To Hell and Back – recovering from hypothyroidism (a Dietitian’s Journey – Part II)

Last Monday, I went to the lab for updated blood work, including a thyroid hormone panel, additional thyroid antibody tests, and an iron panel. I have moved past the frustration of there being no pricelist available for consumers who are self-paying for lab tests, and am now focusing on the lab test results, and the dietary changes that I need to make in light of those, as I am recovering from hypothyroidism.

The results came back late Monday afternoon and I met with my doctor to discuss them on Thursday, The good news is that based on calculation estimates converting the bovine Natural Desiccated Thyroid (NDT) medication that I had been taking, to a mixture of Synthroid® (a synthetic T4 medication) and Cytomel® (a synthetic T3 medication), my free T4 and free T3 are almost perfect. As my doctor said when we met, “between your research and my experience, we got this“.

This is a beautiful picture.

TSH, fT4 and fT3 levels on T4/T3 thyroid hormone replacement medication

It shows, as my doctor and I had hoped, that my free T3 (the active thyroid hormone) is in the higher part of the reference range (65.5%); a level considered optimal by endocrinologists and thyroidologists who are well-versed in the use of the combination T4/T3 medications that I have been prescribed.

While my free T4 could be in the higher part of the range on the type of medication that I am taking, it may slightly lower because of the feedback from having sufficient free T3. That’s okay! I am feeling so much better, although it will take another year or more until I am really well again.

As expected, my TSH (Thyroid Stimulating Hormone, the pituitary hormone that tells the body how much thyroid hormone to make) is low because the amount of free T3 is optimal. This is a classic feedback loop where free T3 provides feedback on the pituitary gland, indicating that there isn’t a need to make more thyroid hormone. Think of it like a thermostat.  When the room gets warm enough, there is feedback on the thermostat that no additional heat is required, and it turns it off until the room gets cold again.

Of importance, my TSH is not considered “suppressed” (TSH ≤0.03 mU/L) but “low” (TSH = 0.04-0.4 mU/liter) [1], so there is no increased risk of cardiovascular disease or bone fractures. Those with a “high” TSH (>4.0 mU/liter) — which was the level that I was at before being treated, and those with a “suppressed” TSH (≤0.03 mU/L) both have an increased risk of cardiovascular disease, abnormal heart rhythms and bone fractures. Those with “low” TSH (0.04-0.4 mU/liter) like I have, do not [1,2]. So more good news.

I have been diagnosed with Hashimoto’s disease (also known as Hashimoto’s thyroiditis) which is an autoimmune disease and diagnosis is based both on symptoms of hypothyroidism, along with the presence of thyroperoxidase antibodies (TPO-ab) and thyroglobulin antibodies (TG-ab) in the blood [3].

In many cases of hypothyroidism, it is these antibodies that contribute to the gradual disappearance of thyroid cells and the development of hypothyroidism.  In my case, it was the trauma to the thyroid that resulted from surgery that I had 30 years ago to remove a benign tumour that was the major contributor to the eventual decrease in thyroid function.

Prior to being diagnosed, as you can read about here, I had all the classic symptoms of hypothyroidism, including body aches, joint pain, fatigue, feeling chilled, constipation, dry skin, hair loss, being forgetful, and even feeling depressed.

By the point I realized that these symptoms were not consistent with long-Covid (which is what I initially suspected) or aging (which my sons assumed), I had developed some of the symptoms of severe hypothyroidism [3], including difficulty with speech, significant water retention, and peripheral edema (swelling) of the ankles and face [3]. There are more photos of what I looked like when I was very sick here as well as photos from the beginning part of my recovery.


To hell and back – 5 months of recovery from hypothyroidism

The photo on the left, above is what I looked like on June 3, 2022, at my youngest son’s wedding.  I was so sick. I needed help walking on the beach for family photos, getting out of a chair or a car,  I ached all over my body and I was beyond exhausted.  I knew I was ill and had plans to see my doctor when he returned from vacation but in the meantime, I attended my son’s wedding, without talking about how I felt. No one really knew how sick I felt until afterwards and I didn’t know how seriously ill I really was until August.

The middle picture, above was taken on September 3, 2022 after losing half my hair as a result of several nutrient deficiencies related to hypothyroidism that I have been correcting through adding specific foods high in these nutrients into my diet, as well as highly bioavailable supplements.  At the time the middle picture was taken, I had been on Natural Desiccated Thyroid hormones (natural T4/T3 medication) for 6 weeks. While my doctor wanted me to continue on them because I was doing so much better, I wanted to go on synthetic T4 and T3 thyroid replacement hormones as it would be easier to travel across borders with these recognized medications.

The picture on the right, is me today.  I feel as though I have been to “hell and back“.  Last week, my doctor said that it will take another year until I feel really well again, and probably another 6 months on top of that until my hair grows back, but I am so thankful for the difference in how I feel the last 5 months. I get tired easily. Hiking is out, and so are evening activities, but as my nutrient status continues to improve and the thyroid hormones permeate all my body’s tissues, I will gradually feel better and better.


The blood tests confirm that I have both thyroperoxidase antibodies (TPO-Ab) and thyroglobulin antibodies (TG-Ab), which along with my symptoms, confirms my diagnosis of Hashimoto’s disease, but thankfully my blood test results indicate that neither are elevated.

Thyroperoxidase-Ab = 9 (<35 IU/mL)

Thyroglobulin Ab = 14 (<40 IU/mL)

While they are not elevated, they are present. 

Gliadin and Transglutaminase

For many years I avoided gluten containing products because I thought I was gluten intolerant, although not celiac.

A year ago that I stumbled across some novel ingredients and had an idea to create low carb breads to provide dietary options for those with diabetes. My goal was to enable people who would not otherwise consider a low carbohydrate diet to be able to adopt one, for health reasons.   I was mainly thinking of those from bread-centric cultures such as South East Asians (Indian) and Hispanics but in time, I developed many more types of low carb bread. 

I was aware of the connection between high gluten consumption and leaky gut syndrome, but against that I weighed the serious morbidity and mortality linked to uncontrolled diabetes. I had come across many people who would rather stay diabetic, and potentially lose their toes or vision than give up bread and developing these breads seemed like the lesser of two evils. 

Since being diagnosed with hypothyroidism that I had been developing over the previous 9 years (more about that here), I learned that the gliadin fraction of gluten structurally resembles transglutaminase. Transglutaminase is an enzyme that makes chemical bonds in the body, and while present in many organs, there are higher concentrations of transglutaminase in the thyroid.

In leaky gut syndrome, gliadin (and other  substances) result in the gaps in between the cells of the intestinal wall to widen. This results in the immune system of the body reacting to food particles that are inside the intestine, that it normally would not see. It is thought that the immune system reacts to gliadin and creates antibodies to it, seeing it as a foreign invader.  Since gliadin and transglutaminase have very similar structural properties, it is thought that in those with leaky gut syndrome, the immune system begins to attack the transglutaminase in the thyroid, and other tissues, contributing to the development of auto-immune conditions, including hypothyroidism

A-1 Beta Casein and Gluten

A few years ago, I had leaky gut syndrome but it resolved with dietary changes, including avoiding gluten and A-1 beta casein dairy (you can read about what A-1 beta casein dairy is here).  Naturally, as I had been working on recipe development for the low carb bread book, I had been eating gluten as I tested them. I also became more liberal in including dairy products from A1-beta casein cows, when I hadn’t used it in years. That started when there was severe flooding last year in Chilliwack last year due to heavy rains after the summer, and that was where my goat milk came from.  Even once the roads were open again and the highways rebuilt, I never really went back to using goat milk, which is naturally A-2 beta casein. In the interest of an abundance of caution, I will go back to using dairy products from A-2 beta casein cows, or from goat or sheep milk (that are naturally A-2). Humans produce A-2 beta casein protein, and using milk from A-2 beta casein animals does not result in an immune response. It is not seen as “foreign.”

From what I’ve read and in discussing it with my doctor, it is likely that my hypothyroidism has been developing over the last 30 years, related to the surgery I had to remove a benign tumour. Further supporting that me becoming hypothyroid has been a long time in the making, I have had high-normal levels of TSH over the last 9 years — which happens to be a time period over which I was avoiding both gluten and A-1 dairy. Given that, I think it’s logical to conclude that my hypothyroidism is primarily related to the destruction of thyroid tissue in the invasive surgery connected to removal of the tumour. Further supporting this hypothesis, I currently have fairly low levels of TPO and TG antibodies, so I suspect they have begun developing fairly recently. Since a 2018 study reported that  both TPO-antibodies and TG antibodies are decreased in hypothyroid patients following a gluten-free diet [4], it seems wise for me to go back to avoiding gluten, with the goal of lowering my TPO-antibodies and TG-antibodies down to as close to zero, as possible.

Cruciferous Vegetables

Cruciferous vegetables such as Brussels sprouts, broccoli, bok choy, cauliflower, cabbage, kale are known goitrogens. Goitrogens are naturally occurring substances that are thought to inhibit thyroid hormone production. The hydrolysis of a substance known as pro-goitrin that is found in cruciferous vegetables produces a substance known as goitrin, that is thought to interfere with thyroid hormone synthesis [5]. Since cooking cruciferous vegetables limits the effect on the thyroid function, and eating cruciferous vegetables have many health benefits, I will usually eat them cooked, but not in huge quantities. There are studies that found a worsening of hypothyroidism when people ate very large quantities of these (e.g. 1 – 1 ½ kg / day) so it is recommended that intake of these vegetables be kept relatively constant day to day, and limited to no more than 1-2 cup / day. I’ve decided that when I do eat them, to keep intake to the lower end of that range, and eat more non-cruciferous vegetables instead.

Iron Deficiency and Low Stomach Acid (hypochlorhydria)

I now know why I am still so tired. I asked my doctor to run an iron panel and the results show I have low iron. Previous results indicate my vitamin B12 are fine and I continue to supplement methylated folate and B12, so I know those are not a problem.

While my iron stores (ferritin) are okay, they are not optimal i.e., ferritin = 93 (15-247 ug/L) instead of >100ug/L.

My hematology panel is low-normal i.e. hemoglobin = 122 (115-155 g/L), hematocrit = 0.37* (0.35-0.45 L/L), MCV = 88 (82-98 fl), MCH = 29.5 (27.5-33.5 pg), MCHC = 334 (300-370 g/L)

My serum iron and iron saturation are very low i.e., serum iron = 11.9 (10.6-33.8 umol/L), iron saturation = 0.15 (0.13-0.50)

Low iron status is common with hypothyroidism, but it was surprising to me because I eat beef liver, or chicken livers every week, and also take a heme polysaccharide supplement (like Feramax®), so it may be due to an absorption problem.

Low stomach acid (hypochlorhydria) is common in hypothyroidism, and since low pH is needed for iron absorption, I have made dietary changes to improve that.

Final Thoughts…

I am very grateful that my doctor recognizes my knowledge as a clinician and is receptive to me advocating for my health. I am incredibly fortunate that he involves me in decisions regarding blood tests, as well as discussing medication types and dosages.  As for the dietary changes and supplementation, he is content to let me handle that!

I hope that out of my experience that I have called “to hell and back” that I am able to help others better understand hypothyroid symptoms, diagnosis and treatment options so that they can discuss them with their doctor.

To your good health,

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd

Articles about Hypothyroidism

References

  1. van Vliet NA, Noordam R, van Klinken JB, et al. Thyroid Stimulating Hormone and Bone Mineral Density: Evidence From a Two-Sample Mendelian Randomization Study and a Candidate Gene Association Study. J Bone Miner Res. 2018;33(7):1318-1325. doi:10.1002/jbmr.3426
  2. Flynn RW, Bonellie SR, Jung RT, MacDonald TM, Morris AD, Leese GP. Serum thyroid-stimulating hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term thyroxine therapy. J Clin Endocrinol Metab. 2010;95(1):186-193. doi:10.1210/jc.2009-1625
  3. Puszkarz, Irena, Guty, Edyta, Stefaniak, Iwona, & Bonarek, Aleksandra. (2018). Role of food and nutrition in pathogenesis and prevention of Hashimoto’s thyroiditis. https://doi.org/10.5281/zenodo.1320419
  4. Krysiak, R.; Szkróbka, W.; Okopień, B. The Effect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto’s Thyroiditis: A Pilot Study. Exp. Clin. Endocrinol. Diabetes 2018, 127, 417–422.
  5.  Felker P, Bunch R, Leung AM. Concentrations of thiocyanate and goitrin in human plasma, their precursor concentrations in brassica vegetables, and associated potential risk for hypothyroidism. Nutr Rev. 2016;74(4):248-258.

 

Copyright ©2022 The LCHF Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Blood Tests and Lab Frustrations – a Dietitian’s Journey Part II

NOTICE: This my personal experience as a private consumer of lab services, and is not related to my profession as a Dietitian. This article is posted in a separate section of the web page titled “A Dietitian’s Journey” which is about my personal health journeys.

“A Dietitian’s Journey – Part I” was about my two year journey recovering from obesity, and poor metabolic health and “A Dietitian’s Journey-Part II” is my current  personal journey recovering from hypothyroidism.

This article is written as a private consumer, which is why it is categorized as a personal account, and an editorial.


This past Monday, I went to the lab to have blood tests to measure my thyroid hormones, anti-thyroid antibodies, and an iron panel. When I had met with my doctor last week, I learned that I would need to pay for the free T3 test because the British Columbia guidelines and protocols for ordering thyroid tests state that a free T3 test is only covered to rule out suspected cases of hyperthyroidism [1]. As I wrote last Thursday, I was “more than willing to pay for a $9.35 test to have all the data.” 

I think most people are aware that the healthcare system is economically stretched, and I certainly understand and accept the need to reduce costs. One way to do that is to restrict the ordering of laboratory tests to only medically justifiable circumstances, which makes good sense. 

While I recognize that I am not objective in this situation, it would seem to me that when someone is on thyroid hormone replacement medication that includes both synthetic T4 and T3 hormones, that the expense of both a free T4 test and free T3 test should be covered by the provincial healthcare system as the cost is justifiable because the prescribing doctor needs to determine if the dosage of both synthetic hormones is adequate, but not too high. 

As I said above, I knew last week that I would be paying for the free T3 test and was fine with that, but what I wasn’t prepared for was that I would be expected to pay three times the cost the government pays for the same test, and that there would no patient-price list available.

When I arrived at the lab on Monday, I was told that the free T3 test would cost $32.00.  I replied that there must be a mistake, because the cost of the test is $9.35. I was informed that the government pays $9.35 for the free T3 test, but the patient-pay cost for the same test is $32.00I explained to the person at the desk that I could understand the test costing more if there was a set-up fee for a stand-alone test, or for a separate blood draw, but this test was going to be run with others using the same blood draw.  I was informed that $32.00 is the patient-pay cost of the free T3 test regardless of whether it is done with other tests, or by itself.

I asked if I could please see the price list with the patient-pay costs, and was told that there isn’t one. I was asked if I wanted to have the free T3 test period formed, and if I did that I would need to pay $32.00. What choice did I have?  It was not as though I could go to one of the lab’s competitors, as this private lab company is the only one providing laboratory services in this city. 

[NOTE (October 28, 2022: I have spoken to people in other provinces, and it appears from what people have said that the practice of diagnostic laboratories not disclosing patient-pay prices occurs in Manitoba, Ontario, and British Columbia. This practice may also occur in others provinces as well, but I don’t know. This article written as private consumer is about the practice of diagnostic labs not disclosing patient-pay prices to consumers, irrespective of which province the practice occurs in, or by what company.]

I paid the $32.00 for the test because I needed this information to know the effect of the medication on my thyroid hormones, and for my doctor to know whether a medication adjustment was needed. I had the disposable income to pay for it, but what about consumers who need a laboratory test to make health decisions or for their doctor to be able to, and who cannot afford that? 

… and why are patient-pay clients charged 3 times as much as the government pays for the same test?  Even if a private consumer was only requesting a stand-alone test and had to pay the ~$15 blood draw fee, this test would only cost $25, not $32.

After my appointment, I wrote the regional office of the lab company and asked “to have the patient-pay lab prices for British Columbia.” I heard back from a Client Service Advisor who told me that “We do not provide a list of what we charge to patients“.

I was flabbergasted. 

I’ve always made the assumption that private businesses are required to post their prices, or at least make them available when asked.

As an individual consumer, what happened at the lab would be like going to the grocery store to buy food, but none of the items for sale have marked prices. You are required to pick out the things you need, but only find out at the cash register what the price is. 

When you get to the cash, you ask the cashier about the prices, and she tells you there’s no price list,  but she can give you the total cost at the end, and you can either pay, or put the items back. Needing the items, you pay what you are told, and take your receipt.

When you get home, you decide to write the head office and ask if they can send you a price list, and are told there IS one, but that they can’t give it to you.

[UPDATE October 29, 2022: The way things are currently set up, one has to make an appointment with the lab, go there, line up and give the person at the desk their requisition, and only then can find out how much the patient-pay part will cost.

After investing so much time, consumers are put in a position of having to make a decision on the spot — pay whatever is being asked, or leave without the test.

Consumers should be able to access the prices online and make a decision at their leisure, before investing so much time.] 

I don’t know whether private businesses in Canada required to post their prices, or make them available when asked. I’ve always assumed they were, but I could be wrong. If there is a requirement to do so, do diagnostic labs have an exemption that enables them not to make their prices available to members of the public?


UPDATE October 28, 2022: I have since found out the same company provides a price list to allied health professionals so that they can provide laboratory assessment services to their clients, and if they choose they can mark up the cost in their own billing.

There are 2 versions of this test list available. They are identical except the one for British Columbia does not have the prices indicated, whereas the Ontario one does (see below).

I have also since found out that the company DOES have patient-pay price list that is titled “British Columbia Private Price List for Commonly Ordered Lab Tests” and is dated April 2021. It is marked “confidential” and as a result cannot be publicly shared.  See #3, below.

        1. The allied healthcare price list available in Ontario, dated November 2018 has the prices marked. I have removed the company’s identifying colours, logo, and information and posted their allied health professional test list here.
        2. The allied healthcare price list available in British Columbia, dated June 2020 does not have the prices marked. I have likewise removed the company’s identifying colours, logo and information and have posted their allied health professional test list here. 

 

Above is the allied health professional cost (November 2018) for an entire thyroid panel of 6 thyroid-related lab tests, including;

          • TSH
          • free T4
          • free T3
          • reverse T3
          • thyroperoxidase antibody (TPO)
          • anti-thyroglobin antibody (TG-ab)

Compared to what the BC government pays for the same tests (minus the reverhttp://from http://www.bccss.org/bcaplm-site/Documents/Programs/laboratory_services_schedule_of_fees.pdfse T3 which isn’t paid for by MSP) the above panel costs $80. Presumably naturopaths are charged prices similar to what MSP pays.

3. I have since found out that there IS a patient-pay price list and it is titled “British Columbia Private Price List for Commonly Ordered Lab Tests” and is dated April 2021.

The prices cannot be posted because the notice at the top of the price list reads;

This is a confidential document. Please do not disclose our prices publicly except in conversations with your patients.”

Why is the private-pay price of lab tests a confidential document, and why can’t the prices of lab tests be disclosed to the public?

Are business in British Columbia required to disclosed their prices and if so, are diagnostic labs exempt from making their private-pay prices available to consumers?

I don’t know.

How many people would be willing to order dinner at a restaurant that did not post the price of its menu items until after they ordered?

 


My Thoughts on Patient-Pay Prices

I believe that as consumers, private-pay individuals have a right to have access to the prices for laboratory tests in advance, so that they can consider their decision to purchase, or not purchase these services. Consumers expect grocery stores and department stores to post their prices, and it is my personal opinion that privately owned laboratories from whom private consumers purchase services should be no different.

