medication, but for whom low carb eating doesn’t lower glucose adequately alone.  For those people with an A1c around 7.5% or less, it appears that berberine may have the best results, lowering glucose and A1c levels into more normal range, around or less than 5.5%, where risks of complications of DM2 are eliminated.  For people whose A1c falls between 7.5 and 8.5%, berberine may be effective, but it may require a longer period of time to see the normalization of glucose and A1c levels. There isn’t enough long-term data out that can help us understand this impact yet.

chart metabolism of metformin

As for my N=1 experiment, I began taking berberine around June 15, 2018, when my FBS had increased to 98-110, up significantly from about a year ago, without any “carb creep” or change in diet.  While I’m not a faithful glucose tester, I have tested several times during this experiment and have found that my glucose levels have dropped back into the 80s, consistently, after about 6 weeks of twice daily berberine 500 mg.  For me, that’s a WIN!

 

References

Retrieved August 1, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2410097/

Retrieved August 1, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839379/

Retrieved August 13, 2018, from https://www.sciencedirect.com/science/article/pii/S037887411400871X

Retrieved August 13, 2018, from https://www.spandidos-publications.com/ol/15/5/7409?text=fulltext

Retrieved August 13, 2018, from https://www.sciencedirect.com/science/article/pii/S0014299915300571

 

 

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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.”

—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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Measures of “Improving Health”

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


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

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

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

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Tips & Tricks to Master LCHF 

Sometimes life impacts our food choices and our intake of processed foods increases, although they may be higher in fat or lower carb. Many times, I get messages, asking for our “approval” to consume off-plan foods like keto breads and ice creams. While some of these foods’ ingredients may be included on the LCHF food list, I strongly encourage people to consume the majority of your intake from real foods. Real meats. Real vegetables. Real fats. Eating from a bag, box or can/jar provides very few essential vitamins and minerals because many manufacturing methods contribute to decreased nutrients. Vegetables contain a lot of micronutrients and phytonutrients our bodies use daily; some have to be replaced regularly. Going days or weeks without any vegetables at all can contribute to a variety of vague symptoms, including increased fatigue, headache, & nausea. There are no magic vitamins in a bottle that can replace your veggies. Meats are strongly encouraged on LCHF as they also contain many essential nutrients, especially red meat – beef, venison, & other wild game. Red meat is about the only source of high quantities of b12 & iron – both of which are essential to our health. Chicken, turkey & pork contain only minuscule amounts of iron,if any at all. Iron is what gives meat its red color, thus the need for red meat. (Yes, vegetarians can eat LCHF, but must pay very special attention to the iron and b12 sources or risk poor health.)

Do not fear red meat. Red meat has been falsely accused of causing health hazards. People survived eating red meat and its fat for centuries before the industrial revolution came along and packaged all our food. Manufacturing processes, including planting, harvesting, & packaging always decrease nutrient density – meaning everything that comes from a company and packaged, contains very little nutrition. Choose real bacon over turkey bacon. Choose 30% fat in burger meat. Choose real butter over margarine. Choose preservative-free foods when possible.

Questions about bacon always surface… LOL Bacon IS best with fewest additives, or if you can find pork belly or side meat, it usually doesn’t have added sugars or preservatives; even so, most bacon is still way better for us than most anything in a bag or box.

Baaaaacon!

Reading nutrition labels and ingredient lists is required reading for truly gaining control over health. Just because a nutrition label says 1.5 grams of carbs per serving doesn’t always mean it’s good for you. Look at ingredients –

Watch for hidden grains, sugars, and dextrin components. There are over

60 different terms that companies use to disguise sugar. Become aware of how companies sneak sugars and sweeteners into their packages. If the 1.5 grams of carbs come from wheat, and you’re sensitive to it, those carbs might send your glucose jumping! And then you’ll battle that glucose spike for hours or even days. Also, remember to check serving size. An example is a 20 ounce soda which is typically 2.5 servings; nutrient info then is NOT for the entire bottle.