I also think private-pay individuals have a right to know why they are required to pay a premium price for the same services that the government gets for a third the cost, and allied healthcare professionals obtain for approximately half the cost.

This differential pricing for allied health professionals is a little like retailers selling supplements to practitioners at wholesale prices, while expecting the consumer to pay full price. Even car dealerships have “employee pricing” events so that the average consumer can take advantage of the same discounts provided to their employees, but at these diagnostic labs, consumers are unable to know in advance how much they will be paying for services before they arrive at the cash.

I believe that as private businesses, diagnostic laboratories are free to set their prices as they see fit but it would seem that (1) consumers should be able to know what those prices are in advance, and (2) that consumers should also know that they are paying a premium price for the same services, compared to what the government and allied health professionals are paying.


I am very grateful to live in a country where publicly funded medical care is available. I am thankful to have access to excellent diagnostic lab tests, and don’t even mind paying the same cost the government pays for tests that I want to have done. But as a private consumer, I believe the cost of services need to be available and that there needs to be transparency with regards to pricing discounts provided to others.

To your good health,

Joy

References

  1. BC Guidelines & Protocols Advisory Committee, Thyroid Function Testing in the Diagnosis and Monitoring of Thyroid Function Disorder, October 24, 2018

 

Copyright ©2022 The LCHF Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

Six-Week Follow-Up Doctor Visit – a Dietitian’s Journey

This morning I met with my doctor for my 6-week follow-up appointment to review my ongoing hypothyroid symptoms, current T4 & T3 medication dosages, and to discuss additional blood work to see how my body is responding to medication, as well as nutrient supplementation. I continue to be in awe of how cooperative my doctor is being! I am very well aware how many people with hypothyroidism do NOT get this kind of support from their doctors! I am very thankful.

My doctor agreed to my request for a thyroid panel [TSH, free T4, and free T3] even though I may have to pay for FT3 because of the provincial guidelines.

In British Columbia, free T3 testing is only available for those with suspected hyperthyroidism, not to assess levels of T3 as a result of thyroid hormone replacement medication. I am more than willing to pay for a $9.35 test [1] to have all the data.

I will also be having a full iron panel to see how my body is responding to nutrient supplementation , as iron status tends to be low in those with hypothyroidism. I have already had blood tests for other nutrients of concern in hypothyroidism, as well as for those I have been supplementing.

My doctor even ordered a thyroglobulin antibody (TG-ab) test, even though TPO antibodies for Hashimoto’s were negative. Interestingly, he thinks as do I that it is prudent to assume a Hashimoto’s diagnosis even in the absence of antibodies and act accordingly when it comes to diet and increased risk of other auto-immune disorders.

This coming Monday, I am going for my blood tests and should have the results back in 24-48 hours and am meeting with my doctor again next Thursday to go over the results, and consider medication dosage adjustment.

I am very grateful to be able to work with my doctor to advocate for my health, to be involved in the decision regarding blood tests, as well as discussing together medication adjustment.

I hope that out of my experience navigating my own care related to hypothyroidism, to better be able to help others advocate for themselves in this area.

To your good health,

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd

Articles about Hypothyroidism

References

  1. BC Guidelines & Protocols Advisory Committee, Thyroid Function Testing in the Diagnosis and Monitoring of Thyroid Function Disorder, October 24, 2018

 

Copyright ©2022 The LCHF Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

What Does Success Looks Like Now – A Dietitian’s Journey II

This article is the fourth entry in A Dietitian’s Journey Part II, which began with my recent diagnosis of hypothyroidism. This post is about how I will measure success as I recover from hypothyroidism.

NOTE: Articles posted under A Dietitian’s  Journey are separate from referenced clinical articles (categorized as Science Made Simple articles) because these are about what happened to me (i.e., anecdotal) and based on my personal observation.

A Dietitian’s Journey – Part I

What “success” looked like after the first A Dietitian’s Journey

“A Dietitian’s Journey” (Part I) was my personal weight-loss and health-recovery journey that began on March 5, 2017 when I decided to make dietary and lifestyle changes so that I could reclaim my health. At that time, I was obese, had type 2 diabetes for the previous 8 years, and extremely high blood pressure. 

Two years later, on March 5, 2019, I accomplished all but one of my goals, and the last one I achieved three months later. In all, I lost 55 pounds and more than a foot off my waist, and met the criteria for partial remission of type 2 diabetes, and remission of hypertension (high blood pressure).

To get an idea of what I looked like at the beginning and the end of that journey, there are two short videos on my Two Year Anniversary post that tell the story well.  The first video was taken when I started and it is very apparent how obese I was, and how difficult it was for me to walk and talk at the same time. The second clip was taken when I completed my journey, and the difference is unmistakable.  

A Dietitian’s Journey – Part II

Without much difficulty I maintained my health and my weight-loss from March 2019 until August 2020 but then I came down with Covid.  This was at the very beginning of the pandemic and no one really knew what to expect in terms of symptoms. As you can read about in the first post in what has become A Dietitian’s Journey Part II, (When a New Diagnosis is a Long Time Coming ) I had symptoms that both my doctor and I assumed were related to the virus, including muscle aches and joint pain, being exhausted, having ‘brain fog,’ headaches, and having the shivers.

Afterwards, I had to work very hard to regain my mobility. No one knew this wasn’t ‘normal.’

At first, I could barely walk up a flight of stairs. At the time, “success” was being able to walk around the block.  Then I began taking several dietary supplements to help strengthen my immune system and in retrospect, the reason I felt better was likely due to the fact that these were all supplements involved in thyroid support. Success at the time was being able to walk around the man-made lake at the local park, but over the weeks and months of supplementing my diet and walking every weekend, success was being able to complete several medium difficulty hikes in the local mountains. 

Unfortunately, in March of 2022,  I came down with what my doctor assumed was Covid again. At first the symptoms were similar to what I experienced in August 2020, including muscle aches, joint pain, being exhausted, feeling cold all the time, with the only difference being that I didn’t have headaches. The symptoms persisted for several months and I was beginning to think that I had “long-Covid.” As most people did over the pandemic, I put on 20 pounds, but from March to May, I began to look as though I was putting on significant weight, but every time I got on the scale it indicated only a few pounds of difference. I had no idea what was going on.

The next symptom that I became aware of was swelling in my ankles. It wasn’t just a little bit of swelling, but significant enough that I needed to wear compression stockings all day.

At my youngest son’s wedding at the beginning of June, I looked like I did when I was 55 pounds heavier, but I wasn’t.

LEFT: March 5, 2017, RIGHT: June 3, 2022

About three weeks after the wedding, I was diagnosed with hypothyroidism, and started taking desiccated thyroid. At first, I felt significantly better, and within several weeks, the edema in my legs began to subside.

There is still a fair amount of mucin accumulation in my legs, but as of this weekend, I can begin to grab a very small amount of flesh between my fingers. From what I have read it will take at least 6 months for this to resolve. You can read a referenced article about the skin symptoms associated with hypothyroidism here.

It is easy to see from the above photo that in less than 3 months on thyroid medication treatment, my face has lost its puffy, “inflated” look yet amidst the positive improvements of decreased edema and looking more like myself in some respects is the reality that I have lost ~1/2 of my hair due to telogen effluvium that often occurs with sustained hypothyroidism. You can read more different causes for hair loss here.

Loss of half my hair in 3 months due to telogen effluvium.

Even though I have already been on thyroid replacement hormones for several months, it usually takes ~3-6 months for hair loss to stop and another 3-6 months for regrowth to be seen and 12-18 months to complete regrowth [3]For someone like my who has lost half their hair, six months to a year to begin to see hair growth can seem like an eternity.

I recently changed medication forms from desiccated thyroid to a mixture of T4 medication (Synthroid®) and T3 medication (Cytomel®). The overall distribution of T4:T3 is about the same, but it is hoped that this mixture will result in more stable thyroid hormones day-to-day.

In six weeks I will have new blood tests to re-evaluate whether my levels have improved.  At last check, my TSH was still high-normal (3.47 mU/L) when in most patients on thyroid hormone replacement the goal TSH level is between 0.5 to 2.5 mU/L [7]My Free T4 =  14.0 pmol/L which is still in the lower end of the range (10.6-19.7 pmol/L) when it is considered optimal to be in the higher end of the range. 

Metabolic Changes due to Hypothyroidism

It’s well known that people with hypothyroidism experience several clinical changes including different type of anemia, changes in how their heart functions, changes in blood pressure, blood sugar and cholesterol and weight gain due to a slower metabolism. My recent medical work up indicates that I was no different in this regard.

Different Types of Anemia

People with hypothyroidism have a decrease in red blood cells and experience different types of anemia, including the anemia of chronic disease. In addition, 10% of people with hypothyroidism develop pernicious anemia, which is associated with vitamin B12 and folate (folic acid). Iron deficient anemia is also common due to decreased stomach acid that results in decreased absorption of iron.

I was supplementing with B12 and folate and as a result have no signs of pernicious anemia, however my hematology panel indicates that I may have iron deficient anemia. An iron panel would be able to quantify this, however I am already taking heme iron supplements, along with vitamin C to support absorption.

Heart Changes

The slowing of metabolism associated with hypothyroidism also results in a decrease in cardiac (heart) output, which results in both slower heart rate and less ability for the heart to pump blood.  This is what results in the unbearable fatigue.

High Blood Pressure

The decreased ability of the heart to pump leads to increased resistance in the blood vessels, which results in increased blood pressure (hypertension).

In those who had normal blood pressure previous to developing hypothyroidism, blood pressure can rise as high as 150/100 mmHg. Hypothyroidism may increase it further for those previously diagnosed with high blood pressure. While my blood pressure had been normal for more than a year, it gradually started increasing the last year, which in retrospect is the period of time over which I was exhibiting more and more symptoms of hypothyroidism. I have since been put back on medication for hypertension to protect my kidneys, which I hope to be able to get off of again within the next six month to a year, as my thyroid hormones normalize.

Weight Gain

Thyroid hormones act on every organ system in the body, but the thyroid is well-known for its role in energy metabolism. When someone has overt hypothyroidism, there is a slowing of metabolic processes, which results in symptoms such as fatigue, cold intolerance, constipation, and weight gain. 

Weight gain is not only about diet or how much someone eats versus how much they burn off. It is also about the person’s metabolic rate, which can be impacted by several things, including decreased thyroid hormones. I gained 20 pounds over the pandemic (much of which overlaps with the period of time over which I was exhibiting more and more symptoms of hypothyroidism. I also gained 10 pounds from March to June which is mostly water weight, due to the mucin accumulation.

High Cholesterol

It has long been known that those with hypothyroidism have high total cholesterol, high low-density lipoproteins (LDL) [4], and high triglycerides (TG) [5], which results from a decrease in the rate of cholesterol metabolism. My doctor deliberately did not want to check these last time, because he knew they would be abnormal only as a result of the hypothyroidism. He plans to evaluate them once I have been stable on hormone replacement for several months.

So, What Does Success Look Like Now?

Just as I had a clear idea of what success looked like in my first A Dietitian’s Journey, I have a clear idea of what I would like success to look like this time, as I recover from my hypothyroid diagnosis.

Over the next year, this is what I want to accomplish;

    1. weight same as March 5, 2019 (end of A Dietitian’s Journey, part I)
    2. waist circumference same as March 5, 2019 (end of A Dietitian’s Journey, part I)
    3. regrowth of my hair to same thickness as before clinical symptoms of hypothyroidism
    4. restoration of iron deficient anemia:
      (a) normal ferritin 11-307 ug/L
      (b) iron 10.6-33.8 umol/L
      (c) TIBC 45–81 µmol/L
      (d) transferrin  2.00-4.00 g/L
    5. Blood pressure ≤  130/80 mmHg
    6. Blood sugar:
      (a) non-diabetic range fasting blood glucose ≤  5.5 mmol/L
      (b) non-diabetic range HbA1C ≤  5.9 %
    7. Thyroid Hormones:
      (a) optimal TSH= 0.5 to 2.5 mU/L
      (b) optimal Free T4 = 15-18 pmol/L (10.6-19.7 pmol/L)
    8. Cholesterol:
      (a) LDL ≤ 1.5 mmol/L
      (b) TG ≤ 2.21 mmol/L

Final Thoughts…

While I don’t know if it will be possible to achieve all of these within the time frame or within adjustments to medication that my doctor will be willing to make, these are my goals. I believe that most of these are possible, and as far as they are within my control, this is what I would like to accomplish.

I have achieved a lot the last 3 months, but I am not “done.” I want the rest of my life back!

I want to be able to do the things that I enjoy, and to have the freedom to make plans in the evening knowing I will have the energy to follow through.

I think this is reasonable to ask and I will do everything I can to make this a reality.

A Dietitian’s Journey Part II continues…

To your good health,

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd

References

  1. Rotondi M et al. Serum negative autoimmune thyroiditis displays a milder clinical picture compared with classic Hashimoto’s thyroiditis. Eur J Endocrinol 2014;171:31-6. Epub April 17 2014
  2. Croce, L., De Martinis, L., Pinto, S. et al. Compared with classic Hashimoto’s thyroiditis, chronic autoimmune serum-negative thyroiditis requires a lower substitution dose of L-thyroxine to correct hypothyroidism. J Endocrinol Invest 43, 1631–1636 (2020). https://doi.org/10.1007/s40618-020-01249-x
  3. Malkud S. Telogen Effluvium: A Review. J Clin Diagn Res. 2015;9(9):WE01-WE3. doi:10.7860/JCDR/2015/15219.6492
  4. Lithell, H., Boberg, J., Hellsing, K., Ljunghall, S., Lundqvist, G., Vessby, B., & Wide, L. (1981). Serum lipoprotein and apolipoprotein concentrations and tissue lipoprotein-lipase activity in overt and subclinical hypothyroidism: the effect of substitution therapy. European journal of clinical investigation11(1), 3–10. https://doi.org/10.1111/j.1365-2362.1981.tb01758.x
  5. Nikkila E, Kekki M, Plasma triglyceride metabolism in thyroid disease, J Clin Invest. 1973;51:203. 
  6. Iron Disorders Institute, Iron Deficiency, Understanding Iron Deficiency Anemia, http://irondisorders.org/iron-deficiency-anemia/
  7. American Thyroid Association, Is the TSH (thyroid stimulating hormone) a good way to titrate my thyroid hormone therapy? https://www.thyroid.org/patient-thyroid-information/what-are-thyroid-problems/q-and-a-tsh-thyroid-stimulating-hormone/

DISCLAIMER: The information in this post should not be taken as a recommendation to self-diagnose, self-interpret diagnostic tests, or self-treat any suspected disorder. It is essential that people who suspect they may have symptoms of any condition consult with their doctor, as only a medical doctor can diagnose and treat.

 

Copyright ©2022 The LCHF Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

Judging By Appearance – a Dietitian’s Journey

We form an opinion about someone’s appearance when we haven’t seen them in a while, or meet them for the first time. We do so unintentionally, but we judge by appearance. Sometimes the appearance of weight gain is not about diet but a diagnosis. 

DISCLAIMER: (August 28, 2022): This article a personal account posted under A Dietitian’s Journey. The information in this post should in no way be taken as a recommendation to self-diagnose, self-interpret diagnostic tests, or self-treat any suspected disorder. It is essential that people who suspect they may have symptoms of any condition consult with their doctor, as only a medical doctor can diagnose and treat.

The photos below are both of me. On the left is what I looked like when I began my personal weight-loss and health-recovery journey on March 5, 2017. Over the following two years, I lost 55 pounds and 12 ½ inches off my waist following a low carb, and then a ketogenic diet. The process was slow — agonizingly slow and in retrospect, I now know why. The photo on the right is what I looked like two years later, maintaining my weight loss.

LEFT: March 5, 2017 RIGHT: December 2021 – after two years weight maintenance

Almost imperceptibly, my appearance began to change.  I didn’t “see it” at the time, but I was aware that my waist circumference was different and that my clothes felt tighter. What I couldn’t understand was that I had only “gained” approximately five pounds.

The two photos below clearly show the subtle difference.

LEFT: Hiking March 5, 2021, RIGHT: Hiking March 5, 2022

The photo on the left was taken on the two-year anniversary of completion of my weight loss journey which lasted from March 5, 2017-March 5, 2019 (documented under A Dietitian’s Journey). This entry in that journal which is titled From the Mountains Through the Valleys was written for my fifth anniversary, the day before the photo on the right.

The photo on the right was taken this past year in March, exactly one year after the photo on the left.  The comparison is easy because I was wearing the same clothes. While my weight was only approximately five pounds greater than on the left, it is clear to see that my face was puffier, as were my legs.  I remember getting dressed that morning and wondering why all my hiking clothes felt so tight. I also vividly remember how difficult the hike was that day — and it was a simple one with very little elevation. My legs felt heavy, and it was hard to walk up even the gentlest of inclines.

Despite having both vaccines in April 2021 and July 2021, a few days later I came down with what my doctor and I presumed was my second case of Covid-19.

I had Covid the first time in August 2020 and wrote about it in the journey entry titled, To Covid and Back).  In retrospect, I think the ‘post-viral arthritis’ I experienced afterwards may have been linked to my thyroid’s response to the virus (documented in the literature). In that post, I wrote about recovering from Covid the first time;

“By the end of August (after Covid) it was difficult for me to even walk up (or down!) a flight of stairs. This both shocked and scared me.

I began to go for walks — even though it was very hard.  At first they were literally just around the block, but I kept at it.  One of my young adult sons who lives with me kept encouraging me to walk, and would sometimes go with me.  As my legs became stronger, walks turned into short  inadvertent hikes’ and I discovered I really liked being out in the woods, even though it remained very hard to step up onto rocks, or step down from them.  I dug out the wood hiking staff that I brought with me when I moved from California and put it into service., invested in some hiking boots and other essentials’. As I said in the previous article, my hiking stick — along with my fuchsia rain gear has become somewhat of an identifier— but the truth is, without the hiking stick, I could not have possibly begun to hike.

My first breakthrough was in late November, when I did my 4th real hike which was 12 km around Buntzen Lake — which in terms of a few elevation gains was really beyond my capabilities. With frequent stops and lots of encouragement from my son, I did it.  I had to. He couldn’t exactly carry me back to the car! That day I felt as though I had beaten the post Covid muscle weakness and was on my way back to health.”

When I got Covid again this past March, the symptoms were pretty much the same as in August 2020, muscle aches and joint pain, being exhausted, feeling cold all the time and my lips were frequently blue. The only difference was this time I did not have headaches.  I was loaned an oximeter by a family member who is a nurse and I found it quite strange that my body temperature was always two degrees below normal even though I had fever-like symptoms of being cold and shivering.  The muscle aches were significant, as was the fatigue, but since these are also symptoms of Covid, I didn’t think much of it.  It was only when I began to develop symptoms that were not associated with Covid that I began to become concerned.  

Me at my youngest son’s wedding, June 3, 2022

Fast forward to the beginning of June which was my youngest son’s wedding. I was so very unwell, but avoided talking about it as I did not want to detract from the very special occasion.

I was experiencing joint pain and muscle aches, and chills that would come and go. I would frequently get bluish lips, and continued to have significant non-pitting edema in my legs and ankles, and was wearing compression stockings all the time — even at the wedding. Most pronounced was the debilitating fatigue.

The skin on my cheeks had become flaky and dry and despite trying multiple types of intense moisturizers, nothing helped. My mouth symptoms had progressed to the point that I found it difficult to say certain words when speaking because my tongue seemed too large for my mouth, and the salivary glands underneath my tongue were swollen.

The muscle weakness had progressed to the point where it was difficult for me to get up from a chair, or to get out of my car without pushing myself up with my hands. My eldest son was helping me get to and from the beach for the photos, and out of the car.  He thought it was me aging, and when I recently asked my other two sons, they assumed the same thing.  I was wondering if I had some form of “long-Covid,” but what got me starting to think that my symptoms had something to do with my thyroid was the very noticeable swelling in my face.