Choose water over soda, sparkling drinks, and commercially prepared flavored waters – most of these items contain added sweeteners of one sort or the other and will almost always impact glucose level. Avoid ALL foods labeled as sugar-free and read labels extremely carefully. If it’s sugar free, the company has added SOMETHING to it to make it palatable and desirable. Manufacturers are catering to our “sweet tooth” by making foods sweeter and sweeter; heck, they are even modifying our fruit for maximal sweetness!!
Speaking of fruits… avoid them! In low carb nutrition, we recognize the horrible impact of fruits on our glucose levels. But most people who’ve followed the ADA way for many years are totally unaware that fruit has such an impact. They still believe fruits are good for us, but they aren’t. Only occasional berries – AFTER glucose normalization occurs – are allowed on our LCHF way of eating. If in doubt, perform your own experiment. Test before and after. For experts and such highly educated people to proclaim that fruits and grains are good for us over the past 50 years, is beyond my comprehension. They claim their diet is based on scientific data – tests – measurable numbers. But they’ve never run REAL tests! Their diet is based solely on hypothesis and conjecture. Our way of eating is based on 70+ scientific studies AND thousands of people who live LCHF every day.
Read vitamin & supplement labels! Many contain cellulose, maltodextrin, corn syrup solids, and wheat as binders and fillers; these items will cause elevated glucose levels. Be very wary of any vitamin drink, protein shake, or miracle concoction that promises symptom relief or improved health. Most of these mixes are completely filled with difficult-to-pronounce chemicals, not foods. Even the “all-natural” ones are loaded with sugars. (Just a side note: cyanide & arsenic are natural.) Our bodies were meant to eat/chew food, not obtain empty calories from chemical concoctions. It’s important for the brain to perceive intake, and part of that process includes chewing. Drinking calories totally bypasses that signal to the brain, and so the body can still feel hungry and not satiated, even with hundreds of calories consumed.


Hopefully, these tips will help y’all get a better grasp of how I eat and teach people to eat and how so many people are able to drastically reduce glucose levels and lose weight. If you are at a stall — your glucose just won’t fall any more, or your weight just isn’t budging — it may be time for re-evaluation of your intake; take a real look at the packaging you’re eating from. Look at all labels. Look at all ingredients. Look at serving sizes. Eat fresh or frozen veggies – without added sauces and such. Canned veggies can be ok – but always check labels.
Record all intake and verify nutrient info in your app with google or label on package. The more accurate your info, the healthier your intake will be. Many apps are “editable” by users – meaning you could enter data that says your avocados only have 1 gram of carbs per avocado – very untrue. But if that’s what you select in your app, your numbers will not be accurate and it will show in your glucose level — but you will be posting about how frustrating it is to eat from the list but still have high glucose.
If you’ve reached a stall, you should also re-evaluate your macros – the fats, proteins, & carbs – you’re consuming. There are many methods of identifying ideal weight, but this is the one I use. For the first 5 feet, one is allowed 100 pounds. For females, we’re allowed 5 pounds for every inch over 5′. Males are allowed 6 pounds for every inch over 5′. Divide your ideal weight by 2.2 and this will give you an approx protein need for you at your ideal weight. This is the number of grams of protein you’ll need in one day, and should be approx 15-25% of calories you consume daily. Divide this number of grams by the number of meals you typically have daily and then you’ll know how many grams of protein you’ll need in one meal; also remember that on average, there are approx 7 grams of protein in 1 ounce of meat. For instance, a 4 ounce filet would contain approx 28 grams of protein for one meal of your day.

To determine your fat needs, double the number of protein grams per day. For example, if your protein needs are 56 grams per day, you should need approx 112 grams of fat in your meals daily, preferably evenly divided over all meals.


For a female who is approximately 5′ 5″ tall, her protein needs would be approx 57 grams per day, and fat needs would be approx 114 grams per day. 20 grams of carbs would be the maximum allowed. Now, to calculate how much of this is CALORIC intake percentage, we have to convert grams into calories. Carbs provide 4 calories per gram, so for our female client here, that would be 20 x 4 = 80 calories. Protein also provides 4 calories per gram, so this lady would consume 57 x 4 = 228 calories of protein daily. Fats provide 9 calories per gram; 114 x 9= 1,026. Total these: 80 + 228 + 1026 = 1334 calories per day. Then, figure percent of caloric intake: 80/1334 = 6% of intake comes from carbohydrates. 228/1334= 17% of calorie intake is from protein. 1026/1334 = 77% of calories will come from fat. To calculate YOUR needs, follow this example carefully, & you will figure your grams and percentage of calories quite easily.
If you use current weight or too high of an ideal weight to determine your macro needs, you’re likely to reach stalls and plateaus, becoming frustrated. If you’re very active, your protein needs will be a bit higher; if you’re pretty sedentary, your protein needs will be a bit less.
I realize I’ve rambled on far too long, now. Sorry about that. I just wanted to share some of these tips because I see many of you struggling with these concepts and questions.

diabetes, diet, gluten-free, Grain free, Guidelines, hormone, immune system, insulin, insulin resistant, keto, ketogenic, lifestyle, low carb, NAFLD, nurse, nurse practitioner, paleo, PCOS, Recipes, steroid, supplement, vitamin, vitamin D

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/