At my son’s wedding I looked like I did when I was 55 pounds heavier!

LEFT: March 5, 2017, RIGHT: June 3, 2022 at my youngest son’s wedding.

The photo on the left, above is what I looked like when I began my weight-lost journey on March 5, 2017. The photo on the right is what I looked like June 3, 2022, at my youngest son’s wedding. I look more or less the same in both pictures, but with a fifty pound difference in weight. 

I found out a few weeks later, I had hypothyroidism and was displaying many of the symptoms of myxedema. [I have written an article from a clinical perspective about the symptoms of hypothyroidism, which is posted here.]

While we do it unintentionally, we all judge by appearance, and “weight gain” is no different. If we see someone at one point in time, we form an opinion based on what we see.  If anyone would have bumped into me three months ago, it would have been reasonable for them to assume that I had gained back all the weight I had lost, and then some. But that wasn’t the case. 

But what causes the appearance of “weight gain,” without gaining significant amounts of weight? 

As I explain in this recent clinical post about hypothyroidism, the “puffiness” is due to the accumulation of mucin under the skin. Mucin is a glycoprotein (a protein with a side chain of carbohydrate known as hyaluronic acid) that is naturally produced in the skin. Under normal circumstances, hyaluronic acid binds water to collagen and traps the water under the skin, keeping it looking moist and plump, In fact, hyaluronic acid is injected into the skin by dermatologists to make aging skin appear younger. The problem in hypothyroidism is that an excess of mucin accumulates under the skin, giving it a “tight, waxy” swollen texture. (I would describe it as feeling like an over-inflated balloon). 

Below is a photo showing the change in appearance in my left leg from November 3, 2021 (left), to July 16, 2022 (middle), to August 26, 2022 (right).

The photo on the left was taken by me last November while I was doing some stretches. It was still on my phone in mid-July when I took a picture of the swelling in my lower legs and ankles caused by mucin accumulating in the skin. The photo on the right was taken this morning, and while much of the swelling has been reduced, I am still unable to pinch any skin on my legs due to the remaining mucin. I have read that it can take 6 – 8 months for this to resolve.

I want people to understand that the appearance of “weight gain” and “weight loss” in hypothyroidism is different than weight gain and weight loss due to dietary changes. The difference, however can be very subtle.

In my case, the appearance of “weight gain” occurred very slowly.

My appearance between March 5, 2021 and exactly a year later are almost indistinguishable. It is only in retrospect, that I can see the puffiness in my face and legs. At the time, I was puzzled why my clothes fit tighter when there was only a 5 pound difference in my weight, but beyond that I didn’t give it any thought.

Below is a composite photo to help illustrate how slowly my appearance changed at first, and how quickly it progressed as my thyroid disorder progressed. Look how rapidly my appearance changed in only three months, between March 5, 2022, and my son’s wedding on June 3, 2022! 

[NOTE: As I’ve mentioned in all of my previous articles and posts about hypothyroidism, each person will present with different symptoms, and even those with the same symptoms may have very different appearance because of differences in their thyroid dysfunction.  Keep in mind, these photos describe only my own experience.]

Below is a composite photo to illustrate how quickly the appearance on my my face has resolved after only two months of thyroid treatment.

[NOTE: Again, this is my experience and each person’s will be different, depending on the nature of their thyroid dysfunction, as well as the type, timing and dosage of treatment their doctor prescribes.]

Last two photos are only 2 months after beginning thyroid treatment
I understand “regular” weight gain and the “weight gain” that often goes with hypothyroidism from both sides of the clinical desk.

An Expanded Perspective

My clinical practice changed 5 years ago when I came to understand what hyperinsulinemia was, and how early clinical signs of developing type 2 diabetes are evident as long as 20 years before diagnosis. In a similar way, my clinical practice is changing again now as the result of what I am learning about hypothyroidism.

Understanding the wide range of clinical and subclinical symptoms that people may have leads me to ask additional questions, to look at lab test results differently, and to ask for additional ones if it seems clinical warranted. While it is beyond the scope of practice of a Dietitian to diagnose any disease or to treat hypothyroidism, I am more aware of what to look and this helps me to refer people back to their doctor if I feel there may be a clinical concern.

Final Thoughts…

We form an opinion about someone’s appearance when we haven’t seen them in a while or when we meet them for the first time. While we do so unintentionally, in developing that opinion, we judge by appearance but sometimes the appearance of “weight gain” is not about diet, but about a diagnosis.

If anyone had seen me three months ago after not seeing me in a while, they might have assumed that I had gained back all the weight I had lost.

When we encounter someone who is overweight, we ought to bear in mind that don’t know where they are on their journey. We don’t know if they have metabolic issues related to glucose and insulin metabolism, are struggling with food addiction, or have an endocrine dysfunction, like hypothyroidism, or something else.

photos taken less than 3 months apart

People seeing me now have no idea that less than three months ago I looked as I did on the left, and was very ill.

As much as it is natural for all of us to form an opinion, let’s try not to let that opinion become a judgement.  Listening is a great way to find out more.

To your good health!

Joy

 

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd

 

Copyright ©2022 The LCHF Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Measure of Health With a New Diagnosis – a Dietitian’s Journey

This article is the second entry in A Dietitian’s Journey Part II, which began with my recent diagnosis of hypothyroidism. The first entry in Part II was written last Friday, and you can find it here. This article is about how the factors by which I measure health have changed due to my diagnosis.

NOTE: Articles posted under A Dietitian’s  Journey are separate from referenced clinical articles (categorized as Science Made Simple articles) because these are about what happened to me (i.e., anecdotal) and based on my personal observation.

DISCLAIMER: The information in this post should not be taken as a recommendation to self-diagnose, self-interpret diagnostic tests, or self-treat any suspected disorder. It is essential that people who suspect they may have symptoms of any condition consult with their doctor, as only a medical doctor can diagnose and treat.

A Dietitian’s Journey – Part I

“A Dietitian’s Journey” was my personal weight-loss and health-recovery journey that began on March 5, 2017 when I decided to make dietary and lifestyle changes so that I could reclaim my health. At that time, I was obese, had type 2 diabetes for the previous 8 years, and extremely high blood pressure.  I achieved my goal two years later, on March 5, 2019. In retrospect, I realize why it took a year longer than I anticipated.  It is because I had high TSH levels, almost out of range. I had borderline subclinical hypothyroidism.

I believe that you can’t achieve a goal you don’t set“.  In other words, I accomplished my health goals the last time, because I set them. As the popular expression goes, “A goal without a plan is a wish.”

I also believe that success needs to measurable — that is the “m” in SMART goals (specific, measurable,  achievable,  relevant /realistic and timely.)  Before I began of Part I of A Dietitian’s Journey, I not only set my goals, I asked myself “what will success look like” which helped me define how I would measure success.

I wanted to achieve a normal body weight, be in remission of both type 2 diabetes and hypertension (high blood pressure).

Two years later, on March 5, 2019, I accomplished all but one of my goals, and the last one I achieve 3 months later. I lost:

    • 55 pounds
    • 12- 1/2 inches off my waist
    • 3 -1/2 inches off my chest
    • 6 -1/2 inches off my neck
    • 4 inches off each arm
    • 2- 1/2 inches off each thigh
    • I met the criteria for partial remission of type 2 diabetes 3 months earlier
    • my blood pressure still ranged between normal and pre-hypertension

If you want to get an idea of what I actually looked like at the beginning and at the end, there are two short videos on my Two Year Anniversary post that tell the story well.  The first video was taken when I started my journey, and it is very apparent how obese I was, and how difficult it was for me to walk and talk at the same time. The second clip was taken when I completed my journey and the difference is unmistakable.  

After recovering from Covid, I began hiking, and posted this encouraging “mountain top experience” post as my 5-year update. That was the pinnacle of recovering my heath. 

Except for the 19 pounds (my “Covid-19”) that I gained over the past 2 years, my weight has been stable. I continued to remain in partial remission of type 2 diabetes, and my blood pressure was normal until this past December.  In retrospect, that is when my health began to change. 

A Dietitian’s Journey – Part II

As told in last week’s post which was the first entry in Part II of A Dietitian’s Journey), things didn’t go as planned. Here is an excerpt from that post;

“Despite having had both vaccines (April 2021, July 2021), in March of 2022, I came down with what my doctor assumed was Covid again. At first, the symptoms were pretty much the same as in August 2020, muscle aches and joint pain, being exhausted, feeling cold all the time and my lips were frequently blue, but I did not have a headache.  I was loaned an oximeter by a family member who is a nurse and I found it quite strange that my body temperature was always two degrees below normal even though I had fever-like symptoms of being cold and shivering.  The muscle aches were significant, as was the fatigue, but since these are also symptoms of Covid, I didn’t think much of it.  It was only when I began to develop symptoms that were not associated with Covid that I began to become concerned.”

When I saw my doctor last Friday, he thought that it was very likely I had hypothyroidism, but wanted to run some lab tests to rule out any other possibilities.  I went to the lab last Monday morning, and my results came back late in the day. The ones I was waiting for showed exactly what both my doctor and I expected they would based on the supplements I had been taking prior to seeing him.  What I didn’t expect was that my blood sugar would indicate that I was no longer in partial remission of type 2 diabetes.  My blood pressure was higher than it had been in many years in his office, so I began taking it several times a day to see if it was “white coat syndrome” or genuinely high.  Unfortunately, it was the latter.  I knew what I had to do.  I sent him a fax, reported my blood pressure readings, and asked if he thought it was warranted, that he call in a prescription for the same medication I was on 4 years ago.

Last week I did quite a bit of research in the literature to better understand how low thyroid hormones could contribute to my high blood sugar and high blood pressure  — despite me continuing to eat a low carb diet. I wrote this referenced article on the blog of my long standing clinical practice about the metabolic changes that occur due to hypothyroidism. It is about how thyroid hormones act on every organ system in the body, and as a result when someone has hypothyroidism, there is a slowing of metabolism, which results in weight gain, high cholesterol, high blood sugar and high blood pressure.  Now it was making sense.

I now understood how over a period of three months (March 5, 2022 – June 3,2022) I went from looking as I have the last 5 years to looking as I did 55 pounds heavier.

TOP: 8 photos showing weight loss over 2 YEARS (March 5, 2017- March 5, 2019) BOTTOM: Changes in my appearance over 5 MONTHS (March 5, 2022- Aug 8, 2022)

I knew one of the symptoms of hypothyroidism was “weight gain,” but I had no idea that it could occur over such a short time frame!

Two months ago at my youngest son’s wedding, I looked like I did when I was 55 pounds heavier!

As described in last week’s post, I was very sick but it was devastating to look  like I did!

Today my appearance is almost back to normal. [August 24, 2022: see updated picture below]

Sometimes we have to look beyond what something looks like to the timeframe over which it occurred.

Following Up With my Doctor

Today I had my follow-up appointment with my doctor where we reviewed my lab test results from last week, and discussed next steps. My doctor requisitioned a free T4 test to see how my body is responding to the thyroid hormone treatment that he is overseeing.  He also gave me a requisition for a Thyroid Peroxidase antibody (TPO) test to find out if I have Hashimoto’s disease or if my hypothyroidism is due to my past thyroid surgery for a benign tumour. This article from my long-standing dietetic practice explains what these are.

Since Hashimoto’s is an autoimmune disease, how I would choose to approach my diet if the results of that test are positive would be different than if it comes back negative. 

I should have the results back tomorrow or Monday, but in the meantime, I am thinking about what I will do to recover my health once again, and how I will measure my success.

Once again, I am asking myself “what does success look like,” but this time it is in the context of this new diagnosis.

From what I have read, it is possible for my blood sugar and blood pressure to return to normal once the doctor adjusts my thyroid hormone replacement to its optimal dose, however for this goal to be “measurable” I need to have a better idea of how long this could take. 

A Dietitian’s Journey continues…

To your good health,

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd

 

UPDATE (August 19, 2022) – terrific news!  I do not have TPO antibodies AND my fT4 is almost half way through the normal range. According to an April 25, 2021 webinar given by Endocrinologist Dr. Theodore Freidman, MD, PhD titled “Updates on Treating Hypothyroidism”, it is normal and expected for fT4 to be slightly lower given the type of thyroid hormone replacement that my doctor is overseeing.

[Put in plain English, this means I am the best kind of sick and the amount of medication I am currently taking is pretty close to optimal.]

I would have thought that not having antibodies meant that I didn’t have Hashimoto’s, but rather another type of primary hypothyroidism due to my past thyroid surgery (which is still a possibility).  I was wrong. Not all people with Hashimoto’s have measurable TPO antibodies!

It was previously thought that 5% of people diagnosed with Hashimoto’s thyroiditis have serum-negative thyroiditis, which is where they do not have measurable TPO  antibodies (TPO-ab) and ~50% don’t have positive thyroglobulin (Tg-ab) antibodies, either [1]. People with serum-negative thyroiditis are diagnosed with Hashimoto’s based on clinical presentation, or by ultrasound appearance.

An updated study from 2020 indicates that the percentage of people Hashimoto’s with serum-negative thyroiditis is 20.8%, not 5% as previously thought. It is very encouraging that in subsequent follow-up only ~16% of those with SN-CAT eventually developed positive antibody tests for TPO-Ab and/or Tg-Ab [2].

In my opinion, in terms of a diagnosis of hypothyroidism, this is the best I could have hoped for. It is does not appear to be the autoimmune type (although Tg-ab antibodies weren’t tested, they are only positive in half of those with Hashimoto’s).

Based on this new study, there is a low likelihood of me going on to develop thyroid antibodies especially since I have no family history of autoimmune disorders!

I will take my time and read through the literature and then in light of these results determine what dietary changes I will make.  Now that I know my fT4 is just about optimal, I will determine how I will measure success in terms of my restored health in the day’s ahead.

To your (and my!) good health!

Joy

References

  1.  Rotondi M et al. Serum negative autoimmune thyroiditis displays a milder clinical picture compared with classic Hashimoto’s thyroiditis. Eur J Endocrinol 2014;171:31-6. Epub April 17 2014
  2. Croce, L., De Martinis, L., Pinto, S. et al. Compared with classic Hashimoto’s thyroiditis, chronic autoimmune serum-negative thyroiditis requires a lower substitution dose of L-thyroxine to correct hypothyroidism. J Endocrinol Invest 43, 1631–1636 (2020). https://doi.org/10.1007/s40618-020-01249-x

 

UPDATE (August 24, 2022)It has been exactly 2 ½ months since my son’s wedding and 2 months since I began thyroid replacement medication and I am feeling quite a bit better about the image I see in the mirror. The change is more subtle this week, but I see less swelling in the cheeks. It will take a few more months for the less seen parts of my body to recover, but I am feeling hopeful.

 

 

 

 

 

Copyright ©2022 The LCHF Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

When a New Diagnosis is a Long Time Coming

Three weeks ago, I wrote an article for my long-standing dietetic practice (BetterByDesign Nutrition Ltd.)  about how a diagnosis of hypothyroidism is made and why it takes until someone has been unwell for quite a while before they are finally diagnosed. In one sense, that article laid the foundation for this one, and in another sense this article is the most recent update of my personal weight and health-recovery story (A Dietitian’s Journey).

DISCLAIMER(August 14, 2022): This article a personal account posted under A Dietitian’s Journey. The information in this post should in no way be taken as a recommendation to self-diagnose, self-interpret diagnostic tests, or self-treat any suspected disorder. It is essential that people who suspect they may have symptoms of any condition consult with their doctor, as only a medical doctor can diagnose and treat.


Two years ago, in the summer of 2019, I was feeling fantastic and was in remission of type 2 diabetes and hypertension and was celebrating my “little black dress moment.”

In August 2020, I had what my doctor assumed was Covid (back pain, non-stop headache, and couldn’t stop shivering) and since at that point the line up for a nasal swab was 6 hours long due to one of the testing sites closing, my doctor recommended that I simply assume I was positive, and self-isolate for two weeks, which I did.

For many weeks afterwards, I had overall muscle pain and weakness, as well as tingling and numbness in my fingertips, what is referred to as “brain fog”, and unbelievable fatigue. I went from being reasonably active and fit in the spring, to finding it difficult to even walk up or down a flight of stairs by August. Covid was new at that point, so none of us knew what to expect, but it took months until I began to feel reasonably normal. I learned to live with the muscle aches, joint pain, ‘brain fog’, and fatigue. The joint pain persisted for a long time, and was assumed to be post-viral arthritis as I had this once before when I had rubella as an adult.

Despite having had both vaccines (April 2021, July 2021), in March of 2022, I came down with what my doctor assumed was Covid again. At first, the symptoms were pretty much the same as in August 2020, muscle aches and joint pain, being exhausted, feeling cold all the time and my lips were frequently blue, but I did not have a headache.  I was loaned an oximeter by a family member who is a nurse and I found it quite strange that my body temperature was always two degrees below normal even though I had fever-like symptoms of being cold and shivering.  The muscle aches were significant, as was the fatigue, but since these are also symptoms of Covid, I didn’t think much of it.  It was only when I began to develop symptoms that were not associated with Covid that I began to become concerned.  One of those symptoms was non-pitting edema in my lower legs and feet, and I don’t mean just a little bit of swelling. Below is a picture of before, and during;

I ordered compression stockings on-line and wore them daily to help keep the swelling down, but carried on working and writing the book, even though I was very tired all the time. I also began to have a very weird sensation in my mouth – my tongue became enlarged, and the salivary glands under my tongue were swollen. Since both of these affected my sense of taste, I thought this may be related to Covid, but then it progressed to the point where I found it difficult to talk properly because my tongue seemed too big for my mouth. I also began losing hair, but this had occurred several years ago, too.  At the time, my TSH was “in the normal range”, so no further testing was done (see this article to know why TSH alone is not good indicator of hypothyroidism, especially when it is at the high end of the normal range, which mine was).  In retrospect, the subclinical problem with my thyroid has been going on quite a while. Sometimes it would be worse than others, which is not unusual.

Fast forward to two months ago (beginning of June), which was my youngest son’s wedding. I was still experiencing fatigue and muscle aches, chills that would come and go, would get bluish lips, and continued to have significant (non-pitting) edema in my legs and ankles, and was wearing compression stockings all the time — even at the wedding. The skin on my cheeks had become flaky and dry and despite trying multiple types of intense moisturizers, nothing helped. My mouth symptoms had progressed to the point that I found it difficult to say certain words when speaking with my clients because my tongue seemed too large for my mouth, and the salivary glands underneath my tongue were swollen. I continued to have overall muscle aches and weakness, but it had slowly progressed to the point where it was difficult for me to get up from a chair, or to get out of my car without pushing myself up with my hands.  I was wondering if I had some form of “long-Covid,” but what got me starting to think that my symptoms had something to do with my thyroid was the very noticeable swelling in my face. At my son’s wedding I looked like I did when I was 55 pounds heavier, but without significant weight gain.

After doing some reading in the scientific literature, as well as chatting with a couple of functional medicine doctors, I began to think that my symptoms were consistent with hypothyroidism.  In addition, I knew that when I was in my early 20s I had a benign tumour removed from the isthmus of my thyroid and as part of the pre-surgery work up, I had an x-ray that required me to drink radioactive iodine. It wasn’t known at the time but it is known now that both the surgery on the thyroid (even though it remains largely intact), as well as the exposure to high doses of radioactive iodine can initiate a process that can lead to hypothyroidism years later.

It is also apparently possible that having had Covid back in 2020 may have initiated it and/or it may have been initiated as a response to the having the vaccines. I am not blaming either the virus or the vaccines because my thyroid surgery and exposure to high doses of radioactive iodine predated this by decades, but they may have been the precipitating event to symptoms.  It is also possible that symptoms would have started on their own simply as a result of age.

I knew I was unwell and needed to see my doctor in person. After my son’s wedding, I called his office and wanted to go in and have him assess me for hypothyroidism, but he was out of town. Instead of meeting with the locum, I decided to wait until he was back. In the meantime I began using some supplements that are involved in thyroid metabolism, such as kept (for iodine), selenium and some other nutrients and while they helped a little bit, it was not significant. After doing a great deal of reading in the literature and listening to several medical presentations by a well-known endocrinologist and professor of medicine from the US, I decided while waiting to see my doctor that I would try using a very small amounts of another type of supplement to see if it made any difference in my symptoms. I introduced it at half the rate and half of the dose usually used because (1) I had not yet seen my doctor (was not under medical supervision yet) and (2) I was aware that use of this supplement was not something to be taken lightly as it can cause problems for older individuals, or those with heart disease (which I don’t have). 

This morning I saw my doctor for the first time since Covid began. I had sent him a fax last week outlining the ways I had improved because I knew it was too much information for a 10 minute visit. I explained that I was feeling significantly better. My face swelling had gone down a great deal, the edema in my legs had almost disappeared – to the point that I could walk around bare-legged in the excessive heat we had last week with NO swelling what-so-ever. The skin on my legs is still very tight and shiny, but no edema. I lost 5-6 pounds of water-weight (face, legs and abdomen) and most noticeable, the muscle weakness is gone!  I could walk up and downstairs, carry heavy parcels, and can get up from a chair or out of my car with ease.  I also explained in the fax that I rarely feel cold, but still have occasional blue lips and chills late in the afternoon, but that from what I’ve read in the literature, many people do better on the same amount split over 3 doses, rather than two. 

When my doctor entered the examining room, he said he had just re-read the fax and based on what I wrote, he thinks it is very likely that I have hypothyroidism, but he wants to rule out other things that could look like it and aren’t, or that mimic it. He wasn’t in a rush, like he usually is. He looked at the pictures I had on my phone —ones I had taken of my legs, my tongue, my face. When he saw the picture of me two months ago at my youngest son’s wedding, he simply said “oh my.” He then gave me a very thorough examination.  He palpitated my thyroid and listened for a long time to my heart and lungs.  After examining me, he pointed out several other physical symptoms that I have that are quite consistent with hypothyroidism, and said “Joy, I think your conclusion is right on.” I was somewhere between shocked and elated.

My doctor then brought up my past lab work on his screen and remarked that my TSH has been “high normal” since 2013 (see below), and that I often had low ferritin with no explanation, as well as past “unexplained” issues with hair loss.  I had nine years with subclinical symptoms but no testing could be done because as indicated on the lab test results below “The free T4 was cancelled. The protocol recommends no further testing.

TSH – 2013 – “in normal range”
TSG – 2015 – “in normal range”

I mentioned to him that I wondered what the results would have shown if my T3 or T4 were tested in 2013, or 2015, when my TSH was high-normal. He replied “unfortunately, unless someone has clear symptoms that are consistent with hypothyroidism there is nothing we can do, but your symptoms are very consistent now, but I think this diagnosis was a long time coming.” Surprisingly, we saw eye to eye.

I think my doctor realized that the guidelines being as they are means that people like me have to get quite unwell before they are finally diagnosed and treated.  I realized that his hands were effectively tied by a system that will not enable him to test T3 or T4 even with high-normal TSH, without overt symptoms. He could do nothing until I got much sicker. 

I was delighted by his response. He has been my doctor for 20 years and was not receptive to my use of a low carb and then a ketogenic diet to put my type 2 diabetes into remission, and previously refused twice to test my fasting insulin, along with my fasting blood glucose.  Today he was very different.

When I asked if he was going to refer me back to the endocrinologist I used to see when I was diabetic and have her manage my thyroid replacement medication and he said “No. I don’t believe in changing something that is clearly working. I want you to keep taking what you’re taking in the same amount you are now, and I am going to run some lab work to see if you have gotten the amount right. We may need to increase it a little or change the timing to address the late afternoon chills, but no, I’m not going to “fix” something that is no longer broken.” He even agreed to add a fasting insulin test, without any protest!

I don’t know what happened to make my doctor change his mind and how he approaches these types of matters, but today I said to him that it has been a long time since I was this delighted with his approach, and that I am very thankful that he is my doctor because he practices good medicine. I offered him my hand and he shook it warmly and thanked me.

I guess if I can change how I practice dietetics based on new evidence, so can my doctor — or your doctor.  Don’t give up, or be hesitant to have those difficult conversations with your primary care physician. We need them to oversee our care, and maybe just maybe in the process of interacting with some patients, they learn something they didn’t before, or change because of things they see in their practice. The bottom line was that I needed my doctor to know what I was doing and to examine me and make sure I was not doing something that could cause me harm.  He not only rose to the occasion with grace, but responded in a manner I could have only dreamt of before.

I do not believe that self-treating is ever advisable, and certainly if it were not for Covid and my doctor not having in-person office hours unless it was an emergency, I  would have gone to see him months ago. I am glad I saw him today and am very thankful that he is being so supportive.

I know once we get the levels of thyroid hormones right, that losing the 20 pounds I gained over the pandemic will be possible, but in the meantime, it is no small matter that I got my life back!!

A Dietitian’s Journey continues…

To your good health,

Joy

I don’t post the comparison picture below easily. It is very hard for me to see how bad I looked, but it is important to see just like the leg pictures, above. The photo on the right was taken at my youngest son’s wedding, June 3, 2022 (exactly 2 months ago) at the height of my hypothyroid symptoms.  The photo on the left is a selfie I took today, August 5, 2022, almost exactly two months later. There is still swelling in my face and legs to come down, but any adjustment in thyroid meds only be done after the upcoming lab work.

LEFT: August 5, 2022, RIGHT: July 3, 2022 (2 months apart)

 


NOTE (August 15, 2022): It is important to keep in mind that too little, or too much thyroid hormone can have serious consequences.

Untreated or under-treated hypothyroidism can be serious and is when the body gets too little thyroid hormone. This can lead to a myxedema crisis (covered in this article).

Thyrotoxicosis can also be serious and is when the body gets too much thyroid hormone. This can occur in untreated hyperthyroidism, or by self-treating hypothyroidism (covered in this article).

If you suspect you may have hypothyroidism (or any other clinical condition), consult with your doctor, and “don’t try this at home.”

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd

 

Copyright ©2022 The LCHF Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

From the Mountains Through the Valleys – 5 year update

Tomorrow is March 5th and it is five years since I began my personal health and weight recovery journey that I’ve dubbed “A Dietitian’s Journey“.  While it began in 2017, in a way it still continues today and that is the point behind this post. 

March 2017

Five years ago, I was obese, had type 2 diabetes for the previous 8 years, and had developed dangerously high blood pressure. 

This picture is what I looked like then.  There is no mistaking that I was a very sick woman.

You can hear it in my voice in the video below. It is very apparent that I could barely walk and talk at the same time.

A year after I had adopted a low carbohydrate lifestyle (March 5, 2018), I had lost:

  • 32 pounds
  • 8 inches off my waist
  • 2 inches off my chest
  • 3 inches off my neck
  • 1 inch off my arms
  • 1/2 inch off my thighs
  • no longer meet the criteria for type 2 diabetes (achieved without the use of medication)
  • had blood pressure that ranges between normal and pre-hypertension without medication
  • had ideal triglycerides and excellent cholesterol levels achieved without any medication.
April 2017 – April 2019

Two years after beginning my journey I had lost a total of;

  • 55 pounds
  • 12- 1/2 inches off my waist
  • 3 -1/2 inches off my chest
  • 6 -1/2 inches off my neck
  • 4 inches off each arm
  • 2- 1/2 inches off each thigh
  • met the criteria for partial remission of type 2 diabetes
  • blood pressure still ranged between normal and pre-hypertension
  • had ideal triglycerides and excellent cholesterol levels
March 2020

On the third anniversary of beginning my journey, March 5, 2020, I remained at a normal body weight, had an optimal waist circumference (slightly less than half my height), and was still in remission of type two diabetes and high blood pressure.

I had gone from taking 12 different medications three years earlier, to being on one prescription for something non-metabolically related. I felt so good — so happy in my own skin that decided to stop straightening my hair, and began wearing it the way it grows out of my head.

March 5 2021 was 4 years from when I began my journey. Here is a short clip from a podcast I was on around that time. Listen to how different I sounded from the clip above.

Then I took up hiking! 

Four years earlier, I could barely walk and talk at the same time and for six months, I was hiking every week, or two.

This photo was taken last year on March 6, 2021 — the 4th anniversary of beginning my journey.

But like most journeys, this one has had ups and downs. There have been “mountain top experiences,” and “valleys,” and currently I am in a bit of a valley.

About two months ago, I was exposed to the Delta variant of Covid and while I didn’t get more than cold-like symptoms, once again my body responded to the exposure with post viral arthritis that I have had a twice since my late 20s.  The first time was after I contracted rubella as a young adult, and the second time was after having what was presumed to be Covid in August 2020 (covered in previous posts). Despite the overall joint pain, I was not going to let it get me down. I kept pushing myself — working on developing recipes for my upcoming book, Low Carb Breads of the World.

The joint pain has eased up quite a bit over the past few weeks, but there remained increasing discomfort at the base of my thumb on my right hand that kept getting worse. Last week it became unbearable.  I assumed that I had developed arthritis in the CMC joint of my thumb, but I found out this week that it is DeQuervain’s tenosynovitis that developed from the repetitive motion of kneading bread several times a week for long periods of time. This was an unfortunate by-product of working on recipe development for the low carb bread book.

Out of necessity, many of the things I was actively doing suddenly came to a halt. For the next 4-6 weeks I have to wear a brace 24-hour per day that splints my thumb and wrist, and enables it to heal.  It is discouraging, but there isn’t much I can do about it. I apply ice, do my physio, wear the brace and focus on looking ahead.

In a way, tomorrow being the 5th anniversary of my journey encourages me.

While not the “mountain top experience” of a year ago, even in this temporary “valley”, things are SO much better than they were 5 years ago.

While I haven’t managed to lose all the 20 pounds I had put on during Covid as I had planned to do, I also haven’t regained my weight, either. My blood sugars are still good, and so is my blood pressure and that is something I am very thankful for, and to celebrate.

Despite the ups and downs, I am still moving forward. I continue to eat low carb and have no desire to eat any other way. I am metabolically healthy and that is a lot to be thankful for.

While we all go through ups and downs, it is what we do day-to-day that really counts towards putting diseases like type 2 diabetes and hypertension into remission.

People ask me why I “still” eat this way and the answer is easy. If I go back to eating the way I did before, I will become “fat and sick” like I was before, too! No, thanks.

For me, there is no looking back — only forward. From the mountains to the valleys, I choose to remain low carb for my ongoing health. 

I hope my story and persistence encourages you.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
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Copyright ©2022 The LCHF Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Video Update: Maintaining Weight and Health – Four Years Later

As I was heading out the door early this morning to begin walking again at the local track, I realized it was the same weather as it was more than four years ago, when I made my first video. I decided to wear the same glasses and rain shell that I did in that video and post the side-by-side comparison. This is that video update!

That first video was part of a post called “The Road to Better Health” in what I ended up calling ”A Dietitian’s Journey”, my personal weight-loss and health-recovery story.  In the post which accompanies that video, I mentioned how just three weeks earlier I was faced with two choices; (1) go on medication or (2) change my lifestyle — and on March 5, 2017, I chose the latter.

In retrospect, that video really marked the beginning of my journey, and over time hundreds of people ended up following me on social media in order to watch my progress. I never set out to do that, but I think the novelty of someone posting “before” pictures, before there were “after” photos caused people wanted to see if I would actually be successful.  I was — and I still am.

Here is that first video, which I posted on YouTube.  In it, you can clearly see how I was not only obese, but could barely walk and talk at the same time!

 

Since the weather was almost the same today, I thought it would be a great time to post an update to encourage those who have followed my journey from the beginning.

While it took me two years to attain my weight loss and put my diabetes and high blood pressure into remission, here it is more than 2 years since then and I have maintained remission of type 2 diabetes and hypertension.

Like most people, I gained almost 20 pounds over the past year due to the Covid pandemic, but I have already lost half of that and anticipate losing the rest by the end of the summer.

Everyone’s weight and health-recovery “journey” will be different. This is mine.

I hope this update encourages you that it is both “doable” and “sustainable”.

More Info?

If you’d like to know more about what I do, and how I may be able to help you achieve your own weight-loss and health recovery, please have a look under the Services tab, above. If you have questions, please send me a note using the Contact Me form and I will reply as soon as I am able.

To your good health!

Joy

You can follow me on:

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Losing My Covid 19 – (update) to Covid and Back – A Dietitian’s Journey

This article is an update to my A Dietitian’s Journey article, “To Covid and Back” that I posted on January 25, 2021. At that point, I was working hard at overcoming the post-viral arthritis that I was experiencing after (presumably) having had Covid-19 the first few weeks of August. I had a plan on how I was going to lose the 19 pounds I had gained during those weeks and the several that followed — due largely to decreased mobility.


It is 3 months since I wrote the last article, and 8 months since I was sick, and the last month has been huge!  It’s only in writing this article that I have been able to take stock in all that I’ve accomplished.

I realize that it has been a month since my joints have been swollen and painful — and I am very grateful for the recommendations of a wonderful Functional Medicine MD who suggested several nutraceuticals that really worked!  Even though I had looked up studies on them,  at the time I remained very skeptical,  but my pain and discomfort motivated me to give them a try as they were all very safe, albeit expensive. The last week or ten days due to decreased pain and inflammation in my joints, I have begun spreading out the dosage and so far so good. Last night I ordered more of each in order for me to continue with them in the days ahead, but at reduced frequency.

As for my “Covid 19” that I needed to deal with (the 19 pounds I gained during the 3 weeks that I was sick and the decreased mobility that followed), my plan was to lose it all by yesterday, May 1st — which would have been my father (of blessed memory)’s birthday. In retrospect it wasn’t at all realistic for me to expect to lose 19 pounds in 13 weeks by simply modifying my macros — when previous to getting sick, my BMI was well within the normal range, with an ideal waist circumference.  I would have advised a client that it was not reasonable to expect to lose that much with modest dietary changes when so close to goal weight, but I didn’t stop to consider that myself.  That being said, I did lose half that amount of weight during this time, as well as lose 2 of the 3 inches that I had put on around my waist, so I am very happy.  Currently, my waist is within an inch of being optimal, and by Canada Day this year (July 1st) I am hopeful that the remainder of my post-Covid weight loss goals will be realized.

Most importantly, since Covid I have regained my mobility (and then some!) — and for this I am very thankful! Last spring, before I got sick, I was reasonably active and fit and doing strength training once or twice per week, but by the end of August (after Covid) it was difficult for me to even walk up (or down!) a flight of stairs. This both shocked and scared me.

I began to go for walks — even though it was very hard.  At first they were literally just around the block, but I kept at it.  One of my young adult sons who lives with me kept encouraging me to walk, and would sometimes go with me.  As my legs became stronger, walks turned into short  inadvertent hikes’ and I discovered I really liked being out in the woods, even though it remained very hard to step up onto rocks, or step down from them.  I dug out the wood hiking staff that I brought with me when I moved from California and put it into service., invested in some hiking boots and other essentials’. As I said in the previous article, my hiking stick — along with my fuchsia rain gear has become somewhat of an identifier— but the truth is, without the hiking stick, I could not have possibly begun to hike.

My first breakthrough was in late November, when I did my 4th real hike which was 12 km around Buntzen Lake — which in terms of a few elevation gains was really beyond my capabilities. With frequent stops and lots of encouragement from my son, I did it.  I had to. He couldn’t exactly carry me back to the car! That day I felt as though I had beaten the post Covid muscle weakness and was on my way back to health.

Hikes 5 & 6 took me to Malcolm Knapp & Golden Ears East Canyon, then through the snow at Lynn Valley Loop in North Vancouver.  Hike 8 on January 16th was my second “victory” where I made it up and down 3 climbs that were above my capacity of 100 meters per kilometer, but I did it!

When I last wrote, I had just completed hike #9 at Lighthouse Park, in West Vancouver and while I found it difficult, my trusty hiking stick and I hiked down to ocean level by climbing on the large rocks, and between the crevices.

Nothing was going to stop me. Not the virus. Not the after effects, and not my discouragement and how much mobility I had lost.

Here it is 3 months later and I have since done a 9 km hike in the pouring rain at Hayward Lake (Feb 6 2021) with a hiking friend, and her husband.

Then I did a 3.2 km hike around Sasamat Lake (Feb 12, 2021) and when that wasn’t enough…we hiked over to Admiralty Point and did a 10.5 km hike down to Burrard Inlet.

a week or two later there was the “not a hike” hike on February 20th  to show my son and his fiancée Lower Falls at Golden Ears Provincial Park, which was my very first hike.  It was so easy, I didn’t even count it as a hike.

Hike 12 was March 6th at Thornhill Trail plus Silver Ghost and even though my hiking partner and I got lost, it was fun!!

Hike #13 on March 13, 2021 was a 13 km walk from Derby Reach to Fort Langley, via the Fort to Fort Trail by which time my feet were killing me!

It was not as rustic as I was used to and my boots were not designed for that type of walk.

That said, my hiking friend and I had a lovely walk and chat. The scenery across the Fraser River reminded me of my frequent camping trips to Maine when I lived in Montreal.

Hike 14 was to Menzies, Lookout and Loop Trail in Golden Ears Provincial Park on March 20th and I wasn’t going to let the waterfall from the torrential rain that week stop me!

My last hike on April 17th after a 3 week break (as my usual hiking partners were all busy) was, as they say in French, la pií¨ce de résistance!

Hike #15 was a 16.2 km hike on an unseasonably warm (25 degree Celsius) day was a 6 km hike down Valley Trail to the start of Viewpoint Trail.  Then, up to the top to the viewpoint, and then down something my son dubbed “Oh Sh¡t Ridge” — a brutal  “shortcut”  down a 175 ft. descent in only 500m (from 450 feet).

I was 1/2 the way down and the sun was now behind the trees and  I realized that there was no turning back in order for us to get back to the car before dark. Again, I had no option but to keep going.

Covid was not going to beat me. Jug Island didn’t beat me, and “Oh Sh¡t Ridge” wasn’t going to either!

When I got down, the first thing I did was bathe my face and upper body in a freezing cold mountain stream and it was the most wonderful experience I can remember in a very long time!! This is how I posted about that hike, the next day on social media;

“Yesterday I bathed in an ice-cold mountain stream. I managed to make it down a 175ft drop in 500m — climbing over several large fallen trees and under two large ones that blocked the path, using my arms to suspend myself. I pushed myself harder than I thought I could because I had no choice (we HAD to get down and started that way). I am stiff and sore — and feel WONDERFUL. #livinglifetoitsfullest”

 

Even though I had what my doctor and I presumed was Covid back last August, I made the well-thought through (albeit difficult) decision to take the vaccine last week when I became eligible — mainly because I am older and prior to two years ago had several known “pre-existing conditions” that make outcome in Covid more risky.

My original “A Dietitian’s Journey” was my health and weight recovery from obesity, type 2 diabetes and hypertension which took place from March 5, 2017 – March 5, 2019.  For the following year and a half, my weight, waist circumference and blood sugar and pressure were all stable, without medication. The last 8 months have been my return from a little ‘detour’, that I’ve called “from Covid and back”.

I’m not naí¯ve.

Maintaining a 55 pound weight loss is not easy. It takes diligence and determination and even though I gained almost 20 pounds and 3 inches around my waist after having been sick, I am more than half way “home”.  I look at my face in the mirror and am satisfied with the reflection looking back. I think, “not bad for an ‘ol lady’!

While my weight loss was not what I had unrealistically planned, I also need to factor in the inch or so of muscle that I have gained on each of my legs from hiking, and my arms are stronger too from supporting myself on my trusty stick. I have conquered obstacles that I hadn’t even dreamed of doing before I had gotten sick and discovered a love of hiking that I would not have known, if not for this ‘detour’.

We are all on our own ‘journeys’ and even though they are not always linear or what we planned in advance, we can be either be resigned to the inevitable outcome or fight with everything we have to reclaim our lives and our health, and become even better than before.

This is what I have chosen, and keep choosing.

If I can help you on your journey, please let me know.

To our good health!

 

Joy

 

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd

 

Copyright ©2021 The LCHF Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

A Dietitian’s Journey – rewriting the script of my life

INTRODUCTION: We CAN change the storyline of our lives and this is a short post about how I set out 4 years ago to put my type 2 diabetes, high blood pressure and obesity into remission. I met that goal 2 years ago, and 2 years later I’m achieving things I never thought possible!

Remember, everyone’s health recovery journey will be different. This is my story.


March 5, 2017, I was obese, had type 2 diabetes for 8 years and had dangerously high blood pressure. In the previous 6 months I had two girlfriends die — one of a heart attack and one of a stroke and like me, both were in healthcare. I new that unless I changed what I was doing, I stood the risk of being next. I began following a low carbohydrate meal pattern, then lowered it to a ketogenic level and two years later (March 4, 2019) I was normal body weight, with optimal waist circumference, normal blood pressure, and was in remission of type 2 diabetes. In addition, with my doctor’s oversight  I had gotten off 12 different types of prescription medication.

Today, March 4, 2021 is the 4th anniversary since I began to reclaim my health and my life, and to celebrate the two years that I am in remission and off meds, I have put together two 30-second video clips that capture it best.

The first 30 second video clip was taken just 3 weeks into “A Dietitian’s Journey” in March 2017 where it is very obvious that I can barely walk and talk at the same time.

Hear past the huffing and puffing, to the voice of determination.

The second short video clip was taken this past summer when I was a guest on Laban Ditchburn’s Become Your Own Superhero podcast*.

Listen to my response when I was introduced.

It say’s it all…

 

* you can find a links to the podcasts I have been a guest on under the About Me tab.

Rewriting the Script of My Life

January 26, 2021

The photo on the left is me hiking in North Vancouver this winter.

Four years ago I could barely walk and talk and now I am hiking! If someone would have told me then that this was possible, I would not have believed them.

Golden Ears Provincial Park, December 19, 2020

The photo on the right is me hiking in Golden Ears Provincial Park in Maple Ridge, BC.

West Vancouver, January 23, 2021

While I can’t get back the years I spent overweight and sick, I can live today and the days I have ahead enjoying my health and celebrating life to the fullest.

I am continuing to re-write the script of my life one day at a time and having the joy of helping others do the same.

 

More Info?

If you would like to know how I support others in their health-recovery journey, please have a look around my web page and if you want more information, feel free to send me a note through the Contact Me form.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd

 

Copyright ©2021 The LCHF Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

 

 

 

A Dietitian’s Journey – to Covid and back

It’s been a while since I wrote an update to A Dietitian’s Journey but it’s “time”. A lot has happened since then.  Last year at this time, I wrote one of my last updates about my most recent lab tests and coming to terms with what 55 pounds of weight looks like as compared to a 5 pound fat model I had purchased for use in my practice. Not quite 2 weeks later, I posted the first of several articles about a novel coronavirus that was discovered in Vancouver, in someone who had not visited China. At this point, the virus did not yet have a name — a name we all know too well now, Covid.

How the world has changed since then.

We have all been through many changes. Some of us have had family succumb to Covid, others of us have had people we know live through it, and some of us have had it ourselves.  We’ve all had our movements limited to varying degrees, and have faced shortages of everything from food to bathroom tissue. Some have lost their businesses, their homes and their sense of security due to Covid, while many of us haven’t seen loved ones in what seems like way to long, because it is.

And we’re not “done” it seems.

Even with the two mRNA Covid vaccines that are currently being given, we are being told that it may only keep the person themselves from getting sick, but that they still may be able to transmit the virus. We’ve also become aware recently that the studies are based on a specific timing between the first and second dose — something other than what reality is dictating. We wonder if the arbitrary timings, or the mix and match vaccines will be anywhere “as effective” as studies indicated, or effective at all.

Shifting Gears

In mid-July, after making the decision to close my in-person professional office, I had a photoshoot to get ready to re-launch my Dietetic practice as on-line only. Due to Covid, the photographer wore a mask the entire time. Whenever I went out to get groceries, I too wore a mask and sanitized my hands frequently. Nevertheless, two week’s later I was sicker than I had been in years.  Because of Covid being “a thing” and the unusualness of my symptoms, as I did with my weight- and health-recovery journey, I kept notes about my symptoms and how long they lasted. While I never had a fever or a cough, I found out at the time that only 50% people get either. That’s not what I had thought until I looked it up — in fact all the “warning” information at the time listed fever and cough as ‘first’.

Covid – not what I would have expected

I had symptoms that I didn’t think were ‘typical’  of Covid, including back pain, and a non-stop headache.  While the temperature outside had soared to the mid-30s°C  (~100° F), I had blue lips and just couldn’t stop shivering. The headaches wouldn’t let up, and then there were the muscle aches that had set in. I called my doctor and let him know I was self-isolating but since the line-up for a nasal swab at that point in time was ~ 6 hours, there was no way I was up to doing that. He recommended that I continue to self-isolate for 2 weeks in total and assume that I was positive, which is what I did. The muscle pain and weakness and tingling and numbness in my fingertips left me unable to do much else, anyways. I still worked part days and when I wasn’t working, I was resting. After 3 weeks, I stopped keeping notes, because the lingering symptoms were the same.

Lingering Disability

After all was said and done, what remained was muscle weakness and joint pain. The joint pain I understood having been under the care of a rheumatologist for a year after being diagnosed with post-viral arthritis after contracting rubella in my early 20s. At that point, the pain was in my hands, feet and hips, not my knees, but since both post viral arthritis and reactive-arthritis are both documented post Covid, it made sense.  The lingering muscle pain did not.

I went from being reasonably active and fit in the spring, to finding it difficult to even walk up or down a flight of stairs by August. I expected it somewhat while I was sick, but what I didn’t expect was to have come very close to losing my mobility. This scared me. No one loses mobility that quickly!

The some pieces started to come together. I stumbled across an article about Covid that was written by an MD from UT Southwestern Medical Center in Texas and which indicated that pain and muscle weakness is known to be related to actual muscle damage resulting from the illness [1]. 

“A study published in Emerging Infectious Diseases found that rhabdomyolysis, a breakdown of muscle tissue, may be a late side effect of the virus. During this breakdown, enzymes such as creatine kinase and lactate dehydrogenase enter the bloodstream.”

At the time I was telling friends and family members that it felt as if I had ‘lactic acid build up in my muscles’, except that I didn’t do any exercise. The article resonated. Lactic acid IS lactate dehydrogenase. It was like a bread-crumb trail in which the various pieces ‘fit’.

The Road to Recovery

Once I was well enough, I began to go for walks, even though it was very hard. Just walking the stairs was hard. I forced myself to walk.  My first walks were literally around the block, and were difficult.  I kept at it.  One of my young adult sons kept encouraging me to walk, and would go with me.  As my legs became stronger, walks turned into short ‘hikes’. I discovered I really liked being out in the woods, even though it remained very hard to step up onto rocks, or step down from them.  I dug out my wood hiking staff that I brought with me when I moved from California and put it into service. Wearing winter boots wasn’t working out, so after my first ‘hike’, I ordered my first pair of hiking boots. It ended up being the beginning of several orders in order to get the ‘essentials’.

November 21, 2020 – Hike # 3 – Golden Ears Provincial Park, East Canyon

My hiking stick, along with my fuchsia rain gear has become somewhat of an identifier– but the truth is, without the hiking stick, I could not have possibly begun to hike.

Each week, I pushed myself a little harder and did a little more.

On hike #3 to Golden Ears Provincial Park, I met Jackie and her husband and found out from her about a local ladies hiking group, and joined as soon as I got home. There are no group hikes currently for obvious reasons, but those days will come.

Hike #4, November 28, 2020, Buntzen Lake

On November 28, 2020, I did hike #4 at Buntzen Lake. It was 12 km and was really beyond what I was capable of, but with frequent stops and the encouragement of one of my young adults sons, I did it.

I had to. My son couldn’t exactly carry me back.

I came home exhausted, but feeling very satisfied.  I had almost lost my mobility, but I didn’t.

That day, I felt as though I had ‘won’.

When I got home, I decided to invest in myself and ordered some more essential hiking gear.

Hike #5 – December 5, 2020, UBC Malcolm Knapp & Golden Ears East Canyon

At the beginning of December, I hiked the Red Trail at Malcolm Knapp, but found it too short, so then hiked the Yellow trail, too. I found them easy and there was still time before it would start to get dark. My legs were stronger than they had been in ages, so I drove over to Golden Ears to do the East Canyon again, which was my first real “hike”.

It felt amazing!!

For the first time since I got sick, I felt like “me” again.

December 12, 2020 was hike #6 to North Vancouver, and the Lower Lynn Valley Trail.

We didn’t expect to encounter snow when we set out up the trail, but there was plenty of it about half way up and it got heavier. It made things slippery. I hadn’t yet bought mud or ice ‘crampons’, but I soon realized I would need these next.

Even though it wasn’t that cold, I experienced some numbness in my fingertips — like I did when I had the virus. I tried to ignore it, but found it very disconcerting.

Hike #6, Dec. 12, 2020, Lynn Valley Loop, North Vancouver

I borrowed a pair of heavily insulated gloves, but it took a good hour before I could feel my fingers again. Little reminders like this pop up now and then, reminding me that what I had was nothing like anything I had experienced before.

December 19th was just a local hike along the Coquitlam River, to Crystal Falls.  It had been raining a lot the previous week, and the trail was very muddy. Each hike presents new challenges to my recovering muscles — sometimes trails are rocky, other times made from bark and peat moss, then there is snow and ice, and slippery mud.  Each change in the environment forces me to use muscles that I hadn’t in previous hikes or use them in different ways — and this is exactly what I have needed to recover my strength and mobility.

As I had to do in my first hike at Golden Ears, this trail had streams to cross by stepping on rocks.  It required some degree of co-ordination and agility that I used to have, but had lost. It was perfect “rehab”.

I misstepped and totally soaked one foot, but thankfully the hiking socks I had bought did their job. Nothing was going to deter me.  This was therapy — both for my  body and soul.

Hike #8 January 16, 2021, Jug Island

Hike #8 on January 16, 2021 was the first of the new year. It had been two weeks that I hadn’t hiked and I was apprehensive that I wouldn’t make it. It started out very steep and I almost chickened out.  My son encouraged me that “we are here now” and so I pushed myself on.  It was hard. There were step-ups that I couldn’t do, but I was determined to make myself do them by engaging my core, my knee muscles and my glutes.  When all else failed, there was my hiking stick!

 

There were three ascents on the trail and when I completed the final one, I caught view of the salt water of Indian Arm and Jug Island.  The view was beautiful and so serene.

I made it! 

Of course, I still had to hike all the way back. Again, what choice did I have? I was there and had to go back.  Since there was no way of backing out, I just did it. It felt like I conquered something, even if it wasn’t impressive by anyone else’s standards.

This past weekend I did Hike #9 at Lighthouse Park, in West Vancouver.

We took a wrong turn on the trail and ended up on some other trail than the one we planned but it served the purpose of exercising my legs, knees and glutes.  Then we headed over to the coast to enjoy the sound of the water lapping on the shore and the clear winter sun.

Hike #9, January 23, 2021, Lighthouse Park, West Vancouver

With difficulty, I managed to hike down on the large rocks and between the crevices and when all else failed, there was my trusty hiking stick.

Nothing was going to stop me.

Not the virus. Not the after effects and not my discouragement.

 

 

 

UPDATE (January 31, 2021): Reality and determination are separate things.  I am reluctantly learning to balance the ‘work’ needed to rebuild the muscle that supports my knees, with the ‘rest’ required due to post-viral arthritis in the joints themselves. I am just hoping the latter doesn’t take the year it did when I was in my early 20s, after I contracted rubella.

In a way, my current “health recovery” is not unlike the one I began 3 years ago in March. It requires the determination of doing it as if my life depends on it, because it does.

While I got through half of the pandemic without weight gain, the month long virus and residual symptoms took their toll.

Like many others, I am 19 pounds up — my Covid 19.

Without access to antibody testing, it is officially unknown what I had but presumed to have been Covid. Given the symptoms I had and especially the residual effects, I think it’s reasonable to suspect what it was. At some point, I will know for sure.

Losing My Covid-19

This morning I decided to take pictures of what I look like currently, and have started on a new goal of re-attaining my previous weight by what would have been my father (of blessed memory)’s birthday.

By May 1, 2021 (13 weeks from now) I intend to lose the weight that I gained which is mainly sitting in the worse place possible health-wise — around my middle. 

I am posting this to encourage others that while re-gaining lost weight is not ideal, life happens.

The last year has been anything but normal. Just as I lived my “journey” out in the open from beginning to end — from being an obese Dietitian with type 2 diabetes and high blood pressure, to being normal body weight and waist circumference and in remission of those metabolic conditions, I am doing the same this time. I am not letting my current weight discourage or dissuade me. It is what it is.

If you’ve put on weight during the pandemic — regardless the reason, I invite you to join me on the road back.

To our good health!

Joy

 

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd

References

Barker, Kim MD, Life after coronavirus: Physical Medicine and Rehabilitation (PM&R) helps patients beat muscle weakness, brain fog,  UT Southwestern Medical Center, June 4, 2020.

Jin M, Tong Q. Rhabdomyolysis as Potential Late Complication Associated with COVID-19. Emerg Infect Dis. 2020;26(7):1618-1620. https://dx.doi.org/10.3201/eid2607.200445

 

Copyright ©2021 The LCHF Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

 

 

My Three Year Health Recovery Anniversary — a Dietitian’s Journey

I delayed posting this update to “A Dietitian’s Journey” due to the current Covid 19 pandemic, but thought by now we could all use with a little distraction. I hope that this post about my health and weight recovery serves as encouragement as to what is possible simply by eating real, whole food, and sticking with it.

Me – April 2017, 2019 and 2020

Three years ago, on March 5th, 2017, I was sitting at my desk in my office and I didn’t feel well. I didn’t even know what kind of ”unwell” I felt.  I decided to take my blood pressure to see if that would give me a clue.  I was alarmed with the results and decided to lie down and take it again. That didn’t help. Not only was my blood pressure high, it dangerously high.  I was having what is known as a “hypertensive emergency”.  While I hadn’t done so in way too long, I also decided to take my blood sugar. The result was 13.2 mmol/L (238 mg/dl) only a half an hour after I ate, which was way too high — even for someone who had been diagnosed with type 2 diabetes five years earlier.  Here I was, an obese Dietitian with a body mass index (BMI) well over 30, dangerously high blood pressure and blood sugar that clearly showed my type 2 diabetes was not well controlled and I knew that all of these factors put me at significant risk of having a stroke or heart attack. I was scared. Actually I was terrified.

As I’ve said on every podcast I’ve been a guest on, and have written about many times, what I should have done at that point was to have gone straight to my doctor’s office;  even knowing that he would have sent me directly to the hospital by ambulance or taxi due to my dangerously high blood pressure.  I should have gone, let them treat me to get my blood pressure down, including taking the medications they prescribed.  Then, with my doctor’s oversight I could have begun a well-designed therapeutic diet to lower all of these significant metabolic markers and in time had my doctor gradually de-prescribed the various medications I would have been given, as my weight, blood pressure and blood sugars normalized.

I didn’t. It was foolish. What I did instead was to immediately change my diet and lifestyle and while I fully acknowledge that this was not a wise choice, that’s what I did.

I was so scared.

In the preceding 6 months, I had two girlfriends die within 3 months of each other; one of a massive heart attack, and the other of a stroke. Both worked in healthcare their entire lives and both had become overweight and had developed some of the same metabolic issues I had. I was terrified because I realized that if I didn’t change, I could be next.

March 16 2017

That day, I printed off my last set of blood test results, and took all my body measurements as if I were a client. I then designed a Meal Plan for myself as I do for others and from that day on, implemented it ”as if my life depended on it”, because quite literally, it did.

There’s been no looking back! March 5, 2017 was the beginning of my health and weight recovery journey; A Dietitian’s Journey.

April 2018

In the first year, I lost 32 pounds and 8 inches off my waist, and my glycated hemoglobin (HbA1C) no longer met the criteria for Type 2 Diabetes (i.e. was ≤ 6.0 %), and my blood pressure ranged between normal and pre-hypertension. Updated lab work indicated that my triglycerides and cholesterol levels were optimal, however my updated measurements showed that my waist circumference was still not half my height, which is what it needed to be (you can read more about the reason for that here.). In addition, my fasting blood sugar remained higher than it should be. I still had work to do. I was in recovery, but not recovered yet.

After consulting with two physician colleagues, I made the decision to lower my carbohydrate intake, and continued to monitor my blood pressure daily and blood sugar several times per day.  I also began doing some resistance training exercises with equipment I had on hand (and that had been collecting dust for years).

April 2017 & April 2019 (same outfit)

After 2 years on my recovery journey, I had lost a total of 55 pounds and 12 inches off my waist but since my blood pressure remained between the pre-hypertensive and hypertensive range, and in discussion with my doctor’s colleague, I decided to go on a ”baby dose” of Ramipril to protect my kidney function. Even though my blood sugar was good and my HbA1C was below the cut-off for type 2 diabetes, my endocrinologist started me on Metformin as a result of my father’s recent diagnosis of Alzheimer’s disease.

I didn’t look at starting on either of those medications as “failure”, as I probably would have been prescribed those at much higher doses from the beginning had I gone to see my doctor March 5, 2017. It was part of my recovery process. My goal however was to make changes so that blood pressure medication would no longer be necessary, but I didn’t know what other changes I could make to have it to come down to a normal level, and for my fasting blood glucose to continue improve as well. After much reading in the scientific literature about circadian rhythms , I realized that to be successful I needed to change when I ate (and didn’t eat) as well as when I was exposed to bright light in order to get my body working according to its natural circadian (24-hour) cycles. I made the changes documented in the literature and began to sleep much better (falling asleep and staying asleep, when I had previously had poor sleep for years). After just a few months, home monitoring indicated my blood pressure was normal or slightly below normal and I was getting fasting blood glucose numbers I hadn’t seen before (4.7mmol/L – 5-2 mmol/L). I hadn’t “arrived” but my recovery phase was definitely approaching the end.

A visit to my doctor’s office just before Covid 19 began indicated I had blood pressure that was just below the normal cutoff of 120/70 for someone who is not diabetic, so my doctor deprescribed the blood pressure medication.  Recent lab test results also indicated that I have completely normal fasting blood sugar [5.2 mmol/L (94 mg/dl)].  Over the past year without trying, I lost another 5 pounds and a little less than an inch off my waist and I am guessing this was probably the result of continued loss of fat balanced by increased weight from added muscle I gained as a result of the intermittent resistance training I was doing.

April 2020

I am now a normal body weight. I have an optimal waist circumference (slightly less than half my height). I am in remission of type two diabetes; both as assessed by fasting blood glucose and HbA1C, and my high blood pressure is in remission. I went from taking 12 different medications three years ago, to leaving my doctor’s office a few weeks ago with one prescription for something non-metabolically related, and a prescription for glucose test strips.

I feel good about myself, about my health and how I look — so much so that in September of this past year I decided to stop straightening my hair and now wear it the way it grows out of my head.  I am “comfortable in my own skin” (and hair) for the first time in almost 3 decades. I didn’t lose weight quickly but it took me many years to become THAT metabolically unhealthy that I gave myself the time I needed to get well and am staying well, without any added effort. The process wasn’t at all difficult to accomplish, or difficult to maintain. All it took was eating real, whole food and reducing the amount of carbohydrate-based foods I ate.  What is nice is that after 3 years on a therapeutic diet, I am now able to add in small amounts of higher carbohydrate-based whole foods into my diet, and tolerate them very well.

While there are many studies showing many others have accomplished similar clinical results as I have eating the same way, doing it myself enables me to encourage my clients because I have “been” there, and I came back!

More Info?

If you would like more information about how I can help you lose weight and keep it off or improve blood pressure, blood sugar or cholesterol please reach out to me. All my services are now provided via Distance Consultation but I already have more than a decade of experience providing virtual nutrition support, so this is nothing new for me.  I am licensed as a Dietitian in every province in Canada except PEI and can also provide nutrition education services to those in the US and elsewhere.

You can find more about the details of the different packages I offer by looking under the Services tab or in the Shop. If you have any service-related questions please feel free to send me a note using the Contact Me form above, and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2020 LCHF-RD (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only. The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything you have read or heard in our content.

 

Five Pounds or Fifty Pounds of Fat – in very real terms

Whether one loses 5 pounds of fat or 50 pounds of fat, I think it is very helpful to visualize just how much that is. Yes, five pounds of fat is much larger than most people realize!

This past week, I purchased a life-sized model of 5 pounds of fat from a well-known nutrition supplier; the same supplier I have purchased life-sized food models from, which I used to use a lot in my practice.  When I received it, I was quite surprised how much room it took up and just how heavy it was.

Here is a photo of the life-sized model 5 pounds of fat on a scale, with my left hand for a size reference:

5 pounds of fat on a scale, with adult hand as reference – © BBDNutrition

Here is a photo of it on an ordinary steno chair:

5 pounds of fat on a steno chair – © BBDNutrition

…and here is 5 pounds of fat being held in my hand:

5 pounds of fat in adult hand – © BBDNutrition

Finally, here is 5 pounds of fat being carried as one would carry an infant:

holding 5 pound of fat – © BBDNutrition

Five pounds of fat is a lot! Sure there is the initial water-loss at the beginning of weight loss, but here I’m talking about fat.

Fat takes up a fair amount of room around one’s waist, or worse inside one’s abdomen or organs. If someone has 20 pounds of fat to lose, that is four of those fat models distributed over their body; legs, belly, arms, neck, back and face and perhaps some in their liver.

I had 55 pounds of excess fat before beginning my health- and weight-loss recovery journey.

Comparing these two full length photos, it is easy to see how I had the equivalent of one of those fat models over the length of each leg, one distributed between each arm, one distributed over my neck and face and 2 spread out around my waist and hips and some no doubt, in my liver and pancreas. But still, I can’t actually imagine where I was carrying 11 of those, all told! It must have been packed in pretty tight.

No doubt, the fat in my abdomen must have been more than I imagined as it was wreaking metabolic havoc on my body.  I had very high blood pressure and had type 2 diabetes for 8 years.  You can read the entire story (including lab test results) under “A Dietitian’s Journey“,  by clicking here.

Whether you have 5 or 10 pounds of fat to lose, or like I did ⁠— a whole lot more, it is really only done a pound or so at a time.  If you have significant amount of weight to lose,  I can not only help you do that, but since I’ve been through it myself, I can encourage you and coach you through it. I provide services across Canada (except PEI) via HIPAA-compliant video conferencing, and most extended benefits providers will reimburse for licensed Dietitian services.

More Info?

If you would like more information about the services I offer, please have a look under the Services tab or in the Shop for more information. If you have service-related questions, please feel free to send me a note using the Contact Me form above, and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2020 LCHF-RD (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

A Dietitian’s Journey – update of lab tests and metabolic markers

Recently, my endocrinologist requisitioned a fasted c-peptide and a fasting blood glucose (FBG) lab test which enabled comparison with results done fasted and at the same time of day 4-1/2 years ago. At that point in time, I had been type 2 diabetic for 4 years. This article is an update.

In August 2015, my FBG was 9.7 mmol/L (175 mg/dl) and my c-peptide was 569 nmol/L (1.72 ng/mol).

Using Oxford’s HOMA2-IR calculator, it is easy to see that I was quite as I was well over the 1.00 to be insulin resistant (IR=1.56) and my estimated steady state beta cell function (%B) was only 32.7%.

With my endocrinologist’s encouragement, knowledge and support, I began to implement a low carb dietary approach. Unfortunately, in November of that year, a family matter ended up derailing things, and while I could have (should have!) restarted a therapeutic low carb in January 2016, when I could, I didn’t.  As written about in an early entry to this journal, I was in classic denial as to just how metabolically unwell I was.

It wasn’t until March 5, 2017 when my blood pressure had reached a hypertensive emergency that I changed. At that point, I was obese, had uncontrolled type 2 diabetes and severe hypertension. You can read about this in the first entry to this personal account. My life literally depended on me improving my off-the-chart metabolic markers, and for me sticking with my endocrinologist’s recommendations was essential.

If you’ve read though my “journey”, then you already know how two years later, I had lost over 50 pounds, lost 12 inches off my waist, and brought my HbA1C down to the high end of the normal range, but that I still had moderately high blood pressure. Over the past year, I adopted changes to my daily routine based on the research of circadian biologist, Dr. Sachidananda Panda of Salk Institute’s research, as it had evidence for lowering cortisol and blood pressure. It did. After 3 months, my GP halved my high blood pressure medication and it’s been 3 months since I have been off them completely, with absolutely normal blood pressure. My 3-month glycated hemoglobin (HbA1C) results have remained just about 6.0% for the last year, which is good (i.e. normal for a non-diabetic), but not as good as I would like it. I still have work to do.

As mentioned above, recently my endocrinologist re-ran the above tests and in December 2019, my FBG was 5.2 mmol/L (94 mg/dl) which is normal for someone who is non-diabetic and my c-peptide was was 531 nmol/L  (1.6 ng/mol).

Using Oxford’s HOMA2-IR calculator again, here is the update:

I was almost completely below the threshold of 1.00 definition of being insulin resistant (IR=1.19) and my estimated % beta cell function (%B) had gone up to over 98%. I was encouraged by this update.

Comparing my August 2015 and 2019 update results, my muslin resistance significantly improved, and my steady state beta-cell function did too (from 33% to 98%), while FBG fell to well below the normal cutoff of 5.5 mmol/L (99 mg/dl). This seems to indicate that I regained some beta-cell capacity.  In 2015,  when my FBG was 9.7 mmol/L (175 mg/dl), my pancreas “wanted” to do more, but couldn’t. What this update shows is that at the end of 2019, my pancreas was able to do what was required.

It is reasonable to assume, that in another year or so that when I update these labs again (given I continue to minimize carbs) that my FBG is going to be lower, which could actually make my steady-state beta-cell function lower (yes, lower) because with the improved insulin sensitivity, less insulin will be needed. My pancreas will have to work less hard, leaving more capacity for a second phase  insulin response (which clearly I don’t have yet, from my recent half-a-donut story, available here).

Theoretically, if I wanted to assess my body’s actual insulin response to a carbohydrate load, I could have a 3-hour Kraft Assay performed, which would measure my blood sugar and insulin response at fasting, and every 30 minutes for 3 hours. You can read more about that here. This test is quite costly and I would need to justify the need in order for my endocrinologist to requisition it. As well, since I normally eat low carb in order to manage my blood sugar levels, I likely have what is called “physiological insulin resistance”, which is where the body spares glucose by reducing glucose uptake. This is very different than the “pathological insulin resistance” I referred to above, which is due to the body ignoring insulin’s signals to uptake glucose due to hyperinsulinemia (chronic high levels of circulating insulin) which accompanies uncontrolled type 2 diabetes and pre-diabetes. I have several previous articles about this topic that you can read by searching for “hyperinsulinemia” in the search bar in the lower left hand corner of this web page. In any case, if I wanted to have a 3-hour Kraft Assay to assess my first and second stage insulin response (and by proxy, beta-cell function) I would need to eat between 100 and 130 g of carbohydrate per day for a week or 10 days, in order to lower physiological insulin resistance prior to the Kraft Assay.  At this point in time, this is not something I feel is necessary, but maybe in a year or more, when my FBG and HbA1C comes down even more, it may be interesting to do.

While I have been in partial remission of type 2 diabetes for about 6 months (explained here), my donut adventure clearly indicates that I have not reversed (“cured”) it.

While I many not ever recover my pre-diabetic beta-cell function, being in remission is a very good thing! My symptoms of the disease are gone, lab tests are in the normal (non-diabetic range), and I have lowered my cardiovascular and metabolic risks. Remission, in my option, is the next best thing to reversal.

Some final thoughts…

Critics of a low carb / very low carb (ketogenic) diet say that it is ”not sustainable” but for me (and many others too), eating real, whole food is very sustainable! For me, my life and my health depend on me remaining in remission, and that is all the motivation I need.

More Info?

If you would like more information about the services I offer, please have a look under the Services tab or in the Shop for more information. If you have service-related questions, please feel free to send me a note using the Contact Me form above, and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
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Copyright ©2020 LCHF-RD (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Holiday Eating: a harsh reminder that I am not ‘cured’- a Dietitian’s Journey

I was eating low carb for a year and following that, eating keto for 1.5 years, and for the past 6 months I’ve been in partial remission of my type 2 diabetes (with HbA1C significantly ≤ 6.5%). Two weeks ago my fasting blood sugar (FBG) was assessed at the lab as being 5.2 mmol/L (94 mg/dl), so for all intents and purposes, it is though I am not diabetic (normal HbA1C and normal FBG). My blood pressure too is totally normal (120/70) — which is a huge drop from the hypertensive emergency level that started me on my “journey” March 5, 2017.  I feel well and I look well and provided I continue to eat a very low carbohydrate diet, I am well. But this past weekend, I had conclusive evidence that I am NOT cured of my type 2 diabetes!

Sunday I was invited over to a friend’s house for a holiday party and I decided for the first time in as many years to eat “off plan”; not that I haven’t had the odd taste of something , but I’ve not had an off-plan meal in two and a half years. This past Sunday, I did.  I didn’t go crazy — certainly not as when compared with all of the goodies I would eat at special events in the past. I had a few homemade falafel balls, 1/2 a potato pancake and 1/2 a freshly made donut, and the rest of what I ate was baked salmon, low carb veggies and club soda. 

Naturally, I expected my blood sugar to be elevated afterwards, but an hour later it was 11.3 mmol/L (204 mg/dl)!! That is the above the 10.0 mmol/L (180 mg/dl) blood sugar level cutoff where the body excretes the excess sugar in the urine (called glucosuria). I was clearly still very diabetic (i.e. not cured).

I had some Metformin in the house and took one tablet and also did 20 slow squats in order to coax my muscles to accepting the excess blood sugar. An hour later my blood glucose was 8.6 mmol/L (155 mg/dl); still very much above the so-called “ideal” of 7.8 mmol/L upper cut-off for someone with type 2 diabetes. An hour later my blood sugar was 6.8 mmol/L (123 mg/dl).  Dejected, I went to bed.

I woke up 3 hours later to use the washroom (not surprising given my body was trying to get rid of so much excess sugar!!) and I decided to test my blood sugar one more time to see what it went down to. It was 4.1 mmol/L (74 mg/dl)) — which is usually what it is after a day-long fast. To be sure, I checked the result 3 times. Surprisingly, I was still producing small amounts of ketones 0.3 mmol. It was evident was that my muscle (as a bi-product of my significant weight loss (50 pounds) and encouraged by the squats) and my liver (also a bi-product of my significant weight loss and encouraged by the Metformin*) accepted the excessively high sugar load and the rest left via my urine. This is certainly a MUCH better response than I had to eating carbs 2 – 1/2 years ago, but by no means am I “cured”. I am still a person with type 2 diabetes, just in remission.

*the Metformin helped suppress the breakdown of fat from my fat cells (lipolysis) and the resulting release of glycerol, since I had all that sugar to use. I also helped promote glycogen storage.

Despite having had type 2 diabetes for 8 years prior to adopting a low carb lifestyle, I did have a first-phase insulin response to eating all those carbs, but it was clearly inadequate. I did have a second phase insulin response, but having been eating only low carb, my pancreas was not used to such a huge sugar load. It was ill-prepared. As a result, my blood sugar hit glucosuria levels (above 10 mmol/L), resulting in my body dumping excess sugar in my urine. 

It’s hard to know what my first phase and second phase insulin response would have been had a eaten 100 or so grams of carbs for 3 sequential days before eating this huge carb load, in order to prepare my pancreas (i.e. this is what is encouraged for those eating low carb before having an oral glucose tolerance (OGTT) test).

It’s also hard to know how much of the improved insulin sensitivity was due to my significant weight loss and resistance exercise that I am doing and how much was due to the Metformin I took, but I have NO desire to repeat this experiment without the Metformin, in the interest of science!  In fact, I am VERY content to go back to eating “on-plan” and letting my body recover from the excessively high carb load I gave it. The harsh reality is I am not cured. I still have type 2 diabetes. I am just in remission, provided I continue to eat a very low carb diet.

I’ve been in partial remission of type 2 diabetes for about 6 months now, but I have clearly not reversed (cured) it.  For an explanation of the difference between partial-, complete- or prolonged-remission and reversal / cured, please click here). As discussed in that article, remission of type 2 diabetes can occur with weight loss of ≥ 15 kg (33 pounds) which either results in restoration of β-cell function by either (a) β-cells being reactivated or (b) by existing β-cells functioning better and this is what I’m experiencing. I am in partial remission (using Virta Health’s definition) as my HbA1C < 6.5% using only occasional Metformin, and my fasting blood glucose ≤ 5.5 mmol/l (100 mg/dl).

Diabetes reversal (i.e. being “cured”) is where a person no longer has the symptoms of type 2 diabetes (which has been documented to occur), but is clearly not my case! I am still very much diabetic. But I don’t have any symptoms, provided I continue to eat a very low carbohydrate diet.

Some final thoughts…

Critics of a very low carb / ketogenic diet say that it is “not sustainable”, but when the option for me of not eating this way is to have responses as above, eating real, whole food (instead of refined, prepared foods) is very sustainable! Have a look at some of my articles about what I eat, my posts on Instagram and my recipe tab, you’ll see that I am not suffering!

Those who have been following my “journey” from the beginning know that I had two girlfriends who worked in healthcare die (one of a heart attack and one of a stroke) before I faced my own health crisis in March 2017. I changed March 5th of that year and have not looked back. I do it for me. I do it for my young adult sons. I do it for Kim and Jane who didn’t get the opportunity to change their lifestyle before dying prematurely.

We’ll hear people who advise others to do something “as if their life depended on it” and for me, eating this way is just that. My life (via cardiovascular health) and my quality of life (having my vision, all my toes, etc.) depends on it.  It’s all a matter of motivation and that is mine.

What’s yours?

Perhaps you want to lose weight for health reasons, or for aesthetic reasons or to eat less carbs to bring down high blood sugar or lower a risk that you know runs in your family. Whatever your reasons are, I can support you in accomplishing your goals.

More Info?

If you would like more information about the services I offer, please have a look under the Services tab or in the Shop for more information. If you have service-related questions, please feel free to send me a note using the Contact Me form above, and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2019 LCHF-RD (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Embracing Health and Self-Acceptance – a Dietitian’s Journey

Yesterday, with some encouragement from others, I went to a hairdresser that specializes in cutting “curly hair”. In one sense, it was life-changing to have my hair cut to actually “be” curly, and in another it was another step in my “journey”, a Dietitian’s Journey. My “unruly” hair was not unlike being overweight and in poor health; all were barriers to looking and feeling the way I wanted, but not something I dealt with until recently.

I saw my hair’s texture as a barrier to having the smooth, silky hair I desired and that I saw in the media as being something to be valued.  Growing up, naturally curly or wavy hair was seen as unruly; something that needed to combed or brushed and restrained in some way, in a clip or pin of some kind. Yet older women went for “perms” and these man-made curls were placed where they were desired, in the size that was desired and coloured to the chosen shade.

Growing up in the early 1970s, being overweight was solved with “girdles”; just like unruly hair was solved with combs and hair clips. For those that are unfamiliar with “girdles”, they are essentially torture devices that women squeezed into to arrange their fat in a more acceptable manner, and at least keep it from jiggling where it offended others and embarrassed the individual. Wearing a girdle wasn’t about health; but appearance.

Around this time the “health at every size” movement became popular, but it wasn’t until I was a Dietitian that it came to my awareness. The overweight women around me were not into acceptance, but denial and girdles were their solution.

In the 1990s, I was torn between the reality that being overweight or obese was rarely associated with positive health outcomes, yet at the same time knowing there was a need to be compassionate toward those who themselves were overweight or obese. At this point, I was slim and in good health, so my views were coldly ‘academic’. That said, I was always against “fat-shaming”, but didn’t feel the answer was to “embrace” being fat. I missed the point; it wasn’t about embracing being overweight or obese, but about focusing on health — health at every size.

Me and my 3 sons – White Pine Beach, September 10 2003

After having given birth to 3 children in a little over a year (yes, one set of twins and a singleton), I had little or no time to focus on “me”. My weight continued to creep up and along with it, my blood sugar and blood pressure. The photo on the left is what I looked like at this time 16 years ago. I knew my being overweight (obese, actually) was unhealthy, but despite my education, the idea of “eating less and moving more” seemed impossible.

The years passed and in May 2008, when I graduated with my Masters Degree in Human Nutrition, I was obese and pre-diabetic.  I heeded my GP’s advice and followed the (then) Canadian Diabetes Association’s dietary recommendations to eat 60 g of carbohydrate at each meal, plus protein and carbohydrate at each of 3 snacks. I considered I was being so virtuous by eating “whole grain”, which was whole-wheat pasta, brown rice and multigrain brown bread with seeds.  Despite this, within two years I was diagnosed as having type 2 diabetes and in hindsight, eating that many carbohydrates per day; carbohydrates that were really just less refined and not truly “whole, foods”, and eating that many times a day, made becoming diabetic inevitable. The only issue was how long would it take.

When I first saw an endocrinologist in 2014, she told me that if I continued to eat the way I was eating (same as above) I would be on insulin within 5 years.  She encouraged me to eat a maximum of 100 g of carbs per day and mostly as unrefined vegetables, with only a small amount of fruit and unprocessed, whole grain. It took until my health had become a crisis two years later until I had little choice but to change my lifestyle.  That was March 5, 2017 and the rest as they say, is history.

May 2008 (Masters Convocation) – May 2019

The photo on the left is what I looked like at my Master’s Convocation in May 2008 and the photo on the right is what I looked like this past May 2019. Yes, there’s a big difference — a 55 pound difference and even better, my type 2 diabetes is in remission and I no longer have high blood pressure.

In my health-recovery journey (which you can read in its entirety, here), I didn’t focus as much on weight, as I did on lowering my blood sugar and blood pressure. My focus from the beginning of my journey was on health as I attained a healthy body weight and waist circumference.

Surprisingly, my first experience with ‘fat-shaming’ was in January 2018; ten months into my health-recovery journey. I was told by someone quite well known in low-carb circles on social media that they “wouldn’t trust a fat Dietitian” and that ”once you get in shape then you can dish out advice“.  I was hurt and offended, and my response at the time was to write an article I titled “Competent to Counsel“; where I addressed that what makes me competent or credible is not my own body weight, but my knowledge. I still feel that way now, even thought I’m slim. While it was offensive to be spoken to in this way, it made me acutely aware of the tremendous bias that overweight and obese people face; especially obese clinicians. I think it gave me more compassion towards those that struggle with these issues who have faced this type of disdain for years.

It has been 6 months since I achieved my health and weight loss goals, and both are stable. I’m still below the criteria for type 2 diabetes and have normal blood pressure.

I’m still not used to being ‘slim’. I still think I can’t fit in a space behind a chair, or beside a parked car when I have ample room. I try on clothes that I think are the right size, and they are too big — and then assume the brand must be ‘sized wrong’. I’ve been told it takes a while to adapt.  That said, I am fully aware that as many as 80% of those who lose weight regain it within two years, so being in ‘maintenance mode’ does not mean I do nothing. I continue to monitor my weight weekly and waist circumference every few weeks. While less frequently than before, I continue to test my blood sugar at home and go for my HbA1C test every 3 months and now that I am off blood pressure medication, check my blood pressure frequently. While I am at a good weight and waist circumference and have recovered much of my health, I cannot afford to rest on these accomplishments. When I see my weight creeping up, I take inventory of what I am eating differently and same with changes in blood sugar or blood pressure.

Maintenance isn’t about doing nothing, it is about doing the same thing, over time.

Embracing my health is a bit like embracing my curls. I am no longer the obese Dietitian with type 2 diabetes and high blood pressure and I can share my story with others; to encourage them that I understand, have “been there” and also that I have the knowledge to help. But just like those who embraced their own curls before me and encouraged me to do so too, each person has their own journey. My role is to support people in theirs.

More Info?

If you would like to know about how I can help you, you can learn about the services I provide under the Services tab, or in the Shop and if you have questions, please feel free to send me a note using the Contact Me form above and I will reply as I am able.
To our good health!

 

Joy

 

NOTE: This post is classified under “A Dietitian’s Journey” and is my personal account of my own health and weight loss journey that began on March 5, 2017. Science Made Simple articles are referenced nutrition articles, and can be found here.

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchf-rd/
Instagram: https://www.instagram.com/lchf_rd
Fipboard: http://flip.it/ynX-aq

Copyright ©2019 The Low Carb Healthy Fat Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

A New Little Black Dress – a Dietitian’s Journey continues

May 25 2008 and June 15 2019

Yesterday I had an occasion to wear a new little black dress that I had bought, and remembered the last time I wore one. Ironically, it was for my Master’s convocation just over 11 years ago, and the dress was a size 16. My degree was in Human Nutrition, yet I was very overweight and had pre-diabetes.

The degrees on the wall did not help me understand why — despite my best efforts to “exercise more and eat less”, I was still overweight.  Despite my research related to the neurotransmitter dopamine, it was not known at the time how dopamine is involved in the potent joint reward system of eating foods that are a combination of both carbohydrate and fat (you can read more about that here). 

I did not understand why following the advice of my physician didn’t help.  I ate according to the (then) Canadian Diabetes Association (now called Diabetes Canada)’s recommendation to eat 65 g of carbohydrate at each meal and 25-45 g of carbs at each snack — along with lean protein and monounsaturated and polyunsaturated fat and participated in exercise several days each week. I ate “plenty of healthy whole grains” and “lots of fruit and vegetables“, along with low fat dairy,  yet a year later progressed to Type 2 Diabetes; what I was told was a “progressive, chronic disease”.

My studies didn’t help me understand the impact of high levels of circulating insulin on obesity and the effect of the after-meal and after-snack rise in insulin and then it’s drop shortly later on hunger. The reality was, the advice we were taught to “eat less and move more” did nothing to address the underlying issue of being hungry every few hours. In fact, the detrimental effects of high circulating levels of insulin weren’t taught; only the effects of high blood sugar.

My studies didn’t help me understand that “plenty of healthy whole grains” for someone who is already insulin resistant, with high levels of circulating insulin isn’t helpful.  I didn’t understand how eating plenty of fruit was further contributing to my problems;  both because of it’s high carbohydrate load, as well as it being a high source of fructose. I drank 3 glasses of low-fat milk daily, but didn’t understand the effect of all of those extra carbohydrates on my blood sugar, as well as underlying insulin response.  It was not part of what I studied — either in my undergraduate degree or Master’s studies, because it simply was not well known.

It is only recently (April 18, 2019) that the American Diabetes Association (ADA) issued their Consensus Report which indicated that “reducing carbohydrate intake has the most evidence for improving blood sugar” (you can read more about that here). In fact, the ADA now includes both a low carbohydrate eating pattern and a very low carbohydrate (keto) eating pattern as Medical Nutrition Therapy for the treatment of those with pre-diabetes, as well as adults with Type 1 or Type 2 Diabetes.

While these are not currently part of Diabetes Canada‘s options, they are recommendations available to those in the United States.

In fact, the European Association for the Study of Diabetes (EASD) also classifies low carb diets as Medical Nutrition Therapy (see here) and Diabetes Australia released their own updated position paper for people diagnosed with Diabetes who want to adopt a low carbohydrate eating plan. 

Many studies already demonstrate that a well-designed low carbohydrate diet is both safe and effective for the treatment of obesity and Diabetes (you can find a convenient list of studies under the Physician and Allied Health Provider tab), but much of this has only come to light in the years since I graduated with my Master’s degree.

In the last 4+ years since I first learned about the therapeutic use of a low carbohydrate diet, I have read scores of studies in an effort to become well-informed and continue to do so in order to stay current with the emerging evidence. Under the Science Made Simple tab, you can read some of the almost 170 articles I have written so far, many of them fully referenced.

April 2017 – April 2019

On March 5, 2017 I began what I have called “A Dietitian’s Journey” where over the subsequent two years, I put my Type 2 Diabetes into remission, lowered my dangerously high blood pressure and achieved a normal body weight and optimal waist circumference. You can read my story under A Dietitian’s Journey.

I have been in maintenance mode for more than three months and have been able to maintain my weight loss and health gains with little effort. My ongoing personal articles since being in maintenance appear under Making Health a Habit which can be read here.

I continue to maintain my original Dietetic practice that focuses on food allergy and food sensitivity (including Celiac disease, Irritable Bowel Syndrome, Inflammatory Bowel Disease) through BetterByDesign Nutrition, and through continued reading in the scientific literature, I am now able to provide a range of options for weight loss and improvement in many metabolic conditions, including Type 2 Diabetes, hypertension and abnormal cholesterol that I was unable to offer a few years ago.  Through BetterByDesign Nutrition, I offer variety of evidence-based approaches, including a Mediterranean Diet, a plant-based whole foods approach (vegetarian or including meat, fish and poultry), as well as a low carbohydrate approach and through this division, The Low Carb Healthy Fat Dietitian I focus exclusively on using a low carbohydrate or ketogenic approach.

If you would like to learn how I might be able to help you, you can learn more about my services under the Services tab or in the Shop.

If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.

 

To your good health!

Joy

NOTE: This post is classified under “A Dietitian’s Journey” and is my personal account of my own health and weight loss journey that began on March 5, 2017. Science Made Simple articles are referenced nutrition articles, and can be found here.

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

Two Year Anniversary of Adopting a Low Carb Lifestyle- a short video update

Tomorrow will be two years since I began what I’ve called “A Dietitian’s Journey” — which is my personal journey to restore my health and then to achieve optimal health.

My journey began March 5, 2017 when I felt unwell just sitting at my office desk. I didn’t know what was wrong, although in retrospect I should have given that I was a Registered Dietitian.

I took my blood pressure and it was astronomically high — so high, that had I gone to my doctor at that point he probably would have sent me directly to the hospital in an ambulance. He certainly would not have let me drive!  After checking my blood sugar for the first time in ages (even though I was diagnosed with Type 2 Diabetes 8 years earlier) it was also ridiculous.

The very first step of my ‘journey’ was to come out of denial.

When we ‘deny’ something, we say it is untrue — but it was not as though I was deliberately deceiving myself or anyone else about my health, I was simply neglecting to find out the magnitude of reality, so in psychological terms, I was in denial. Taking my blood pressure and blood sugar two years ago was a huge dose of reality. I had no choice but to face the fact that I was metabolically very unwell!

As I’ve said many times on podcasts and written in my blogs, what I should have done at that point was go straight to my doctor’s office and let him either treat me with multiple medications himself or send me to the hospital to be treated and released with medications, but I didn’t. I was scared…no, I was terrified. In the preceding months, I had two girlfriends who spent their lives working in healthcare die of natural causes within 3 months of each other; one from a massive heart attack and the other from a stroke. I knew if I didn’t do something I was at very high risk of being next.  When I say I changed my lifestyle “as if my life depended on it” it’s because quite literally it did.

The short video directly below was taken during my first walk at the local track 2 weeks after I had adopted a low carbohydrate lifestyle on March 5, 2017. It’s clear how obese I was and how difficult it was for me to walk and talk at the same time.

Last night I decided that the most appropriate way for me to ‘celebrate’ my two year anniversary of reclaiming my health was to go back to the very same place and make an updated short video, which is what I did this morning — even though it was really cold out this morning (for March in Vancouver, that is)!

Before you watch the updated short video, here is a summary of what I was able to accomplish this time last year — after following a low carbohydrate lifestyle for only a year;

March 5, 2018

By March 5, 2018, I had lost;

  • 32 pounds
  • 8 inches off my waist
  • 2 inches off my chest
  • 3 inches off my neck
  • 1 inch off my arms
  • 1/2 inch off my thighs
  • I no longer meet the criteria for Type 2 Diabetes (achieved without the use of medication)
  • I had blood pressure that ranges between normal and pre-hypertension without medication
  • I had ideal triglycerides and excellent cholesterol levels achieved without any medication.

As of today, March 4, 2019, I have lost;

selfie taken March 3, 2019 in the smallest jeans I have (size 12)
  • 55 pounds
  • 12- 1/2 inches off my waist
  • 3 -1/2 inches off my chest
  • 6 -1/2 inches off my neck
  • 4 inches off each arm
  • 2- 1/2 inches off each thigh
  • I met the criteria for partial remission of Type 2 Diabetes 3 months ago*
  • My blood pressure still ranges between normal and pre-hypertension**
  • I still have ideal triglycerides and excellent cholesterol levels

* My dad was diagnosed with Alzheimer’s disease in August (sometimes referred to as Type 3 Diabetes), so even though my HbA1C was 6% at the time, my endocrinologist agreed to start me on Metformin. ** I started on a ‘baby dose’ of Ramipril in October 2018 to protect my kidneys from the residual high blood pressure.

Here is the video taken this morning, after two years of following a low carbohydrate diet (of which the last 14 months was ketogenic).

If you would like to know how I can help you or a family member with weight loss or reversing the symptoms of Type 2 Diabetes, high blood pressure or high cholesterol, please click on the Services tab to learn more. If you have questions please send me a note using the Contact Me form located on the tab above and I will reply as soon as I am able.

To your good health!

Joy

NOTE: This post is classified under “A Dietitian’s Journey” and is my personal account of my own health and weight loss journey that began on March 5, 2017. Science Made Simple articles are referenced nutrition articles, and can be found here.

You can follow me at:

         https://twitter.com/lchfRD

          https://www.facebook.com/lchfRD/

           https://plus.google.com/+JoyYKiddieMScRD

https://www.instagram.com/lchf_rd

 

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Why I Posted My “Before” Pictures When I was Still Obese

INTRODUCTION: It is not uncommon for people to post their “before” pictures after they’ve reached their goal weight to show how much they’ve accomplished, but why on earth did I post pictures of myself when I was still obese and metabolically unwell? That’s a good question.

There’s a saying that “it is not the healthy who need a physician, but the sick” and while people will consult with Dietitian for many different reasons, those who are significantly overweight find it very difficult to take that first step when it is weight loss they’re seeking. Why?

People feel ashamed of being overweight or obese.

Oftentimes, overweight people feel that they are assumed to be undisciplined or lazy — that their condition is their own fault. They have heard over and over again that;

“If only they would eat less and move more they wouldn’t be so fat!”

or

“If only they ate ‘real food’ instead of ‘junk food’ they would be so much slimmer!”

Really?

If it were that simple, why would 1 in 4 Canadians (and 1 in 3 Americans) be obese?

Because it’s not that simple.

It’s been my experience that many overweight people and obese people often eat what has traditionally been thought of as a “healthy diet”; plenty of fruit and vegetables, low fat dairy products and only brown bread, rice and pasta and they feel frustrated and ashamed of being what is perceived as “a failure”.

Some have told me that sometimes their own healthcare providers have given them the impression that they must be being untruthful about what they’ve been eating because surely if they were eating the way they say, they would have been losing weight. In other words, they are not believed, or in stronger words, they are thought to be lying or at least incapable of accurately assessing how much they are ‘really’ eating.

Why would an overweight or obese person seek help in losing weight from a healthcare professional that views them as undisciplined, lazy or unrealistic about what they are eating?

They don’t.

Often people will try various diets that they read about online because no one will see them try and more importantly no one will see when they give up, feeling once again that they are ‘failures’.

I don’t think that overweight and obese people are failures. I believe many are doing what they’ve been told is the “right thing” but for different reasons. it is not working for them.  My role as a Dietitian is to help people understand what isn’t working and to enable them to be successful — without judgement.

It is for just such people that I posted my “fat pictures” online before I started to lose weight!

I wanted people to see me as no different and certainly no better than they are, because I’m not. Sure, I have an undergraduate and graduate degree in nutrition, but I don’t get any “free passes” when it comes to losing weight and turning around my own metabolic health. I needed to do it just like everybody else.

I’ve lived each step of my weight loss and metabolic health recovery journey in public (logged under “A Dietitian’s Journey”) because I wanted people to experience in “real time” my frustrations and my victories. I wanted people to see that the path is not linear; that there are twists and turns and stalls, but yes it is possible to be successful. It just takes time and some dedicated work to get well and achieve a healthy body weight.

I look at it this way;

If it took me 20 years to become metabolically unhealthy and obese, what’s a couple of years to become metabolically healthy and normal weight?

Everyone’s weight loss and health restoration journey will be different.

There are no “magic bullets” or “super diets”— but there are different dietary and lifestyle options that can be pursued for success.

I can help. 

If you would like to learn more about how I can help you or a family member achieve and maintain a healthy body weight and metabolic health, please send me a note using the Contact Me form located on the tab above.

To our good health!

Joy

NOTE: This post is classified under “A Dietitian’s Journey” and is my personal account of my own health and weight loss journey that began on March 5, 2017. Science Made Simple articles are referenced nutrition articles, and can be found here.

You can follow me at:

       https://twitter.com/lchfRD

         https://www.facebook.com/lchfRD/

          https://plus.google.com/+JoyYKiddieMScRD

https://www.instagram.com/lchf_rd

 

Copyright Ltd. ©LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

My Weight Loss Progress to Date

Today, a photo memory popped up on Facebook from a year ago which was a composite photo from the 2 1/2 years previous to that along with an updated photo at the bottom from that day, February 12 2018. At first I thought I hadn’t changed much from a year ago until I added a “bathroom selfie” that I took on Sunday, beside it.  Without a doubt, there has continued to be significant progress. This post is about my weight loss and non-scale progress to date.

My weight loss progress to date

All of the photos in the composite were taken with the same cell phone, so while they aren’t great shots they document my journey to date — A Dietitian’s Journey.

The first photo from the left at the top, with me in the plum shirt was taken April 2015, around the time a retired-physician friend came to talk to me about the therapeutic use of a low carbohydrate diet for reducing the symptoms of Type 2 Diabetes and for weight loss.

The second photo. where I am wearing a ivory silk scarf was taken in September 2015, shortly after I began eating a liberal lower carb diet of ~130 g carbohydrate per day.

The third photo in the middle was taken exactly a year after the second one, in September 2016.  While it’s clear I had lost weight, the crocheted cardigan I was wearing was still quite stretched.

The fourth photo at the top was taken in April 2017, only a month after I had begun following a low carbohydrate lifestyle on March 5, 2017 — which in three weeks from today will be two complete years. I happened to be wearing the same outfit as I had the previous September because at that weight I had no interest in buying new clothes and didn’t go out much. Even after only a month of eating low carb, my face, neck and abdomen were beginning to show signs of progress.

In the fifth photo taken September 2017, I deliberately wore the same cardigan and skirt that I had randomly ended up wearing in the previous two photos — with the identical camisole in a different colour, underneath. What can’t be seen easily unless one looks at the very bottom of the crocheted cardigan, is the space between it and me that was previously  filled with my belly fat. At this point there was a space where fat used to be! I still had ~ 25 more pounds to lose to reach a waist circumference that was 1/2 my height but I knew this was entirely achievable and maintainable.

The photo on the left at the bottom was taken exactly a year ago today, February 12, 2018. That’s why it popped up in “memories” on Facebook.  When I first saw it, I thought looked pretty much the way I do now until I decided to put the bathroom selfie from Sunday beside it.  Admittedly, the 20 additional pounds I have lost in the last year “shows”.

I am 2 pounds from my ‘goal weight’ which I am pretty sure I will reach by three weeks from now, on my 2-year anniversary of beginning my journey.

I am in remission of Type 2 Diabetes and have an ideal waist-to-height ratio. My lab tests reflect my progress as much as as the reflection in the mirror and best of all, I feel great.  I shoveled snow for an hour yesterday and since we had a second snow storm, I did it all over again this morning — without getting out of breath or even sweaty! Two years ago, I could barely walk around the track at Town Center without being totally out of breath!  Check out this video to see what I looked and sounded like when I started! There have been huge changes.

This “journey” has never been about losing weight for vanity’s sake; but about reclaiming my health from chronic illness (Type 2 Diabetes and hypertension) that was brought about by eating what most would see as a very “healthy diet” but that was way too high in carbohydrates for someone as metabolically unwell as I was.

As I’ve written about in previous journal entries, I had two girlfriends my age drop dead within 3 months of each other from similar health conditions as I had and when I took my blood pressure and blood sugar on March 5 2017, I knew that if I didn’t change my lifestyle, I could literally be next.  I changed my lifestyle two years ago because my life literally depended on it.

When I look in the mirror each day I am reminded that two of my girlfriends no longer have the opportunity that I do; to do things differently. I am fortunate and blessed and don’t take my reclaimed health for granted.

If you have questions about how a low carbohydrate approach may be helpful for you to achieve weight loss, or put your own high blood sugars or Type 2 Diabetes into remission, then please send me a note using the Contact Me form located on the tab above.

For more information about the hourly consultations and packages I offer, please check under the Services tab, or in the Shop.

To our good health!

Joy

NOTE: This post is classified under “A Dietitian’s Journey” and is my personal account of my own health and weight loss journey that began on March 5, 2017. Science Made Simple articles are referenced nutrition articles, and can be found here.

You can follow me at:

       https://twitter.com/lchfRD

         https://www.facebook.com/lchfRD/

          https://plus.google.com/+JoyYKiddieMScRD

https://www.instagram.com/lchf_rd

 

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

Getting to Know Me – a short video introduction

This 1/2 hour video interview was filmed January 4, 2019 for a conference I was appearing at remotely that was held in Charlottetown, Prince Edward Island on January 12, 2019.  I thought that it would make an excellent introduction to my background (both educational and clinical) and how and why I came to practice and offer a low carbohydrate dietary approach.

In this video, I am interviewed by pharmacist Angela Doucette and the topics I cover are;

  • my educational and clinical background and the nature of my Dietetic practice before being exposed to a low carbohydrate dietary approach (focus on Mental Health Nutrition & food sensitivities / food allergies, IBS etc.) i.e. my being obese had no bearing on my Dietetic practice as it was not weight management focused
  • the impetus to change: visit from a retired MD girlfriend who wanted my opinion about using a low carbohydrate dietary approach to improve the symptoms of Type 2 Diabetes (T2D) and cardiovascular risk factors
  • First exposure was to blog of Dr. Jason Fung, Canadian nephrologist (kidney specialist), before he published his first book, his assistance in me getting started
  • my initial reservations regarding some of the approach i.e. safety and efficacy of using long term intermittent fasting, very high saturated fat intake, moderate protein intake (especially in post menopausal women due to predisposition to sarcopenia i.e. muscle deterioration with aging)
  • how and why I decided to take a slightly different approach; taking components of what I learned from Dr. Fung and others
  • influence of lectures by Dr. Eric Westman, MD and Dr. Ted Naiman, MD on limiting ‘added fat’ especially during weight-loss phase
  • influence of Dr. Stephen Phinney MD, PhD and Dr. Jeff Volek RD, PhD in the process of modifying my initial approach
  • starting to apply knowledge to my own clinical practice gleaned from reading clinical studies and listening to lectures by above and others
  • took 3 months off to rethink how I was going to implement this knowledge before using it in my practice i.e. changes needed to be evidence-based
  • success of initial clients long before I implemented the changes in my own life, clients still maintaining weight loss today
  • transformation to following a low carbohydrate dietary approach myself; March 5, 2017; a crisis in my own metabolic health
  • reality was brought “home” as a result of the deaths of two girlfriends both of whom also worked in healthcare
  • how I felt when I was faced with the need to lose a foot off my waist to achieve a healthy waist to hip ratio;

“I don’t have to lose a foot now, I only have to lose 1/2 an inch at a time”

  • how much weight and inches I’ve lost in 22 months following a low carbohydrate dietary approach
  • having put my Type 2 Diabetes into remission (not cured)
  • my MDs reaction to me having lost 50 pounds (was very skeptical at first!), why he referred me recently to an endocrinologist
  • 16:00 an IMPORTANT SECTION on the different types of low carbohydrate and ketogenic diets and some clinical limitations I noticed in those that followed a very high fat diet (not loosing weight, sometimes gaining weight) even though carbohydrate content remained low. Selection of the appropriate macrodistribution is selected based on a person’s age, gender (whether they’re male or female), their stage of life (post partum, breast-feeding, pregnant, older adult), whether they are athletic or sedentary (i.e. desk job). There’s no one-size-fits-all low carb or keto diet.
  • Dietary Reference Intakes (DRIs) based on needs of those that eat a large percentage of carbohydrate intake, unknown what the difference in biological needs are of those that follow a low carbohydrate dietary approach
  • role of lab tests in dietary assessment along with a thorough dietary history
  • need to lower carbohydrate intake to below 130 g per day is not always required
  • special considerations for those of South Asian background “thin on outside, fat on inside TOFI)
  • why I create multi-ethnic recipes (i.e. roti)

“There are lots of different ways to do low carb and lots of different ways to do keto, and everyone’s nutrient needs are different; it depends on their age, their gender (whether they’re male or female), their stage of life (post partum, breast-feeding, pregnant), whether they are athletic or sedentary (i.e. desk job). There’s no one-size-fits-all

  • reflections on the role of therapeutic nutrition with other healthcare disciplines i.e. physicians, pharmacists, nurses, LPNs, physiotherapists, chiropractors, even dentists
  • role of Canadian Clinicians for Therapeutic Nutrition (CCTN)

You can watch the video interview here:

If you have specific questions about how a low carbohydrate approach may be helpful for you to achieve weight loss, or aiming to put your own high blood sugars into remission, lower blood pressure or triglycerides then please feel free to send me a note using the Contact Me form located on the tab above. For more information about the types of consultations and packages I offer, as well as their prices you can find out more under the Services tab or in the Shop.

To your good health!

Joy

You can follow me at:

       https://twitter.com/lchfRD

         https://www.facebook.com/lchfRD/

          https://plus.google.com/+JoyYKiddieMScRD

https://www.instagram.com/lchf_rd

 

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Different Ways to Measure Success – a Dietitian’s Journey

There are different ways to measure ‘success’ and not all of them involve weight.

Six weeks ago, I wrote about my overall progress in reaching the non-diabetic range for HbA1C after ten years since being diagnosed with Type 2 Diabetes, my improvements in blood pressure and other markers.

A month ago, I wrote about my changes in body measurements over the last 12 months and where the 25 pounds I lost came from.

Two weeks ago ‘success’ was documented with a series of composite of photos from when I was obese until now, along with some other details.

 

Last week, ‘success’ was comparing a series of videos that I have taken since the beginning of my journey until now.

 

 


Just have look at me in the first video (just a little over 1 minute long, link below) and even the first few minutes of the most recent video (a little over 1/2 an hour, link below) back to back!

This first video was taken March 16, 2017, just two weeks after I began my health and weight-loss journey. As significant as my size, listen to how out of breath I was!

This most recent video was filmed a week and a half ago (January 4, 2019) for the Keto-Solutions Bootcamp in Charlottetown, Prince Edward Island. Sure, I’m not walking in this one but trust me, I can do that and so much more now without getting winded!

Weight loss update

Yesterday, my weight dropped to a BMI of 24 (well into the normal weight category) which was pretty exciting given when I started it was around 32 (in the obese category) and as I suspected from the number of times I needed to get up last night, my weight dropped again today. I normally weigh myself only once a week, unless I know my weight has dropped.

Body Mass Index (BMI) changes from January 2018 – January 2019

With the drop in weight over the last few days (even with adjustments for body water fluctuation) and am around 3  1/2 pounds from my goal weight — well actually my third goal weight.

When I first started my journey, I set as a preliminary “goal weight” as the weight I would like to get to, if possible.  That was the weight I was a year ago!

Having achieved that, last January I set a new “goal weight” of what I’d like to get to where I thought my waist circumference would be 1/2 my height. Once I reached that weight, I revised my “goal weight” downward — closer to the lowest adult weight that I was where I once looked best. Currently, I am just a little over 3 pounds from that weight.

Below is a graph of what my weight loss progress looks like over the past year (since the beginning of January 2018).

I’ve lost 27.5 more pounds on top of the 24 pounds I lost from March 5, 2017 until January 2018.

Weight loss – January 2018 to January 2019

To date, I’ve lost a total of 51.5 pounds and to be honest I have no idea what my final weight will be!

My focus over the next several months is on achieving optimal health and that is about building additional muscle and continue to lose about 10 pounds of excess fat. It’s hard for me to know what “weight” I will be when I’ve accomplished that, but in the end, I don’t think it matters much.

Building muscle for me is all about health — and of reducing my risk of sarcopenia as I age (you can read more about that here). Continuing to lose the excess fat is all about further reducing any insulin resistance and continuing to lower my HbA1C even lower into the normal range with the goal of achieving full remission from Type 2 Diabetes (you can read more about that here).

At this point in my journey it is about striving for “optimal” rather than some measure of “ideal”.

The way I look at it, optimal is what makes sense for a ‘woman of a certain age’ who is newly in remission from Type 2 Diabetes almost 10 years after being diagnosed.  Optimal is based on the exercise I am capable of doing now — after having both knees operated on in the past, as well as a back injury 8 years ago. Given my age, my knees and my back, what is optimal won’t be anywhere near what I was capable at 25 years old when I was doing 10 hours of karate a week! Those days are gone, but what is ahead is whatever I make of it now.

Pushing for the muscle gains now will factor into what what kind of “old age” I will live and losing the rest of the fat may enable me to achieve full remission from Type 2 Diabetes. This is more important than how I look!

And so begins another calendar year in my journey – a journey now focused on achieving optimal, not ideal.

If you’d like to know more about how I can help you accomplish your health and nutrition goals please have a look at the Services tab to learn more about the sessions and packages I offer and feel free to send me a note using the Contact Me form located on the tab above, if you have specific questions about how I can help.

To our good health!

Joy

NOTE: This post is classified under “A Dietitian’s Journey” and is my personal account of my own health and weight loss journey that began on March 5, 2017. Science Made Simple articles are referenced nutrition articles, and can be found here.

You can follow me at:

       https://twitter.com/lchfRD

         https://www.facebook.com/lchfRD/

          https://plus.google.com/+JoyYKiddieMScRD

https://www.instagram.com/lchf_rd

 

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

Beyond Appearance to Health – 22 months of A Dietitian’s Journey in video clips

Tomorrow will be 22 months to the day (March 5, 2017-January 5, 2019) that I realized that I was metabolically very unwell; having a resting blood pressure in the hypertensive emergency category and uncontrolled blood sugar which was topping 13 mmol/L (235 mg/dl) after a meal. As I have said in every podcast and interview that I have done since and have written in several articles, what I should have done at that point was to go straight to my doctor and let him put me on the medications required and then have changed my diet and lifestyle, but I was frightened with the prospect of coming out of denial and decided instead to immediately change how I ate and recover my own health. That was a risky thing to do as my risk of heart attack and stroke was very high and in retrospect it is not what I would have done.  It is certainly not something I would recommend anyone else to do! Knowing what I know now, I should have started on medications and then adopted the same dietary and lifestyle changes and as my health improved, had my doctor lower the dosages and then eventually discontinue them. But that as they say is water under the bridge now.

In my first entry in “A Dietitian’s Journey” simply titled “The Beginning” I set the following goals;

I want;

(1) blood sugar in the non-diabetic range

(2) normal blood pressure

(3) normal / ideal cholesterol levels

(4) a waist circumference in the ”at or below” recommended values of the Heart and Stroke Foundation

Will I meet all these goals?  Who knows?! But I won’t know if I don’t try and the alternative of a life of medication for blood sugar, blood pressure and eventually cholesterol too does not appeal to me!

March 16, 2017 I posted my second entry titled The Road to Better Health about why I decided to add a walking routine to my dietary changes and this was where I posted my first video.

You have to see this to believe it!

It’s not only how I look but how I sound!  Its evident that I am unable to walk at a reasonable pace and talk without being out of breath.

Here is my second video, posted July 25, 2017, just 4 months into eating a low carbohydrate (not ketogenic) diet.  As you can see, I had already lost some weight and could talk without being totally winded while walking.

At this point, I had lost 10 pounds, my HbA1C (3 month average blood sugar level) was down from an average of 12 mmol/L to 8.5 mmol/L. My blood pressure which had dropped to ~140/80 mmHg had begun to rise to in the 160/90 mmHg range so I decided to ask my doctor to put my on Ramipril (Altace) until diet and weight loss is sufficient to maintain it at a normal level on its own. My goals at that point were;

I still have at least another 30 pounds to go to get to the ”goal weight” that I set at the beginning of this journey, and am now aiming to lose another 40-45 pounds instead in order to reach my ideal (healthiest) waist to height ratio.

By my one-year anniversary of following a low carbohydrate diet, this is what I had achieved;

So far, I’ve lost;

  • 32 pounds
  • 8 inches off my waist
  • 2 inches off my chest
  • 3 inches off my neck
  • 1 inch off my arms
  • 1/2 inch off my thighs.
  • I no longer meet the criteria for Type 2 Diabetes
  • I have blood pressure that ranges between normal and pre-hypertension
  • I have ideal triglycerides and excellent cholesterol levels.

While I’m still overweight and have approximately another 20 pounds to lose to reach a healthy waist circumference, I am not as desperately unhealthy as I was this time last year.

I am alive, much healthier and committed to continuing this journey.

July 25, 2018, a full year after the previous video above and 16 months into A Dietitian’s Journey, I posted the next video update. By this point I had lowered the amount of carbohydrate in my diet down considerably in order to achieve the metabolic recovery I sought. The difference between the very first video from March 16, 2017 and this one is remarkable; not just in the way I look, but how I sound!

By this date, I had lowered my fasting insulin from when I began where it was 54 pmol/L (7.8 μU/ml) to 33 pmol/L (4.8 μU/ml) which was in the ideal range, between 2-6 μU/ml. My HbA1C had dropped from 7.5% to 6.3% which was finally below the cutoffs for Type 2 Diabetes, which is 6.5%. Using diet alone and without taking any medication, I was finally in partial remission of Type 2 Diabetes.

This brings us to today. Five months have passed since the last video update above and tomorrow will be 22 months since I began A Dietitian’s Journey. I recently achieved my last two health goals of (a) having my waist circumference that is half my height and (b) having lost the last 20 pounds. Yesterday, my doctor took my blood pressure and it was in the normal range (still taking a “baby dose” of Ramipril) and next week I will be having my HbA1C done, which will be the first time since I voluntarily started on Metformin after having reached partial remission from Type 2 Diabetes with diet alone. I chose to do this for several reasons, including my dad’s recent Alzheimer’s diagnosis and it’s relationship to glucose dysregulation, as well as because I was still having difficulty lowering my early morning fasting blood glucose due to my liver’s gluconeogenesis (making glucose) in the wee hours of the morning.

Yesterday I taped a 1/2 hour talk with a Pharmacist colleague in Prince Edward Island who is holding a one-day workshop in Charlottetown on Saturday, January 12th, called Keto Solutions Bootcamp. Since I was unavailable to appear ‘live’ that day, I taped the segment yesterday that will be shown during my scheduled slot.

I gave her my word that I would not post the video until after the workshop but posted a screenshot instead.

UPDATE: January 13, 2019

Here is the link to the video:

Some final thoughts…

I have also demonstrated that even for someone who was overweight and obese for YEARS, it is entirely possible to achieve a healthy body weight eating whole, real food.

I didn’t deprive myself. I ate burgers and pizza, Chinese, Thai, Indian and Canadian food, and even some treats once in a while like batter fried fish and New York Style Cheesecake; all adapted to be low carb (see the recipe section for details).

As I coach my clients to do, I ate if I was hungry but didn’t eat just because it was “time” if I wasn’t. I ate delicious real food with a wide range of diversity in tastes and textures and made sure to get sufficient micronutrients (vitamins and minerals) not just “macros” (protein, fat and carbohydrate).  I didn’t have bulletproof coffee once and never ate a “fat bomb”. Yes, there is a lot more to a low carbohydrate diet than bacon, cream and butter!

If you’re curious to learn more, please have a look around my web page.  Have a read of some of the articles under the Food for Thought tab. Most are fully referenced and written in my “Science Made Simple” style so that anyone can understand.

If you are interested in knowing more about the packages and hourly consultations that I provide, please click on the Services tab to find out more.  Should you decide you want to get started, everything you need is there, including the Intake and Service Option Form to download and complete.  If you would like a password protected one to secure the completed information so you can email it to me, please drop me a note and I will be glad to send it to you.

Finally, if you have questions about how I can help you, please send me a note using the Contact Me form on the tab above and I will reply as soon as possible.

My “A Dietitian’s Journey” is my “sample set of one” (n=1) account of what I was able to accomplish, but everyone’s journey is different.  Some people take less time than I did to reach their goals and some take more depending on where they start from, but this is about recovering one’s health and achieving a healthy body weight and the way I look it is if it took us years to get to the place of ill-health we begin from, are we not worth the investment to take whatever time it takes to get well?  I think so!

Please let me know if I can help you restore your own health or help a loved one.

To your good health!

Joy

NOTE: This post is classified under “A Dietitian’s Journey” and is my personal account of my own health and weight loss journey that began on March 5, 2017. Science Made Simple articles are referenced nutrition articles, and can be found here.

You can follow me at:

       https://twitter.com/lchfRD

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Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

2018 in Review – a Dietitian’s Journey

This morning I went to do my exercises and realized that it’s been 10 months since I took my last photo in gym clothes and decided it was a good time for an update.

During the first year of my “journey”, I didn’t exercise at all except for walking and had set the goal of implementing some weight and resistance training beginning March 5th, 2018 (my one year “anniversary” of adopting a low carb lifestyle). I was inspired by some doctor colleagues in the Canadian Clinicians for Therapeutic Nutrition group and decided to start slow HIT (slow high intensity training) following the method of Dr. Doug McGuff (Body By Science) but in hindsight, given my age and the number of years I had not exercised, I probably should have started by retraining major muscle groups and strengthening my core first.  I didn’t and ended up aggravating an old back injury and spent most of the summer going through physiotherapy for that. I was in so much pain that even walking was difficult at first, so exercise outside of daily physio was set aside.

As a result of my back injury, I engaged the help of a terrific kinesiologist, and asked her for exercises to build up my knees and shoulders, as well as my back as I knew these were “weak links”.  I faithfully worked on training one of those areas daily, until I ended up injuring one of my knees (also an old injury!) getting out of one of my son’s low-slung car! Sheesh, I felt like I couldn’t ‘win’. Years ago I had each of my knees operated on (torn meniscus in each) after various injuries from years of dance, horseback riding and karate, so my best made plans for exercise this year did not turn out as I  intended.

February 2, 2018 – December 30, 2018

Even without doing most of the exercise that I planned to do during this past year, my body shape evolved, as can be seen in these two photos.  The one on the left was taken February 2, 2018 and the one on the right, this morning (Dec 30, 2018).

For the last 6 weeks, I have been both resting my knee injury as any amount of weight bearing hurt and only worked to gently build up the supporting muscles in that knee. Last week after much patience and frustration, I was finally able to walk up the stairs without pain (provided I didn’t try to carry anything heavy at the same time)!

Since I didn’t want to overdo it but knew I needed to start moving forward with my exercise commitment, I began by doing a few slow deep-knee bend squats each day; first 5 at a time.  The last week, I began adding a set here and there whenever I went upstairs for something (a random excuse which served as a reminder).  By the end of this week I was doing 20 – 30 full-knee bend squats per day, 5 at a time.  This is HUGE progress! My goal now is to begin exercising regularly WHILE NOT injuring anything by not being adequately focused on my body mechanics!

While my exercise plans this year didn’t turn out as I hoped, in the end I did end up strengthening my core muscles and building up my knees, lower back and shoulders (one of which is still causing me a bit of grief). I am not letting these setbacks deter me — any more than I let past weight loss stalls deter me.

My goal is to get as healthy as I can and that takes me being dedicated to the process regardless of setbacks.  Setback happen.  They happen to everyone.

Here’s my recap of my progress so far;

In the first year (March 5, 2017 – 2018) I lost a total of 32 pounds and lost 8 inches off my waist. I no longer met the criteria for Type 2 Diabetes (when I began my blood sugar was uncontrolled) and at the end of the first year my blood pressure ranged from between normal and pre-hypertensive  (when I began it was dangerously high). At the end of the first year, my triglycerides were ideal and I had excellent cholesterol levels (details here).

This past year, I lost an additional 18.5 pounds and another 4 inches off my waist; making it a foot in total! My waist to height ratio is now below .50 so I am satisfied. I am 1.5 inches from my final goal weight and am trying to decide if I want to lose another 5 pounds or if I want to focus on toning up my muscles, or both.  For details on exactly what I lost from my arms, legs, belly etc. you can read more here.

Two and a half years of change — from April 2015 — September 2017

Twenty-two months ago this coming week, I was an obese, metabolically very unwell Dietitian with Type 2 Diabetes, very high blood pressure and abnormal cholesterol.

February 2, 2018 – December 30, 2018

I certainly haven’t “arrived” by any means, but I am a whole lot healthier and feel better than I have in years.

As I tell my clients, its about “progress”, not “perfection”.

 

 

I hope my journey has inspired you that losing weight and getting healthy can be done and while it’s not a straight-forward line of progress all the time, and stalls and setbacks do occur, goals that are realistic set CAN be accomplished. Sometimes they just take a little longer than planned.

If you’d like to know more about how I can help you accomplish your health and nutrition goals this coming year, please have a look at the Services I offer and if you have questions, please send me a note using the Contact Me form located on the tab above. If you’d like some help setting some realistic goals for this coming year, please have a look at the special package I put together which is at a special price during the month of January.

Wishing you and yours the very best for a healthy and happy New Year!

Joy

NOTE: This post is classified under “A Dietitian’s Journey” and is my personal account of my own health and weight loss journey that began on March 5, 2017. Science Made Simple articles are referenced nutrition articles, and can be found here.

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Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.